Grades of Fredericson et al for Tibial Stress Fracture as Seen on Imaging Studies

Fredericson et al graded tibial stress fractures based on their appearance on imaging studies. The authors are from Stanford University.

Imaging studies:

(1) bone scan

(2) magnetic resonance imaging (MRI)

Bone Scan

Cortical Area Showing Activity	Activity in Cortical Area	Grade
small and ill-defined	mildly increased	1
better-defined	moderately increased	2
wide to fusiform, cortical-medullary area	highly increased	3
transcortical	intensely increased	4

MRI

Periosteum on T2 Weighted Image	Marrow on T1 and T2 Weighted Images	Fractures Line	Grade
mild to moderate edema	normal	not clearly visible	1
moderate to severe edema	edema present on T2 images	not clearly visible	2
moderate to severe edema	edema present on T1 and T2 images	not clearly visible	3
moderate to severe edema	intensely increased on T1 and T2 images	clearly visible	4

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