Medial tibial pain: a dynamic contrast-enhanced MRI study

Area of Science:

• Radiology
• Orthopedics
• Medical Imaging

Background:

• Medial tibial pain is often associated with periosteal edema and bone stress reactions.
• Accurate depiction of periosteal edema and associated muscular changes is crucial for diagnosis and management.

Purpose of the Study:

• To compare the sensitivity of various magnetic resonance imaging (MRI) sequences for detecting periosteal edema.
• To evaluate dynamic contrast-enhanced imaging (DCES) for assessing muscular perfusion alterations in patients with medial tibial pain.

Main Methods:

• Fifteen patients with medial tibial pain underwent MRI using T1-, T2-weighted, proton density, STIR, and dynamic contrast-enhanced sequences.
• Images were analyzed for periosteal and bone marrow edema, and compartment enhancement patterns during DCES were quantified.

Main Results:

• Post-contrast T1-weighted images were superior for periosteal edema, while STIR best visualized bone marrow edema.
• DCES effectively demonstrated periostitis and revealed abnormal enhancement in the deep posterior compartment in patients with severe edema.
• Patients showed greater percentage enhancement and prolonged enhancement duration in the deep posterior compartment compared to controls.

Conclusions:

• MRI, particularly with post-contrast T1-weighted and STIR sequences, is effective for diagnosing periosteal edema and bone marrow edema in medial tibial pain.
• DCES can identify abnormal muscular perfusion, suggesting impaired venous flow due to periosteal edema.
• An optimized MRI protocol should include STIR, pre/post-contrast T1-weighted, and DCES for comprehensive evaluation.