Magnetic resonance imaging features of fractures using the short tau inversion recovery (STIR) sequence: correlation with radiographic findings

Abstract

The MRI characteristics of fractures have been described on the basis of spin echo (SE) images emphasizing T1 and T2 contrast. These previous studies were carried out for injuries in which radiographic proof was often lacking. In comparison with SE images, short tau inversion recovery (STIR) images have been shown to provide superior contrast between normal and abnormal marrow. To determine the MRI characteristics of fracture using STIR pulse sequences, we reviewed 28 patients who had radiographic evidence of fracture and were examined with T1-weighted SE and STIR sequences. MRI marrow signal abnormalities were demonstrated at all fracture sites ranging in age from less than 24 h to 8 weeks. The extent of marrow signal abnormalities exceeded the size of corresponding radiographic findings of fracture in all cases. The MRI features of fractures on T1-weighted SE images consisted of irregular intramedullary zones of hypointensity. On STIR images a corresponding zone of hyperintensity extended to the outer cortical margin. Intramedullary lines of hypointensity extending to the inner cortical margin were identified within the hyperintense marrow abnormality on STIR images in 64% of the fractures. The results of this study show that MRI using T1-weighted SE and STIR sequences can consistently demonstrate prominent signal abnormalities at fracture sites including those in which radiographic signs are subtle.

Percutaneous vertebroplasty and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures and osteolytic tumours

“…MR is the most useful imaging technique for the detection of oedema indicating acute fracture. This is best depicted on sagittal MR images with short tau inversion recovery (STIR), 31,32 which is also a good predictor of correction of deformity with balloon kyphoplasty. 26 When patients are unable to tolerate MRI, 99 Tc-methyldiphosphonate bone scanning combined with computerassisted tomography can provide useful information on relatively fresh vertebral fractures.…”

Stress-Induced Spiculated Periosteal Reaction Appearing as a Malignant Bone Tumor: A Case Report

“…12 MRI is also more specific than scintigraphy. 13 Information about the surrounding soft tissues is obtained in addition to the changes seen in bone. The pulse sequences that best show stress injuries in bone are T2 and short tau inversion recovery techniques.…”

Comparison of Unilateral versus Bilateral Kyphoplasty in Multiple Myeloma Patients and the Importance of Preoperative Planning

“…Patient were candidates for cement augmentation if they had a VCF with at least 20% loss of anterior or middle vertebral body height and persistent pain not related to other causes as determined by the clinical exam, and imaging (e.g., discogenic or fascetogenic pain); the pain level should have been at least 4/10 on a numerical scale, and not responsive for at least 2 weeks to conventional medical therapy, including narcotic analgesics, bracing, physical therapy, and bed rest. Symptoms had to be localized to the index vertebral body, and MRI (STIR sequence) was used to confirm the presence of edema in the fractured vertebra(e), which implied an acute or non healed state [16]. However, due to multi-level bone marrow involvement in the majority of cases, we frequently performed prophylactic augmentation in the adjacent vertebrae, especially in the thoracolumbar junction, to avoid subsequent fractures.…”