ANKLE PPT FINAL radiologist perspective .pptx

ANKLE PPT FINAL radiologist perspective

1. Inflammatory and Infective Ankle Pathologies VS by Vishal Singh

2. Inflammatory Pathologies: Overview 1 Rheumatoid Arthritis (RA) A chronic, systemic inflammatory disorder characterized by symmetric joint involvement, gradual onset, morning stiffness, and responsiveness to anti-inflammatory treatment. 2 Psoriatic Arthritis An inflammatory arthritis associated with psoriasis, distinguished by asymmetric joint involvement and a unique radiographic feature known as the "pencil-in-cup deformity." 3 Gout A crystal-induced arthropathy characterized by acute, painful attacks, often affecting the big toe. Radiographically, it presents with punched-out erosions with overhanging edges. 4 Osteoarthritis A degenerative joint disease characterized by progressive cartilage loss, osteophyte formation, and subchondral sclerosis. It typically affects weight-bearing joints, including the ankle.

3. Rheumatoid Arthritis: Imaging Features Radiographic Features - Soft tissue swelling - Periarticular osteopenia - Uniform joint space narrowing - Marginal erosions MRI Findings - Synovial hypertrophy and enhancement - Bone marrow edema - Erosions (more sensitive than X-ray) - Tenosynovitis Ultrasound Characteristics - Synovial hypertrophy - Increased vascularity on Doppler - Erosions

4. Rheumatoid Arthritis: Imaging Features Radiographic Features - Soft tissue swelling - Periarticular osteopenia - Uniform joint space narrowing - Marginal erosions MRI Findings - Synovial hypertrophy and enhancement - Bone marrow edema - Erosions (more sensitive than X-ray) - Tenosynovitis Ultrasound Characteristics - Synovial hypertrophy - Increased vascularity on Doppler - Erosions

5. Rheumatoid Arthritis: Imaging Features Radiographic Features - Soft tissue swelling - Periarticular osteopenia - Uniform joint space narrowing - Marginal erosions MRI Findings - Synovial hypertrophy and enhancement - Bone marrow edema - Erosions (more sensitive than X-ray) - Tenosynovitis Ultrasound Characteristics - Synovial hypertrophy - Increased vascularity on Doppler - Erosions

6. Rheumatoid Arthritis: Imaging Features Radiographic Features - Soft tissue swelling - Periarticular osteopenia - Uniform joint space narrowing - Marginal erosions MRI Findings - Synovial hypertrophy and enhancement - Bone marrow edema - Erosions (more sensitive than X-ray) - Tenosynovitis

7. Rheumatoid Arthritis: Imaging Features Radiographic Features - Soft tissue swelling - Periarticular osteopenia - Uniform joint space narrowing - Marginal erosions MRI Findings - Synovial hypertrophy and enhancement - Bone marrow edema - Erosions (more sensitive than X-ray) - Tenosynovitis Ultrasound Characteristics - Synovial hypertrophy - Increased vascularity on Doppler - Erosions

8. Rheumatoid Arthritis: Imaging Features Radiographic Features - Soft tissue swelling - Periarticular osteopenia - Uniform joint space narrowing - Marginal erosions MRI Findings - Synovial hypertrophy and enhancement - Bone marrow edema - Erosions (more sensitive than X-ray) - Tenosynovitis Ultrasound Characteristics - Synovial hypertrophy - Increased vascularity on Doppler - Erosions

9. Rheumatoid Arthritis: Imaging Features Radiographic Features - Soft tissue swelling - Periarticular osteopenia - Uniform joint space narrowing - Marginal erosions MRI Findings - Synovial hypertrophy and enhancement - Bone marrow edema - Erosions (more sensitive than X-ray) - Tenosynovitis

10. Rheumatoid Arthritis: Imaging Features Radiographic Features - Soft tissue swelling - Periarticular osteopenia - Uniform joint space narrowing - Marginal erosions MRI Findings - Synovial hypertrophy and enhancement - Bone marrow edema - Erosions (more sensitive than X-ray) - Tenosynovitis 32-year-old woman with rheumatoid arthritis. Fat- saturated, gadolinium-enhanced sagittal TI-weighted iimage of ankle shows uneven and thick synovial enhancement (arrow) and extensive bone marrow enhancement arrowheads) of calcaneus .

