T1ρ Magnetic Resonance Imaging to Assess Cartilage Damage After Primary Shoulder Dislocation.

BACKGROUND: Patients who suffer anterior shoulder dislocations are at higher risk of developing glenohumeral arthropathy, but little is known about the initial cartilage damage after a primary shoulder dislocation. T1ρ is a magnetic resonance imaging (MRI) technique that allows quantification of cartilage proteoglycan content and can detect physiologic changes in articular cartilage. PURPOSE: This study aimed to establish baseline T1ρ MRI values for glenoid and humeral head cartilage, determine whether T1ρ MRI can detect glenohumeral cartilage damage after traumatic primary shoulder dislocation, and assess for patterns in cartilage damage in anterior shoulder dislocation. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Nine male patients (mean age, 32.0 years; range, 20-59 years) who sustained first-time anterior shoulder dislocations underwent 3T T1ρ MRI. Five healthy controls (mean age, 27.4 years; range, 24-30 years) without prior dislocation or glenohumeral arthritis also underwent 3T T1ρ MRI. The T1ρ relaxation constant was determined for the entire glenoid and humeral head for patients with a dislocation and for healthy controls. The glenoid and humeral head were divided into 9 zones, and T1ρ values were determined for each zone in dislocated and control shoulders to identify patterns in cartilage damage in dislocated shoulders. RESULTS: Average overall T1ρ values for humeral head cartilage in dislocated shoulders were significantly greater than in controls (41.7 ± 3.9 ms vs 38.4 ± 0.6 ms, respectively; P = .03). However, average overall T1ρ values for glenoid cartilage were not significantly different in dislocated shoulders compared with controls (44.0 ± 3.3 ms vs 44.6 ± 2.4 ms, respectively; P = .40), suggesting worse damage to humeral head cartilage. T1ρ values in the posterior-middle humeral head were higher in patients with a dislocation compared with controls (41.5 ± 3.8 ms vs 38.2 ± 2.2 ms, respectively; P = .021) and trended toward significance in the posterior-superior and middle-superior zones (35.2 ± 4.9 ms vs 31.3 ± 1.0 ms and 33.7 ± 5.0 ms vs 30.5 ± 1.3 ms, respectively; P = .056). These 3 humeral head zones are where Hill-Sachs lesions predominate. T1ρ values in the anterior-inferior glenoid zone trended toward significance in patients with a dislocation compared with controls (47.4 ± 5.0 ms vs 43.5 ± 3.5 ms, respectively; P = .073). CONCLUSION: Humeral head cartilage sustained greater damage than glenoid cartilage in primary dislocation. T1ρ values were higher in glenohumeral zones associated with Bankart and Hill-Sachs lesions. Widespread initial cartilage damage may predispose patients to glenohumeral arthropathy.

Characterization of viscosupplementation formulations using chemical exchange saturation transfer (ViscoCEST).

BACKGROUND: Osteoarthritis (OA) is characterized by progressive loss of cartilage in joints, and is a major cause of pain and disability, and imposes significant health care expense. New therapies are being developed to treat the symptomatic effect of OA, one of which is intra-articular injection of viscosupplementations of different forms of hyaluronic acid (HA). The current study evaluates the chemical exchange saturation transfer (CEST) effect from two popular viscosupplementations [Hylan gf-20 (Synvisc) and hyaluronan (Orthovisc)] by targeting the exchangeable hydroxyl protons present on these molecules (ViscoCEST). METHODS: ViscoCEST imaging from two viscosupplementations (Synvisc and Orthovisc) was performed on a 7T Siemens whole body MRI scanner. ViscoCEST images were collected with different combination of saturation pulse power and saturation duration. Z spectra were acquired at B1rms of 3.6 µT and 1 s saturation duration by varying the frequency from -4 to +4 ppm in step size of 0.1 ppm. Field inhomogeneity (B0) and radiofrequency (B1) maps were also acquired to correct ViscoCEST contrast map for any inhomogeneity. RESULTS: Both viscosupplementations showed broad CEST effect (ViscoCEST), which peaked ~0.8 ppm from down field of water resonance. Orthovisc showed 20 % higher ViscoCEST contrast than Synvisc suggestive of more HA component in Orthovisc. Increased ViscoCEST contrast was observed from both viscosupplementations with increase in B1rms and saturation pulse duration. CONCLUSION: ViscoCEST has a potential to image the spatial distribution of viscosupplements in vivo in patients' intra-articular space as well as temporal variation in their spatial distribution.

