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Sonography and MR Imaging of Posterior Tibial Tendinopathy

Ahalya Premkumar1, Monique B. Perry2, Andrew J. Dwyer1, Lynn H. Gerber2, Diane Johnson1, David Venzon3 and Thomas H. Shawker1

1 Department of Radiology, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bldg. 10, Rm. 1C660, 10 Center Dr., MSC 1182, Bethesda, MD 20892-1182.
2 Department of Rehabilitation Medicine, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892-1182.
3 Division of Biostatistics, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-1182.



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  		Fig. 1A. —MR imaging in 40-year-old healthy man. Sagittal T1-weighted spin-echo MR image shows low-signal-intensity posterior tibial tendon (arrow).

 


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  		Fig. 1B. —MR imaging in 40-year-old healthy man. Sagittal T2-weighted MR image with fat suppression, at same level as A, also shows low-signal-intensity posterior tibial tendon (arrow).

 


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  		Fig. 1C. —MR imaging in 40-year-old healthy man. Axial unenhanced T1-weighted MR image shows normal low-signal-intensity posterior tibial (long arrow) and flexor digitorum longus (short arrow) tendons.

 


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  		Fig. 1D. —MR imaging in 40-year-old healthy man. Axial contrast-enhanced spoiled gradient-recalled acquisition in a steady-state MR image, at same level as C, also shows normal low-signal-intensity posterior tibial (long arrow) and flexor digitorum longus (short arrow) tendons. Minimal peritendinous enhancement is seen.

 


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  		Fig. 2A. —Sonography in 45-year-old healthy woman. Longitudinal sonogram shows normal posterior tibial tendon (between calipers). Arrow points to medial malleolus.

 


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  		Fig. 2B. —Sonography in 45-year-old healthy woman. Minimal fluid (arrow) is seen adjacent to distal posterior tibial tendon on longitudinal sonogram.

 


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  		Fig. 2C. —Sonography in 45-year-old healthy woman. Transverse sonogram shows normal posterior tibial tendon (between calipers). Arrow points to flexor digitorum longus tendon adjacent to posterior tibial tendon.

 


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  		Fig. 3A. —35-year-old man with tendinosis and peritendinosis. Axial T1-weighted MR image of ankle reveals increased peritendinous soft tissue (arrow).

 


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  		Fig. 3B. —35-year-old man with tendinosis and peritendinosis. Contrast-enhanced spoiled gradient-recalled acquistion in a steady-state MR image, at same level as A, reveals enhancement of posterior tibial tendon (arrow) and peritendon area.

 


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  		Fig. 3C. —35-year-old man with tendinosis and peritendinosis. Transverse color Doppler sonogram of posterior tibial tendon shows peritendinous flow (arrow) and intratendon flow (arrowhead).

 


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  		Fig. 4A. —63-year-old woman with tendinosis. Axial T1-weighted MR image of ankle shows enlarged posterior tibial tendon containing subtle foci of increased signal intensity (arrow).

 


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  		Fig. 4B. —63-year-old woman with tendinosis. Transverse sonogram of posterior tibial tendon (between calipers) shows enlarged inhomogeneous tendon.

 


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  		Fig. 5A. —38-year-old woman with peritendinosis. Axial T1-weighted MR image of ankle shows increased soft tissue with mixed signal intensity in peritendon area (arrow).

 


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  		Fig. 5B. —38-year-old woman with peritendinosis. Axial T2-weighted MR image at same level as A also reveals mixed signal intensity and increased peritendinous soft tissue (arrow).

 


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  		Fig. 5C. —38-year-old woman with peritendinosis. Axial contrast-enhanced spoiled gradient-recalled acquisition in a steady-state MR image, at same level as A, shows enhancement of peritendon area (arrow).

 


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  		Fig. 5D. —38-year-old woman with peritendinosis. Transverse sonogram of posterior tibial tendon shows corresponding increased hypoechoic tissue in peritendon region (arrow).

 


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  		Fig. 5E. —38-year-old woman with peritendinosis. Transverse color Doppler sonogram, at same level as D, shows flow in peritendon area.

 

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