11. Psoriatic Arthritis: Imaging Features Radiographic Features - Asymmetric joint involvement - Erosions and joint space narrowing - Periosteal reaction - Pencil-in-cup deformity (in advanced cases) MRI Findings - Enthesitis (hallmark feature) - Synovitis - Tenosynovitis - Bone marrow edema

12. Psoriatic Arthritis: Imaging Features Radiographic Features - Asymmetric joint involvement - Erosions and joint space narrowing - Periosteal reaction - Pencil-in-cup deformity (in advanced cases) MRI Findings - Enthesitis (hallmark feature) - Synovitis - Tenosynovitis - Bone marrow edema

13. Psoriatic Arthritis: Imaging Features Radiographic Features - Asymmetric joint involvement - Erosions and joint space narrowing - Periosteal reaction - Pencil-in-cup deformity (in advanced cases) MRI Findings - Enthesitis (hallmark feature) - Synovitis - Tenosynovitis - Bone marrow edema

14. Psoriatic Arthritis: Imaging Features Radiographic Features - Asymmetric joint involvement - Erosions and joint space narrowing - Periosteal reaction - Pencil-in-cup deformity (in advanced cases) MRI Findings - Enthesitis (hallmark feature) - Synovitis - Tenosynovitis - Bone marrow edema

15. Psoriatic Arthritis: Imaging Features Radiographic Features - Asymmetric joint involvement - Erosions and joint space narrowing - Periosteal reaction - Pencil-in-cup deformity (in advanced cases) MRI Findings - Enthesitis (hallmark feature) - Synovitis - Tenosynovitis - Bone marrow edema

16. Psoriatic Arthritis: Imaging Features Radiographic Features - Asymmetric joint involvement - Erosions and joint space narrowing - Periosteal reaction - Pencil-in-cup deformity (in advanced cases) MRI Findings - Enthesitis (hallmark feature) - Synovitis - Tenosynovitis - Bone marrow edema This image shows PsA of the ankle and foot in a 32 year old man with psoriasis. The MRI scan shows diffuse swelling and inflammation of all the tissues. The red arrows show inflammation at the "functional enthesis " where_ the tendon wraps around the bone. The yellow arrows show diffuse bone marrow inflammation ( osteitis ). The blue arrows show diffuse inflammation of the soft tissues on top of the foot. This pattern of soft tissue swelling may be linked to bone inflammation ( osteitis ) that triggers a reaction on the bone surface ( periostium ).

17. Gout: Imaging Features Radiographic Features - Soft tissue swelling - Preservation of joint space until late stages - Punched-out erosions with overhanging edges Dual-energy CT Findings - Allows visualization of urate crystal deposits - Helps differentiate from other arthritides Ultrasound Characteristics - Double contour sign (pathognomonic) - Tophus as hyperechoic aggregates

18. Gout: Imaging Features Radiographic Features - Soft tissue swelling - Preservation of joint space until late stages - Punched-out erosions with overhanging edges Ultrasound Characteristics - Double contour sign (pathognomonic) - Tophus as hyperechoic aggregates

19. Gout: Imaging Features Radiographic Features - Soft tissue swelling - Preservation of joint space until late stages - Punched-out erosions with overhanging edges Ultrasound Characteristics - Double contour sign (pathognomonic) - Tophus as hyperechoic aggregates Anteroposterior foot radiograph shows juxta -articular punched-out sclerotic erosions involving the first metatarsophalangeal and interphalangeal joints with associated periarticular soft tissue swelling.  Rounded lucencies at the base of the third metatarsal may represent either erosions or intraosseous tophi .

20. Gout: Imaging Features Radiographic Features - Soft tissue swelling - Preservation of joint space until late stages - Punched-out erosions with overhanging edges Ultrasound Characteristics - Double contour sign (pathognomonic) - Tophus as hyperechoic aggregates

21. Gout: Imaging Features Radiographic Features - Soft tissue swelling - Preservation of joint space until late stages - Punched-out erosions with overhanging edges Ultrasound Characteristics - Double contour sign (pathognomonic) - Tophus as hyperechoic aggregates Punched-out juxta -articular erosions of the first and fifth metatarsal heads with overhanging edges are typical for gout. Overlying soft tissue swelling and increased density represent tophi . The patient has hyperuricaemia .

