HOW DOES MAGNETIC RESONANCE IMAGING REPRESENT HISTOLOGIC FINDINGS IN THE EQUINE DIGIT?

Magnetic resonance (MR) imaging is increasingly used in the diagnosis of equine foot pain, but improved understanding of how MR images represent tissue-level changes in the equine foot is required. We hypothesized that alterations in signal intensity and tissue contour would represent changes in tissue structure detected using histologic evaluation. The study objectives were to determine the significance of MR signal alterations in feet from horses with and without lameness, by comparison with histopathologic changes. Fifty-one cadaver feet from horses with a history of lameness improved by palmar digital analgesia (n = 32) or age-matched control horses with no history of lameness (n = 19) were stored frozen before undergoing MR imaging and subsequent histopathological examination at standard sites (deep digital flexor tendon, navicular bone, distal sesamoidean impar ligament, collateral sesamoidean ligament, and navicular bursa). Using MR images, signal intensity and homogeneity, size, definition of anatomic margins, and relationships with other structures were described. Alterations were graded as mild, moderate, or severe for each structure. For each anatomic site examined histologically the structures were described and scored as no changes, mild, moderate, or severe abnormalities, also taking into account adhesion formation within the navicular bursa detected on macroscopic examination. Alterations in MR signal intensity were related to changes at the tissue level detected by histologic examination. A sensitivity and specificity comparison of MR imaging with histologic examination was used to evaluate the significance of MR signal alterations for detection of moderate-to-severe lesions of the deep digital flexor tendon (DDFT), navicular bone, distal sesamoidean impar ligament (DSIL), collateral sesamoidean ligament (CSL) and navicular bursa. Agreement between the MR and histologic grading was assessed for each structure using a weighted kappa agreement. Direct comparison between histology and MR imaging for individual limbs revealed that signal alterations on MR imaging did represent tissue-level changes. These included structural damage, fibroplasia, fibrocartilaginous metaplasia, and hemosiderosis in ligaments and tendons; trabecular damage, osteonecrosis, fibroplasia, cortical defects, and increased vascularity in bone; and fibrocartilage defects. MR imaging had a high sensitivity and specificity for most structures. MR imaging had high specificity for lesions of the DDFT, CSL and navicular bursa, quite high specificity for lesions of the medulla of the navicular bone and its proximal aspect, with moderate specificity for the DSIL, and distal, dorsal and palmar aspects of the navicular bone, and was sensitive for detection of abnormalities in all structures except the dorsal aspect of the navicular bone. When MR and histologic grades alone were compared, there was good agreement between MR and histologic grades for the navicular bursa, DDFT, navicular bone medulla and CSL; moderate-to-good agreement in grades of the distal and palmar aspects of the navicular bone; fair to moderate in grades of the DSIL, and poor agreement for the dorsal and proximal aspects of the navicular bone. The results of this study support our hypothesis and indicate the potential use and limitations of MR imaging for visualization of structural changes within osseous and soft tissue structures of the equine foot.     

Magnetic resonance imaging application to live horse for diagnosis of tendinitis

Six live horses with various stages of acute to chronic superficial digital flexor (SDF) tendinitis were examined using magnetic resonance imaging (MRI). In each case, MRI findings were compared to the corresponding ultrasonographic (USD) and histologic findings, to establish the usefulness of MRI. In the acute cases, lesions characterized by hemorrhage were well defined as high signal intensity on MRI and hypoechoic regions on USD. Chronic tendon fibrosis was slightly hyperechoic and difficult to distinguish from the normal tendon tissue around the original injury by using USD. In contrast, MRI visualized the chronic lesion as a low intensity signal, which could be distinguished from the black background of the normal SDF tendon tissue. This study clearly demonstrated MRI was the better imaging modality for the objective detection of chronic scar tissue in live horses. These findings, from living horses, suggest an advantage of MRI in the clinical application to diagnose tendinitis in cases where there is chronic scar tissue that is difficult to discern on USD.     

