Nuclear Medicine Imaging of Lower Leg Injuries

  • Wouter Broos
  • Felix Mottaghy
  • Boudewijn BransEmail author


This chapter deals with sports injuries of the lower leg that have been addressed with nuclear medicine imaging techniques. Medial tibial stress syndrome, stress fractures of the lower leg, chronic exertional compartment syndrome, and miscellaneous conditions showing abnormalities on scintigraphy are reviewed. Emphasis is placed on the position of the nuclear imaging technique in the diagnostic workup, as well as interpretative criteria of scintigraphies, including SPECT/CT.


Stress Fracture Bone Scintigraphy Ankle Sprain Interosseous Membrane Medial Tibial Stress Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Chronic exertional compartment syndrome


Computerized tomography


Intramuscular compartment pressure


Mega Becquerel




Magnetic resonance imaging


Medial tibial stress syndrome


Post injection


Single-photon emission computerized tomography






  1. Aweid O, Del Buono A, Malliaras P, Iqbal H, Morrissey D, Maffulli N et al (2012) Systematic review and recommendations for intracompartmental pressure monitoring in diagnosing chronic exertional compartment syndrome of the leg. Clin J Sport Med: Off J Can Acad Sport Med 22:356–370. doi: 10.1097/JSM.0b013e3182580e1d CrossRefGoogle Scholar
  2. Batt ME, Ugalde V, Anderson MW, Shelton DK (1998) A prospective controlled study of diagnostic imaging for acute shin splints. Med Sci Sports Exerc 30:1564–1571CrossRefPubMedGoogle Scholar
  3. Beck BR (1998) Tibial stress injuries. An aetiological review for the purposes of guiding management. Sports Med 26:265–279CrossRefPubMedGoogle Scholar
  4. Beck BR, Bergman AG, Miner M, Arendt EA, Klevansky AB, Matheson GO et al (2012) Tibial stress injury: relationship of radiographic, nuclear medicine bone scanning, MR imaging, and CT Severity grades to clinical severity and time to healing. Radiology 263:811–818. doi: 10.1148/radiol.12102426 CrossRefPubMedGoogle Scholar
  5. Clanton TO, Solcher BW (1994) Chronic leg pain in the athlete. Clin Sports Med 13:743–759PubMedGoogle Scholar
  6. Courtenay BG, Bowers DM (1990) Stress fractures: clinical features and investigation. Med J Aust 153:155–156PubMedGoogle Scholar
  7. Edwards PD, Miles KA, Owens SJ, Kemp PM, Jenner JR (1999) A new non-invasive test for the detection of compartment syndromes. Nucl Med Commun 20:215–218CrossRefPubMedGoogle Scholar
  8. Fredericson M, Bergman AG, Hoffman KL, Dillingham MS (1995) Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 23:472–481CrossRefPubMedGoogle Scholar
  9. Gaeta M, Minutoli F, Scribano E, Ascenti G, Vinci S, Bruschetta D et al (2005) CT and MR imaging findings in athletes with early tibial stress injuries: comparison with bone scintigraphy findings and emphasis on cortical abnormalities. Radiology 235:553–561. doi: 10.1148/radiol.2352040406 CrossRefPubMedGoogle Scholar
  10. Groves AM, Cheow HK, Balan KK, Housden BA, Bearcroft PW, Dixon AK (2005) 16-Detector multislice CT in the detection of stress fractures: a comparison with skeletal scintigraphy. Clin Radiol 60:1100–1105. doi: 10.1016/j.crad.2005.05.014 CrossRefPubMedGoogle Scholar
  11. Hartgens F, Hoogeveen AR, Brink PR (2008) Athletes with exercise-related pain at the medial side of the lower leg. Ned Tijdschr Geneeskd 152:1839–1843PubMedGoogle Scholar
