Gavin L. Duke, M.D. East River Medical Imaging

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Presentation transcript:

Gavin L. Duke, M.D. East River Medical Imaging Imaging of Foot Tumors Gavin L. Duke, M.D. East River Medical Imaging

Imaging Modalities X-ray is procedure of choice for initial imaging of bone tumors, but no soft tissue detail. MRI – bones and soft tissues CT- margins of bone tumors,? pathologic #’s Ultrasound- soft tissue lesions- cystic vs solid. MR spectroscopy, perfusion, diffusion scans Nuclear medicine: Bone scans, PET/CT- FDG or F18 imaging

MRI-most useful modality Multi-planar Demonstrates all tissues Characterizes tumors and their margins Usually well tolerated

Imaging Planes Coronal Sagittal Axial Insert coronal sagittal and axial image

Imaging Sequences Anatomy Proton density T1 Pathology Fat suppressed T2 Inversion recovery

Do we need contrast? USUALLY NOT. Most tumors are easily characterized without gadolinium. Non-contrast sequences can usually distinguish cystic vs solid. Gadolinium can be useful: -Ganglion vs peripheral nerve tumor or varix -Hematoma vs malignancy -Defining extent of soft tissue invasion of malignant tumors

Benign tumors of the foot and ankle BONE: Osteiod-Enostosis (bone island),Osteoma, Osteid osteoma, osteoblastoma Chondroid-Enchondroma, osteochondroma, chondroblastoma Fibrous-Fibroxanthoma, fibrous dysplasia Fat-Intraosseous lipoma Vascular-osseous hemangioma Unknown origin-Giant cell tumor, simple bone cyst, aneurysmal bone cyst

Benign tumors of the foot and ankle SOFT TISSUE/MESENCHYMAL: Fat: lipoma Fibrous tissue: plantar fibroma, Morton’s neuroma Muscle: myxoma Vascular: hemangioma, AVM’s, glomus tumor Neural: Schwannoma, neurofibroma Synovium: PVNS

Malignant tumors of the ankle and foot Primary bone malignancies Bone metastases Primary soft tissue malignancies Soft tissue metastases

Pseudotumors Varix Ganglion/synovial cyst Abscess/phlegmon Hematoma/seroma Nodular tendinopathy Tophus Foreign body granuloma Adventitious bursitis Fat necrosis Callous

Ganglion

Ganglion

Ganglion + stress reaction

Ganglion + stress reaction

Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome

Varix

Varix

Morton’s neuroma

Morton’s neuroma

Morton’s neuroma

Plantar Fibroma

Plantar Fibroma

Plantar fat pad signal alteration

Adventitious bursitis

Adventitial Bursitis

Adventitial Bursitis

Nodular tendinosis

Gout

Gout

Gout-Tophi

Gout-Tophi

Peripheral nerve tumor

Peripheral nerve tumor

Plantar Fibroma

PVNS

PVNS

PVNS

Giant Cell Tumor/PVNS

Giant Cell Tumor /PVNS

Giant Cell tumor/PVNS

Intraosseous Lipoma

Intraosseous Lipoma

Intraosseous Lipoma

Aneurysmal bone cyst

Aneurysmal bone cyst

Glomus tumor

Glomus tumor Pre contrast Post contrast

Glomus Tumor Early post contrast Delayed post contrast

Glomus Tumor

Enchondroma

Enchondroma

Enchondroma

Synovial cell sarcoma

Synovial cell sarcoma

Synovial cell sarcoma

Synovial cell sarcoma

Synovial cell sarcoma

Synovial cell sarcoma

Synovial cell sarcoma

Synovial cell sarcoma

Summary Pseudotumors most common – ganglion, Morton’s neuroma, plantar fibroma MRI – most useful modality, multiplanar capabilities, deliniates all tissues, not just bone Contrast – only when necessary X-ray – still very useful for bone tumors