A COMPARISON OF RADIOGRAPHY, COMPUTED TOMOGRAPHY, AND MAGNETIC RESONANCE IMAGING FOR THE DIAGNOSIS OF PALMAR PROCESS FRACTURES IN FOALS

The relative sensitivity of radiography, computed tomography, and magnetic resonance imaging for detecting palmar process fractures of the distal phalanx in foals was determined and the imaging findings were compared with histomorphologic evaluations of the palmar processes. Compared to radiography, computed tomography and magnetic resonance imaging did not improve the sensitivity for detection of palmar process fractures. Statistical agreement for palmar process fracture diagnosis was excellent among the three imaging modalities. Histomorphologic evaluations were more sensitive for diagnosis of palmar process fracture than any of the imaging modalities. Three-dimensional image reconstructions and volume measurements of distal phalanges and palmar process fracture fragments from computed tomography studies provided more complete anatomical information than radiography. Magnetic resonance imaging confirmed that the deep digital flexor tendon insertion on the distal phalanx is immediately axial to the site where palmar process fractures occur, and differentiated cartilage, bone, and soft tissue structures of the hoof.     

EFFECT OF DEEP DIGITAL FLEXOR TENDON ORIENTATION ON MAGNETIC RESONANCE IMAGING SIGNAL INTENSITY IN ISOLATED EQUINE LIMBS—THE MAGIC ANGLE EFFECT

Ten normal equine isolated limbs were imaged using a knee coil in a 1.5 Tesla magnetic field, with short echo time sequences (TE < 15 ms). Magnetic resonance imaging was performed on each isolated limb in different positions, with and without extension of the metacarpophalangeal joint. Deep digital flexor tendon orientation ranged from 20 to 60 degrees in relation to the static magnetic field. Increased intratendinous signal intensity was observed when the angle between the deep digital flexor tendon and the constant magnetic field approached 55 degrees ("magic angle"). The increased signal intensity was independent from extension of the metacarpophalangeal joint. Recognition of the magic angle phenomenon is essential for proper evaluation of magnetic resonance imaging studies of the equine foot.     

FEASIBILITY AND REPEATABILITY FOR IN VIVO MEASUREMENTS OF STIFFNESS GRADIENTS IN THE CANINE GASTROCNEMIUS TENDON USING AN ACOUSTOELASTIC STRAIN GAUGE

B‐mode ultrasound is an established imaging modality for evaluating canine tendon injury. However, full extent of tendon injury often remains difficult to estimate, as small changes in sonographic appearance are associated with large changes in biomechanical strength. The acoustoelastic strain gauge (ASG) is an ultrasound‐based tissue evaluation technique that relates the change in echo intensity observed during relaxation or stretching of tendons to the tissue's mechanical properties. This technique deduces stiffness gradient (the rate of change of normalized stiffness as a function of tissue strain) by analyzing the ultrasound dynamic images captured from gradually deforming tissue. ASG has been proven to accurately model strain and stiffness within tendons in vitro. To determine the feasibility and repeatability for in vivo ASG measurements of canine tendon function, stiffness gradients for the gastrocnemius tendons of 10 clinically normal dogs were recorded by two nonindependent observers at three sites (musculotendinous junction, mid tendon, and insertion). Average stiffness gradient indices (0.0132, 0.0141, 0.0136) and dispersion values (0.0053, 0.0054, 0.0057) for each site, respectively, were consistent with published mechanical properties for normal canine tendon. Mean differences of the average stiffness gradient index and dispersion value between observers and between limbs for each site were less than 16%. Using interclass coefficients (ICC), intra‐observer (ICC 0.79–0.98) and interobserver (ICC 0.77–0.95) reproducibility was good to excellent. Right and left limb values were symmetric (ICC 0.74–0.92). Findings from this study indicated that ASG is a feasible and repeatable technique for measuring stiffness gradients in canine tendons.     

SONOGRAPHY OF THE MUSCULOSKELETAL SYSTEM IN DOGS AND CATS

Sonography of the musculoskeletal system in dogs and cats was undertaken to evaluate the application of this imaging procedure in orthopedics. In most of the patients a 7,5 MHz linear transducer was used because of its flat application surface and its resolving power. The evaluation of bone by sonography is limited, but sonography can provide addition information regarding the bone surface and surrounding soft tissue. Ultrasound is valuable for assessing joint disease. Joint effusion, thickening of the joint capsule and cartilage defects can be identified sonographically. It is also possible to detect bone destruction. Instabilities are often identified with the help of a dynamic examination. Soft tissue abnormalities of the musculoskeletal system lend themselves to sonographic evaluation. Partial or complete muscles or tendon tears are able to be differentiated and the healing process can be monitored. Most of the diseases that are in the area of the biceps or the achilles tendon, such as dislocation of the tendon, old injuries with scarification, free dissecates in the tendonsheath, tendinitis and/or tendosynovitis can be differentiated by sonography. In addition, with clinical and laboratory findings, it is often possible to make a correct diagnosis with ultrasound in patients with abscesses, foreign bodies, hematomas, soft tissue tumors and lipomas.     

