Tokuda O, Awaya H, Taguchi K, Matsunga N. Kinematic MRI of the normal ankle ligaments using a specially designed passive positioning device. Monica S. Epelman, MD 34, No. In this article I review the etiology, imaging findings and current treatment associated with these conditions. Tear of the peroneus longus tendon: MR imaging features in nine patients. Note the bony protuberance (asterisks, Griffith JF, Lau DT, Yeung DK, Wong MW. Accessed January 22, 2015. 1991;181(2):389-392. PRACTICE PARAMETER MRI Ankle and Hindfoot / 15. 2015;35(1):164-178. 26, No. Diagnostic and therapeutic injections of the foot and ankle. 43, No. AJR Am J Roentgenol. 1996;37(4):572-577. Diego Jaramillo, MD, MPH 80. MRI of the Elbow Mark E. Schweitzer, MD; William B. Morrison, MD Figure 4-29-1 Anatomy Osseous-radius ulna humerus Ligamentous-medial collateral lateral collateral Musculotendinous Posterior: triceps Anterior: biceps, brachialis Medial: flexor-pronator Lateral: common extensor Neurovascular Articular Anatomy Diagnostic accuracy of 3.0 tesla magnetic resonance imaging for the detection of articular cartilage lesions of the talus. Is superolateral Hoffa fat pad edema a consequence of impingement between lateral femoral condyle and patellar ligament? 111. 2009;61(1):188-195. Nancy K. Rollins, MD Foot Ankle Int. 30. Skeletal Radiol. 2001;9(3):553-566, xi. 56, No. Zanetti M, Steiner CL, Seifert B, Hodler J. 9). MRI of ankle and lateral hindfoot impingement syndromes. 82, No. Heel pain is a common condition bringing patients into the doctor's office. Impingement lesions can also involve structures other than the rotator cuff that lie in the impingement zone, such as the biceps tendon and the subacromial bursa. 136. The clinical diagnosis of anterolateral impingement is reasonably accurate and based on the anterolateral tenderness, swelling, and pain exacerbated by single-leg squatting, ankle eversion, or dorsiflexion. 2003;32(1):1-12. 2008;12(2):154-169. AJR Am J Roentgenol 181:551559, Oh CS, Won HS, Hur MS et al (2006) Anatomic variations and MRI of the intermalleolar ligament. Documentation that satisfies medical necessity includes 1) signs and symptoms and/or 2) relevant history (including known diagnoses). 1999;81(1):97-101. Imaging sports injuries of the foot and ankle. 137. These may be sagittal, coronal, transverse, or oblique to the bore of the magnet and to the limb, depending on the position of the ankle. 1999;172(2):475-479. Magnetic resonance (MR) imaging, including high-resolution MR neurography, allows detailed evaluation of the course and morphology of peripheral nerves, as well as accurate delineation of surrounding soft-tissue and osseous structures that may contribute to nerve entrapment. However, this nonstandard position may make visualization of the ankle ligaments more difficult [54,152] and may make it harder to include the entire Achilles tendon in the FOV. Indeed, the condition was first described in European soccer players as footballers ankle. The theory hypothesised at the time, however, was one of repetitive traction injury of the anterior joint capsule in extreme plantarflexion causing anterior exostoses. 79. 2. Several choices are available for the ankle and hindfoot [148]. Joshua M. McDonald, MD, Co-Chair Right hip pain in a five-year-old girl who was operated on for congenital dysplasia of the hip. Verhoek G, Zanetti M, Duewell S, Zollinger H, Hodler J. MRI of the foot and ankle: diagnostic performance and patient acceptance of a dedicated low field MR scanner. 2008;28(5):1493-1518. 3. Symptoms are generally progressive and relate to impingement of hypertrophied synovial scar tissue and bony spurs within the anterior ankle joint. MR imaging technique and principles. AJR Am J Roentgenol. It should be realized that MRI is not suitable to diagnose the flatfoot deformity, which requires weight-bearing ankle radiographs for proper identification. 1, Radiology Research and Practice, Vol. Radiology Coated Foam Positioners : New Stealth-Cote is our COATED light green Stealth-Core polyurethane foam. 1999;23(5):707-712. J Magn Reson Imaging. Hottya GA, Peterfy CG, Uffmann M, et al. 50. a, b. 1, Journal of Orthopaedic & Sports Physical Therapy, Vol. 57. Tocci SL, Madom IA, Bradley MP, Langer PR, DiGiovanni CW. Contrast tenography, which has been described in the evaluation and treatment of tenosynovitis in the hindfoot [17], has largely been replaced by sonography in centers where this modality is performed. Congenital and developmental conditions: dysplasia, tarsal coalition, and symptomatic and asymptomatic normal variants [76,104-109]. Osteochondral abnormalities, articular cartilage abnormalities, and intra-articular bodies, degenerative or traumatic [13,29,68-74] 2004;232(3):635-652. 2003;23(3):613-623. Radiology. Most patients recover with conservative measures, including rest, activity modification, and physical therapy. A provocative physical examination test can be performed in which pressure is applied over the anterolateral ankle while the ankle is brought from the plantar flexed position to full dorsiflexion. See also, Stanley v. McCarver, 63 P.3d 1076 (Ariz. App. Ankle or subtalar instability [6,51,55,126,127] Do CT scans aid assessment of distal tibial physeal fractures? and Ankle. Cascio BM, King D, Yen YM. The https:// ensures that you are connecting to the Impact of high field (3.0 T) magnetic resonance imaging on diagnosis of osteochondral defects in the ankle joint. Achilles Tendon The Achilles tendon is formed by the communion of the gastrocnemius and soleus muscles. However, they have been increasingly recognized in the pediatric population, particularly during adolescence. Yu JS, Spigos D, Tomczak R. Foot pain after a plantar fasciotomy: an MR analysis to determine potential causes. Choplin RH, Buckwalter KA, Rydberg J, Farber JM. 16. Peer-reviewed literature pertaining to MR safety should be reviewed on a regular basis [136,137]. Radiology. Midfoot impingement syndrome usually resolves with non-surgical treatment and rarely requires surgical treatment. In this impingement type, which has been increasingly recognized during the last 1015 years, acetabular labrum and sometimes joint cartilage is compressed between the acetabulum and proximal femur usually during flexion. Impingement syndromes are just one possible etiology of persistent ankle pain, and although the diagnosis is often made or suspected clinically, the radiologist might be the first person to raise the possibility of the diagnosis or be called upon to provide support for the clinically suspected diagnosis. On examination, there is restricted and painful dorsiflexion. In rare cases where isolated acute sprain of the iliotibial band is present, edema usually surrounds both the superficial and deep sides of the iliotibial band, whereas with iliotibial band friction syndrome, edema is usually observed only deep in the iliotibial band (31). 