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

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.