In suspected occult fracture with negative X-ray, which imaging modality is most sensitive for early detection?

• A. MRI of the affected region
• B. CT scan
• C. X-ray
• D. Ultrasound

Answer: (A)

Bone marrow edema is the earliest sign of an occult fracture, and MRI is the only modality that reliably detects this change within hours to days after injury. Even when X-rays are normal, MRI can reveal a fracture through the edema pattern and also assess surrounding soft tissues, which helps confirm the diagnosis and guide management. CT can show cortical disruption, but in the very early phase edema may be present without a visible fracture line, making MRI more sensitive in this window. Ultrasound isn’t dependable for deep bony injuries, and X-ray is negative by definition in this scenario. So MRI of the affected region is the best choice for early detection.