2003;13(10):2315-2322. American College of Radiology. 7); other patellofemoral malalignment/maltracking features such as a short distance between the patellar ligament and lateral femoral condyle; and an increased distance from the tibial tubercle to the trochlear groove (26). Sussman WI, Han E, Schuenke MD. American College of Radiology. 94. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in this document when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of this document. Extraarticular lateral hindfoot impingement with posterior tibial tendon tear: MRI correlation. Radiology 221:186190, Nazarian LN, Gulvartian NV, Freeland EC, Chao W (2018) Ultrasound-guided percutaneous needle fenestration and corticosteroid injection for anterior and anterolateral ankle impingement. Because this injury involves ligaments located above the ankle joint it is sometimes called a high ankle sprain. 72, No. MRI readily shows talar and calcaneal bone marrow edema-like changes of talocalcaneal impingement centered at the critical angle of Gissane and the accessory anterolateral talar facet itself (Fig. Bush CH. 122. Subhas N, Vinson EN, Cothran RL, Santangelo JR, Nunley JA, 2nd, Helms CA. David A. Rubin, MD, FACR, Chair Jerry R. Dwek, MD Careers. 71. Like any other osteophyte, however, they may break off into the joint, forming a loose body. 3, Revista chilena de radiologa, Vol. Impingement or friction syndromes may be the only or primary explanation for some childrens symptoms. Standard imaging protocols may be established and varied on a case-by-case basis when necessary. Shellock FG, Spinazzi A. MRI safety update 2008: part 2, screening patients for MRI. The use of higher magnetic field strengths requires familiarity with the anatomic substructure of the deltoid ligament to better localize and characterize pathologic findings. The Van Dijk radiographic classification system, based on osteophyte appearance and degree of joint space narrowing, demonstrated the importance of osteoarthritis as a postoperative prognostic factor. All chapters provide an Different clinical and magnetic resonance imaging features between Charcot-Marie-Tooth disease type 1A and 2A. 86. AJR 2009; 193:672-678. Biomechanical alterations following corrective or tumor removal surgery may be a reason for the development of some impingement syndromes, and it is important to be familiar with their MRI findings as these syndromes may explain persistent or new onset pain following such surgeries. Terry L. Levin, MD The prone position is more comfortable for some patients, reduces involuntary motion, and may reduce claustrophobic feelings in susceptible individuals [153]. Kanamoto T, Shiozaki Y, Tanaka Y, Yonetani Y, Horibe S. The use of MRI in pre-operative evaluation of anterior talofibular ligament in chronic ankle instability. 6, Journal of Endometriosis and Pelvic Pain Disorders, Vol. 124. A wide variety of pulse sequencesconventional spin-echo, fast (turbo) spin-echo, and gradient-recalled echo are available for ankle and hindfoot MRI [148]. 6, Magnetic Resonance Imaging Clinics of North America, Vol. Posterior hindfoot impingement most commonly occurs in middle-aged and older individuals with a chronic hindfoot valgus deformity. Before The physician should be familiar with relevant ancillary studies that the patient may have undergone. Lynn Ansley Fordham, MD, FACR Hindfoot malalignment plays a crucial role in the develop-ment of foot and ankle pathologies, both as predisposing factor and as consequence of conditions involving biome-chanical imbalance [1, 2]. This facet is associated with painful talocalcaneal impingement in the presence of flatfoot deformity. 1, Journal of Bone and Joint Surgery, Vol. 3). Iliopsoas, subspine, and ischiofemoral impingements have been recently described, while some features of femoroacetabular and talocalcaneal impingements have recently gained increased relevance in the pediatric population. The presence of this facet is associated with sinus tarsi pain in adolescents with peroneal spastic flatfoot (37). Arthroscopy 34:866871, Robinson P, White LM, Salonen D, Ogilvie-Harris D (2002) Anteromedial impingement of the ankle: using MR arthrography to assess the anteromedial recess. Prospective study on diagnostic strategies in osteochondral lesions of the talus. Over time, attempted repair, including fibrosis and fibrocartilage proliferation, leads to the formation of bony spurs on the anterior rim of the tibia and sulcus of the talus. There was no evidence of avascular necrosis on the frontal radiograph of the hips (a) and coronal fat-saturated T2-weighted images (b, c; I, ischium; F, femur). The sagittal view shows the typical "double posterior cruciate ligament sign," in which the low-signal bucket-handle fragment parallels the normal low-signal posterior cruciate ligament. J Magn Reson Imaging. 1, 15 January 2015 | RadioGraphics, Vol. Bouysset M, Tebib J, Tavernier T, et al. Impingement is a clinical syndrome of chronic pain and restricted range of movement caused by compression of abnormal bone or soft tissue within the ankle joint. 2008;65(1):140-147. J Bone Joint Surg Br. 131. Ligamentous abrasion of the exposed anterolateral talar cartilage also can sometimes be seen. Eur Radiol. The tear is likely secondary to an impingement from the deformed femoral head. Eur Radiol. Particularly in ballet dancers this should be performed in conjunction with correction of technique to correct overpronation where appropriate. AJR Am J Roentgenol. Matthew S. Pollack, MD, FACR 55, No. Dussault RG, Kaplan PA, Roederer G. MR imaging of Achilles tendon in patients with familial hyperlipidemia: comparison with plain films, physical examination, and patients with traumatic tendon lesions. PRACTICE PARAMETER MRI Ankle and Hindfoot / 9. Sagittal (b) and consecutive oblique axial (c) T1-weighted MR arthrography images show a labral base tear (arrows) at the anterosuperior aspect of the acetabulum. These sequences complement short-TE (T1-weighted or proton-densityweighted) ones for plantar fascia and tendon imaging [37,41,81,150] and are especially important to compensate for magic angle artifact seen in tendons [155]. 49. Skeletal Radiol. Cerezal L, Llopis E, Canga A, Rolon A. MR arthrography of the ankle: indications and technique. 