# Zero Echo Time MRI for Osseous Assessment of Sports-Related Pathology in Athletes: A Pictorial Essay

**Authors:** David F. Hanff, Filip M. Vanhoenacker, Edwin H.G. Oei

PMC · DOI: 10.5334/jbsr.4198 · Journal of the Belgian Society of Radiology · 2026-02-16

## TL;DR

Zero Echo Time MRI improves imaging of bone and mineralized tissue in athletes, offering benefits similar to CT within MRI protocols.

## Contribution

Demonstrates the added value of ZTE MRI in detecting sports-related bone and mineralized tissue pathologies.

## Key findings

- ZTE MRI provides CT-like visualization of cortical bone and mineralized tissue.
- ZTE enhances detection of stress injuries, fractures, and other bone-related conditions in athletes.
- ZTE complements conventional MRI by improving depiction of cortical and mineralized abnormalities.

## Abstract

Assessment of cortical bone and mineralized tissue in athletes traditionally relied on radiographs and CT, as conventional MRI provides limited/no signal from cortical bone. Recent advances, particularly zero echo time (ZTE) MRI, enable CT-like visualization of osseous structures within routine MRI protocols. This pictorial essay highlights the added value of ZTE in sports imaging, illustrating its role in the evaluation of stress injuries, occult fractures, osteoid osteoma, osteochondral lesions, calcified tendon pathology, hip and groin pathologies, and relevant differential diagnosis. ZTE complements conventional MRI by improving the depiction of cortical and mineralized abnormalities relevant to athletic populations.

## Linked entities

- **Diseases:** osteoid osteoma (MONDO:0009808)

## Full-text entities

- **Genes:** CALM3 (calmodulin 3) [NCBI Gene 808] {aka CALM, CAM1, CAM2, CAMB, CPVT6, CaM}
- **Diseases:** injuries (MESH:D014947), inflammatory (MESH:D007249), fracture (MESH:D050723), Hip and/or groin pain (MESH:D010146), shoulder pain (MESH:D020069), axial spondylarthritis (MESH:D025241), calcification (MESH:D002114), femoroacetabular impingement syndrome (MESH:D057925), sports injuries (MESH:D001265), osseous abnormalities (MESH:D010001), pubic apophysitis (MESH:C566735), bone marrow edema (MESH:D004487), ankle injury (MESH:D016512), anterior knee pain (MESH:D046788), sclerosis (MESH:D012598), distal fibular fracture (MESH:D020427), ankylosis (MESH:D000844), injury to the articular cartilage (MESH:D002357), low back and buttock pain (MESH:D017116), Stress injuries (MESH:D000079225), Osteochondral lesions (MESH:D010007), hip dysplasia (MESH:D006617), abnormalities (MESH:D000014), ZTE (MESH:D004454), Osteoid osteoma (MESH:D010017), back pain (MESH:D001416), acute and overuse injuries (MESH:D001930), tendinitis (MESH:D052256), inflammatory sacroiliitis (MESH:D058566), joint pain (MESH:D018771), erosions (MESH:D014077), bone (MESH:D001847), mucoid degeneration (MESH:D009410), cortical (MESH:D054220), apophysitis of the pubic symphysis (MESH:D046548), Bone stress injuries (MESH:D015775), Calcified lesions (MESH:D018333), bony abnormalities (MESH:D018213), elbow (MESH:D000092464)
- **Chemicals:** ZTE (-)
- **Species:** Homo sapiens (human, species) [taxon 9606]

## Full text

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## Figures

12 figures with captions in the complete paper: https://tomesphere.com/paper/PMC12922674/full.md

## References

20 references — full list in the complete paper: https://tomesphere.com/paper/PMC12922674/full.md

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Source: https://tomesphere.com/paper/PMC12922674