Crönlein Moritz, Rauscher Isabel, Beer Ambros J, Schwaiger Markus, Schäffeler Christoph, Beirer Marc, Huber Stephan, Sandmann Gunther H, Biberthaler Peter, Eiber Matthias, Kirchhoff Chlodwig
Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
Eur J Med Res. 2015 Dec 23;20:99. doi: 10.1186/s40001-015-0193-6.
Diagnosis and treatment of stress fractures still remains to be a clinical and radiological challenge. Therapeutic options vary from conservative treatment to surgical treatment without a clear treatment concept. Recently the combination of PET and MRI has been introduced, aiming a superior diagnostic accuracy in clinical practice. Therefore the aim of our study was to analyse whether PET-MRI would be a feasible technique to recognize stress fractures of the foot and to analyse if our conservative treatment plan leads to a good clinical outcome.
Therefore, 20 patients with suspected stress fractures of the foot and ankle underwent plain radiography and (18)F-Fluoride PET-MRI. Two blinded readers assessed in consensus both imaging techniques for the presence of stress fracture, stress reaction or osteoarthritis. Patients with stress fractures or stress reactions in the foot and ankle area underwent our conservative treatment plan, with immobilization in a VACO®ped cast for 6 weeks under partial weight bearing on forearm crutches. The benefit of our conservative therapeutic concept was evaluated by the patients on the basis of VAS and FAOS scoring systems before and after treatment.
8 out of 20 patients underwent conservative treatment after diagnosis of either a stress fracture or a stress reaction of the foot and ankle area. PET-MRI identified four stress fractures and seven stress reactions. In all cases, no pathological findings were present on plain X-ray. FAOS and VAS significantly improved according to the patients' records.
PET-MRI seems to be a useful modality to diagnose stress fractures and stress reactions of the foot and ankle area, especially when conventional modalities, such as plain radiographs fail. Conservative management is a promising therapeutic option for the treatment of stress fractures. To rule out the benefits compared to a surgical treatment plan, further studies are needed.
应力性骨折的诊断和治疗仍然是临床和放射学上的一项挑战。治疗选择从保守治疗到手术治疗不等，尚无明确的治疗理念。最近，正电子发射断层扫描（PET）和磁共振成像（MRI）的联合应用已被引入，旨在提高临床实践中的诊断准确性。因此，我们研究的目的是分析PET-MRI是否是识别足部应力性骨折的可行技术，并分析我们的保守治疗方案是否能带来良好的临床结果。
因此，20例疑似足踝部应力性骨折的患者接受了X线平片和（18）F-氟化物PET-MRI检查。两名不知情的阅片者共同评估这两种成像技术，以确定是否存在应力性骨折、应力反应或骨关节炎。足踝部有应力性骨折或应力反应的患者接受我们的保守治疗方案，使用VACO®ped支具固定6周，在前臂拐杖辅助下部分负重。患者根据治疗前后的视觉模拟评分法（VAS）和踝关节功能评分系统（FAOS）对我们保守治疗理念的益处进行评估。
20例患者中有8例在被诊断为足踝部应力性骨折或应力反应后接受了保守治疗。PET-MRI识别出4例应力性骨折和7例应力反应。在所有病例中，X线平片均未发现病理改变。根据患者记录，FAOS和VAS评分显著改善。
PET-MRI似乎是诊断足踝部应力性骨折和应力反应的有用方法，尤其是在传统方法如X线平片检查失败时。保守治疗是治疗应力性骨折的一种有前景的治疗选择。为了排除与手术治疗方案相比的益处，还需要进一步的研究。