Trochlear inclination angles in normal and dysplastic knees.

Trochlear morphology impacts component position in patellofemoral arthroplasty. We devised a measurement of the trochlear inclination angle (TIA) and determined the average TIA in normal and dysplastic knees. Three hundred twenty-nine consecutive magnetic resonance imagings of normal and dysplastic knees were evaluated. The TIA was measured by 2 reviewers. The Student t test was used, and intraobserver reliability measurements were made. The mean TIA in normal and dysplastic knees was internally rotated 11.4° (range, 6°-20°) and 9.4° (range, 4°-15°), respectively. The mean TIA did not differ significantly by sex or age. Trochlear inclination angles in both normal and dysplastic knees tend toward internal rotation. Positioning a trochlear patellofemoral arthroplasty component flush with the articular surface of the native trochlea would result in internal rotation malposition.

Hybrid peripheral nerve sheath tumor.

In recent literature, there have been case reports of an extremely rare entity characterized by hybrid peripheral nerve tumors consisting of elements of neurofibroma, schwannoma, and/or perineurioma. The authors present a unique case of a patient with multiple painful hybrid tumors with negative genetic testing for neurofibromatosis Type 1 and no clinical evidence of neurofibromatosis Type 2 or schwannomatosis. A 28-year-old woman presented with tentatively diagnosed schwannomatosis. She had painful bilateral retromastoid scalp tumors as well as multiple other painful tumors in the distribution of the saphenous, femoral, and sciatic nerves. Her family history was significant for a paternal grandfather with a solitary schwannoma. The patient underwent multiple surgical procedures for tumor resection, including tumors in the regions of the retromastoid scalp, bilateral sciatic nerves, left femoral nerve, and left axilla. These tumors were examined and evaluated histologically. Within the tumors, components of both neurofibromas and schwannomas were found, even though these 2 peripheral nerve sheath tumors have been long considered to be distinct entities. This case report suggests a distinct syndrome that has not previously been appreciated.

Frontiers in musculoskeletal MRI: articular cartilage.

The techniques and uses of MRI in current clinical practice, primarily as a means to detect morphologic abnormalities, are reviewed. Ongoing development of techniques that can improve morphologic assessment including techniques to increase spatial and contrast resolution is discussed, as are methods to measure cartilage volumes and thickness. Finally, several of the more widely studied techniques used to probe loss of the macromolecular structure of cartilage prior to the development of macroscopic defects are presented and compared.

Sodium and T1rho MRI for molecular and diagnostic imaging of articular cartilage.

In this article, both sodium magnetic resonance (MR) and T1rho relaxation mapping aimed at measuring molecular changes in cartilage for the diagnostic imaging of osteoarthritis are reviewed. First, an introduction to structure of cartilage, its degeneration in osteoarthritis (OA) and an outline of diagnostic imaging methods in quantifying molecular changes and early diagnostic aspects of cartilage degeneration are described. The sodium MRI section begins with a brief overview of the theory of sodium NMR of biological tissues and is followed by a section on multiple quantum filters that can be used to quantify both bi-exponential relaxation and residual quadrupolar interaction. Specifically, (i) the rationale behind the use of sodium MRI in quantifying proteoglycan (PG) changes, (ii) validation studies using biochemical assays, (iii) studies on human OA specimens, (iv) results on animal models and (v) clinical imaging protocols are reviewed. Results demonstrating the feasibility of quantifying PG in OA patients and comparison with that in healthy subjects are also presented. The section concludes with the discussion of advantages and potential issues with sodium MRI and the impact of new technological advancements (e.g. ultra-high field scanners and parallel imaging methods). In the theory section on T1rho, a brief description of (i) principles of measuring T1rho relaxation, (ii) pulse sequences for computing T1rho relaxation maps, (iii) issues regarding radio frequency power deposition, (iv) mechanisms that contribute to T1rho in biological tissues and (v) effects of exchange and dipolar interaction on T1rho dispersion are discussed. Correlation of T1rho relaxation rate with macromolecular content and biomechanical properties in cartilage specimens subjected to trypsin and cytokine-induced glycosaminoglycan depletion and validation against biochemical assay and histopathology are presented. Experimental T1rho data from osteoarthritic specimens, animal models, healthy human subjects and as well from osteoarthritic patients are provided. The current status of T1rho relaxation mapping of cartilage and future directions is also discussed.

