Ankle and Foot 47 - Department of Radiology - University of ...

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2310 VII Imaging of the Musculoskeletal System A C E G B D F H Figure 47-115. Developing calcaneal osteomyelitis in a 63-year-old diabetic patient. A, Lateral radiograph of the calcaneus shows intact cortex along the plantar surface (white arrowheads). Incidentally seen is mural calcification of the posterior tibial artery (gray arrowheads). Such arterial calcifications are common in diabetic patients. B, Midsagittal T1-weighted image shows no bone destruction. C, Corresponding sagittal inversion recovery (IR) image shows little, if any, bone marrow edema. D, Corresponding sagittal post– intravenous (IV) gadolinium contrast T1-weighted fatsuppressed image reveals diffuse enhancement of the plantar soft tissues, indicative of cellulitis, but no nonenhancing abscess pockets. When the patient’s symptoms did not respond to antibiotics, repeat imaging was obtained 2 weeks later. E, Lateral radiograph now demonstrates loss of cortex along the plantar surface of the calcaneus (arrowheads). F, Midsagittal T1-weighted image reveals infiltration of the fatty heel pad (arrows). G, Corresponding sagittal inversion recovery image reveals fluid bright signal (arrows) in the soft tissues adjacent to the calcaneus, as well as bone marrow edema in calcaneus (arrowheads). H, Corresponding sagittal post-IV gadolinium contrast T1-weighted fat-suppressed image reveals a nonenhancing abscess pocket (arrows) as well as enhancing bone marrow (arrowheads). Coronal T1-weighted (I), inversion recovery (J), and post-IV gadolinium contrast T1- weighted fat-suppressed (K) images through the abscess pocket confirm the findings seen in the sagittal plane: an abscess pocket (gray, white, and black arrows) adjacent to the osteomyelitis (white arrowhead) of the planter surface of the calcaneus. I J K Ch047-A05375.indd 2310 9/9/2008 5:36:17 PM
A B C D E T1 T2fs T1fs IVGd F G H Figure 47-116. Brodie’s abscess in a young child. A, Anteroposterior radiograph of the asymptomatic right leg. B, Anteroposterior radiograph of the swollen left leg reveals a lucency in the distal fibula metaphysis (arrow in the magnified dashed box). This lucency has a well-defined and sclerotic margin, indicating chronicity. There are also thick, chronic periosteal reactions (arrowheads) extending up the diaphysis. C, Coronal T1-weighted image through the distal fibula confirms the radiographic findings of a thick chronic periosteal reaction (white arrowheads), as well as the well-circumscribed dark line (open arrowheads) around the lesion corresponding to the sclerotic margin. D, The corresponding coronal T2-weighted fat-suppressed image shows that the well-circumscribed lesion (arrow) is as bright as fluid and thus probably cystic. E, The corresponding coronal T1-weighted fat-suppressed post–intravenous (IV) gadolinium contrast image not only confirms that the lesion (arrow) is mostly nonenhancing and thus mostly cystic, but demonstrates peripheral enhancement, in some places thick (black arrowhead), characteristic of an abscess, in this case an intraosseous or Brodie’s abscess. (There is inadequate fat suppression of the heel pad [large white arrowhead] on both of the fat-suppressed sequences, D and E.) F to H, Axial images through the fibular abscess reveal it to be isointense to muscle on T1-weighted image (F, arrow) and fluid bright on T2-weighted fat-suppressed image (G, arrow), with peripheral but not central enhancement on fat-suppressed T1-weighted image after IV gadolinium (H, arrow). There are edema and enhancement of the soft tissues surrounding the fibula, indicating an active inflammatory component to this chronic Brodie’s abscess. Ch047-A05375.indd 2311 9/9/2008 5:36:20 PM
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Ankle and Foot 47 - Department of Radiology - University of ...

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