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Figure 3a. Metatarsal stress fracture in a 53-year-old woman with forefoot pain. (a) Short-axis T1-weighted fat-suppressed MR image, obtained after the intravenous administration of a gadolinium chelate, shows enhancement of the marrow of the fourth metatarsal (arrowhead) as well as the surrounding soft tissues (arrow). (b) Sagittal T1-weighted MR image shows mild and poorly defined low-signal-intensity edema (arrowhead) in the marrow of the distal fourth metatarsal, with a slight angulation of the dorsal cortex (arrow), findings suggestive of a stress fracture. Follow-up radiographs (not shown) revealed callus formation at the site, a finding that helped confirm the diagnosis. Stress fractures and stress reaction often result in relatively mild marrow edema on T1-weighted images, compared with more pronounced marrow and soft-tissue edema on T2-weighted images. Marrow and soft-tissue enhancement after gadolinium administration also is fairly common.
