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?