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

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2314 VII Imaging of the Musculoskeletal System A B C T1 T2fs D IR Figure 47-119. Osteoid osteoma in a 19-year-old with symptoms clinically thought to be due to a tibial stress fracture. A, Axial CT scan through the level of the syndesmosis. The nidus is the small lucent lesion (black circle). B, Axial T1-weighted image through same level as A. The low-intensity nidus (white circle) is masked by the surrounding marrow edema. C, Corresponding T2-weighted fat-suppressed image. The low-intensity nidus (white circle) is unmasked by the bright signal of the surrounding marrow edema. D, Sagittal inversion recovery (IR) image reveals bone marrow edema around the small nidus (white circle). A B Figure 47-120. Chondroblastoma in a 16-year-old. A, Lateral radiograph demonstrates an expansile mass arising from the back of the tibia. B, Midsagittal T1- weighted image shows that the mass is purely epiphyseal, deforming but not crossing the distal physis in this patient who is not yet skeletally mature. C, Corresponding sagittal T2-weighted image shows heterogeneous bright signal in the mass. There is also edema in the adjacent soft tissues (arrows), a common finding with chondroblastomas. D, Corresponding sagittal cartilage-sensitive sequence (fat-suppressed three-dimensional gradient echo) reveals signal intensity in this cartilaginous tumor that is nearly as bright as the nearby normal articular hyaline cartilage. C D Ch047-A05375.indd 2314 9/9/2008 5:36:24 PM
A B 47 Ankle and Foot 2315 47 Figure 47-121. Intraosseous lipoma discovered as an incidental finding in a 43-year-old. A, Lateral radiograph of the right calcaneus shows the lucent lesion in the anterior half with a well-circumscribed border (open arrowheads). Centrally, there is a small sclerotic focus (black arrowhead), characteristic of an intraosseous lipoma. B, Lateral radiograph of the contralateral left calcaneus is shown for comparison. A lipoma, intraosseous or otherwise, should be isointense to fat on all imaging sequences. C, Midsagittal T1-weighted image shows the signal intensity of the lipoma (open arrowheads) to be isointense to that of the surrounding fatty bone marrow. The central sclerotic focus (black arrowhead) is dark on all imaging sequences. D, On the corresponding T2-weighted fat-suppressed image, the fat in the lipoma suppresses to a degree similar to that of the surrounding fatty bone marrow so that it is nearly inconspicuous. C D A B Figure 47-122. Chondrosarcoma arising from the calcaneal tuberosity 30-year-old. A, Lateral radiograph. This patient complained of heel pain for 10 months until the sclerosis in her calcaneus was recognized. B, Sagittal T1-weighted image shows diffusely decreased signal in the calcaneus corresponding to the radiographic sclerosis. C, Sagittal fat-suppressed T2-weighted image reveals marrow edema only at the periphery of the sclerotic region. There is, however, extensive bright signal in the soft tissues immediately plantar to the calcaneus, indicating that the tumor is extending out of the bone and into the soft tissues. D, Sagittal post–gadolinium contrast fat-suppressed T1-weighted image demonstrates enhancement only at the periphery of the osseous and soft tissue masses. This enhancement pattern is due to the relative hypovascularity of chondrosarcomas. C D Ch047-A05375.indd 2315 9/9/2008 5:36:27 PM
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Ankle and Foot 47 - Department of Radiology - University of ...

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