184. Appropriate emergency equipment and medications must be immediately available to treat adverse reactions associated with administered medications. Smart Bookmarks with Notes, Highlights, History, and Sharing 2015;35(1):179-199. Emphasis on anatomy and injuries to lateral collateral ligaments. Biomechanically, LHI is the sequela of lateral transfer of weight bearing from the central talar dome to the lateral talus and fibula. Several ankle ligaments ensure the static and dynamic stability of the ankle joint, but they are prone to injury due to acute trauma as well as repetitive ankle sprains. Cheung Y, Rosenberg ZS. At least in cadaveric ankle studies, images obtained with a 3T scanner may have higher accuracy for articular cartilage abnormalities in the ankle compared to those obtained with 1T or 1.5T scanners [140,141]. 160. What is Hindfoot impingement? Marrow abnormalities: fractures, bone contusions, osteonecrosis, marrow edema syndromes, and stress fractures* [90-94] 12 / MRI Ankle and Hindfoot PRACTICE PARAMETER. Magnetic resonance imaging (MRI) plays a key role in the diagnosis of musculoskeletal impingement and friction syndromes. Koivunen-Niemela T, Komu M, Viikari J, Alanen A. Haacke EM, Lenz GW. Iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) fast spin-echo imaging of the ankle: initial clinical experience. Radiology. AJR Am J Roentgenol. This practice parameter was developed and written collaboratively by the American College of Radiology (ACR), the Society for Pediatric Radiology (SPR), and the Society of Skeletal Radiology (SSR). MRI is excellent at identifying and characterizing extraarticular lateral hindfoot impingement (Fig. Volume rendering of tendon-bone relationships using unenhanced CT. AJR Am J Roentgenol. 10. Liem MD, Zegel HG, Balduini FC, Turner ML, Becker JM, Caballero-Saez A. Premkumar A, Perry MB, Dwyer AJ, et al. FOIA Timothy L. Swan, MD, FACR, FSIR There may also be a palpable soft tissue swelling or a spur over the anterior joint. Radiology. As with femoroacetabular impingement, MR arthrography exquisitely shows labral and/or labrocartilaginous tears that may be associated with subspine impingement. 1994;2(1):39-58. 6, 12 February 2016 | RadioGraphics, Vol. Am J Sports Med. Equinovalgus Foot is an acquired foot deformity commonly seen in pediatric patients with cerebral palsy, spina bifida, or idiopathic flatfoot, that present with a equinovalgus foot deformity. Radiol Res Pract. Radiographics. Close. Patients with this type of an impingement are usually adults and are older than patients with other types of impingement around the hip. MR imaging of the ankle at 3 Tesla and 1.5 Tesla: protocol optimization and application to cartilage, ligament and tendon pathology in cadaver specimens. 2. 4. For these reasons and those set forth below, the American College of Radiology and our collaborating medical specialty societies caution against the use of these documents in litigation in which the clinical decisions of a practitioner are called into question. 68. Dorsal hindfoot and midfoot with talus removed. 38. Three-dimensional volume rendering can show the anatomic relationships of bones and tendons, which may be useful for preoperative planning [27,28]. 164. Magee T, Hinson G. Association of paralabral cysts with acetabular disorders. The anterolateral recess is a triangular structure bordered posteromedially by the anterolateral tibia and talus and posterolaterally by the anterior fibula. Shows medial, frontal, lateral, and plantar views as well as a cross section. MR procedures: biologic effects, safety, and patient care. Jonathan S. Luchs, MD, FACR 40. B, Hindfoot valgus angle is measured at intersection of line along medial calcaneal wall and line parallel to longitudinal axis of tibia. Magn Reson Imaging Clin N Am. ACR guidance document on MR safe practices: 2013. 6. B. MRI of the ankle and hindfoot may be indicated to further clarify and stage conditions diagnosed clinically and/or suggested by other imaging modalities, including, but not limited to: 1. Jacqueline A. Bello, MD, FACR The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. The imaging matrix should balance SNR with desired in-plane spatial resolution and reduction of truncation artifacts, but should be at least 192 steps in the phase-encoding direction and 256 steps in the frequency-encoding direction for 2-D imaging. 7. 3 ). The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by the practitioner in light of all the circumstances presented. Adam C. Zoga, MD, Committee on Body Imaging (Musculoskeletal) 2009;30(11):1053-1059. Figures 1a and 1b show the clinical photograph and oblique radiograph of a 52-year-old man who has plantar first metatars However, in the presence of a labral tear associated with low-lying AIIS, paralabral cysts may also be observed on MRI or MR arthrography. Any sports activity that involves a lot of running (such as soccer, basketball, and field hockey) also has the risk for this condition. 1997;168(1):141-147. Kanal E, Barkovich AJ, Bell C, et al. Additionally, CT can be used for diagnosis of bone and soft-tissue injuries when there is a contraindication to MR imaging [25,26]. Federal government websites often end in .gov or .mil. Diego Jaramillo, MD, MPH Amisha J. Shah, MD Synovial-based disorders: inflammatory and nodular synovitis, tenosynovitis, bursitis, and ganglion cysts* [46,86-89] Postoperative infection in the foot and ankle. Nallamshetty L, Nazarian LN, Schweitzer ME, et al. Ultrasound can be used to direct intra-articular injection of cortisone and local anaesthetic ( Fig. 147. Rubin DA, Kneeland JB. MR imaging features of tumors of the ankle and foot. BMC Musculoskelet Disord. MRI and surgical findings in deltoid ligament tears. 2004;24(4):999-1008. The size of the anatomic structures under consideration and the suspected pathology determine the necessary FOV. Schreibman KL. Fuller S, Reeder S, Shimakawa A, et al. Kulkarni MV, Patton JA, Price RR. 11). Andrew M. Zbojniewicz. Ba-Ssalamah A, Schibany N, Puig S, Herneth AM, Noebauer-Huhmann IM, Trattnig S. Imaging articular cartilage defects in the ankle joint with 3D fat-suppressed echo planar imaging: comparison with conventional 3D fat-suppressed gradient echo imaging. Clin Radiol 72:10141024, Haller J, Bernt R, Seeger T et al (2006) MR-imaging of anterior tibiotalar impingement syndrome: agreement, sensitivity and specificity of MR-imaging and indirect MR-arthrography. ac. This cam-type deformity was later suggested to be a consequence of an alteration of the growth plate (in the form of a larger extension of the femoral capital growth plate toward the neck in the entire cranial femoral head hemisphere in young basketball athletes) rather than reactive bone formation (7). b) after the reduction of the tumor size by chemotherapy