MRI: The Top Five Hit Parade
Robert L. Baron, D.P.M., FACFAOM
CONFLICT OF INTEREST I have no conflicts of interest pertaining to the material presented in this lecture.
OUTLINE Brief Review of MR Basics Top 5 Hit Parade
MRI Basics
T1 Sequence – Fat weighted – Adipose tissue, mature medullary bone
T2 Sequence – Water weighted – Edema, inflammation
MRI Basics
IR Sequence (Inversion recovery) – Suppresses fat signal – Enhances fluid contrast – MSK pathology
T1 Sequence
T2 Sequence
IR Sequence
No. 5 SOFT TISSUE MASSES
5. Soft Tissue Masses
MR excellent for evaluating ST masses Superficial vs. deep Imaging characteristics Size and extent
Plantar Fibroma
Plantar Fibroma
Plantar Fibroma
Ganglion Tarsal Tunnel
FHL Tenosynovitis TT
Ganglion Cyst
GCT
GCT
IM Myxoma
IM Myxoma
IM Myxoma
Verrucous Carcinoma
Verrucous Carcinoma
Verrucous Carcinoma
Verrucous Carcinoma
No. 4 ACHILLES TENDON
4. Achilles Tendon Pathology
Source of heel and posterior ankle pain Multiple etiologies Usually hypovascular watershed Hypoxic degeneration
Acute Partial and FT Tears
Delamination
Acute Delamination
Achilles Tendinitis
Mid and Insertional Tears
Avulsion Fragment
Hypertrophic Tendinopathy
Retrocalcaneal Bursa
No. 3 HEEL PAIN
3. Heel Pain Multiple etiologies Plantar fasciitis or fasciosis Calcaneal fracture Nerve entrapment (Baxter’s neuroma) Soft tissue mass (bursa)
Acute Plantar Fascitis
Partial Thickness Tear
Acute Partial Thickness Tear
Acute Tear Post-traumatic
No. 2 POSTERIOR TIBIAL
TENDON
2. Posterior Tibial Tendon
Very common source medial ankle pain Three separate grades of PT tendon tear – Type 1 Enlargement of tendon with partial tear – Type 2 Attenuated tendon with partial tear – Type 3 Complete tear
Accessory navicular syndrome
Type 1 PT Tear
Focal Tenosynovitis
Accessory Navicular Syndrome
No. 1 LATERAL ANKLE
SPRAINS
1. Lateral Ankle Sprains
Very common injury ATAF usually involved – Three grades
Grade 1 Acute inflammation Grade 2 Partial tear Grade 3 Complete rupture (can involve capsular tear)
Normal ATAF, CF and PTAF Ligs.
Normal CF Ligament
Grade 2 Sprain
Acute Grade 2 Sprain
Acute Grade 3 Sprain
Acute Grade 3 Sprain
In Conclusion
MR becoming gold standard for variety of ST and osseous pathology Imaging just one facet of evaluation Clinical assessment and plain radiographs Pain is a symptom, NOT a diagnosis Review advanced imaging studies
Thank You
Questions?