Answer for BIR CoW 04 Jan 2026
Stress fracture of left neck of femur
Findings
Linear T1 hypointensity noted in the neck of left femur. T2/STIR hyperintense bone marrow edema noted in the superolateral aspect of head and neck of femur with no obvious cortical break.
Discussion
MRI is the most sensitive modality for early detection of femoral neck stress injuries, identifying marrow edema before radiographic changes and preventing progression to displacement and avascular necrosis. Stress injuries most commonly involve the inferomedial (compressive) femoral neck, which has a better prognosis than superolateral (tensile-side) injuries that carry a higher risk of displacement. MRI severity correlates with clinical outcome, with progression from isolated marrow edema to visible fracture line and increasing fracture width associated with longer recovery and delayed return to activity. An MRI-based grading system provides objective risk stratification, improves communication with clinicians, and guides conservative versus surgical management decisions. Early, accurate MRI reporting by radiologists plays a critical role in patient management, helping prevent catastrophic complications such as fracture displacement and femoral head osteonecrosis.
Findings
Linear T1 hypointensity noted in the neck of left femur. T2/STIR hyperintense bone marrow edema noted in the superolateral aspect of head and neck of femur with no obvious cortical break.
Discussion
MRI is the most sensitive modality for early detection of femoral neck stress injuries, identifying marrow edema before radiographic changes and preventing progression to displacement and avascular necrosis. Stress injuries most commonly involve the inferomedial (compressive) femoral neck, which has a better prognosis than superolateral (tensile-side) injuries that carry a higher risk of displacement. MRI severity correlates with clinical outcome, with progression from isolated marrow edema to visible fracture line and increasing fracture width associated with longer recovery and delayed return to activity. An MRI-based grading system provides objective risk stratification, improves communication with clinicians, and guides conservative versus surgical management decisions. Early, accurate MRI reporting by radiologists plays a critical role in patient management, helping prevent catastrophic complications such as fracture displacement and femoral head osteonecrosis.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
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Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!