before surgery. These impingements are sequelae of flatfoot deformity and hindfoot valgus from a variety of causes such as posterior tibial tendon (PTT) deficiency, rheumatologic disorders, diabetes, calcaneal fractures, and congenital flatfoot [ 7, 8 ]. The MRI equipment specifications and performance must meet all state and federal requirements. Zbojniewicz, A.M. Impingement syndromes of the ankle and hindfoot. Tarsal sinus: arthrographic, MR imaging, MR arthrographic, and pathologic findings in cadavers and retrospective study data in patients with sinus tarsi syndrome. Lehtinen A, Paimela L, Kreula J, Leirisalo-Repo M, Taavitsainen M. Painful ankle region in rheumatoid arthritis. Improving MR image quality in the presence of motion by using rephasing gradients. A, Normal hindfoot valgus ( 6) and no lateral impingement. Mengiardi B, Pfirrmann CW, Vienne P, et al. 4, 1 February 2014 | RadioGraphics, Vol. AJR Am J Roentgenol. The supervising physician must also understand the pulse sequences to be used and their effect on the appearance of the images, including the potential generation of image artifacts. Du J, Pak BC, Znamirowski R, et al. 8, Chiropractic & Manual Therapies, Vol. Several more recent studies have agreed that secondary osteoarthritis confers a poorer postoperative prognosis. 1994;162(2):377-383. 2001;14(4):464-471. 2000;175(1):251-260. Stevens KJ, Busse RF, Han E, et al. 2001;30(4):179-191. 19. DISCUSSION: The MRI scans show a displaced bucket-handle medial meniscus tear that can be visualized on coronal, sagittal, and axial views. Bae S, Lee HK, Lee K, et al. 163. a), which is a synovial recess, would not turn posteriorly around the lateral epicondyle. Ankle and foot injuries: analysis of MDCT findings. 2015;36(3):288-292. 1998;18(6):1481-1498. The sole purpose of this document is to assist practitioners in achieving this objective. 2006 (Resolution 4, 35) Ligamentous ankle pathology mainly involve the lateral ligaments and to a lesser extent the. 2002;179(4):939-947. 175. will also be available for a limited time. 1998;170(5):1231-1238. Iliopsoas, subspine, and ischiofemoral impingements have been recently described, while some features of femoroacetabular and talocalcaneal impingements have recently gained increased relevance in the pediatric population. 36, No. 2009;193(3):672-678. AJR Am J Roentgenol. 4. Magnetic resonance imaging of hindfoot involvement in patients with spondyloarthritides: comparison of low-field and high-field strength units. Yu JS. Part of Springer Nature. 34, No. 2001;9(3):465-473, x. Foot Ankle Spec 11:6166, Robinson P, White LM (2002) Soft-tissue and osseous impingement syndromes of the ankle: role of imaging in diagnosis and management. Radiology. The information is entirely evidence-based, outcome based and up-to-date. Bencardino J, Rosenberg ZS, Beltran J, et al. https://doi.org/10.1007/s00247-019-04459-5. 11, Medical Clinics of North America, Vol. Intravenous contrast enhancement may be useful for evaluating ankle and hindfoot tumors and infections [98,100,101] and may have an adjunct role for tendon imaging [32] and for intrasynovial disorders [60]. 2008;46(6):973-994, v. 14. The tear is likely secondary to an impingement from the malformed femoral head undercovered by the hypoplastic acetabulum. Klein MA. 2, Clinical Journal of Sport Medicine, Vol. 7. Foot Ankle Int. Radiology 207:357360, Jordan LK 3rd, Helms CA, Cooperman AE, Speer KP (2000) Magnetic resonance imaging findings in anterolateral impingement of the ankle. Siebenrock KA, Behning A, Mamisch TC, Schwab JM. Spine in the subspine impingement refers to the anterior inferior iliac spine (AIIS). 2008;46(6):995-1002, v. 72. Bethesda, MD 20894, Web Policies 13. 2007;11(2):149-161. 1 posterior ankle impingement syndrome refers to a group of abnormal entities that result from repetitive or acute forced plantar flexion of the foot. Imaging of tibialis posterior dysfunction. Notice the plantaris on the medial aspect. From an imaging evaluation standpoint, it is important to realize that MRI findings in iliotibial band friction syndrome, which is a chronic injury, are different from acute injury to the iliotibial band, which is usually associated with a significant internal derangement of the knee (particularly cruciate ligament rupture, posterolateral corner injury, and patellar dislocation) (31). Rosenberg ZS, Jahss MH, Noto AM, et al. 15, Orthopedic Clinics of North America, Vol. In this condition, which was first described in 2011 (18), the variable morphology of AIIS is such that the spines lower position causes an impingement of the intervening soft tissues (including the acetabular labrum) against the spine, rectus femoris tendon, and distal femoral neck during flexion (18, 19). It is said about 10 percent of the population will be affected by heel pain in their lifetime. Stress radiography has been used with variable success in ankles with ligament injuries [18]. 39. Anterolateral impingement is predominantly a soft tissue abnormality and therefore radiography and conventional computed tomography (CT) have limited specific utility. AJR Am J Roentgenol 169:829835, Article AJR Am J Roentgenol 186:943947, Kudas S, Donmez G, Isik C et al (2016) Posterior ankle impingement syndrome in football players: case series of 26 elite athletes. Indeed, postexcision recurrence of the bony spurs is not necessarily accompanied by recurrence of symptoms. Greenstein AS, Marzo-Ortega H, Emery P, OConnor P, McGonagle D. Magnetic resonance imaging as a predictor of progressive joint destruction in neuropathic joint disease. IV. Biomechanically, LHI is the sequela of lateral transfer of weight bearing from the. MRI of spring ligament tears. Duc SR, Mengiardi B, Pfirrmann CW, Hodler J, Zanetti M. Improved visualization of collateral ligaments of the ankle: multiplanar reconstructions based on standard 2D turbo spin-echo MR images. 112. Bedi A, Kelly BT. 93. AJR Am J Roentgenol. 1993;161(4):831-836. 2000;214(3):700-704. Few studies regarding iliopsoas impingement existing in the literature reveal a strong female predominance, wherein patients age ranged between 12 and 57 years (13, 1517). 