Detection of changes in articular cartilage proteoglycan by T(1rho) magnetic resonance imaging.

The purpose of this work is to demonstrate the feasibility of T(1rho)-weighted magnetic resonance imaging (MRI) to quantitatively measure changes in proteoglycan content in cartilage. The T(1rho) MRI technique was implemented in an in vivo porcine animal model with rapidly induced cytokine-mediated cartilage degeneration. Six pigs were given an intra-articular injection of recombinant porcine interleukin-1beta (IL-1beta) into the knee joint before imaging to induce changes in cartilage via matrix metalloproteinase (MMP) induction. The induction of MMPs by IL-1 was used since it has been extensively studied in many systems and is known to create conditions that mimic in part characteristics similar to those of osteoarthritis. The contralateral knee joint was given a saline injection to serve as an internal control. T(1rho)-weighted MRI was performed on a 4 T whole-body clinical scanner employing a 2D fast spin-echo-based T(1rho) imaging sequence. T(1rho) relaxation parameter maps were computed from the T(1rho)-weighted image series. The average T(1rho) relaxation rate, R(1rho) (1/T(1rho)) of the IL-1beta-treated patellae was measured to be on average 25% lower than that of saline-injected patellae indicating a loss of proteoglycan. There was an average reduction of 49% in fixed charge density, measured via sodium MRI, of the IL-1beta-treated patellae relative to control corroborating the loss of proteoglycan. The effects of IL-1beta, primarily loss of PG, were confirmed by histological and immunochemical findings. The results from this study demonstrate that R(1rho) is able to track proteoglycan content in vivo.

Cartilage volume quantification via Live Wire segmentation.

RATIONALE AND OBJECTIVES: A reduction in cartilage volume is characteristic of osteoarthritis and hence there exists a need for an accurate and reproducible method to measure in vivo cartilage volume. Quantification of cartilage volume from magnetic resonance (MR) images requires a segmentation technique such as the user-driven "Live Wire" strategy that can reliably delineate object volumes in a time-efficient manner. In the present work, the accuracy and reproducibility of the Live Wire method for the quantification of cartilage volume in MR images is evaluated. MATERIALS AND METHODS: The accuracy of the Live Wire method was assessed by comparing the MR-based volume measurement of a patellar cartilage-shaped phantom versus data calculated via water displacement. The inter- and intra-operator reproducibility of the technique was evaluated from Live Wire segmentation of the patellar cartilage volume from fat-suppressed 3-dimensional spoiled-gradient-echo images of five healthy human volunteers performed by three operators. To provide data for analysis of inter-scan reproducibility, the human scans were repeated five times with the aid of a leg-restraining jig to minimize repositioning error. RESULTS: The volume of the patellar cartilage-shaped phantom measured via Live Wire segmentation of MR images was within 97.8% of its true volume. The average inter- and intra-operator coefficients of variation of three operators were 3.0% and 0.4%, respectively. The average inter-scan coefficient of variation of five repeated scans of each volunteer was 2.7%. CONCLUSION: The data suggest that the Live Wire strategy is an accurate, reproducible, and efficient technique to measure cartilage volume in vivo in a feasible amount of operator time.

In vivo quantification of T1rho using a multislice spin-lock pulse sequence.

A multislice spin-lock (MS-SL) pulse sequence is implemented on a clinical scanner to acquire multiple images with spin-lock-generated contrast of the knee joints of six healthy human subjects. The MS-SL sequence produces images with T1rho contrast with an additional factor of intrinsic T2rho weighting, which hinders direct measurement of T1rho. A method is presented to compensate the MS-SL-generated data with regard to T2rho in an effort to accurately calculate multislice T1rho maps in a feasible experimental time. The T2rho-compensated multislice T1rho maps produced errors in the measurement of T1rho in healthy patellar cartilage of approximately 5% compared to the gold standard measurement of T1rho acquired with single-slice spin-lock pulse sequence. The MS-SL sequence has potential as an important clinical tool for the acquisition of multislice T1rho-weighted images and/or quantitative multislice T1rho maps.

3D-T1rho-relaxation mapping of articular cartilage: in vivo assessment of early degenerative changes in symptomatic osteoarthritic subjects.