22. Gout: Imaging Features Radiographic Features - Soft tissue swelling - Preservation of joint space until late stages - Punched-out erosions with overhanging edges Ultrasound Characteristics - Double contour sign (pathognomonic) - Tophus as hyperechoic aggregates

23. Gout: Imaging Features Radiographic Features - Soft tissue swelling - Preservation of joint space until late stages - Punched-out erosions with overhanging edges Ultrasound Characteristics - Double contour sign (pathognomonic) - Tophus as hyperechoic aggregates Soft tissue swelling / nodule at the medial aspect of first metatarsophalangeal joint with marginal erosions of joint bony margins.

24. Gout: Imaging Features Radiographic Features - Soft tissue swelling - Preservation of joint space until late stages - Punched-out erosions with overhanging edges Dual-energy CT Findings - Allows visualization of urate crystal deposits - Helps differentiate from other arthritides

25. Gout: Imaging Features Radiographic Features - Soft tissue swelling - Preservation of joint space until late stages - Punched-out erosions with overhanging edges Dual-energy CT Findings - Allows visualization of urate crystal deposits - Helps differentiate from other arthritides Generalised oedema of the foot and ankle.  Well-defined para articular erosion of the first proximal phalangeal head medially.  Near circumferential to this articulation is a high attenuation crystal deposition corresponding to monosodium urate on dual energy CT. Further MSU deposition of the third DIP joint, second MTP joint, mid foot involving all of the TMT joints and the navicular -cuneiform articulation. There is also MSU deposition of the sinus tarsi and involving the lateral ankle ligament complex.

26. Gout: Imaging Features Radiographic Features - Soft tissue swelling - Preservation of joint space until late stages - Punched-out erosions with overhanging edges Dual-energy CT Findings - Allows visualization of urate crystal deposits - Helps differentiate from other arthritides

27. Gout: Imaging Features Radiographic Features - Soft tissue swelling - Preservation of joint space until late stages - Punched-out erosions with overhanging edges Dual-energy CT Findings - Allows visualization of urate crystal deposits - Helps differentiate from other arthritides Generalised oedema of the foot and ankle.  Well-defined para articular erosion of the first proximal phalangeal head medially.  Near circumferential to this articulation is a high attenuation crystal deposition corresponding to monosodium urate on dual energy CT. Further MSU deposition of the third DIP joint, second MTP joint, mid foot involving all of the TMT joints and the navicular -cuneiform articulation. There is also MSU deposition of the sinus tarsi and involving the lateral ankle ligament complex .

28. Osteoarthritis: Imaging Features Radiographic Features - Asymmetric joint space narrowing - Osteophyte formation - Subchondral sclerosis and cysts MRI Findings - Cartilage loss - Bone marrow lesions - Osteophytes - Subchondral cysts

29. Osteoarthritis: Imaging Features Radiographic Features - Asymmetric joint space narrowing - Osteophyte formation - Subchondral sclerosis and cysts MRI Findings - Cartilage loss - Bone marrow lesions - Osteophytes - Subchondral cysts

30. Osteoarthritis: Imaging Features Radiographic Features - Asymmetric joint space narrowing - Osteophyte formation - Subchondral sclerosis and cysts MRI Findings - Cartilage loss - Bone marrow lesions - Osteophytes - Subchondral cysts Deformity and severe degenerative changes are seen at the ankle, accompanied by distal fibular bowing and malposition . The posterior part of the talus is fragmented. A small plantar calcaneal spur is also evident.

31. Osteoarthritis: Imaging Features Radiographic Features - Asymmetric joint space narrowing - Osteophyte formation - Subchondral sclerosis and cysts MRI Findings - Cartilage loss - Bone marrow lesions - Osteophytes - Subchondral cysts

32. Osteoarthritis: Imaging Features Radiographic Features - Asymmetric joint space narrowing - Osteophyte formation - Subchondral sclerosis and cysts MRI Findings - Cartilage loss - Bone marrow lesions - Osteophytes - Subchondral cysts Deformity and severe degenerative changes are seen at the ankle, accompanied by distal fibular bowing and malposition . The posterior part of the talus is fragmented. A small plantar calcaneal spur is also evident.