4, Journal of Clinical Ultrasound, Vol. It serves as the primary stabilizer of the axially loaded ankle. They most commonly occur after a sprain injury or repetitive microtrauma at the extreme ranges of movement. There were no other positive knee MRI findings. Van Hecke PE, Marchal GJ, Baert AL. SSR a) that is characteristic of iliotibial band friction syndrome. Eur J Radiol 58:450460, Shim DW, Kim S, Hwang Y et al (2018) Detection of the tram track lesion in the ankle joint: comparing 3.0-tesla magnetic resonance imaging and arthroscopy. MRI of tibialis anterior tendon rupture. Magnetic resonance imaging (MRI) is an excellent tool to detect soft tissue abnormalities and also the osseous background and/or changes in such impingement or friction syndromes. In most cases ankle impingement is managed conservatively, with arthroscopic or open debridement of the abnormal bone or soft tissue reserved for refractory cases. Pedal abscesses in patients suspected of having pedal osteomyelitis: analysis with MR imaging. Psoas impingement causing labrum tear: a series from three tertiary hip arthroscopy centers. An MRI hindfoot valgus angle has been defined as the angle between a line along the long axis of the tibia and along the medial wall of the calcaneus on the most posterior coronal image that includes the calcaneus and tibia [ 21 ]. Skeletal Radiol. Lo LD, Schweitzer ME, Fan JK, Wapner KL, Hecht PJ. 69. Familiarity with the normal MR imaging anatomy of the nerves in the knee, leg, ankle, and foot is essential for accurate assessment of the presence of peripheral entrapment syndromes. Jonathan S. Luchs, MD, FACR 169. 105, No. A rectangular FOV for coronal and transaxial images of the hindfoot can save imaging time without sacrificing in-plane resolution [148]. We'll gain an understanding of the best imaging strategies utilizing MRI to assess ankle pathology, and we'll develop a checklist approach to evaluation of MRI ankle pathology. Lastly, arthroscopy provides a detailed examination of the internal structures of the tibiotalar and subtalar joints, allowing the surgeon to diagnose as well as treat many internal derangements. 2005;235(3):977-984. . The .gov means its official. 176. 121. Link, Google Scholar; 7 Schweitzer ME, van Leersum M,. 170. Policies and procedures related to quality, patient education, infection control, and safety should be developed and implemented in accordance with the ACR Policy on Quality Control and Improvement, Safety, Infection Control, and Patient Education appearing under the heading Position Statement on QC & Improvement, Safety, Infection Control, and Patient Education on the ACR website (http://www.acr.org/guidelines). AJR Am J Roentgenol. Donovan A, Rosenberg ZS. Low-field dedicated extremity machines are more susceptible to artifacts and degraded image quality than their high-field counterparts [145,146]. For example, the number of signals averaged can be increased at the expense of longer imaging times and increased risk of involuntary patient motion [144]. In the tibia, stress injury is often referred to as medial tibial stress syndrome, encompassing shin splints (which may show no MRI findings) at 1 end of the spectrum to injury involving the medial fascial attachment on the tibia and stress fracture at the other end of the spectrum. Miller TT, Staron RB, Feldman F, Parisien M, Glucksman WJ, Gandolfo LH. AJR Am J Roentgenol. 8600 Rockville Pike 64. Chandnani VP, Harper MT, Ficke JR, et al. Chemical shift artifact is most severe at high field strengths and may necessitate an increase in the receiver bandwidth on high-field scanners [144,174]. 25. Patients or relatives with familial hypercholesterolemia or hyperlipidemia [31,132,133] Susceptibility artifacts, which originate from heterogeneity of the local field, are also more severe at higher field strengths, in the presence of metallic implants, and when using gradient-recalled pulse sequences. 53. 2008;18(8):610-618. Microscopy coil for preoperative MRI of small soft-tissue masses of the hand and foot: comparison with conventional surface coil. Magee T. Comparison of 3.0-T MR vs 3.0-T MR arthrography of the hip for detection of acetabular labral tears and chondral defects in the same patient population. Fat/water separation in single acquisition steady-state free precession using multiple echo radial trajectories. Khoury V, Guillin R, Dhanju J, Cardinal E. Ultrasound of ankle and foot: overuse and sports injuries. Although MRI is typically the preferred imaging modality for suspected stress fractures and osteomyelitis of the foot and ankle, radionuclide imaging can also be useful to confirm or exclude these diagnoses [9]. Chung KW, Suh BC, Shy ME, et al. Bouysset M, Tavernier T, Tebib J, et al. 156. Skeletal Radiol. 4, Journal of Medical Ultrasound, Vol. Kiss ZS, Khan KM, Fuller PJ. Smith DK, Wright J. Magnetic resonance imaging of ankle ligaments. The British Journal of Radiology. Magnetic resonance imaging (MRI) is a proven imaging modality for the detection, evaluation, staging, and follow-up of disorders of the ankle and hindfoot. Various diseases with confusingly similar or overlapping MRI features can cause ankle and hindfoot bone marrow edema. 1 If left untreated, it may cause severe and debilitating discomfort that can ultimately lead to dysfunction. It's location is the anterior side of the ankle in the talocrural joint. Congenital tarsal coalition: multimodality evaluation with emphasis on CT and MR imaging. 2, Clinical Journal of Sport Medicine, Vol. AJR Am J Roentgenol. Erdem CZ, Tekin NS, Sarikaya S, Erdem LO, Gulec S. MR imaging features of foot involvement in patients with psoriasis. AJR Am J Roentgenol. 73. 1999;173(3):699-701. 2003;32(5):259-265. Radiographics 22:14571469, De Maeseneer M, Wuertzer S, de Mey J, Shahabpour M (2017) The imaging findings of impingement syndromes of the lower limb. 2008;67(3):521-525. Inferior tibiofibular syndesmosis: Tenderness andrea.donovan@sunnybrook.ca PMID: 20729435 Repair of Achilles tendon ruptures with a polylactic acid implant: assessment with MR imaging. Common entrapment neuropathies in the knee, leg, ankle, and foot include those of the common peroneal nerve, deep peroneal nerve, superficial peroneal nerve, tibial nerve and its branches, and sural nerve. Radiol Clin North Am. Ledermann HP, Morrison WB, Schweitzer ME. 3. 