title: Magnetic resonance imaging evaluation of tubercular arthritis of the ankle and foot.
abstract: BACKGROUND
  Ankle and foot tuberculosis is relatively uncommon. Magnetic resonance imaging (MRI) is highly sensitive in detecting the changes but there is limited experience with MRI evaluation and differentiation from other mono-articular arthritis, particularly pyogenic arthritis, is a challenge.
  
  
  OBJECTIVE
  To report MRI findings in ankle and foot tuberculosis.
  
  
  METHODS
  MRI was performed in 17 selected patients with ankle and foot tuberculosis. T1-weighted, proton density (PD) weighted, T2-weighted, and postcontrast sequences were performed in multiple imaging planes. Recorded findings included: number of bones involved; specific bones involved; extent of involvement; erosions; joint effusion, synovial thickening, tenosynovitis; joint effusion; adjacent soft-tissue changes; and involvement of sinus tarsi. Clinical data of all patients were also reviewed. Radiographic correlation at the time of MRI was available in selected patients.
  
  
  RESULTS
  The most common abnormality was synovial thickening. Signal abnormality was noted most frequently in the talus (n = 14). Erosions and intra-osseous abscesses were noted in 10 (58%) and eight (47%) patients, respectively. Tenosynovitis was present in eight (47%) patients. Soft tissue changes were noted in all patients, including abscesses in 13 patients (76%).
  
  
  CONCLUSIONS
  A multiplicity of findings (both osseous and extra-osseous) on MRI favors the diagnosis of tuberculosis. Three findings (intra-osseous abscess, soft tissue abscess, tenosynovitis), when present together, have a high sensitivity and specificity.
authors.affiliation: Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India image73@gmail.com.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Prakash
authors.affiliation: Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Gupta
authors.affiliation: Department of Orthopaedics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Ramesh Kumar
authors.initials: RK
authors.lastname: Sen
authors.affiliation: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Aman
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Niranjan
authors.initials: N
authors.lastname: Khandelwal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000382:microbiology*; D001170:Arthritis, Infectious / Q000175:diagnosis* / Q000382:microbiology; D003287:Contrast Media; D005260:Female; D005528:Foot / Q000382:microbiology*; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014394:Tuberculosis, Osteoarticular / Q000175:diagnosis* / Q000382:microbiology
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: Ankle tuberculosis; gadolinium enhanced MRI; magnetic resonance imaging (MRI); tuberculosis