Radiology: Volume 263: Number 3-June 2012
Belinda R. Beck, PhD A. Gabrielle Bergman, MD Mark Miner, MD Elizabeth A. Arendt, MD Alan B. Klevansky, MB, BCh Gordon O. Matheson, MD, PhD Tracey L. Norling, BHMS, BN Robert Marcus, MD
Purpose: To examine the relationship between severity grade for radiography, triple-phase technetium 99m nuclear medicine bone scanning, magnetic resonance (MR) imaging, and computed tomography (CT); clinical severity; and re-covery time from a tibial stress injury (TSI), as well as to evaluate interassessor grading reliability.
Materials and methods: This protocol was approved by the Griffith University Hu¬man Research Ethics Committee, the Stanford University Panel on Human Subjects in Medical Research, the U.S. Army Human Subjects Research Review Board, and the Australian Defense Human Research Ethics Committee. Informed consent was obtained from all subjects. Forty subjects (17 men, 23 women; mean age, 26.2 years ± 6.9 [standard deviation]) with TSI were enrolled. Subjects were examined acutely with standard anteroposterior and lateral radiography, nuclear medicine scanning, MR imaging, and CT. Each modality was graded by four blinded clinicians. Mixed-effects models were used to examine associations between image severity, clinical severity, and time to heal-ing, with adjustments for image modality and assessor. Grading reliability was evaluated with the Cronbach a coefficient.
Results: Image assessment reliability was high for all grading systems except radiography, which was moderate (α = 0.565-0.895). Clinical severity was negatively associated with MR imaging severity (P ≤ .001). There was no sig-nificant relationship between time to healing and severity score for any imaging modality, although a positive trend existed for MR imaging (P = .07).
Conclusion: TSI clinical severity was negatively related to MR imaging severity. Radiographic, bone scan, and CT severity were not related to time to healing, but there was a positive trend for MR imaging. ©RSNA, 2012