Stress fracture imaging findings and severity classification

Grade	Plain radiographs	Bone scan^[1]	MRI^[2]
1	Normal	Small ill-defined cortical area of mildly increased activity	Positive STIR image
2	Normal	Larger well-defined elongated cortical area of moderately increased activity	Positive STIR and T2-weighted images
3	± Periosteal reaction	Wide, fusiform cortico-medullary area of highly increased activity	Positive T1- and T2-weighted images, no cortical fracture line
4	Periosteal reaction, ± fracture line	Extensive trans-cortical area of intensely increased activity	Cortical fracture line; positive T1- and T2-weighted images

Stress_fx_XR_classificatn.htm

STIR: short-tau inversion sequence.

1. Zwas, TS, Elkanovitch, R, Frank, G. Interpretation and classification of bone scintigraphic findings in stress fractures. J Nucl Med 1987;28(4):452.
2. Fredericson, M, Bergman, AG, Hoffman, KL, Dillingman, MS. Tibial stress reaction in runners: Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 1995;23:472.

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Stress fracture imaging findings and severity classification