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BackgroundDiagnosis 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.MethodsTherefore, 20 patients with suspected stress fractures of the foot and ankle underwent plain radiography and 18F-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.Results8 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.ConclusionsPET-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.

The incidence of severe traumatic head injury in children has constantly increased over the last years. Diagnostic imaging has become an unrenounceable tool for the documentation and follow-up of intracranial lesions. The use of magnetic resonance imaging (MRI) in the early posttraumatic phase has led to a more thorough understanding of intracranial injuries. We retrospectively analyzed the cranial computed tomography (CCT) and magnetic resonance (MR)-studies of patients with traumatic head injuries for primary cerebrovascular complications. In 64 children (45 male, 19 female) with traumatic head injuries, CCT and MR examinations were available for analysis. The children's age ranged from 3 months to 15 years with a median age of 7 years. All patients had initial CCT on admission to the hospital with follow-up examinations depending on clinical state and initial imaging findings. All patients had at least one MR examination between 0 to 120 days after the trauma with a median time interval of 17 days. In five of 64 (7.8%) patients, cerebrovascular complications were found on imaging studies. Initial imaging within the first 24 h after the trauma detected a complete middle cerebral artery infarction in one patient and extensive sinus thrombosis after a complex skull fracture in another. In two patients, thrombosis of the transverse sinus appeared on MRI 4 to 6 days after the trauma. In another patient with open-skull injury, a posttraumatic aneurysm of the pericallosal artery was diagnosed on MRI 30 days after the trauma. Our study shows that, although primary cerebrovascular lesions after traumatic head injuries in children are rare, the radiologist should be aware of the characteristic injury patterns and the time appearance of imaging findings on CT and MRI.

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