Resolution of abnormal MR signal intensity in patients with stress fractures of the femoral neck

OBJECTIVE: The purpose of this study was to describe the natural evolution of abnormal MR signal intensity after the diagnosis of a stress fracture of the femoral neck and to ascertain the time to resolution of that abnormal signal intensity. SUBJECTS AND METHODS: Ten patients who had been previously diagnosed with stress fractures of the femoral neck after positive MR scans of the hip were examined with MR imaging at regular intervals. In each patient T1-weighted and short inversion time inversion recovery (STIR) sequences were obtained until the abnormally bright, diffuse MR signal intensity (representing edema) disappeared from the STIR images. Time to resolution was correlated with each patient's age and presence or absence of a fatigue line on MR imaging. Statistical analysis was done using Fisher's exact test. RESULTS: Edema resolved in seven patients within 3 months of initial diagnosis, in two patients within 6 months, and in the remaining patient within 12 months. We found no statistically significant correlation between time to resolution and patient age or the presence of a fatigue line on MR imaging. Residual sclerosis occurred in five patients, all of whom had a fatigue line. Two of these patients developed bright T1 signal (fatty marrow conversion) around the area of sclerosis. In the remaining three patients, STIR images revealed a brightened fatigue line, which we presumed was caused by granulation tissue. CONCLUSION: In this study, 90% of patients showed resolution of abnormal MR signal intensity on STIR imaging within 6 months of the initial diagnosis of stress fracture of the femoral neck. Such data may prove helpful in examining patients with recurrent symptoms who undergo repeated MR scanning. When an abnormally bright, diffuse MR signal intensity on STIR imaging is seen more than 6 months after an original injury, such abnormal signal intensity is likely to represent new injury.