European Journal of Nuclear Medicine

, Volume 21, Issue 6, pp 493–496 | Cite as

Three-phase radionuclide bone imaging and magnetic resonance imaging detection of occult knee fractures in athletes

  • Francesco Giammarile
  • Carlo Masciocchi
  • Antonio Barile
  • Massimo di Pietro
  • Augusto Carducci
  • Ivo Baschieri
Original Articles


Twelve athletes presenting acute knee injury with normal radiological findings underwent both three-phase radionuclide bone imaging (TPBI) and magnetic resonance imaging (MRI). The association of these highly sensitive diagnostic procedures detected occult fractures in all patients. The areas of signal intensity alterations on MRI corresponded to those of increased radionuclide uptake in blood pool images. However, the same areas seemed to be more extended on delayed TPB images. TPBI yielded early diagnostic information about lesion sites and functional activities, while MRI provided better anatomical definition and specific information about associated soft tissue lesions and served to establish the correct therapeutic approach and follow-up.

Key words

Three-phase radionuclide bone imaging Magnetic resonance imaging Occult fractures Knee Sports medicine 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Lynch TC, Crues JV III, Morgan FW, Sheenan WE, Harter LP, Ryu R. Bone abnormalities of the knee: prevalence and significance at MR imaging. Radiology 1989; 171: 761–766.Google Scholar
  2. 2.
    Berger PE, Ofstein RA, Jackson DW Morrison DS, Silvino N, Amador R. MRI demonstration of radiographically occult fractures: what have we been missing? Radiographics 1989; 9: 408–436.Google Scholar
  3. 3.
    Pavlov H. Athletics injuries. Radiol Clin North Am 1990; 28: 435–443.Google Scholar
  4. 4.
    Stafford SA, Rosenthal DI, Gebhardt MC, Brady TJ, Scott JA. MRI in stress fracture. AJR 1986; 147: 553–556.Google Scholar
  5. 5.
    Lee JK, Yao L. Stress fractures: MR imaging. Radiology 1988; 169: 217–220.Google Scholar
  6. 6.
    Rupani HD, Holder LE, Espinola DA, Engin SI. Three-phase radionuclide bone imaging in sports medicine. Radiology 1985; 156: 187–196.Google Scholar
  7. 7.
    Mooar P, Gregg J, Jacobstein J. Radionuclide imaging in internal derangement of the knee. Am J Sports Med 1987; 15: 132–137.Google Scholar
  8. 8.
    Mink JH, Deutsch AL. Occult cartilage and bone injuries of the knee: detection, classification and assessment with MR imaging. Radiology 1989; 170: 823–829.Google Scholar
  9. 9.
    Vellet AD, Marks PH, Fowler PJ, Munro TG. Occult post-traumatic osteochondral lesions of the knee: prevalence, classification and short-term sequelae evaluated with MR imaging. Radiology 1991; 178: 271–276.Google Scholar
  10. 10.
    Prather JL, Nusynowitz ML, Snowdy HA, Hughes AD, McCartney WH, Bagg RJ. Scintigraphic findings in stress fractures. J Bone Joint Surg [Am] 1977; 59: 869–874.Google Scholar
  11. 11.
    Meurman KO, Elfving S. Stress fractures in soldiers: a multifocal bone disorder. A comparative radiological and Scintigraphic study. Radiology 1980; 134: 483–487.Google Scholar
  12. 12.
    Zwas ST, Elkanovitch R, Frank G. Interpretation and classification of bone Scintigraphic findings in stress fractures. J Nucl Med 1987; 28: 452–457.Google Scholar
  13. 13.
    Yao L, Lee JK. Occult intraosseous fracture: detection with MR imaging. Radiology 1988; 167: 749–751.Google Scholar
  14. 14.
    Fischer SP, Fox JM, DelPizzo W, Friedman MJ, Snyder SJ, Ferkel RD. Accuracy of diagnoses from magnetic resonance imaging of the knee. A multi-center analysis of one thousand and fourteen patients. J Bone Joint Surg [Am] 1991; 73: 2–10.Google Scholar
  15. 15.
    Rosen MA, Jackson DW, Berger PE. Occult osseous lesions documented by magnetic resonance imaging associated with anterior cruciate ligament ruptures. Arthroscopy 1991; 7: 45–51.Google Scholar
  16. 16.
    DiPaola JD, Nelson DW, Colville MR. Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy 1991; 7: 101–104.Google Scholar
  17. 17.
    Marks PH, Goldenberg JA, Vezina WC, Chamberlain MJ, Dale Vellet A, Fowler PJ. Subchondral bone infractions in acute ligamentous knee injuries demonstrated on bone scintigraphy and magnetic resonance imaging. J Nucl Med 1992; 33: 516–520.Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • Francesco Giammarile
    • 1
  • Carlo Masciocchi
    • 2
  • Antonio Barile
    • 2
  • Massimo di Pietro
    • 3
  • Augusto Carducci
    • 3
  • Ivo Baschieri
    • 1
  1. 1.Cattedra di Medicina NucleareDipartimento di S.T.B.B, CollemaggioL'AquilaItaly
  2. 2.Cattedra di Radiologia, Dip. Med. SperimentaleUniversità L'AquilaL'AquilaItaly
  3. 3.Servizio di Medicina NucleareOspedale San Salvatore, L'AquilaL'Aquila Italy

Personalised recommendations