MAGNETIC RESONANCE, ULTRASOUND AND HISTOPATHOLOGIC CORRELATION OF ACUTE AND HEALING EQUINE TENDON INJURIES

Ultrasonography and MRI have become valuable tools for imaging of tendon injuries. The current study examines the histopathologic basis for the imaging abnormalities. Five injured equine forelimbs and two normal contralateral limbs were studied with high resolution real time ultrasound and MRI. Histologic sections were made and correlated with the diagnostic images. All lesions were readily seen by both modalities. Lesions characterized by hemorrhage, edma, and cellular infiltration were sonolucent on ultrasound and bright on MRI images. MRI returned to normal as fibrogenesis ensued. Ultrasound images remained abnormal until fibrillar reallgnment occured with completion of the healing process. High resolution real time ultrasound and MRI both accurately reflect the tissue abnormalities in acute tendon injuries. The injured horse does appear to be an effective model for correlative imaging studies of tendon injuries.     

MAGNETIC RESONANCE IMAGING OF THE EQUINE STIFLE

The purpose of this study was to define normal gross anatomic structures in the equine stifle with magnetic resonance images. Magnetic resonance (MR) images were made in sagittal, 15° supinated, transverse, and dorsal planes of two equine stifles. The MR images were scrutinized by comparing MR images to dissection specimens and frozen cross sections of stifle joints. Sagittal and 15° supinated images were the most valuable in assessing articular cartilage, subchondral bone, and soft tissue structures within the joint. Cranial and caudal cruciate ligaments, medial and lateral menisci, meniscotibial and meniscofemoral ligaments, long digital extensor tendon, and patellar ligaments were easily evaluated. MR images provided substantially more gross anatomical information than the currently available imaging modalities.     

Magic angle magnetic resonance imaging of diode laser induced and naturally occurring lesions in equine tendons

Magic angle magnetic resonance (MR) imaging consists of imaging tendons at 55° to the magnetic field. In people, magic angle MR imaging is valuable for detection of chronic tendon lesions and allows calculation of tendon T1 values. Increased T1 values occur in people with chronic tendinopathy. The T1 values of normal equine tendons have been reported but there are no available data for abnormal equine tendons. Twelve limbs were studied. Two limbs had diode laser tendon lesions induced postmortem, four limbs had diode laser tendon lesions induced in vivo and six limbs had naturally occurring tendon lesions. The limbs were imaged at 1.5 T using both conventional MR imaging and magic angle MR imaging. The post-mortem laser induced lesions were identified only with magic angle MR imaging. The in vivo induced lesions and naturally occurring lesions were identified with both techniques but had a different appearance with the two imaging techniques. Magic angle imaging was helpful at identifying lesions that were hypointense on conventional imaging. Increased T1 values were observed in all abnormal tendons and in several tendons with a subjectively normal MR appearance. The increased T1 value may reflect diffuse changes in the biochemical composition of tendons. Magic angle imaging has potential as a useful noninvasive tool to assess the changes of the extracellular tendon matrix using T1 values.     

Surgical Treatment of Mineralized and Nonmineralized Supraspinatus Tendinopathy in Twenty-four Dogs

Objective— To report and compare the clinical diagnosis, surgical treatment, histopathologic changes, and outcomes of dogs with mineralized and nonmineralized supraspinatus tendinopathy (ST).
Study Design— Case series.
Animals— Dogs (n=24) with ST.
Methods— Medical records (1995–2006) of dogs with ST that had surgical treatment were reviewed. Results of clinical examination, diagnostic imaging, surgery, histopathology of resected tendon tissue, and outcome were compared between dogs with mineralized and nonmineralized ST.
Results— There were 15 dogs with mineralized ST and 9 with nonmineralized ST. Chronic, unilateral, intermittent or waxing-waning lameness, and pain elicited on palpation of the cranial aspect of the shoulder were the most consistent findings. On ultrasonographic or magnetic resonance imaging (MRI) of 35 shoulders, enlargement of the supraspinatus tendon (54%), increased fluid content (63%), and medial displacement of the biceps tendon (60%) were observed. Eleven of 12 dogs with bilateral abnormalities only had unilateral lameness. Surgery was performed in 30 shoulders. Resected tendon specimens had myxomatous degeneration and/or cartilaginous metaplasia in 11 of 13 dogs in the mineralized group and all 9 dogs in the nonmineralized group. Functional outcome after surgery was poor in 3 dogs and good-to-excellent in 16.
Conclusions— Mineralized and nonmineralized ST have many similarities. Although lameness is usually unilateral, the supraspinatus tendon may be affected bilaterally.
Clinical Relevance— Ultrasonography and MRI are good imaging techniques for detection of ST especially the nonmineralized form. Surgical treatment results in good recovery of limb function. Nonmineralized ST is a recently described disorder in dogs and evaluation of more cases is necessary to determine outcome after surgical or medical treatment.     