RATIONALE AND OBJECTIVES: To determine the in vivo feasibility of quantifying early degenerative changes in patellofemoral joint of symptomatic human knee using spin-lattice relaxation time in the rotating frame (T(1rho)) magnetic resonance imaging (MRI). MATERIALS AND METHODS: All the MRI experiments were performed on a 1.5 T whole-body GE Signa clinical scanner using a custom built 15-cm diameter transmit-receive quadrature birdcage radiofrequency coil. The T(1rho)-prepared magnetization was imaged with a three-dimensional gradient-echo pulse sequence pre-encoded with a three-pulse cluster consisting of two hard 90 degrees pulses and a low power spin-lock pulse. Quantitative T(1rho) relaxation maps of asymptomatic (n = 8 males), and six symptomatic human volunteers (four men, two women) were computed using a appropriate signal expression. RESULTS: All six symptomatic volunteers showed elevation in T(1rho) relaxation times when compared with asymptomatic subjects. In symptomatic population, the T(1rho) relaxation times varied from 63 +/- 4 ms to 95 +/- 12 ms (mean +/- standard deviation) depending on the degree of cartilage degeneration. The increase in T(1rho) of symptomatic population was statistically significant (n = 6, P <.002) when compared with corresponding asymptomatic population. However, in asymptomatic population the relaxation times varied only from approximately 45 to 55 ms (n = 8, age range 22-45 years). CONCLUSION: Preliminary results demonstrated the in vivo feasibility of quantifying early biochemical changes in symptomatic osteoarthritis subjects employing T(1rho)-weighted MRI on a 1.5 T clinical scanner. This study on limited number of symptomatic population shows that T(1rho)-weighted MRI provides a noninvasive marker for quantitation of early degenerative changes of cartilage in vivo. However, further studies are needed to correlate early osteoarthritis determined from arthroscopy with T(1rho) in a large symptomatic population.

Proteoglycan loss in human knee cartilage: quantitation with sodium MR imaging--feasibility study.

The feasibility of using sodium magnetic resonance (MR) imaging to detect proteoglycan loss in early-stage osteoarthritis is evaluated. Fixed charge density (FCD) maps were calculated from sodium MR imaging data collected in nine healthy volunteers and three individuals with symptoms of early-stage osteoarthritis by using a 4.0-T clinical MR imaging unit. Data from the healthy individuals revealed a mean FCD of -182 mmol/L +/- 9. Data from the symptomatic subjects revealed focal regions of decreased FCD, with mean values ranging from -108 to -144 mmol/L, indicating proteoglycan loss from the cartilage matrix. The data suggest that sodium MR imaging has potential for use as a quantitative diagnostic tool to measure changes in proteoglycan content in early-stage osteoarthritis.

Sodium magnetic resonance imaging of proteoglycan depletion in an in vivo model of osteoarthritis.

RATIONALE AND OBJECTIVES: The aim of the study was to investigate the feasibility of using sodium magnetic resonance imaging (MRI) as a noninvasive quantitative technique for measuring proteoglycan (PG) content in an in vivo porcine model of osteoarthritis (OA). MATERIALS AND METHODS: Biochemical conditions similar to those of OA were created by an intra-articular injection of recombinant porcine interleukin-1beta (IL-1beta) into the knee joint of pigs (n = 6) before performing MRI. The contralateral knee joint was given a saline injection to serve as an internal control. Sodium MRI data were acquired on a 4-T clinical MR scanner and used to compute quantitative sodium and fixed charge density (FCD) maps based on a previously established methodology. In vivo FCD maps were compared with FCD maps obtained using ex vivo patellae harvested from the specimens. The tissue and joint fluid were subjected to histologic and immunohistochemical analyses as independent measurements of IL-1beta activity and PG loss. RESULTS: The average FCD of IL-1beta-treated patellae was measured to be 49% lower than that of saline-treated patellae, indicating a loss of PG content. These results were supported by histologic and immunochemical findings, most notably a reduction in staining for PG and an increase in matrix metalloproteinases in the synovial fluid. CONCLUSION: Sodium MRI can serve as a quantitative method to measure in vivo changes in PG content in an animal model of OA. The use of a noninvasive quantitative in vivo PG measurement technique such as sodium MRI on an animal model would aid greatly in efforts to monitor the efficacy of treatments for OA. Furthermore, these results indicate that early degenerative events could be detected noninvasively in vivo in humans with PG-depleting diseases such as OA.

