Medial tibial pain: A dynamic contrast-enhanced MRI study

The purpose of this study was to compare the sensitivity of different magne tic resonance imaging (MRI) sequences to depict periosteal edema in patient s with medial tibial pain. Additionally, we evaluated the ability of dynami c contrast-enhanced imaging (DCES) to depict possible temporal alterations in muscular perfusion within compartments of the leg. Fifteen patients with medial tibial pain were examined with MRT, T-1-, T-2-weighted, proton dens ity axial images and dynamic and static phase post-contrast images were com pared in ability to depict periosteal edema. STIR was used in seven cases t o depict bone marrow edema. Images were analyzed to detect signs of compart ment edema. Region-of-interest measurements in compartments were performed during DCES and compared with controls, In detecting periosteal edema, post -contrast T-1-weighted images were better than spin echo T-2-weighted and p roton density images or STIR images, but STIR depicted the bone marrow edem a best. DCES best demonstrated the gradually enhancing periostitis. Four su bjects with severe periosteal edema had visually detectable pathologic enha ncement during DCES in the deep posterior compartment of the leg. Percentag e enhancement in the deep posterior compartment of the leg was greater in p atients than in controls, The fast enhancement phase in the deep posterior compartment began slightly slower in patients than in controls, but it cont inued longer. We believe that periosteal edema in bone stress reaction can cause impairment of venous flow in the deep posterior compartment, MRI can depict both these conditions. In patients with medial tibial pain, MR imagi ng protocol should include axial STIR images (to depict bone pathology) wit h T-1-weighted axial pre and post-contrast images, and dynamic contrast enh anced imaging to show periosteal edema and abnormal contrast enhancement wi thin a compartment. (C) 1999 Elsevier Science Inc.