RESOLUTION OF LESIONS ON STIR IMAGES IS ASSOCIATED WITH IMPROVED LAMENESS STATUS IN HORSES

Magnetic resonance (MR) imaging is important in diagnosing musculoskeletal injuries in horses. However, there is still much to learn regarding the significance of lesions identified in equine MR images. Of particular importance is the clinical significance of signal change as a function of pulse sequence. We hypothesized that a resolution of tendon, ligament, and bone marrow lesions on short‐tau inversion recovery (STIR) images would be associated with a return to soundness, and that a persistence of tendon and ligament lesions on only T1‐weighted (T1w) gradient recalled echo (GRE) images would not be associated with persistent lameness. The medical records and MR images of 27 horses that had a hyperintense lesion in initial STIR MR images followed by a subsequent follow‐up MR imaging examination were reviewed. Horses whose tendon or ligament lesions had resolved on STIR images at the time of the recheck examination were significantly more likely to be sound than horses whose lesions persisted on STIR images (P=0.039). This association did not exist in horses with bone marrow lesions (P=1.00). Horses whose tendon or ligament lesions persisted only on T1w GRE images were no more likely to be sound than horses whose lesion persisted on at least one other sequence type (P=0.26). However, the low number of horses included in this analysis may have precluded identification of a significant difference in lameness status. Tendon or ligament lesions visualized on STIR images may represent active lesions that may contribute to lameness in the horse.     

RADIOGRAPHIC, COMPUTED TOMOGRAPHIC AND MAGNETIC RESONANCE IMAGING EVALUATION OF A CHRONIC LONG DIGITAL EXTENSOR TENDON AVULSION IN A DOG

Long digital extensor tendon avulsion is reported in a 5 month old Great Dane. Clinically the dog presented with a unilateral weight-bearing pelvic limb lameness. Joint effusion was present and there was pain and crepitance associated with flexion of the stifle. Orthopedic evaluation and radiographs were suggestive of a long digital extensor tendon injury which was confirmed by computed tomography and magnetic resonance imaging.The injury was surgically repaired with screw and spiked washer fixation.     

ULTRASONOGRAPHY OF THE DORSAL AND LATERAL ASPECTS OF THE EQUINE CARPUS: TECHNIQUE AND NORMAL APPEARANCE

The normal ultrasonographic appearance of the dorsal and lateral soft tissue structures and anatomic landmarks of the equine carpus useful in clinical imaging are described.
Both limbs of 5 cadavers and 5 clinically sound adult horses were imaged using a 7.5 MHz sector transducer. At the dorsal aspect of the carpus and distal radius, the extensor carpi radialis- and the common digital extensor tendon and their tendon sheaths were easily identified. These two tendons are the most prominent structures in this region. Smaller and more difficult to identify are the tendon and tendon sheath of the extensor carpi obliquus-, the lateral digital extensor- and the ulnaris lateralis muscle. The ultrasonographic appearance and course through the carpal region of the tendons and tendon sheaths mentioned are described. Other soft tissue structures examined include the lateral collateral ligament, the carpal joint capsule and the distal articular cartilage of the radius. Ultrasonographic findings correlated well with gross anatomy in the cadavers limbs.     

ULTRASONOGRAPHIC EVALUATION OF EQUINE TENDONS: A QUANTITATIVE IN VITRO STUDY OF THE EFFECTS OF AMPLIFIER GAIN LEVEL, TRANSDUCER-TILT, AND TRANSDUCER-DISPLACEMENT

