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

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2218 VII Imaging of the Musculoskeletal System Figure 47-14. Normal Achilles tendon in a 14-year-old with a calcaneal stress fracture. A, Lateral radiograph shows the normal sharp interface between the lucent Kager’s fat pad and the semiradiopaque Achilles tendon (white arrows). The sclerosis in the calcaneal tuberosity (black arrowheads) is more subtle radiographically. B, Midsagittal T1-weighted image shows the sharp interface between the normal, bright Kager’s fat pad and the normal, straight and uniformly dark Achilles tendon (Ach), which is uniform in thickness throughout its length. The dark line running perpendicular to the trabeculae in the calcaneal tuberosity is the stress fracture (black arrowheads). C, Midsagittal inversion recovery image reveals no abnormally increased signal in the uniformly dark Achilles tendon. A normal amount of fluid is present in the retrocalcaneal bursa (white arrowhead). There is bone marrow edema throughout the calcaneus as a response to the stress fracture in the tuberosity. A B C Ch047-A05375.indd 2218 9/9/2008 5:33:39 PM
47 Ankle and Foot 2219 47 A B Figure 47-15. Plantaris tear in a 71-year-old who, while playing tennis, heard a “snap” and experienced sudden onset of posterior calf pain. A, Coronal T2-weighted fat-suppressed images through both calves reveal a band of edema tracking between the left calf muscles (white arrowheads). B, Axial T2-weighted fat-suppressed images taken at the level of the dotted line in A show the edema tracking between the left soleus (S) and the gastrocnemius (G) muscles. A B C Figure 47-16. Stenosing tenosynovitis of the posterior tibial tendon (PT) in a 57-year-old with chronic medial ankle pain. These are straight axial images, obtained at the same level, with different sequences. A, T1-weighted image shows loss of the normal sharp fat–tendon interface around the PT (arrowhead). B, Proton-density–weighted image shows that the chronically swollen and scarred PT is larger in axial cross section than the normal anterior tibial tendon (AT). C, T2-weighted image shows that the tissue surrounding the PT is not fluid but the chronic fibrotic scarring of stenosing tenosynovitis. Ch047-A05375.indd 2219 9/9/2008 5:33:41 PM
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Ankle and Foot 47 - Department of Radiology - University of ...

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