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IMAGE INTERPRETATION · BONE IMAGING

Femoral Neck Stress Fracture on Bone Scan

Tc-99m MDP bone scan, focal uptake in the hip region
Tc-99m MDP bone scan, focal uptake in the hip region

CC BY 4.0 · Santiago et al. / Wikimedia Commons · source file

Question

This bone scan shows a linear focus of intense increased uptake in the proximal femur/femoral neck region in an athlete presenting with hip pain. No abnormality was visible on initial plain radiographs. This pattern is most consistent with:

  1. AStress fracture
  2. BAvascular necrosis of the femoral head
  3. CMetastatic lesion
  4. DTransient osteoporosis
Show the answer and explanation

A. Stress fracture

Bone scintigraphy is highly sensitive for detecting stress fractures that are radiographically occult (invisible on plain X-ray). A stress fracture typically appears as a linear or fusiform focus of intense increased uptake at the cortex. The clinical context of an athlete with hip pain and a negative radiograph makes stress fracture the most likely diagnosis. Avascular necrosis would typically show a cold (photopenic) area early. A metastasis would be in the medullary space and not linear.

More bone imaging images

Tc-99m MDP bone scan showing focal uptake at the femoral neckFemoral Neck Insufficiency Fracture on Bone Scan Three-phase bone scan: flow, blood pool, and delayed images of the lower extremityOsteomyelitis on Three-Phase Bone Scan Whole-body Tc-99m MDP bone scan (anterior and posterior projections)How Tc-99m MDP Localizes in Bone Whole-body Tc-99m MDP bone scan — anterior and posterior projections showing skeletal metastases patternBone Metastases: Prostate and Breast Primaries Whole-body bone scintigraphy showing diffusely increased skeletal uptakeSuperscan on Bone Scintigraphy Whole-body bone scan showing intense uptake in expanded bony segmentsPaget’s Disease of Bone on Bone Scan
← Diffuse Skeletal Metastases on Bone ScanFemoral Neck Insufficiency Fracture on Bone Scan →

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