33. Osteoarthritis: Imaging Features MRI Findings - Cartilage loss - Bone marrow lesions - Osteophytes - Subchondral cysts

34. Osteoarthritis: Imaging Features MRI Findings - Cartilage loss - Bone marrow lesions - Osteophytes - Subchondral cysts Figure 4. 1l1-defined abnormal high signal in the subchondral distal tibia in representing bone marrow oedema

35. Osteoarthritis: Imaging Features MRI Findings - Cartilage loss - Bone marrow lesions - Osteophytes - Subchondral cysts

36. Osteoarthritis: Imaging Features MRI Findings - Cartilage loss - Bone marrow lesions - Osteophytes - Subchondral cysts Figure 6. PD sequence with normal articular cartilage at the tibiotalar joint

37. Osteoarthritis: Imaging Features MRI Findings - Cartilage loss - Bone marrow lesions - Osteophytes - Subchondral cysts

38. Osteoarthritis: Imaging Features MRI Findings - Cartilage loss - Bone marrow lesions - Osteophytes - Subchondral cysts Figure 7. PD sequence with full thickness cartilage loss at the tibiotalar joint with underlying bony irregularity

39. Infective Pathologies: Overview 1 Septic Arthritis A bacterial infection of the joint space, characterized by rapid onset, significant pain, and systemic symptoms like fever and malaise. 2 Osteomyelitis An infection of the bone and bone marrow, often presenting with soft tissue swelling, periosteal reaction, and focal osteopenia. 3 Tuberculosis A mycobacterial infection of the joint, typically characterized by gradual joint space narrowing, peripheral erosions, and minimal periosteal reaction.

40. Septic Arthritis: Imaging Features Radiographic Features - Joint effusion - Periarticular osteopenia - Joint space widening (early) - Rapid joint destruction (late) MRI Findings - Joint effusion with synovial enhancement - Bone marrow edema - Periarticular soft tissue edema Ultrasound Characteristics - Joint effusion (often complex) - Synovial thickening - Increased vascularity on Doppler

41. Septic Arthritis: Imaging Features Radiographic Features - Joint effusion - Periarticular osteopenia - Joint space widening (early) - Rapid joint destruction (late) MRI Findings - Joint effusion with synovial enhancement - Bone marrow edema - Periarticular soft tissue edema - Synovial thickening

42. Septic Arthritis: Imaging Features Radiographic Features - Joint effusion - Periarticular osteopenia - Joint space widening (early) - Rapid joint destruction (late) MRI Findings - Joint effusion with synovial enhancement - Bone marrow edema - Periarticular soft tissue edema - Synovial thickening

43. Septic Arthritis: Imaging Features Radiographic Features - Joint effusion - Periarticular osteopenia - Joint space widening (early) - Rapid joint destruction (late) MRI Findings - Joint effusion with synovial enhancement - Bone marrow edema - Periarticular soft tissue edema Ultrasound Characteristics - Joint effusion (often complex) - Synovial thickening - Increased vascularity on Doppler

44. Septic Arthritis: Imaging Features MRI Findings - Joint effusion with synovial enhancement - Bone marrow edema - Periarticular soft tissue edema Ultrasound Characteristics - Joint effusion (often complex) - Synovial thickening - Increased vascularity on Doppler

45. Osteomyelitis: Imaging Features Radiographic Features - Soft tissue swelling - Periosteal reaction - Focal osteopenia - Lytic lesions (late finding) MRI Findings - Bone marrow edema - Cortical destruction - Periosteal reaction - Soft tissue/muscle edema - Abscess formation

46. Osteomyelitis: Imaging Features Radiographic Features - Soft tissue swelling - Periosteal reaction - Focal osteopenia - Lytic lesions (late finding) MRI Findings - Bone marrow edema - Cortical destruction - Periosteal reaction - Soft tissue/muscle edema - Abscess formation

47. Osteomyelitis: Imaging Features Radiographic Features - Soft tissue swelling - Periosteal reaction - Focal osteopenia - Lytic lesions (late finding) MRI Findings - Bone marrow edema - Cortical destruction - Periosteal reaction - Soft tissue/muscle edema - Abscess formation There is loss of soft tissue over the great toe, with further lucencies in the surrounding soft tissue. This is very suggestive of superimposed infection. The underlying phalanx shows patchy osteoporosis and is suggestive of osteomyelitis .

