Thesis

136 Part I Chapter 5 Table 1. Calcaneonavicular coalitions, characteristic findings per modality Non-osseous Partly ossified Completely ossified Planar scintigraphy Focal activity (early and late) in the lateral aspect of the articulation between hind- and midfoot Focal activity (early and late) in the lateral aspect of the articulation between hind- and midfoot No abnormal activity at the ossified tarsal coalition site, but increased focal activity (also in the blood pool) in the surrounding structures (navicular bone and naviculocuneiform joints) SPECT/CT Focally increased bone turnover at narrowed joint space, Anteater Nose sign, surface irregularity, subchondral cysts. Rest of foot unremarkable. No synchronous pathology Better at delineating ossified fragments, but not for the soft tissue. Rest of foot unremarkable. No synchronous pathology No abnormal activity at the ossified tarsal coalition site. Precise localization of the naviculocuneiform joints activity and osteoarthritis (sites of pain) MRI Optimal soft tissue characterization Generalized edema in the area No bone edema at the site of osseous tarsal coalition, but may reveal surrounding marrow edema Plain radiograph Anteater nose sign, low sensitivity Anteater nose sign, low sensitivity Osseous calcaneonavicular tarsal coalition visualized CT, computed tomography. Table 2. Talocalcaneal coalitions, characteristic findings per modality Non-osseous Partly ossified Completely ossified Planar scintigraphy Focal activity (early and late) in the lateral aspect of the hindfoot Focal activity (early and late) in the lateral aspect of the hindfoot No abnormal activity at the ossified tarsal coalition site, but increased focal activity can be seen in the surrounding structures ( joints) SPECT/CT Focal activity (early and late) at narrowed joint space. Arthro-SPECT/ CT may help in the evaluation of joint space and cartilage. Semiquantitative estimation with SUVmax is possible. Rest of foot unremarkable. No synchronous pathology. Shows partially fused talocalcaneal coalitions with increased activity in the non-fused area (site of pain generation). Rest of foot unremarkable. No synchronous pathology. No abnormal activity at the ossified tarsal coalition site. Precise localization of the radiotracer activity and secondary osteoarthritis in the adjacent joints (site of pain generation).

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