The objective of the in vitro experiments described in this paper was to quantify the effects of some instrumental variables on the quantitative evaluation, by means of first-order gray-level statistics, of ultrasonographic images of equine tendons. The experiments were done on three isolated equine superficial digital flexor tendons that were mounted in a frame and submerged in a waterbath. Sections with either normal tendon tissue, an acute lesion, or a chronic scar, were selected. In these sections, the following experiments were done: 1) a gradual increase of total amplifier gain output subdivided in 12 equal steps; 2) a transducer tilt plus or minus 3 degrees from perpendicular, with steps of 1 degree; and 3) a transducer displacement along, and perpendicular to, the tendon long axis, with 16 steps of 0.25 mm each. Transverse ultrasonographic images were collected, and in the regions of interest (ROI) first-order gray-level statistics were calculated to quantify the effects of each experiment. Some important observations were: 1) the total amplifier gain output has a substantial influence on the ultrasonographic image; for example, in the case of an acute lesion, a low gain setting results in an almost completely black image; whereas, with higher gain settings, a marked "filling in" effect on the lesion can be observed; 2) the relative effects of the tilting of the transducer are substantial in normal tendon tissue (18%) and chronic scar (12%); whereas, in the event of an acute lesion, the effects on the mean gray level are dramatic (40%); and 3) the relative effects of displacement of the transducer are small in normal tendon tissue, but on the other hand, the mean gray-level changes 7% in chronic scar, and even 20% in an acute lesion. In general, slight variations in scanner settings and transducer handling can have considerable effects on the gray levels of the ultrasonographic image. Furthermore, there is a strong indication that this quantitative method, as far as based exclusively on the first-order gray-level statistics, may be not discriminative enough to accurately assess the integrity of the tendon. Therefore, the value of a quantitative evaluation of the first-order gray-level statistics for the assessment of the integrity of the equine tendon is questionable.     

Magnetic Resonance Imaging Findings in Dogs with Confirmed Shoulder Pathology

Objective— To evaluate the diagnostic potential of magnetic resonance imaging (MRI) compared with a reference standard, arthroscopic and/or open surgery, in dogs with soft tissue shoulder pathology. Study Design— Retrospective study. Animals— Dogs (n=21). Methods— Magnetic resonance (MR) images were retrospectively evaluated in 21 dogs that had surgically identified soft tissue shoulder pathology. The musculotendinous units of the biceps, infraspinatus, teres minor, supraspinatus, subscapularis, and the medial and lateral glenohumeral ligaments (MGHL and LGHL) were graded as either normal or abnormal. Abnormal structures were further classified as being either inflamed, partially torn, or fully torn. Impingement of the biceps tendon was also evaluated. Results were reported in terms of agreement and concordance between MRI findings and surgical findings. Agreement was defined as the percentage of times MRI findings concurred with surgical findings with respect to a structure being either normal or abnormal. Concordance was defined as the percentage of times MRI concurred with the exact surgically assessed pathology when abnormality was identified. Results— The findings were biceps tendon: 90% agreement with 100% concordance; subscapularis: 95% agreement with 62% concordance; MGHL: 84% agreement with 83% concordance; LGHL: 88% agreement with 100% concordance; infraspinatus: 100% both agreement and concordance; biceps tendon impingement: 90% agreement with 100% concordance. Conclusions— Soft tissue abnormalities of the canine shoulder were readily identified on preoperative MR images. Clinical Relevance— MRI shows great potential as a diagnostic tool in the evaluation of canine shoulder disease.     

USE OF RADIOGRAPHY, COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING FOR EVALUATION OF NAVICULAR SYNDROME IN THE HORSE

Radiographic evaluation of navicular syndrome is problematic because of its inconsistent correlation with clinical signs. Scintigraphy often yields false positive and false negative results and diagnostic ultrasound is of limited value. Therefore, we assessed the use of computed tomography and magnetic resonance imaging in a horse with clinical and radiographic signs of navicular syndrome. Cadaver specimens were examined with spiral computed tomographic and high-field magnetic resonance scanners and images were correlated with pathologic findings. Radiographic changes consisted of bony remodeling, which included altered synovial fossae, increased medullary opacity, cyst formation and shape change. These osseous changes were more striking and more numerous on computed tomographic and magnetic resonance images. They were most clearly defined with computed tomography. Many osseous changes seen with computed tomography and magnetic resonance imaging were not radiographically evident. Histologically confirmed soft tissue alterations of the deep digital flexor tendon, impar ligament and marrow were identified with magnetic resonance imaging, but not with conventional radiography. Because of their multiplanar capability and tomographic nature, computed tomography and magnetic resonance imaging surpass conventional radiography for navicular imaging, facilitating earlier, more accurate diagnosis. Current advances in imaging technology should make these imaging modalities available to equine practitioners in the future.     