In vivo proton MR three-dimensional T1rho mapping of human articular cartilage: initial experience.

The purpose of this study was to demonstrate the feasibility of computing three-dimensional relaxation maps of spin-lattice relaxation time in the rotating frame (T1rho) from in vivo magnetic resonance (MR) images of the human patellofemoral joint. T1rho was measured by applying a three-dimensional gradient-echo pulse sequence in six healthy subjects and one symptomatic subject by using a 1.5-T MR imager and a 15-cm-diameter transmit-receive quadrature birdcage radiofrequency coil. Average T1rho measured in healthy patellar cartilage was 49.7 msec +/- 3.2 (mean +/- SD). Two-dimensional T1rho-weighted images were obtained with a fast spin-echo pulse sequence for comparison. There was good correlation between two-dimensional and three-dimensional T1rho values for the six healthy subjects (R2 = 0.88, slope = 1.16).

T 1 rho-relaxation mapping of human femoral-tibial cartilage in vivo.

PURPOSE: To demonstrate the in vivo feasibility of measuring spin-lattice relaxation time in the rotating frame (T(1rho)); and T(1rho)-dispersion in human femoral cartilage. Furthermore, we aimed to compute the baseline T(1rho)-relaxation times and spin-lock contrast (SLC) maps on healthy volunteers, and compare relaxation times and signal-to-noise ratio (SNR) with corresponding T(2)-weighted images. MATERIALS AND METHODS: All MR imaging experiments were performed on a 1.5 T GE Signa scanner (GEMS, Milwaukee, WI) using a custom built 15-cm transmit-receive quadrature birdcage radio-frequency (RF) coil. The T(1rho)-prepared magnetization was imaged with a single-slice two-dimensional fast spin-echo (FSE) pulse sequence preencoded with a three-pulse cluster consisting of two hard 90 degrees pulses and a low power spin-lock pulse. T(1rho)-dispersion imaging was performed by varying the spin-lock frequency from 100 to 500 Hz in five steps in addition to varying the length of the spin-lock pulse. RESULTS: The average T(1rho)-relaxation times in the weight-bearing (WB) and nonweight-bearing (NWB) regions of the femoral condyle were 42.2 +/- 3.6 msec and 55.7 +/- 2.3 msec (mean +/- SD, N = 5, P < 0.0001), respectively. In the same regions, the corresponding T(2)-relaxation times were 31.8 +/- 1.5 msec and 37.6 +/- 3.6 msec (mean +/- SD, N = 5, P < 0.0099). T(1rho)-weighted images have approximately 20%-30% higher SNR than the corresponding T(2)-weighted images for similar echo time. The average SLC in the WB region of femoral cartilage was 30 +/-4.0%. Furthermore, SLC maps provide better contrast between fluid and articular surface of femoral-tibial joint than T(1rho)-maps. The T(1rho)-relaxation times varied from 32 msec to 42 msec ( approximately 31%) in the WB and 37 msec to 56 msec ( approximately 51%) in NWB regions of femoral condyle, respectively, in the frequency range 0-500 Hz (T(1rho)-dispersion). CONCLUSION: The feasibility of performing in vivo T(1rho) relaxation mapping in femoral cartilage at 1.5T clinical scanner without exceeding Food and Drug Administration (FDA) limits on specific absorption rate (SAR) of RF energy was demonstrated.

T1rho MR imaging of the human wrist in vivo.

RATIONALE AND OBJECTIVES: The purpose of this study was (a) to demonstrate the feasibility of computing T1rho maps of, and T1rho dispersion in, human wrist cartilage at MR imaging in vivo and (b) to compare T1rho and T2 weighting in terms of magnitude of relaxation times and signal intensity contrast. MATERIALS AND METHODS: T2 and T1rho magnetic resonance images of wrist joints in healthy volunteers (n = 5) were obtained with a spin-echo sequence and a fast spin-echo sequence pre-encoded with a spin-lock pulse cluster. A 1.5-T clinical imager was used (Signa; GE Medical Systems, Milwaukee, Wis) with a 9.5-cm-diameter transmit-receive quadrature birdcage coil tuned to 63.75 MHz. RESULTS: T1rho relaxation times at a spin-lock frequency of 500 Hz vary from 40.5 msec +/- 0.85 to 56.6 msec +/- 4.83, and T2 relaxation times vary from 28.1 msec +/- 1.88 to 34.5 msec +/- 2.63 (mean +/- standard error of the mean, n = 5, P < .016) in various regions of the wrist. T1rho dispersion was observed in the range of spin-lock frequencies studied. T1rho-weighted images not only have higher signal-to-noise ratios but also show better fluid and fat signal suppression than T2-weighted images. CONCLUSION: It was possible to perform T2- and T1rho-weighted MR imaging of human wrist cartilage in vivo with standard clinical imagers. The higher signal-to-noise ratio and improved contrast between cartilage and surrounding fat achieved with T1rho imaging may provide better definition of lesions and accurate quantitation of small changes in cartilage degeneration.

