Chapter 38: Specific

Radiological Pathology
MRI Pathology
 SPECIFIC RADIOLOGICAL STUDIES
MRI Pathology
1. Posterior tibial tendon tear (grade 2): Photographs 1-4
Discussion: Photograph #1 is a T1 weighted image with a low signal around
the posterior tibial tendon. The dark center is tendon, (clear arrow) which is
not completely dark but has some areas of grey, which indicated an
intrasubstance tear. The low signal around the tendon (dark arrow) indicates
that there is fluid around the tendon. Photograph #2 is a T2 weighted image,
which shows significant fluid around the posterior tibial tendon, indicating a
Grade 2 tear.

Photograph # 1
Photograph #2
Photograph #3 is a T1 weighted image (sagittal view) showing irregularity
with in the tendon (lobulated dark area) with the white area below indicating
fluid accumulation. Photograph #4 is a T2 weighted image (sagittal view)
showing a white area of increased signal intensity behind the posterior tibial
tendon consistent with a grade 2 tear

Photograph #3
Photograph #4
2. Achilles tendon tear: Photograph 5
Discussion: A T1 weighted image (sagittal view) revealing a linear signal
within the Achilles tendon of higher signal intensity, which is consistant with
an intrasubstance tear and overall thickening about 4-6 cm above the
insertion of the tendon

Photograph #5
3. Achilles tendon rupture: Photograph 6 & 7
Discussion: Photograph #6 is a T1 weighted image (sagittal view) revealing a
large signal of low intensity surrounding the Achilles tendon in Kager's
triangle. Photograph #7 is a T2 weighted image (sagittal view) showing a
signal of bright intensity (acute hemorrhage) with complete loss of continuity
of the Achilles tendon

Photograph #6
Photograph #7
4. Aneurysmal bone cyst: Photograph 8 & 9
Discussion: Photograph #8 is a T2 weighted image (axial view) through
the calcaneus and tarsus. In the calcaneus there is a higher signal above and
a lower signal below in each of the pockets. This is consistant with an
aneurysmal bone cyst, which is multiloculated. The reason for the difference
in signal intensity within the pockets, is the blood constituents settling to the
bottom and serosanguinous materials settling to the top. Photograph #9 is a
T1 weighted image (sagittal view) with a low homogenous signal from the
calcaneus. Diagnosis can be made from the T2 image

Photograph #8
Photograph #9
5. Tophaceous gout: Photograph 10
Discussion: Photograph # 10 is a T1 weighted image (sagittal view) with a
low intensity signal visable over the dorsal aspect of the foot invading into
the lesser tarsus. The T2 signal (not shown) has a brighter (higher) signal but
not what fluid filled lesion would look like. This is consistent with tophaceous
gout.

Photograph #10
6. Giant cell tumor: Photograph 11
Discussion: Photograph #11 reveals a T1 weighted image (axial view)
showing a low instensity signal mass inferior to the sesmoid and flexor
apparatus. This is a giant cell tumor over the flexor hallucis longus

Photograph #11
7. Avascular necrosis of tarsal navicular: Photograph 12 Discussion:
Photograph #12 is a T1 weighted image (sagittal view) revealing a signal of
low intensity throughout the navicular. This is consistent with a avascular
necrosis

Photograph #12
8. Osteochondritis dissecans: Photograph 13-15
Discussion: Photograph #13 is a T1 weighted (sagittal view) demonstrating a
low signal lesion on the lateral talar dome. Photograph #14 is a T2 weighted
image (sagittal view) demonstrating a high signal from the lateral talar dome.
Photograph #15 is a T1 (coronal view) demonstrating a low signal intensity
lesion of the anterior talar dome. This is consistent with osteochondritis
dissecans

Photograph #13
Photograph #14
Photograph #15
9. Osteogenic sarcoma: Photograph 16 & 17
Discussion: Photograph #16 is a proton density image (combination of a T1
and T2) demonstrating increased signal intensity with loss of normal fatty
marrow signal. Also there is an increase in dark signal intensity of the
posterior aspect of the tibia. Photograph #17 is a T1 weighted image through
the tibia (sagittal view) showing increased signal intensity centrally. This
lesion was proven by biopsy to be an osteogenic sarcoma
Photograph #17
10. Brodie's abcess/yeast infection: Photograph 18 & 19
Discussion: Photograph #18 is a T1 weighted image (sagittal view)
demonstrating loss of fatty marrow signal in the tibia with a loculated-type
lesion. Photograph #19 is a STIR image (a fat supression technique)
demonstrating increased signal within the lobulated lesion, and increased
signal intensity within the marrow of the distal tibia. This was consistent of a
Brodie's abcess due to a yeast infection in a previously undiagnosed HIV-
positive patient

Photograph #18
Photograph #19
11. Diabetic osteolysis: Photograph 20 & 21
Discussion: Photograph #20 is a T1 weighted image (sagittal view)
demonstrating loss of cortical margins of the first metatarsal head, with loss
of signal intensity of the fatty marrow and destruction of the 1st metatarsal
head. There is a plantar ulceration underneath the first metatarsal head.
Photograph #21 is a STIR image revealing no increased signal within the
meatarsal shaft which helps eliminate the diagnosis of osteomyelitis. This is
consistent with diabetic osteolysis.

Photograph #20
Photograph #21
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