48. Osteomyelitis: Imaging Features Radiographic Features - Soft tissue swelling - Periosteal reaction - Focal osteopenia - Lytic lesions (late finding) MRI Findings - Bone marrow edema - Cortical destruction - Periosteal reaction - Soft tissue/muscle edema - Abscess formation

49. Osteomyelitis: Imaging Features Radiographic Features - Soft tissue swelling - Periosteal reaction - Focal osteopenia - Lytic lesions (late finding) MRI Findings - Bone marrow edema - Cortical destruction - Periosteal reaction - Soft tissue/muscle edema - Abscess formation

50. Osteomyelitis: Imaging Features Radiographic Features - Soft tissue swelling - Periosteal reaction - Focal osteopenia - Lytic lesions (late finding) MRI Findings - Bone marrow edema - Cortical destruction - Periosteal reaction - Soft tissue/muscle edema - Abscess formation

51. Tuberculosis: Imaging Features Radiographic Features - Juxta-articular osteoporosis - Gradual joint space narrowing - Peripheral erosions - Minimal periosteal reaction MRI Findings - Synovitis - Bone erosions - Cold abscesses - Rice bodies (pathognomonic)

52. Tuberculosis: Imaging Features Radiographic Features - Juxta-articular osteoporosis - Gradual joint space narrowing - Peripheral erosions - Minimal periosteal reaction MRI Findings - Synovitis - Bone erosions - Cold abscesses - Rice bodies (pathognomonic)

53. Tuberculosis: Imaging Features Radiographic Features - Juxta-articular osteoporosis - Gradual joint space narrowing - Peripheral erosions - Minimal periosteal reaction MRI Findings - Synovitis - Bone erosions - Cold abscesses - Rice bodies (pathognomonic) Lateral plain radiography of the left ankle shows a poorly defined radiolucency at postero -inferior aspect of talus. Note prominent trabeculation due to osteopenia at calcaneus , and other tarsal bones

54. Tuberculosis: Imaging Features Radiographic Features - Juxta-articular osteoporosis - Gradual joint space narrowing - Peripheral erosions - Minimal periosteal reaction MRI Findings - Synovitis - Bone erosions - Cold abscesses - Rice bodies (pathognomonic)

55. Tuberculosis: Imaging Features Radiographic Features - Juxta-articular osteoporosis - Gradual joint space narrowing - Peripheral erosions - Minimal periosteal reaction MRI Findings - Synovitis - Bone erosions - Cold abscesses - Rice bodies (pathognomonic) Lateral plain radiography of the left ankle shows a poorly defined radiolucency at postero -inferior aspect of talus. Note prominent trabeculation due to osteopenia at calcaneus , and other tarsal bones

56. Tuberculosis: Imaging Features Radiographic Features - Juxta-articular osteoporosis - Gradual joint space narrowing - Peripheral erosions - Minimal periosteal reaction

57. Tuberculosis: Imaging Features Radiographic Features - Juxta-articular osteoporosis - Gradual joint space narrowing - Peripheral erosions - Minimal periosteal reaction

58. Tuberculosis: Imaging Features Radiographic Features - Juxta-articular osteoporosis - Gradual joint space narrowing - Peripheral erosions - Minimal periosteal reaction MRI Findings - Synovitis - Bone erosions - Cold abscesses - Rice bodies (pathognomonic) Lateral plain radiography of the left ankle shows a poorly defined radiolucency at postero -inferior aspect of talus. Note prominent trabeculation due to osteopenia at calcaneus , and other tarsal bones

59. Tuberculosis: Imaging Features Radiographic Features - Juxta-articular osteoporosis - Gradual joint space narrowing - Peripheral erosions - Minimal periosteal reaction MRI Findings - Synovitis - Bone erosions - Cold abscesses - Rice bodies (pathognomonic)