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.