2001;9(3):639-657, xii. 117. Imaging of athletic injuries to the ankle and foot. Dawn M. Hastreiter, MD, PhD Although generally more common in adults, lower extremity impingement and friction syndromes are also observed in the pediatric age group. Iliotibial band friction syndrome: MR imaging findings in 16 patients and MR arthrographic study of six cadaveric knees. The MR features of this diagnosis are bone marrow edema and cystic changes located at the apex of the lateral process of talus and the calcaneous at the apex of the Gissane angle. Schmid MR, Hodler J, Vienne P, Binkert CA, Zanetti M. Bone marrow abnormalities of foot and ankle: STIR versus T1-weighted contrast-enhanced fat-suppressed spin-echo MR imaging. The supervising physician must have complete understanding of the indications, risks, and benefits of the examination, as well as alternative imaging procedures. Lateral ankle instability: MR imaging of associated injuries and surgical treatment procedures. Radiographs should be the first imaging test performed for suspected bone and soft-tissue abnormalities in the ankle and will often permit diagnosis or exclusion of an abnormality or will direct further imaging workup. ac. Radiographic assessment of the tibiotalar joint for secondary signs of degeneration, particularly joint space loss, has prognostic importance. Standard MR software also allows the prescription of oblique images in virtually any plane, if images oriented along the course of a given structure are needed [154]. Pigmented villonodular synovitis: radiologic-pathologic correlation. Semin Nucl Med. Calcaneofibular impingement 1 Syndromes 8 Subtalar joint 5 Correction of hindfoot valgus 1 Trigonum 1 Metatarsal angle 1 Tenderness 1 AOFAS 4 Anatomy of the hindfoot 1 Fracture 8 Arthroscopic 5 Flexor 1 Arthritis 1 Alignment 3 Inversion 1 Arthroscopy 1 Pain 9 Endoscopic 1 Stabilizes the hindfoot 1 Soft tissue 1 Chronic 2 Ligamentous 1 2008;249(3):1026-1033. Chronic ankle instability: evaluation with MR arthrography, MR imaging, and stress radiography. AJR Am J Roentgenol. 2002;224(3):649-655. Effect of tendon orientation on MR imaging signal intensity: a manifestation of the magic angle phenomenon. 36, No. They are characterized by a limited range of motion and pain on attempting specific movements about the joint and often in a load-bearing position. 41, No. 30, No. This document is an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. MR arthrography: pharmacology, efficacy and safety in clinical trials. Amar E, Warschawski Y, Sharfman ZT, Martin HD, Safran MR, Rath E. Pathological findings in patients with low anterior inferior iliac spine impingement. Magn Reson Imaging. 8) between the lateral femoral epicondyle and overlying distal iliotibial band, which is a thickened fascia that inserts on the Gerdys tubercle at the lateral aspect of the proximal tibia (30). Achilles tendon disorders: partial and complete tears, tendinitis, tendinopathy, treated tears, paratenonitis, and xanthomas* [5,30-34] Mary G. Hochman, MD Ankle and hindfoot injuries in athletes [90,122-125]. The presence of synovitis, pericapsular oedema and bone marrow oedema on MR imaging support a diagnosis of impingement in the right clinical context. Jibri Z, Martin D, Mansour R, Kamath S. The association of infrapatellar fat pad oedema with patellar maltracking: a case-control study. 2004;33(2):102-106. 2001;219(3):802-810. According to Neer, a distinction is made between primary impingement (outlet impingement) and secondary impingement (nonoutlet Buckup, Clinical Tests for the Musculoskeletal System . 6. The medial soft tissues may be acutely injured, or may undergo degeneration caused by hindfoot instability or malalignment. Unfortunately, normative measurements of the size of AIIS and its location in reference to the acetabulum have not been reported in the pediatric age group. 2003;181(6):1551-1557. Oblique axial (a) and consecutive sagittal (b) fat-saturated T1-weighted images show a focal basilar tear (arrows) at the anterior aspect of the acetabular labrum with an anterior paralabral cyst (arrowheads); note the close proximity of the iliopsoas tendon to the tear (IP, iliopsoas tendon; RF, rectus femoris tendon). Impingement is a clinical syndrome of chronic pain and restricted range of movement caused by compression of abnormal bone or soft tissue within the ankle joint. Anteriorly it is bordered by the anterolateral joint capsule and capsular ligaments. Kagers fat pad inflammation associated with HIV infection and AIDS: MRI findings. J Foot Ankle Surg 56:13231327, Donovan A, Rosenberg ZS (2009) Extraarticular lateral hindfoot impingement with posterior tibial tendon tear: MRI correlation. Another proposed aetiological factor is direct microtrauma caused by ball striking in soccer with direct impact of the ball typically over the anteromedial tibiotalar joint, where the cartilage is covered only by thin subcutaneous fat. Extra-articular hip impingement: a systematic review examining operative treatment of psoas, subspine, ischiofemoral, and greater trochanteric/pelvic impingement. Impingement can be associated with a prior single traumatic event or repetitive microtrauma, often in an adolescent with anatomical predisposition. These bony spurs or osteophytes can cause anterior joint space narrowing, limiting ankle dorsiflexion ( Fig. Injuries of the deltoid ligament of the ankle are increasingly recognized with the widespread use of magnetic resonance (MR) imaging. The diagnosis is largely clinical but may be supported with a range of imaging techniques. Zanetti M, De Simoni C, Wetz HH, Zollinger H, Hodler J. 81, No. 52. 1999;19(3):673-683. AJR Am J Roentgenol. This is certainly not the case in the anteromedial ankle, where cadaveric analysis has shown that the bony spurs are intra-articular, consistent with osteophyte formation. In: Spounge AR, Pope TL, ed. Posterior tibial tendon and subtalar joint complex in rheumatoid arthritis: magnetic resonance imaging study. The authors declared no conflicts of interest. Semin Musculoskelet Radiol. Os trigonum (posterior impingement syndrome) Os peroneum (injury of Peroneus Longus) Hindfoot Coalition Hindfoot coalitions may be osseous, fibrous or cartilaginous and are found in 1-5% of the population and may be bilateral in 20% of patients. MRI of the ankle joint is useful in excluding other causes of pain that may clinically mimic anterior ankle impingement syndrome, such as occult stress fracture of the anterior aspect of distal tibia and osteochondral lesion of the medial talar dome , .MRI is also useful in assessment of the degree of chondral damage and in detection of capsular thickening and synovial inflammation in the . In cases of severe pes cavus or if previous fusion surgery has been performed, a CT scan with 3D reconstruction may be of use. 2004;77(918):532-537. A typical imaging protocol will be composed of 1 or more pulse sequence types. MRI can also be useful in the investigation of subtalar instability, demonstrating changes of (acute on) chronic inflammation within the supportive ligamentous structures. 2000;20(2):321-332; quiz 526-327, 532. Sonography and MR imaging of posterior tibial tendinopathy. Skeletal Radiol. 2004;183(3):615-622. Jerry R. Dwek, MD It is also useful to check for concomitant pathology, such as osteochondral lesions that may not have been detected on radiography. 