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

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2226 VII Imaging of the Musculoskeletal System A B C Figure 47-28. Longitudinal split of the peroneus brevis tendon (PB) in a 62-year-old. Straight axial T1- weighted (A), proton-density (PD)– weighted (B), and T2-weighted images through the syndesmosis. The PB (black arrow) is well seen on T1 and PD weighting, located between the lateral malleolus (LM) and the peroneus longus tendon (PL). At this level, the PB has a normal flattened appearance. However, the T2-weighted image shows an abnormal amount of fluid in the common peroneal tendon sheath (white arrowhead). Straight axial T1-weighted (D), PDweighted (E), and T2-weighted (F) images through the LM. At this level, the PB is abnormally flattened to such an extent that it is draped over the PL, best seen on the PD image (E). Straight axial T1- weighted (G), PD-weighted (H), and T2-weighted (I) images distal to the LM. D E F G H I Ch047-A05375.indd 2226 9/9/2008 5:33:54 PM
47 Ankle and Foot 2227 47 J K L M N Figure 47-28, cont’d The marker (m) indicates the site of maximal tenderness. At this level, the PB is split into two pieces (black arrows), separated by the intact PL (white arrow). Oblique coronal T1-weighted (J), PD-weighted (K), and T2-weighted (L) images anterior to the LM, through the pain marker (m). All three sequences show increased signal in the PB (black arrow) as opposed to the normal black signal in the PL (white arrow). Although the “magic angle” can artifactually increase the intratendinous signal on the short TE sequences (T1 and PD), magic angle does not affect the long TE T2-weighted sequence. Thus, the bright signal in the PB on the T2-weighted image represents a true intrasubstance tear. The abnormal fluid in the common peroneal tendon sheath (white arrowhead) indicates active tenosynovitis. M and N, Far lateral sagittal inversion recovery images demonstrate the abnormal fluid in the common peroneal tendon sheath (white dotted rectangle) as well as the edema in the swollen PB (black dotted rectangle). Ch047-A05375.indd 2227 9/9/2008 5:33:56 PM
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Ankle and Foot 47 - Department of Radiology - University of ...

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