Question:

Which of the following answer choices is false?
1. In osteoid osteoma, the central "nidus" is hypointense on T1.
2. Sclerosis is visible in osteonecrosis.
3. Osteonecrotic bone may collapse.
4. MRI is always performed if tarsal coalition is suspected.
5. Accessory bones may have an abnormal signal on MRI because of oedema.





Answer:

The correct answer for the question "Which of the following answer choices is false?" is:

4. MRI is always performed if tarsal coalition is suspected.



Explanation
1. The nidus is hypointense on MR T1 weighted imaging. [The central "nidus" has low intensity T1-weighted MR images, due to the presence of calcification.]

2. A rim of sclerosis is visible all around the osteonecrotic area in the subchondral bone. [X-ray demonstrates a radiolucent area in the subchondral bone, surrounded by a rim of sclerosis.]

3. Osteonecrotic collapses usually occur in late disease. [Later in the disease course, the subchondral bone collapses.]

4. MRI is ordered when tarsal coalition is suspected, but x-rays are inconclusive. [MR imaging can help in the diagnosis of osseous coalition when results from conventional radiography are equivocal.]

5. Oedema may occur in accessory bones and it leads to an hypointense signal on T1 and hyperintense on T2 weighted MR imaging. [There is often bone oedema associated to accessory bones (hypointense on T1- and hyperintense on T2-weighted MR images).]



From the manuscript:
Spontaneous talar and calcaneal fracture in rheumatoid arthritis: a case report
Radiology Case. 2011 July; 5(7):15-23


This article belongs to the MSK section.




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From the manuscript

Spontaneous talar and calcaneal fracture in rheumatoid arthritis: a case report

Free full text article: Spontaneous talar and calcaneal fracture in rheumatoid arthritis: a case report

Abstract
Rheumatoid arthritis (RA) leads to a progressive weakening of the skeleton which may result in bone fractures. However, spontaneous fractures (exclusive of stress fractures, vertebral collapse, and superficial articular fragmentation) in patients with rheumatoid arthritis have been only occasionally reported in the medical literature. A case of spontaneous talar and calcaneal fracture in rheumatoid arthritis is described. Bone lesions were identified on radiographs, MR images and scintigraphy in a patient with right ankle pain. The absence of episodes of acute trauma, and the presence of acute clinical manifestations should guide the clinical suspicion.






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