1996;166(5):1203-1206. MR imaging has the advantage over ultrasound in being able to assess for whole ankle pathology, including coexisting or alternative causes of prolonged ankle pain, such as marrow contusions, chondral lesions, intra-articular bodies, and sinus tarsi syndrome. There is no established clinical examination test suggesting ischiofemoral impingement; however, external rotation of the hip with extension and adduction decreases the ischiofemoral space (24) and such a maneuver may elicit or increase pain in persons with this condition. However, ankle MRI should be performed only for a valid medical reason [8] and only after careful consideration of alternative imaging modalities. 2000;175(6):1707-1710. 2 Examinations that use techniques not approved by the Food and Drug Administration, such as the intra-articular injection of gadolinium chelates (direct MR arthrography) [180], can be considered when they are judged to be medically appropriate. It may be possible to shorten the time required for an ankle or hindfoot MR examination without compromising diagnostic yield. 2009;30(3):229-238. However, one distinguishing MRI feature of subspine impingement from femoroacetabular impingement is that paracapsular cysts, when present, are not usually paralabral as in femoroacetabular impingement but rather immediately adjacent to the rectus femoris tendon in subspine impingement (Fig. Patient and hindfoot positioning may be individually tailored to the specific indication(s). 62. 2005;234(1):134-142. Bancroft LW, Peterson JJ, Kransdorf MJ. The medial soft tissue anatomy of the ankle is complex; the ligaments and posterior tibial tendon are closely interrelated both anatomically and functionally. 2007;17(5):1162-1171. Fast short-tau inversion-recovery MR imaging. Imaging of soft tissue lesions of the foot and ankle. 109. Common sites of impingement in the ankle include posterior, posteromedial, anteromedial, anterolateral, and, less commonly, direct anterior; these often coexist and occur in conjunction with other ankle pathologies. Is there a relationship between psoas impingement and increased trochanteric retroversion? Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. Iliopsoas impingement: a newly identified cause of labral pathology in the hip. Newer multichannel coils containing multiple coil elements will further increase SNR and are required to use techniques like parallel imaging that decrease the time of the scan. 8. Tarsal tunnel syndrome. Cahuzac JP, Baunin C, Luu S, Estivalezes E, Sales de Gauzy J, Hobatho MC. 177. However, with advances in MR imaging hardware technology, MR arthrography is now largely redundant and, with sufficient experience, the diagnosis can be made on conventional MR imaging with relative confidence (75%83% sensitivity and 75%100% specificity, depending on the experience of the reporter). Labral injuries due to iliopsoas impingement: can they be diagnosed on MR arthrography? American College of Radiology. Ankle MRI for anterolateral soft tissue impingement: increased accuracy with the use of contrast-enhanced fat-suppressed 3D-FSPGR MRI. Clin Radiol. 1997;205(3):593-618. Murphey MD, Rhee JH, Lewis RB, Fanburg-Smith JC, Flemming DJ, Walker EA. Foot Ankle. Maras Ozdemir Z, Aydingoz U, Gormeli CA, Sagir Kahraman A. Ischiofemoral space on MRI in an asymptomatic population: normative distance measurements and soft tissue signal variations. Symptomatic medial plica is a cause of anterior knee pain (32, 33). 89. 155. 1994;192(1):189-194. The equipment and medications should be monitored for inventory and drug expiration dates on a regular basis. 2) (4), and slipped capital femoral epiphysis (5). Techniques that rely on separate acquisitions to obtain separate fat and water images are prone to misregistration artifacts because of motion, but combining these sequences with a motion-correction algorithm can result in robust fat suppression in reasonable scan times [170]. 31, No. 152. 2003;227(1):155-161. Hillier JC, Peace K, Hulme A, Healy JC. Eur Radiol. It is estimated that the incidence of anterolateral impingement syndrome is 3% following ankle sprains. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. AJR Am J Roentgenol. Other methods that are less reliant on field heterogeneity include pulse sequences that decompose fat and water iteratively, exploit phase differences between fat and water (Dixon), or null signal from fat using an inversion pulse (STIR) [165-169]. 3. It is classically described in young athletic patients following an inversion sprain injury with subsequent chronic anterolateral pain and swelling. Biomechanical alterations following corrective or tumor-removal surgery may be a reason for the development of some impingement syndromes; it is important to become familiar with their MRI findings as they might explain persistent or new onset pain following such surgery. HHS Vulnerability Disclosure, Help Radiology. 10 / MRI Ankle and Hindfoot PRACTICE PARAMETER. 45. Johnson DP, Eastwood DM, Witherow PJ. 5. muscles and tendons. Huh YM, Suh JS, Lee JW, Song HT. Currently, only patients with alterations of AIIS level and rectus femoris tendon and/or peritendinous soft tissue signal alterations on MRI can be considered to have this condition with some reliability. They have variable etiology and pathogenesis. The magnetic resonance imaging of musculoskeletal hemorrhage. 33. 1995;195(3):849-853. 1988;167(2):557-558. Tal Laor, MD Clin Orthop Relat Res. It is painful soft tissue or osseous entrapment within the joint that characterises impingement. Such an extension of fluid-signal on MRI should alert the radiologist for the possibility of this overuse injury. AJR Am J Roentgenol. In selected cases, a description of findings in the bone and bone marrow, synovium, joints, retinacula, muscles, sinus tarsi, plantar fascia, neurovascular structures, and subcutaneous tissue would be appropriate. The axis between the medial calcaneus cortex and the long axis of tibia is measuring about 38 degree (hind foot valgus). Radiology. Semin Roentgenol. Sijbrandij ES, van Gils AP, Louwerens JW, de Lange EE. Tan TC, Wilcox DM, Frank L, et al. Klein MA. In other words, when edema at the superolateral aspect of the infrapatellar fat pad is identified using MRI, patellofemoral malalignment and maltracking need to be scrutinized (27, 28). 10). 2003;85(8):1134-1137. ACRSIR practice parameter for sedation/analgesia. 2012; http://www.acr.org/~/media/536212D711524DA5A4532407082C89BA.pdf. Specific policies and procedures related to MRI safety should be in place along with documentation that is updated annually and compiled under the supervision and direction of the supervising MRI physician. The accompanying clinical information should be provided by a physician or other appropriately licensed health care provider familiar with the patients clinical problem or question and consistent with the states scope of practice requirements. Ledermann HP, Morrison WB, Schweitzer ME, Raikin SM. . 