{
 "serie": "s701_DP_SPAIR_COR",
 "n_imgs": 24,
 "s": 59.2,
 "respuesta": "**Series:** Coronal PD SPAIR (fat‑suppressed, fluid‑sensitive), right ankle, 24 slices ordered anterior → posterior (talar head/midfoot on the first slices, tibiotalar joint and hindfoot in the middle, posterior calcaneus/Achilles region on the last slices). Image left = lateral (fibula), image right = medial.\n\n**Bones / marrow**\n- Distal tibia, fibula, talus, calcaneus, navicular/cuboid: no definite focal marrow edema, fracture line or osteochondral defect on these sampled slices. Talar dome (slices 9–11) appears without a confidently identifiable subchondral cyst or edema focus. *Confidence: medium (sampling is coarse; a small medial/lateral dome OCL cannot be excluded).*\n- Medial malleolar tip (slices 10–12): faint increased signal at the tip/deltoid attachment. Possible mild reactive change or deltoid enthesopathy rather than fracture. *Confidence: low.*\n\n**Joints / fluid**\n- Tibiotalar joint: thin rim of high‑signal fluid along the joint line and medial/lateral gutters (slices 9–11) – small joint effusion, not gross. *Confidence: medium.*\n- Sinus tarsi / posterior subtalar region (slices 8–10): increased fluid‑like signal in the sinus tarsi between the lateral talar neck/body and calcaneus, with less well‑defined interosseous/cervical ligament fibres. Suggests sinus tarsi edema / posterior subtalar–sinus tarsi fluid, compatible with sinus tarsi syndrome after remote sprain. *Confidence: medium.*\n\n**Ligaments**\n- Lateral collateral complex (ATFL/CFL region, anterolateral slices 5–8 and lateral to the fibular tip slices 9–12): ill‑defined intermediate/bright signal at the fibular tip and anterolateral gutter rather than a crisp low‑signal band – consistent with chronic scarring/thickening (remote ATFL ± CFL injury). *Confidence: low–medium (coronal plane not optimal for ATFL).*\n- Deltoid ligament: appears intact but slightly heterogeneous at the medial malleolar attachment (see above). *Confidence: low.*\n- Syndesmosis: no gross fluid between distal tibia and fibula. Normal, *medium confidence*.\n\n**Tendons / medial soft tissues**\n- Medial hindfoot (slices 11–17): curvilinear high signal tracking along the medial wall of the calcaneus beneath the sustentaculum tali and extending toward the plantar aspect – in the course of the flexor tendons (FHL/FDL) and posterior tibial neurovascular bundle. Most likely fluid in the flexor tendon sheaths (FHL/FDL tenosynovitis) and/or prominent venous plexus; no clear intratendinous tear seen. *Confidence: medium for abnormal medial fluid/edema, low for the specific tendon.*\n- Lateral (peroneal) side (slices 9–13): mild high signal along the posterolateral fibula/peroneal groove – possible small amount of peroneal tendon sheath fluid; tendons themselves appear preserved. *Confidence: low.*\n- Achilles tendon (posterior slices 17–20): preserved low‑signal, no thickening or intrasubstance signal identified. Bright curvilinear signal along the superior/posterior calcaneal margin adjacent to the insertion (slices 16–18) may represent minor retrocalcaneal bursal fluid. *Confidence: low.*\n- Anterior/extensor tendons and tibialis posterior: no definite abnormality. *Confidence: medium.*\n\n**Cartilage**\n- Tibiotalar and subtalar cartilage not confidently assessable at this resolution; no gross full‑thickness defect seen. *Confidence: low.*\n\n**Other soft tissues**\n- Mild increased signal in the medial and plantar peri‑calcaneal soft tissues (slices 13–18), likely mild subcutaneous/peritendinous edema; no discrete mass or collection. *Confidence: low–medium.*\n- Muscle signal of the leg and foot intrinsics normal; no denervation edema. *Confidence: medium.*\n\n**Impression**\n1. Small tibiotalar effusion with sinus tarsi fluid/edema – findings compatible with post‑sprain sinus tarsi syndrome / chronic lateral instability sequelae.\n2. Chronic‑appearing scarring/thickening of the lateral collateral ligament complex at the fibular tip (remote ATFL ± CFL injury) – low‑medium confidence.\n3. Fluid along the medial flexor tendon compartment beneath the sustentaculum, favouring FHL/FDL tenosynovitis (vs. prominent veins).\n4. Possible mild peroneal sheath fluid and minor retrocalcaneal bursal fluid – low confidence.\n5. No definite marrow edema, fracture or talar osteochondral lesion on the sampled slices; correlation with the full stack and the sagittal/axial sequences is recommended for the talar dome and ATFL."
}