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Spotters Set 53 – MSK MRI cases

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MSK MRI cases

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  1. Synovial hemangioma: T2 hyperintense synovial lesion with septations. Differentials
  2. Chondrosarcoma: Expansile T2 hyperintense lesion causing endosteal scalloping.
  3. Slow flow vascular (venolymphatic) malformation
  4. Myxopapillary ependymoma
    • Lobulated expansile T2 hyperintense lesion occupying the lower spinal canal.
    • Few T1 hyperintense areas can be secondary to hemorrhage
    • Myxopapillary ependymomas are often associated with hemorrhage which can give rise to the “cap sign”. This is seen as T2 hypointensity at the upper/ lower portion of the tumor due to hemosiderin from prior hemorrhage.
  5. Acute L3 Schmorl’s node: Schmorl’s nodes are commonly asymptomatic. Acute Schmorl’s node associated with marrow edema can cause pain. Treatment ins conservative.
  6. Tethered cord with lipoma. Read this excellent AJR article on imaging features of spinal dysraphism. This topic is also covered well in the old edition of Osborn.
  7. Chondroblastoma
  8. Sinus tarsi impingement with osteoarthritis and synovitis and Baxter’s neuropathy (unrelated).
    • Baxter’s nerve is inferior calcaneal nerve is the first branch of the lateral plantar nerve. It is a mixed nerve, providing innervation to the abductor digiti minimi muscle. Revise ankle MR anatomy. Normal MRI appearance of the abductor digiti minimi muscle
    • Impingement causes chronic heel pain.
    • Causes include compression at the following sites:
      • As the nerve passes between the deep fascia of the abductor hallucis muscle and the medial plantar margin of the quadratus plantae muscle.
      • Anterior aspect of the medial calcaneal tuberosity
      • Check the illustration by RadSource
    • Acute stages show denervation edema of the muscle while chronic stages show fatty atrophy.
    • Treatment is conservative to start. If that fails then decompression of the nerve with neurolysis is performed.
  9. Subtalar (talocalcaneal) coalition
    • Coalition may be fibrous, cartilaginous, or osseous
    • Osseous coalitions ossify at 8–16 years old, leading to restricted motion and symptoms.
    • Bilateral in 20-25 % of cases
    • Signs associated with talocalcaneal coalitions (all seen on lateral radiograph):
      • Talar beak sign: Prominent beak at the anterior talus
      • C sign: Continuation of the inferomedial border of the talus
      • Absent middle facet sign
      • Drunken waiter sign on AP  radiographs due to hypoplastic sustenaculum tali. Body of the calcaneus is considered to be an intoxicated waiter having difficulty in carrying his tray (the upturned /downturned sustentaculum tali).
    • Signs associated with calcaneonavicular coalition:
      • Anteater sign: The appearance of the bony bar is similar to the snout of an anteater
      • Reverse anteater sign: Prominence of the posterolateral aspect of the navicular is known as the
  10. Plantar fibroma
    • Also known as Ledderhose disease
    • Fibrous proliferation of the plantar fascia
    • Characterized by nodular areas of thickening involving the plantar fascia.
    • Treated either conservatively or by wide local excision
    • As fibromatosis elsewhere in the body, it is prone to recurrence.

Recommended MSK MRI books:

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