MRI in Patients with Forefoot Pain Involving the Metatarsal Region Poster No.: C-0151 Congress: ECR 2015 Type: Authors: Keywords: DOI: Scientific Exhibit R. Vukojevi#, M. Mustapic, D. Marjan; Zagreb/HR Inflammation, Connective tissue disorders, Contrast agentintravenous, MR, Musculoskeletal soft tissue, Musculoskeletal joint, Musculoskeletal bone 10.1594/ecr2015/C-0151 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 10
Aims and objectives Disorders that produce discomfort in the metatarsal region of the foot include traumatic lesions of the soft tissues and bones (sesamoiditis, stress fracture), infection, arthritis, tendon disorders (tendinosis, tenosynovitis, tendon rupture), non-neoplastic soft-tissue masses (bursitis, granuloma, Morton neuroma). MRI allows a specific diagnosis based on the location, signal intensity characteristics, and morphologic features of the abnormalities involving metatarsal region (1). The purpose of this study was to depict and analyze possible causes of pain in the metatarsal region of the foot on magnetic resonance imaging (MRI). Methods and materials During one-year period of observation, 38 patients underwent MRI of the forefoot in our hospital due to metatarsalgia. We analyzed changes in the soft tissue, bones and joints that could be the cause of pain in the metatarsal region of the foot. Patients with inflammatory joint disease were excluded. MRI examinations were performed on 1.5 T machine using T1, T2 and fat saturated (fat sat) PD weighted images (WI). In some patients fat sat T1-WI before and after contrast admission were used. Results There were thirty-two (84%) female patients. In 68% of patients right foot was affected. The age of female patients ranged from 36 to 62 years (median 48), and of male patients from 25 to 40 years (median 30.5). Five of six male patients were active in sports. Among female patients the most frequent findings were static changes in the foot, hallux valgus, and small toes deformities, resulting in osteoarthritis (56%) (Fig.1), followed by bursitis in three patients (9%) (Fig.2), Morton's neuroma in two patients (6%) (Fig.3), stress fracture of the metatarsal bone in one patient (3%) (Fig. 4), sesamoiditis in one patient (3%) (Fig.5), and in 23% of cases the cause of metatarsalgia was not found. Among male patients four of them had sesamoiditis (67%) ( Fig.6) and stress fracture of metatarsal bone was found in two patients (33%) (Fig.7). Images for this section: Page 2 of 10
Fig. 1: The coronal fat sat PD-WI of the forefoot shows hallux valgus, atricular cartilage defects with subchondral bone marrow edema and subchondral cysts consistent with osteoarthritis Page 3 of 10
Fig. 2: The transversal fat sat PD-WI of the forefoot shows fluid collection under the fifth metatarsal head consistent with metatarsal bursitis Page 4 of 10
Fig. 3: The transversal T1-WI of the forefoot reveals hypointense area between the second and the third metatarsal head due to perineural fibrosis - Morton neuroma Page 5 of 10
Fig. 4: The sagittal contrast enhanced fat sat T1-WI of the forefoot depicts diffuse edema of the fourth metatarsal with sclerotic area in the distal third of metatarsal diaphysis due to stress fracture Page 6 of 10
Fig. 5: The coronal fat sat PD-WI of the forefoot shows bipartite medial sesamoid bone of the hallux with bone marrow edema consistent with sesamoiditis Page 7 of 10
Fig. 6: The transversal fat sat PD-WI of the forefoot shows bone marrow edema of hallucal medial sesamoid due to sesamoiditis Page 8 of 10
Fig. 7: The sagittal T1-WI of the forefoot depicts hypointense linear area in the distal third of the second metatarsal shaft with periostal reaction and cortical thickening consistent with stress fracture Page 9 of 10
Conclusion The age at which metatarsalgia occurs is significantly different between men and women. In males, it occurs at a younger age, especially in sports active persons, due to repetitive microtrauma and overuse. In females, it occurs at middle and old age, usually due to static changes in the foot and degenerative joint disease. Personal information Rudolf Vukojevi# MD, radiology resident at Department of Diagnostic and Interventional Radiology, "Sestre milosrdnice" University Hospital Centre, Zagreb, Croatia Matej Mustapi# MD, PhD, MSK radiologist at Department of Diagnostic and Interventional Radiology, "Sestre milosrdnice" University Hospital Centre, Zagreb, Croatia Domagoj Marjan MD, Abdominal radiologist at Department of Diagnostic and Interventional Radiology, "Sestre milosrdnice" University Hospital Centre, Zagreb, Croatia References 1.Ashman CJ, Klecker RJ, Yu JS. Forefoot pain involving the metatarsal region: differential diagnosis with MR imaging. Radiographics 2001;21:1425-40. Page 10 of 10