Zur bildlichen Darstellung der gemeinsamen Sehnenscheide des M. flexor hallucis longus und des M, tibialis caudalis beim Pferd

The possibilities for imaging soft tissue structures, especially fluid-filled cavities such as articulations, bursae or tendon sheaths, have been improved markedly by sonography in recent years. Ultrasonic examinations were performed on the common tendon sheath of the musculus flexor hallucis longus and the musculus tibialis caudalis, from the medioplantar aspect of the tarsus, in 12 sound adult draft- and warm blood horses, and in 5 animals with a distended common sheath. The diagnostic precision of the sonographic examination of the tendon sheath is excellent and is superior to conventional radiography. A nuclear magnetic resonance tomogram of an isolated equine tarsus is presented for comparison method.     

The effect of intralesional injection of bone marrow derived mesenchymal stem cells and bone marrow supernatant on collagen fibril size in a surgical model of equine superficial digital flexor tendonitis

Reasons for performing study: Collagen fibril size is decreased in repair tissue following tendon injury compared to normal tendon matrix in horses. Mesenchymal stem cells have been suggested to promote regeneration of tendon matrix rather than fibrotic repair following injury, although this concept remains unproven. Objectives: To explore the hypothesis that implantation of autologous mesenchymal stem cells derived from bone marrow into a surgically created central core defect in the superficial digital flexor tendon (SDFT) of horses would induce the formation of a matrix with greater ultrastructural similarities to tendon matrix than the fibrotic scar tissue formed in control defects. Methods: Tissue was collected 16 weeks after induction of injury and 12 weeks after treatment from normal and injured regions of control and treated limbs of 6 horses and examined using transmission electron microscopy. Collagen fibril diameters were measured manually with image analysis software and surface areas calculated. Three parameters assessed for normal and injured tissue were mass average diameter (MAD), collagen fibril index (CFI) and the area dependent diameter (ADD). Results: Normal regions from both treated and control limbs displayed higher MAD and CFI values, as well as a characteristic bimodal distribution in fibril size. Injured regions from both treated and control limbs displayed significantly lower MAD and CFI values, as well as a unimodal distribution in fibril size. There were no significant differences between treated and control limbs for any of the parameters assessed. Conclusions: Intralesional injection of autologous bone marrow derived mesenchymal stem cells had no measurable effect on the fibril diameter of collagen in healing tissue in the SDFT of this experimental model 16 weeks after injury. Potential relevance: Favouring matrix regeneration over fibrotic repair may not be the mechanism by which autologous mesenchymal stem cells assist healing of tendon injury.     

Magnetic resonance imaging of the palmar aspect of the equine podotrochlear apparatus: normal appearance

The purpose of this study was to describe the normal magnetic resonance (MR) imaging characteristics of the palmar structures of the equine podotrochlear apparatus by means of retrospective evaluation of MR imaging studies of 16 cadaver limbs. The articular aspect of the distal sesamoid bone was not evaluated in this study. Equine digits were imaged with a human knee radiofrequency coil in a 1.5 T magnetic field, using spin echo (SE) T1-weighted, turbo spin echo proton density (TSE PD)-weighted with and without fat saturation (FS), and FS TSE T2-weighted sequences. The limbs were dissected after imaging to validate the absence of gross abnormalities of the flexor aspect of the distal sesamoid bone, of the deep digital flexor tendon, and the distal impar sesamoidean ligament. Seven deep digital flexor tendons were subjected to histologic examination to exclude any microscopic tendon pathology. The anatomic structures of the podotrochlear apparatus were easily identified on MR images. Compact bone of the flexor cortex of the distal sesamoid bone had low intensity signal on all sequences. In 11 digits an increased signal was seen within the thickness of the sagittal eminence of the flexor cortex in SE T1-weighted images and in TSE PD-weighted images without FS. Trabecular bone had a granular appearance and high signal in SE T1-weighted sequences and TSE images without FS. The deep digital flexor tendon had low signal on FS T2-weighted images, while on short echo time sequences (T1- and PD-weighted sequences), the tendon signal varied depending on the relative orientation between its fibers and the static magnetic field. Seven tendons had stippled appearance due to small intratendonous foci of slightly increased signal on transverse T1-weighted images. MR imaging provides a thorough evaluation of the anatomical structure of the podotrochlear apparatus: A good knowledge of the MR imaging appearance and anatomy and an awareness of potential pitfalls will improve diagnostic specificity for the detection of pathologic changes.