0:00

Let's go to, um, one of these cases here that we have.

0:05

This is one that you will, I'm sure, um, uh,

0:09

commonly be asked to, um, look for when you are reading MRI.

0:15

So this was a patient, um, with a, um,

0:21

kind of a wound, a large wound, um,

0:25

over the plantar aspect of the foot, um,

0:30

and on exam,

0:31

and they were concerned, uh, for underlying osteomyelitis.

0:35

What you can see here is there is a, a very large kind of

0:40

wound and abnormality along the planter aspect

0:43

of the foot here.

0:45

Very thick walled, um, kind of collection

0:49

with central fluid here.

0:52

Um, so, um, if, if you're reading this,

0:55

you're gonna be concerned for a large abscess.

0:58

Um, you can see the central pocket of fluid here.

1:03

Whenever you're doing an osteomyelitis case, you always want

1:06

to, um, find the wound, locate the wound, uh, whether it's,

1:11

um, the media tab in the notes, uh,

1:13

or um, the clinical history.

1:16

Try to look in that area specifically

1:18

because deep to that is where you might see pathology.

1:21

And then what you do is you're gonna want

1:24

to look at the bones just deep to the, uh, the wound

1:29

and to see for abnormalities.

1:30

So in this case, uh, I might call this a large, uh, wound

1:33

with abscess.

1:35

Um, I'm looking at the underlying bones

1:38

and what you see is that it kind of tracks to the, um,

1:42

Taylor head here where there's a small amount

1:45

of bone marrow edema.

1:47

And we also wanna look

1:48

to see if we see T one marrow replacement.

1:50

Now in this case we'll show a more, a more,

1:52

uh, dramatic osteo case.

1:53

This, I would say is probably subtle.

1:55

We have a little bit of loss of the T one signal

1:58

and a little bit of high signal on, uh, on the stir.

2:00

So I would say there's probably mild osteomyelitis here,

2:03

but certainly this large, um, kind of collection.

2:06

So another case of osteo is a companion case.

2:11

See here, um, what we can see here is

2:16

that there is focal bone marrow edema

2:19

of the first toe distal phalanx.

2:22

And on T one

2:27

you see corresponding low signals.

2:29

So for a kind of a confident diagnosis of osteomyelitis,

2:33

you do wanna see low signal on T one,

2:37

high signal on T two.

2:39

Um, I like the T ones and the sagittals.

2:42

Um, as I'm sure you've seen, you can have failure

2:45

of fat suppression on a, uh,

2:48

T two fat set sometimes in the foot.

2:50

And so sort of that stir sequence seems to be more

2:53

of the true, uh, signal that I like to see.

2:56

So here on T one, lots of marrow,

3:00

Uh, on the T one low signal.

3:01

And then on the stir image you see high signal.

3:05

It's just deep to a wound.

3:07

And this was a case of acute osteomyelitis of the great

3:10

to distal phx.