  12. Hayes AA, Bower GD, Pitstock KL (1995) Chronic (exertional) compartment syndrome of the legs diagnosed with thallous chloride scintigraphy. J Nucl Med: Off Publ Soc Nucl Med 36:1618–1624Google Scholar
  13. Holder LE, Michael RH (1984) The specific scintigraphic pattern of “shin splints in the lower leg”: concise communication. J Nucl Med: Off Publ Soc Nucl Med 25:865–869Google Scholar
  14. Ishibashi Y, Okamura Y, Otsuka H, Nishizawa K, Sasaki T, Toh S (2002) Comparison of scintigraphy and magnetic resonance imaging for stress injuries of bone. Clin J Sport Med 12:79–84CrossRefPubMedGoogle Scholar
  15. Matin P (1988) Basic principles of nuclear medicine techniques for detection and evaluation of trauma and sports medicine injuries. Semin Nucl Med 18:90–112CrossRefPubMedGoogle Scholar
  16. Moen MH, Tol JL, Weir A, Steunebrink M, De Winter TC (2009) Medial tibial stress syndrome: a critical review. Sports Med 39:523–546. doi: 10.2165/00007256-200939070-00002 CrossRefPubMedGoogle Scholar
  17. Mohan HK, Clarke SE, Centenara M, Lucarelli A, Baron D, Fogelman I (2011) Value of lateral blood pool imaging in patients with suspected stress fractures of the tibia. Clin Nucl Med 36:173–177. doi: 10.1097/RLU.0b013e318208ef88 CrossRefPubMedGoogle Scholar
  18. Oturai PS, Lorenzen T, Norregaard J, Simonsen L (2006) Evaluation of Tc-99m-tetrofosmin single-photon emission computed tomography for detection of chronic exertional compartment syndrome of the leg. Scand J Med Sci Sports 16:282–286. doi: 10.1111/j.1600-0838.2005.00460.x CrossRefPubMedGoogle Scholar
  19. Patel DS, Roth M, Kapil N (2011) Stress fractures: diagnosis, treatment, and prevention. Am Fam Physician 83:39–46PubMedGoogle Scholar
  20. Roland J, Houben L, Vandevivere J (1997) Unsuspected muscular radionuclide uptake due to chronic muscular injury contracted during sports activity. Clin Nucl Med 22:632–633CrossRefPubMedGoogle Scholar
  21. Takebayashi S, Takazawa H, Sasaki R, Miki H, Soh R, Nishimura J (1997) Chronic exertional compartment syndrome in lower legs: localization and follow-up with thallium-201 SPECT imaging. J Nucl Med: Off Publ Soc Nucl Med 38:972–976Google Scholar
  22. Trease L, van Every B, Bennell K, Brukner P, Rynderman J, Baldey A et al (2001) A prospective blinded evaluation of exercise thallium-201 SPET in patients with suspected chronic exertional compartment syndrome of the leg. Eur J Nucl Med 28:688–695CrossRefPubMedGoogle Scholar
  23. Van der Wall H, Lee A, Magee M, Frater C, Wijesinghe H, Kannangara S (2010) Radionuclide bone scintigraphy in sports injuries. Semin Nucl Med 40:16–30. doi: 10.1053/j.semnuclmed.2009.08.006 CrossRefPubMedGoogle Scholar
  24. van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SM, Koes BW (2007) Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med 41:469–480. doi: 10.1136/bjsm.2006.033548; discussion 480PubMedCentralCrossRefPubMedGoogle Scholar
  25. Yates B, White S (2004) The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. Am J Sports Med 32:772–780CrossRefPubMedGoogle Scholar
  26. Zwas ST, Elkanovitch R, Frank G (1987) Interpretation and classification of bone scintigraphic findings in stress fractures. J Nucl Med: Off Publ Soc Nucl Med 28:452–457Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Department of Radiology and Nuclear MedicineMaastricht University Medical CentreMaastrichtThe Netherlands

Personalised recommendations