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

2. 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

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

4. Imaging Planes Coronal Sagittal Axial
Insert coronal sagittal and axial image

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

6. 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

7. 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

8. 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

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

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

11. Ganglion

12. Ganglion

13. Ganglion + stress reaction

14. Ganglion + stress reaction

15. Tarsal Tunnel Syndrome

16. Tarsal Tunnel Syndrome

17. Varix

18. Varix

19. Morton’s neuroma

20. Morton’s neuroma

21. Morton’s neuroma

22. Plantar Fibroma

23. Plantar Fibroma

24. Plantar fat pad signal alteration

25. Adventitious bursitis

26. Adventitial Bursitis

27. Adventitial Bursitis

28. Nodular tendinosis

29. Gout

30. Gout

31. Gout-Tophi

32. Gout-Tophi

33. Peripheral nerve tumor

34. Peripheral nerve tumor

35. Plantar Fibroma

36. PVNS

37. PVNS

38. PVNS

39. Giant Cell Tumor/PVNS

40. Giant Cell Tumor /PVNS

41. Giant Cell tumor/PVNS

42. Intraosseous Lipoma

43. Intraosseous Lipoma

44. Intraosseous Lipoma

45. Aneurysmal bone cyst

46. Aneurysmal bone cyst

47. Glomus tumor

48. Glomus tumor
Pre contrast Post contrast

49. Glomus Tumor
Early post contrast Delayed post contrast

50. Glomus Tumor

51. Enchondroma

52. Enchondroma

53. Enchondroma

54. Synovial cell sarcoma

55. Synovial cell sarcoma

56. Synovial cell sarcoma

57. Synovial cell sarcoma

58. Synovial cell sarcoma

59. Synovial cell sarcoma

60. Synovial cell sarcoma

61. Synovial cell sarcoma

62. 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