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Chapter 38: SpecificRadiological PathologyMRI Pathology

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SPECIFIC RADIOLOGICAL STUDIESMRI Pathology1. Posterior tibial tendon tear (grade 2): Photographs 1-4Discussion: Photograph #1 is a T1 weighted image with a low signal aroundthe posterior tibial tendon. The dark center is tendon, (clear arrow) which isnot completely dark but has some areas of grey, which indicated an

intrasubstance tear. The low signal around the tendon (dark arrow) indicatesthat there is fluid around the tendon. Photograph #2 is a T2 weighted image,which shows significant fluid around the posterior tibial tendon, indicating aGrade 2 tear.

Photograph # 1

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Photograph #2

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Photograph #3 is a T1 weighted image (sagittal view) showing irregularitywith in the tendon (lobulated dark area) with the white area below indicatingfluid accumulation. Photograph #4 is a T2 weighted image (sagittal view)showing a white area of increased signal intensity behind the posterior tibialtendon consistent with a grade 2 tear

Photograph #3

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Photograph # 4

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2. Achilles tendon tear: Photograph 5Discussion: A T1 weighted image (sagittal view) revealing a linear signalwithin the Achilles tendon of higher signal intensity, which is consistant withan intrasubstance tear and overall thickening about 4-6 cm above theinsertion of the tendon

Photograph #5

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3. Achilles tendon rupture: Photograph 6 & 7Discussion: Photograph #6 is a T1 weighted image (sagittal view) revealing alarge signal of low intensity surrounding the Achilles tendon in Kager'striangle. Photograph #7 is a T2 weighted image (sagittal view) showing asignal of bright intensity (acute hemorrhage) with complete loss of continuityof the Achilles tendon

Photograph #6

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Photograph #7

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4. Aneurysmal bone cyst: Photograph 8 & 9Discussion: Photograph #8 is a T2 weighted image (axial view) throughthe calcaneus and tarsus. In the calcaneus there is a higher signal above anda lower signal below in each of the pockets. This is consistant with ananeurysmal bone cyst, which is multiloculated. The reason for the differencein signal intensity within the pockets, is the blood constituents settling to thebottom and serosanguinous materials settling to the top. Photograph #9 is aT1 weighted image (sagittal view) with a low homogenous signal from thecalcaneus. Diagnosis can be made from the T2 image

Photograph #8

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Photograph # 9

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5. Tophaceous gout: Photograph 10Discussion: Photograph # 10 is a T1 weighted image (sagittal view) with alow intensity signal visable over the dorsal aspect of the foot invading intothe lesser tarsus. The T2 signal (not shown) has a brighter (higher) signal butnot what fluid filled lesion would look like. This is consistent with tophaceousgout.

Photograph #10

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6. Giant cell tumor: Photograph 11Discussion: Photograph #11 reveals a T1 weighted image (axial view)showing a low instensity signal mass inferior to the sesmoid and flexorapparatus. This is a giant cell tumor over the flexor hallucis longus

Photograph #11

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7. Avascular necrosis of tarsal navicular: Photograph 12 Discussion:Photograph #12 is a T1 weighted image (sagittal view) revealing a signal oflow intensity throughout the navicular. This is consistent with a avascularnecrosis

Photograph #12

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8. Osteochondritis dissecans: Photograph 13-15Discussion: Photograph #13 is a T1 weighted (sagittal view) demonstrating alow signal lesion on the lateral talar dome. Photograph #14 is a T2 weightedimage (sagittal view) demonstrating a high signal from the lateral talar dome.Photograph #15 is a T1 (coronal view) demonstrating a low signal intensitylesion of the anterior talar dome. This is consistent with osteochondritisdissecans

Photograph #13

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Photograph #14

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Photograph #1 5

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9. Osteogenic sarcoma: Photograph 16 & 17Discussion: Photograph #16 is a proton density image (combination of a T1and T2) demonstrating increased signal intensity with loss of normal fattymarrow signal. Also there is an increase in dark signal intensity of theposterior aspect of the tibia. Photograph #17 is a T1 weighted image throughthe tibia (sagittal view) showing increased signal intensity centrally. Thislesion was proven by biopsy to be an osteogenic sarcoma

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Photograph #1 7

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10. Brodie's abcess/yeast infection: Photograph 18 & 19Discussion: Photograph #18 is a T1 weighted image (sagittal view)demonstrating loss of fatty marrow signal in the tibia with a loculated-typelesion. Photograph #19 is a STIR image (a fat supression technique)demonstrating increased signal within the lobulated lesion, and increasedsignal intensity within the marrow of the distal tibia. This was consistent of aBrodie's abcess due to a yeast infection in a previously undiagnosed HIV-positive patient

Photograph #18

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Photograph #1 9

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11. Diabetic osteolysis: Photograph 20 & 21Discussion: Photograph #20 is a T1 weighted image (sagittal view)demonstrating loss of cortical margins of the first metatarsal head, with lossof signal intensity of the fatty marrow and destruction of the 1st metatarsalhead. There is a plantar ulceration underneath the first metatarsal head.Photograph #21 is a STIR image revealing no increased signal within themeatarsal shaft which helps eliminate the diagnosis of osteomyelitis. This isconsistent with diabetic osteolysis.

Photograph #20

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Photograph # 21

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