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Magnetic Resonance Imaging in Orthopedic Sports Medicine pp 367–425Cite as

Ankle

A. Radiologic Perspective: Magnetic Resonance Imaging of the Ankle

B. Orthopedic Perspective: Foot and Ankle Clinical Applications

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Over the past two decades, magnetic resonance imaging (MRI) has become the imaging modality of choice for evaluating most soft tissue and osseous abnormalities in the ankle. The technique offers a noninvasive and expeditious diagnostic assessment of ankle injuries, which are often occult on conventional radiographs and computed tomography (CT). This chapter provides a brief review of the normal magnetic resonance (MR) anatomy and a detailed discussion of abnormalities around the ankle including tendons, ligaments, nerves, fascia, and bone.

Routine MR images are obtained in the axial, coronal, and sagittal planes (Fig. 11.1). We obtain the axial sequence immediately after a three-plane positioning scout. The coronal and sagittal planes are prescribed obliquely using the information acquired on the axial images. Thus, the coronal images are obtained parallel to the anterior margin of the talar dome, and the sagittal images parallel to the lateral wall of the calcaneus. Imaging the ankle is often performed with the patient supine and the ankle in neutral position.1 The ankle in neutral position has an inherent 10 to 20 degrees of plantar flexion2 and 10 to 30 degrees of external rotation. This mild degree of plantar flexion is useful for eliminating magic angle effect when examining the flexor and extensor tendons in the hindfoot and midfoot. 1 Increasing the fat planes between the peroneus brevis and peroneus longus tendons, and displacing the flexor and peroneal tendons away from the bones are other advantages of imaging the ankle in plantar flexion.3 Mechanical stabilization of the ankle is paramount for good image quality. 4 Immobilization can be achieved using foam sponges between the ankle and the coil and Velcro straps on the leg outside the coil.

Dedicated phased-array extremity coils are currently utilized to perform most studies of the ankle.5 This type of coil provides image homogeneity and an improved signal-to-noise ratio at depth. The main disadvantages are a lower signal-tonoise ratio in the periphery of the study part, and inability to cover the entire area of interest if the anatomy does not fit within the rigid structure of the coil.5 Utilization of the knee coil provided with most available commercial systems is a common practice for examining the ankle.1

We utilize an imaging protocol that combines T1-weighted and fast spin echo T2-weighted images as well as fluid-sensitive T2-weighted sequences with fat saturation.

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Author information

Authors and Affiliations

  1. Franklin and Seidelmann Subspecialty Radiology, Melville, NY, USA

    Jenny T. Bencardino

  2. Department of Radiology, Hospital for Joint Diseases-NYU Medical Center, New York, NY, USA

    Zehava S. Rosenberg

  3. Division of Lower Extremity Reconstruction and Oncology, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada

    Alastair S.E. Younger

  4. British Columbia's Foot and Ankle Clinic, Providence Health Care, Vancouver, BC, Canada

    Margie Pohl

Authors
  1. Jenny T. Bencardino
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  2. Zehava S. Rosenberg
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  3. Alastair S.E. Younger
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  4. Margie Pohl
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Editor information

Editors and Affiliations

  1. Department of Orthopaedics and Sports Medicine, University of South Florida College of Medicine, Tampa, FL, USA

    Robert A. Pedowitz MD, PhD

  2. Department of Radiology, University of California, San Diego, CA, USA

    Christine B. Chung MD  & Donald Resnick MD  & 

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Bencardino, J.T., Rosenberg, Z.S., Younger, A.S., Pohl, M. (2008). Ankle. In: Pedowitz, R.A., Chung, C.B., Resnick, D. (eds) Magnetic Resonance Imaging in Orthopedic Sports Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-48898-1_11

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