Radiography of soft tissue of the foot and ankle with diffraction enhanced imaging - PubMed (original) (raw)

Radiography of soft tissue of the foot and ankle with diffraction enhanced imaging

Jun Li et al. J Anat. 2003 May.

Abstract

Non-calcified tissues, including tendons, ligaments, adipose tissue and cartilage, are not visible, for any practical purposes, with conventional X-ray imaging. Therefore, any pathological changes in these tissues generally necessitate detection through magnetic resonance imaging or ultrasound technology. Until recently the development of an X-ray imaging technique that could detect both bone and soft tissues seemed unrealistic. However, the introduction of diffraction enhanced X-ray imaging (DEI) which is capable of rendering images with absorption, refraction and scatter rejection qualities has allowed detection of specific soft tissues based on small differences in tissue densities. Here we show for the first time that DEI allows high contrast imaging of soft tissues, including ligaments, tendons and adipose tissue, of the human foot and ankle.

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Figures

Fig. 1

Fig. 1

Schematic representation of the DEI set-up at the NSLS synchrotron. The synchrotron beam, whose energy level is selected by the Si (3, 3, 3) double crystal monochromator, passes through the object and subsequently through a matching Si (3, 3, 3) analyser crystal that is located between the object and the detector. The high-resolution X-ray film and the radiographic image plate were used as the detectors. The beam from the synchrotron is a fan beam, 120 mm wide and 3 mm high, that extends into and out of the plane of the paper. The object and the detector are scanned perpendicular to the beams to create a planar image.

Fig. 2

Fig. 2

(a) Conventional synchrotron radiograph of the great toe that includes the distal portion of the first metatarsal (M), the sesamoid bones (S), the proximal phalanx (PP) and the distal phalanx (DP). The osteoporotic bones are evident as are the sclerotic vessels. (b) DE image of the same specimen as in (a) taken at +1 of the rocking curve. The major soft tissue structures that can be identified here, which are not visible in the above radiograph, include the two major tendons of the toe, the fat pad under the ball of the foot (which has been displaced distally somewhat) and the skin. The asterisk indicates the location of the muscles and tendons plantar to the first metatarsal bone. These cannot be delineated from one another in this image.

Fig. 3

Fig. 3

DE image taken at +2 of the rocking curve showing the bones and soft tissues of the ankle and proximal foot of a right lower extremity. Two dorsal tendons are apparent. Labelled structures are: 1, first metatarsal bone; 2, intrinsic muscles of the plantar aspect of the foot; 3, distal attachment of the Achilles tendon on the calcaneus; 4, body of the Achilles tendon; 5, fifth metatarsal bone; and 6, tendons and muscles lying posterior to the tibia and fibula, the most prominent of which is the fibularis longus whose tendon can be seen passing behind the lateral malleolus of the fibula, through the superimposed calcaneus and beneath the calcaneocuboid joint.

Fig. 4

Fig. 4

(a) Conventional synchrotron radiograph of the first metatarsophalangeal joint showing that only the bony components of the joint are visible: M, head of first metatarsal; S, sesamoid bone; P, base of proximal phalanx. (b) DE image of the same specimen at −1 of the rocking curve. Both articular cartilage and the surrounding connective tissue are visible. L, ligament between the head of the first metatarsal bone and base of the first proximal phalanx; C, capsule of the first metatarsophalangeal joint; MC, articular cartilage of the metatarsal; and PC, articular cartilage of the proximal phalanx. Note that the trabecular bone has taken on a three-dimensional appearance. This results from the combination of the refraction information with absorption and scatter-rejection information. Air bubbles are identified by an asterisk.

Fig. 5

Fig. 5

Enlarged DE images of the first metatarsophalangeal joint demonstrating how the character of the image changes at −1, the peak, and +1, respectively, of the rocking curve. M, head of first metatarsal; P, base of proximal phalanx. Note that the shadows have the opposite contrast in the −1 and +1 images. The solid arrows point to the outer boundary of the articular cartilage of the metatarsal while the interrupted arrows point to the outer boundary of the cartilage of the proximal phalanx.

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