Discriminating features between stress and pathologic fractures

Modality	Stress fracture	Pathologic fracture
Radiograph	Endosteal thickening	Aggressive bone marrow pattern of destruction
	Benign-appearing periosteal reaction	Mineralized matrix
	Absence of any aggressive features	Endosteal scalloping Aggressive periosteal reaction Associated soft tissue mass
CT	Endosteal thickening	Aggressive bone marrow and cortical destruction
	Benign-appearing periosteal reaction	Mineralized matrix
	Absence of any aggressive features	Endosteal scalloping Aggressive periosteal reaction Associated soft tissue mass
MRI	Linear or band-like signal abnormality	Well-defined T1-weighted bone marrow abnormality
	Surrounding bone marrow T2-weighted signal abnormality (edema)	Endosteal scalloping
	Absence of or ill-defined T1-weighted signal bone marrow abnormality	Massive muscle edema Associated soft tissue mass
Scintigraphy	Focal or linear uptake	Diffuse uptake
PET scan	Focal or linear uptake	Diffuse uptake

CT: computed tomography; MRI: magnetic resonance imaging; PET: positron emission tomography.

Reprinted by permission from: Springer: Skeletal Radiology. Fayad LM, Kamel IR, Kawamoto S, et al. Distinguishing stress fractures from pathologic fractures: a multimodality approach. Skeletal Radiol 2005; 34:245. Copyright © 2005. https://link.springer.com/journal/256.

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Discriminating features between stress and pathologic fractures