Three-dimensional T1rho-weighted MRI at 1.5 Tesla.

PURPOSE: To design and implement a magnetic resonance imaging (MRI) pulse sequence capable of performing three-dimensional T(1rho)-weighted MRI on a 1.5-T clinical scanner, and determine the optimal sequence parameters, both theoretically and experimentally, so that the energy deposition by the radiofrequency pulses in the sequence, measured as the specific absorption rate (SAR), does not exceed safety guidelines for imaging human subjects. MATERIALS AND METHODS: A three-pulse cluster was pre-encoded to a three-dimensional gradient-echo imaging sequence to create a three-dimensional, T(1rho)-weighted MRI pulse sequence. Imaging experiments were performed on a GE clinical scanner with a custom-built knee-coil. We validated the performance of this sequence by imaging articular cartilage of a bovine patella and comparing T(1rho) values measured by this sequence to those obtained with a previously tested two-dimensional imaging sequence. Using a previously developed model for SAR calculation, the imaging parameters were adjusted such that the energy deposition by the radiofrequency pulses in the sequence did not exceed safety guidelines for imaging human subjects. The actual temperature increase due to the sequence was measured in a phantom by a MRI-based temperature mapping technique. Following these experiments, the performance of this sequence was demonstrated in vivo by obtaining T(1rho)-weighted images of the knee joint of a healthy individual. RESULTS: Calculated T(1rho) of articular cartilage in the specimen was similar for both and three-dimensional and two-dimensional methods (84 +/- 2 msec and 80 +/- 3 msec, respectively). The temperature increase in the phantom resulting from the sequence was 0.015 degrees C, which is well below the established safety guidelines. Images of the human knee joint in vivo demonstrate a clear delineation of cartilage from surrounding tissues. CONCLUSION: We developed and implemented a three-dimensional T(1rho)-weighted pulse sequence on a 1.5-T clinical scanner.

The incidence of pathology detected by magnetic resonance imaging of the knee: differences based on the specialty of the requesting physician.

The usage patterns of magnetic resonance imaging (MRI) by orthopedic and nonorthopedic surgeons were studied. A sample consisting of the radiologist reports from all knee MRIs in a single year at our institution were reviewed. Studies to evaluate tumors or infections were excluded. Reports were classified as normal or demonstrating degenerative joint disease, meniscal tears, cruciate ligament pathology, collateral ligament pathology, focal chondral defects, chondromalacia patella, cysts, extensor mechanism dysfunction, intraosseous edema, or fractures. Six hundred eighteen reports were reviewed. The combined incidence of a normal study or one that found only degenerative joint disease was 45% for nonorthopedic surgeons and 27.6% for orthopedic surgeons (P<.00001). Given the higher incidence of normal findings in studies ordered by nonorthopedic surgeons, these physicians probably use MRI more for screening whereas orthopedic surgeons are more apt to use it for confirmation. Therefore, if clinical guidelines for using MRI are to be established, differences in use as a function of specialty must be acknowledged.

Imaging of athletic injuries to the ankle and foot.

Conventional radiographs in conjunction with clinical examination remains the primary method for evaluating the acute athletic injury. In most cases, suspected acute tendon and ligament injuries are initially treated based on physical examination. Magnetic resonance (MR) imaging, with its multiplanar capability and superb soft tissue contrast, is quickly becoming the method of choice for evaluating chronic foot and ankle pain and further defining the extent of tendon and ligament injuries. This article reviews the common acute and chronic (overuse) foot and ankle athletic injuries with an emphasis on imaging characteristics.