4). 148. Uys HD, Rijke AM. Magnetic resonance imaging (MRI) plays a key role in the diagnosis of musculoskeletal impingement and friction syndromes. 116. 47, No. 12, 1 November 2013 | RadioGraphics, Vol. Growth plate alteration precedes cam-type deformity in elite basketball players. The transfer occurs due to collapse of the medial arch of th It must be remembered that an abnormal nodular or irregular contour of the recess is commonly found in the asymptomatic population and can merely reflect previous anterolateral trauma or surgery. a, b. The foot and ankle: MR imaging of uniquely pediatric disorders. 1986;147(2):373-378. An increased prevalence of a cam-type deformity in the anterosuperior head-neck quadrant of elite adolescent basketball players versus an age-matched control group was reported (6). 2015; http://www.acr.org/~/media/F194CBB800AB43048B997A75938AB482.pdf. Radiology. No established MRI criteria exist for subspine impingement yet. Biomechanically, LHI is the sequela of lateral transfer of weight bearing from the central talar dome to the lateral talus and fibula. AJR Am J Roentgenol. Depending on the clinical question, MRI of the foot should be tailored to a hindfoot, midfoot, or forefoot examination. The DTT-RCA I/II group and the control group were imaged by MRI T2 mapping at baseline and 6 months to determine the area of cartilage degeneration. This fluid-containing recess, however, does not extend posterior to the lateral epicondyle, as does the soft tissue edema (which extends posterior to the lateral femoral epicondyle under the iliotibial band) in iliotibial band friction syndrome. It is important to remember that the finding of anterior bone spurs does not necessarily mean that the patient is symptomatic. These include the anterior talofibular, anterior inferior tibiofibular and calcaneofibular ligaments ( Fig. 37. Injury of the tibiofibular syndesmosis: value of MR imaging for diagnosis. J Bone Joint Surg Am 72:5559, Article 5. Pain is a common symptom with such an impingement or friction. 1999;210(1):189-193. Bone stress injury of the ankle in professional ballet dancers seen on MRI. 11. This new proprietary mixed medical grade coating, when. Haapamaki VV, Kiuru MJ, Koskinen SK. J Magn Reson Imaging. Femoroacetabular impingement, which is more commonly observed in young adults, is also encountered in children (2), sometimes in the presence of preexisting conditions like sequelae from developmental dysplasia of the hip (Fig. For routine ankle and hindfoot studies, a FOV of 16 cm or less is desirable for detecting most clinically relevant disorders. Axial PD-weighted (, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on MR Imaging of Impingement and Entrapment Syndromes of the Foot and Ankle, MR Imaging of the Articular Cartilage of the Knee and Ankle, MR Imaging of Common Soft Tissue Masses in the Foot and Ankle, MR Imaging of the Midfoot Including Chopart and Lisfranc Joint Complexes, Normal Variants and Pitfalls in MR Imaging of the Ankle and Foot, Magnetic Resonance Imaging Clinics of North America Volume 25 Issue 1. Rademaker J, Rosenberg ZS, Delfaut EM, Cheung YY, Schweitzer ME. Skeletal Radiol. Ankle: isotropic MR imaging with 3D-FSE-cubeinitial experience in healthy volunteers. Shellock FG, Crues JV. The goal of treatment of DJD of the midfoot, in contrast, is to lessen or control the pain with non-surgical treatment. RATIONALE AND OBJECTIVES: To use radiomics to detect the subtle changes of cartilage and subchondral bone in chronic lateral ankle instability (CLAI) patients based on MRI PD-FS images. Symptoms often include hindfoot pain on weight-bearing, swelling and tenderness in the region anterior and inferior to the lateral malleolus, and limited subtalar range of motion. Aliasing is reduced or eliminated by repositioning the extremity (eg, plantar flexing the hindfoot to prevent images of the toes from superimposing on the heel), by orienting the phase-encoding direction anterior-to-posterior when possible, by shielding body parts outside of the area of interest, or by the use of phase oversampling [148,174,175]. Her patellae were bilaterally high riding (Insall-Salvati indices >1.4 for both knees). This condition is associated with focal tendonopathy at the lateral aspect of the patellar tendon, a high-riding patella (Fig. 1991(264):264-266. 2006;45(5):304-307. Sinus tarsi syndrome* [85] Finkel JE. 14 / MRI Ankle and Hindfoot PRACTICE PARAMETER. Trenton D. Roth, MD Lower extremity impingement and friction syndromes in children. Campagna R, Pessis E, Biau DJ, et al. AJR Am J Roentgenol. This is a preview of subscription content, access via your institution. In recent years, ultrasonography has come to play an increasingly important role in the diagnostic evaluation of the soft tissues of the ankle and foot, including tendons, ligaments, and soft-tissue masses [14-16]. For very small relatively superficial structures, a microscopy coil provides the SNR for very high spatial resolution at the expense of anatomic coverage [96]. Tightness, spasticity, scarring/adherence, or hypertrophy of the iliopsoas or the immediately adjacent iliocapsularis tendons may be contributing factors to this kind of impingement (13). 8. Ischiofemoral impingement is not necessarily symptomatic (21); however, it may well be the only positive MRI finding in some patients and may help explain symptoms. Trauma is the primary cause of ankle OA, often resulting in varus or valgus deformities. When combined with arthrography, CT can also be used for evaluating the articular cartilage and joint bodies [29]. Evaluation of articular cartilage and osteochondral infractions can be performed with fast spin-echo, long-TR (water-sensitive or intermediate-weighted) images or with gradient-echo sequences [140,159,160]. For practice parameters and technical standards published before 1999, the effective date was January 1 following the year in which the practice parameter or technical standard was amended, revised, or approved by the ACR Council. 1999;28(12):663-669. Lateral hindfoot impingement (LHI) is a subtype of ankle impingement syndrome with classic MRI findings. Gmez-Hoyos J, Schrder R, Reddy M, Palmer IJ, Khoury A, Martin HD. 1997;26(2):82-88. Viviane Khoury, MD 29. Knee Surg Sports Traumatol Arthrosc. 1, Formosan Journal of Musculoskeletal Disorders, Vol. Entrapment neuropathies in the upper and lower limbs: anatomy and MRI features. 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