3T MRI has a high degree of accuracy for detecting soft tissue tendoligamentous and muscular injuries. However our preliminary experience at Panorama Radiology Specialists with Siemens Lumina 3T MRI augmented with Deep Resolve image enhancement – a breakthrough technology enabling significantly enhanced fine image detail – has been a significantly increased sensitivity in the detection of subtle microtrabecular fractures (microfractures) and stress fractures which may not be consistently detected on conventional 3T MRI scanners. 

Microtrabecular fractures are commonly associated with mild to severe soft tissue injuries and overuse stress injuries, and are typically associated with bone marrow oedema or reactive bone contusion. The detection and diagnosis of microtrabecular fractures offers prognostic implications in terms of the management and recovery of non-surgical acute injuries and stress injuries, particularly of the ankle, foot and knee, including recovery time to return to full training, competition or workplace duties. 

Microtrabecular fractures have been well documented in association with bone bruising and stress injury for several decades, and 3T MRI has become the gold standard imaging modality in the detection and characterisation of occult fractures and soft tissue injuries, as an easily-accessible radiation-free alternative to SPECT-CT nuclear medicine scans, which are poorly sensitivity in the detection of soft tissue injuries. Histologically, trabecular microfractures appear as acute meshy microtrabecular disruption with hemorrhage and oedema, progressing to microcallus with variable calcification and trabecular healing, evident with basophilic H&E staining. 

3T MRI augmented with Deep Resolve artificial intelligence image enhancement offers a quantum leap forward in terms of accurate visualisation of fine anatomical structures including tendons, ligaments, nerves and vascular structures. 

In our experience with a current generation Siemens Lumina 3T MRI equipped with Deep Resolve image enhancement, the technology offers an exceptionally high level of soft tissue detail, but also provides an exceptional level of trabecular bone definition, not typically seen with conventional MRI studies without augmented AI image enhancement. 

As a clinic specialising in musculoskeletal imaging,  Deep Resolve 3T MRI technology has significantly enhanced the ability to accurately detect and define very subtle microtrabecular fractures, which are characterised by linear T1 hypointense bands on a background of bone marrow oedema or bone contusion. We are now seeing subtle microfractures in patients with low to intermediate grade soft injuries and overuse stress injuries, particularly in the setting of ankle and knee conditions in athletes, workplace injury and accidental injuries. 

Whilst microtrabecular fracture injuries are generally non-surgical, their presence carries prognostic implications in terms of recovery period, time to return to maximal training for amateur and elite athletes, and lost work days for injured workers, especially those whose occupation demands lifting, long periods of standing or strenuous activity.

Below are some examples of subtle microtrabecular fractures on a background of bone contusion, clearly demonstrated on 3T MRI with Deep Resolve image enhancement. 

3T MRI with Deep Resolve image enhancement of an adult following an acute twisting injury of the knee, showing a microtrabecular fracture of the medial tibial plateau, seen as a T2 hyperintense / T1 hypointense band. XRays showed no abnormality.

3T MRI with Deep Resolve of the hindfoot following over-use injury shows a subtle microtrabecular stress fracture of the calcaneum. T2 images demonstrate bone marrow oedema, whilst T1 images (top) clearly show an associated microfracture line.

3T MRI with Deep Resolve of the knee following an acute hyperextension injury demonstrates a subtle microtrabecular fracture of the lateral femoral condyle.

3T MRI with Deep Resolve image enhancement of the ankle following an acute inversion injury demonstrates microtrabecular impaction fractures of the talus and medial malleolus with associated bone contusion. CT showed no abnormality.

“Imaging of Trabecular Microfracture with Bone Marrow Edema and Hemorrhage”, Yong-Whee Bahk, 2020

“Bone Contusion Patterns of the Knee at MRI”,  AL Lourenco et al, European Congress of Radiology, 2019

I’m always happy to discuss individual cases with referring clinicians – if you’re a medical practitioner seeking an opinion on which imaging-guided pain management measures may be most appropriate and beneficial in an individual clinical situation, please feel free to contact me directly.

Dr Angus Watts


Diagnostic and Interventional Radiologist

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