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Bone Marrow Abnormalities of Foot and Ankle: STIR versus T1-weighted Contrast-enhanced Fat-suppressed Spin-Echo MR Imaging¹

¹ From the Departments of Radiology (M.R.S., J.H., C.A.B., M.Z.) and Orthopedic Surgery (P.V.), Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland. From the 2000 RSNA scientific assembly. Received July 23, 2001; revision requested September 12; revision received November 15; accepted January 9, 2002. Address correspondence to M.R.S. (e-mail: mariusschmid@hotmail.com).

View larger version (122K): [in a new window]   Figure 1a. Ill-defined pattern. MR images obtained in a 74-year-old woman with nonspecific signal intensity alteration, probably related to overuse. Ill-defined bone marrow signal intensity increase (arrowheads) is seen in the calcaneus, the talus, and the lateral cuneiform bone. Discrete signal intensity alteration in the cuboid bone is simulated by partial-volume effect. (a) Sagittal STIR image (4,800/30/150). (b) Corresponding sagittal T1-weighted contrast-enhanced fat-suppressed image (750/20).

View larger version (112K): [in a new window]   Figure 1b. Ill-defined pattern. MR images obtained in a 74-year-old woman with nonspecific signal intensity alteration, probably related to overuse. Ill-defined bone marrow signal intensity increase (arrowheads) is seen in the calcaneus, the talus, and the lateral cuneiform bone. Discrete signal intensity alteration in the cuboid bone is simulated by partial-volume effect. (a) Sagittal STIR image (4,800/30/150). (b) Corresponding sagittal T1-weighted contrast-enhanced fat-suppressed image (750/20).

View larger version (126K): [in a new window]   Figure 2a. Well-defined pattern. MR images obtained in a 63-year-old man with an osteochondral lesion of the talus. (a) Sagittal STIR image (4,800/30/150) shows ill-defined area (arrowheads) in body and neck of talus and several subchondral well-defined lesions (arrows). (b) Sagittal T1-weighted contrast-enhanced fat-suppressed image (700/20) with identical subchondral well-defined lesions (arrows), probably related to granulation tissue, with increased signal intensity with both sequences. Identical amount of surrounding diffuse bone marrow signal intensity alteration (arrowheads) is present as seen in a.

View larger version (114K): [in a new window]   Figure 2b. Well-defined pattern. MR images obtained in a 63-year-old man with an osteochondral lesion of the talus. (a) Sagittal STIR image (4,800/30/150) shows ill-defined area (arrowheads) in body and neck of talus and several subchondral well-defined lesions (arrows). (b) Sagittal T1-weighted contrast-enhanced fat-suppressed image (700/20) with identical subchondral well-defined lesions (arrows), probably related to granulation tissue, with increased signal intensity with both sequences. Identical amount of surrounding diffuse bone marrow signal intensity alteration (arrowheads) is present as seen in a.

View larger version (142K): [in a new window]   Figure 3a. Cystic pattern. MR images obtained in a 56-year-old man with a cystic osteochondral lesion of the talus. (a) Cyst (arrow) 1 cm in diameter is observed on sagittal STIR image (4,800/30/150). Major parts of the talus show ill-defined zones (arrowheads) with increased signal intensity. (b) Corresponding sagittal T1-weighted contrast-enhanced fat-suppressed image (750/20) with hypointense cyst and surrounding contrast enhancement (arrow). Same volume of diffuse bone marrow signal intensity alteration (arrowheads) is present as in a.

View larger version (127K): [in a new window]   Figure 3b. Cystic pattern. MR images obtained in a 56-year-old man with a cystic osteochondral lesion of the talus. (a) Cyst (arrow) 1 cm in diameter is observed on sagittal STIR image (4,800/30/150). Major parts of the talus show ill-defined zones (arrowheads) with increased signal intensity. (b) Corresponding sagittal T1-weighted contrast-enhanced fat-suppressed image (750/20) with hypointense cyst and surrounding contrast enhancement (arrow). Same volume of diffuse bone marrow signal intensity alteration (arrowheads) is present as in a.

View larger version (136K): [in a new window]   Figure 4a. Osteoid osteoma. MR images obtained in a 26-year-old man with subperiostal osteoid osteoma in the neck of the talus. Subperiostal nidus (black arrow) observed on images obtained with both sequences and identical surrounding increased signal intensity within bone marrow (arrowheads) and soft tissue (white arrows). (a) Sagittal STIR image (4,800/30/150). (b) Corresponding sagittal T1-weighted contrast-enhanced fat-suppressed image (650/20).

View larger version (127K): [in a new window]   Figure 4b. Osteoid osteoma. MR images obtained in a 26-year-old man with subperiostal osteoid osteoma in the neck of the talus. Subperiostal nidus (black arrow) observed on images obtained with both sequences and identical surrounding increased signal intensity within bone marrow (arrowheads) and soft tissue (white arrows). (a) Sagittal STIR image (4,800/30/150). (b) Corresponding sagittal T1-weighted contrast-enhanced fat-suppressed image (650/20).