CT and MRI in rheumatoid arthritis (midfoot, hindfoot and ankle)

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CT and MRI in rheumatoid arthritis

(midfoot, hindfoot and ankle)

Th. Tavernier

Except the indication of these procedures due to the common pathology, the sectional imaging in RA is chiefly interesting on the mid-hind-foot and the ankle in RA.

On the forefoot, CT may help to study metatarsal bone involvement (plantar

erosions for instance). MRI may particularly help to observe inter-capito-metatarsal

bursae if necessary.

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74 Foot and ankle in rheumatoid arthritis

Fig. 1 - CT: coronal slice. Bone window. Subtalar arthritis (joint narrowing).

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CT and MRI in rheumatoid arthritis 75

Fig. 2 - (TT: axial slice. Bone window. BiiaU;!

Fie. 3 - CT: bilateral tarso-nietatarsai arthriti,^

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76 Foot and ankle in rheumatoid arthritis

Fig. 4 - CT: soft tissue window. Right talo-crural rheumatoid pannus (arrow)

Fig. 5 - CT: soft tissue window. Bilateral sinus tarsi pannus (arrcnws).

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CT and MRI in rheumatoid arthritis 77

Fig. 6 - CT: soft tissue window. Sinus tarsi pannus on the left side i arro^

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78 Foot and ankle in rheumatoid arthritis

Fig. 7 - CT tenography. a) Tenosynovitis of

fibularis tendons and posterior tibial tendon

(ptt). b) Stage 2 tendinopathy of posterior

tibial tendon.

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CT and MRI in rheumatoid arthritis 79

Fig. 8 - CT tenography. Long fibularis tendon ruptured (empty sheath). (Arrow).

Fig. 9 - CT tenography. Tenosynovitis and tendinopathy of fibularis tendons:

thinned aspect of tendons (arrow).

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80 Foot and ankle in rheumatoid arthritis

Fig. 10 - CT soft tissue window. Bilatcr sheath.

rupture ()( poslenoi- tibial tendon. I'hc ptt is not I'isiblc in its

Fig. 11 - CT soft tissue window. Rigiit pnstci lor ui'iai tendon. lenos\no\ itis and stage 1 tendinopatlix' (arrow).

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CT and MRIin rheumatoid arthritis 81

Fig. 12 - CT soft tissue window. Left ptt: stage 1 tcndinopath\- ! arrow)

Fig. 13 - Same patient, MRI: Tl gadolinium { 1993). Right ptt: tenosynovitis and stage 2 tendinopathv. Left ptt: stage 1 tendinopathv.

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82 Foot and ankle in rheumatoid arthritis

Fig. 14 - Same patient MRI, Tl (1999). Ptt bilateral stage 2 tendinopathy.

Fig. 15 - Same patient. MRI. Tl fat-sat gadolinium (2002). The tendinopathy of the left ptt has worsened:

there is a longitudinal retromalleolar fissure (fig. a) and a stage 2 tendinopathy under medial malleoli (fig. b).

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CT and MRI in rheumatoid arthritis 83

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84 Foot and ankle in rheumatoid arthritis

Fig. 17 - MRI: T] fat sat gadolinium. Pannus of the sheath of the ptt. No pathology of the tendon itself (fig. a and fig. b).

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CT and MRI in rheumatoid arthritis 85

Fig. 18 - MRI: Tl fat sat gadolinium. Ptt:

pannus of the sheath of the tendon and

stage 2 tendinopathy (fig. a). Normal

spring ligament (arrow) (fig. b).

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86 Foot and ankle in rheumatoid arthritis

Fig. 19 - MRI: Tl gadolinium. Fibularis longu.s tendon ruptured. We can only see the fibularis brevis tendon (arrow).

Fig. 20 - MRI: Tl weighted image. Rupture of the right ptt and stage 2 tendinopathv of the left ptt.

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CT and MRI in rheumatoid arthritis 87

Fig. 21 - MRI: T l . Rupture of the right ptt (not visible). The left ptt is normal (arrow

Fig. 22 - MRI. Tl fat-sat gadolinium. Left ptt ruptured (not \ isible) et stage ptt (arrow). Bilateral tenosynovitis of the flexoi" tendons.

2 tendinopath\- of the right

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Foot and ankle in rheumatoid arthritis

Fig. 23 - MRI: Tl gadolinium. Ptt splitting

tendinopathy (arrow) and tenosynovitis (fig. a

and fig. b).

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CT and MRI in rheumatoid arthritis 89

Fig. 24 - MRI: Tl fat-sat gadolinium.

Sinus tarsi pannus. Ruptured interosseous talo-calcaneal ligament (itcl).

Fig. 25 - MRI: Tl gadolinium. Right

sinus tarsi pannus and ruptured itcl

(asterik). On the left side the itcl is

normal (arrow).

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90 Foot and ankle in rheumatoid arthritis

Fig. 26 - MRI: Tl (fig. a): tenosynovitis of

the tibialis anterior tendon (arrow). Tl

fat-sat gadolinium (fig. b): retro-calcaneal

bursitis (white arrow) and plantar bursitis

(grey arrow).

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CT and MRI in rheumatoid arthritis 91

Fig. 27 - MRI: Tl Talo-cmral arthritis,

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92 Foot and ankle in rheumatoid arthritis

Fig. 28 - MRI: Tl (fig. a) and Tl

fat-sat gadolinium (fig. b). Tarsal

arthritis and sinus tarsi pannus.

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CTand MRI in rheumatoid arthritis 93

Fig. 29 - MRI: Tl (fig. a, left side). Tl fat-sat

gadolinium (fig. b, right side). Talo-navicular

arthritis, and strong enhancement after gadoli-

nium injection.

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94 Foot and ankle in rheumatoid arthritis

Fig. 30 - MRI: T2 (fig. a) and Tl (fig. b). Tarsal ankylosis. Xo tendon pathology.

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CT and MRI in rheumatoid arthritis 95

Fig. 31 - MRI: Tl (fig. a) and 1 1 lal-sat gadciliniiim illg. b;. Bilateral stress iractLirc of the lower parts of the tibias.