{
 "serie": "s401_T1_TSE",
 "n_imgs": 24,
 "s": 53.6,
 "respuesta": "**Series reviewed:** Axial (oblique axial) T1 TSE of the right ankle, 24 slices ordered from the plantar heel/hindfoot proximally through the talar dome to the distal tibia/fibula. T1 only – marrow oedema, joint effusion and ligament oedema cannot be reliably assessed without fluid‑sensitive sequences; findings below are limited accordingly.\n\n**Bones / marrow**\n- Distal tibia, fibula, talus, calcaneus, sustentaculum: normal homogeneous fatty marrow signal on all slices. No T1‑hypointense marrow‑replacing lesion, no fracture line, no cyst clearly identified. (high confidence for absence of gross marrow lesion)\n- Anterior tibial plafond / anterior talar neck (slices ~15–18): mild anterior cortical irregularity/beaking at the anterior tibial lip and dorsal talar neck, compatible with residual/recurrent small anterior osteophytes after the 2018 resection (anterior impingement configuration). (low–medium confidence)\n- Talar dome (slices ~14–17): no definite osteochondral lesion; a small focus of subtle subchondral irregularity of the medial dome cannot be excluded on T1 alone. (low confidence)\n- Calcaneus: no plantar or posterior enthesophyte of significance; posterior tuberosity normal. (medium)\n\n**Cartilage / joints**\n- Tibiotalar cartilage not resolvable on this sequence; joint spaces preserved. No obvious loose body. (low – limited by sequence)\n- Subtalar joint and sinus tarsi (slices ~11–14): sinus tarsi fat largely preserved, interosseous/cervical ligaments visible; mild intermediate signal partially replacing fat in the lateral sinus tarsi – possible mild post‑traumatic scarring. (low confidence)\n\n**Ligaments**\n- Anterolateral gutter (slices ~15–17): intermediate‑signal soft tissue thickening in the anterolateral gutter between the fibula and lateral talus, consistent with capsuloligamentous scarring / thickened ATFL remnant (post‑sprain, post‑arthroscopy, \"anterolateral impingement\" type appearance). (medium confidence)\n- Deltoid ligament (medial, slices ~14–16): heterogeneous, slightly thickened intermediate signal in the deep deltoid region – suggests chronic scarring rather than acute tear. (low confidence)\n- Syndesmosis (slices ~19–21): tibiofibular relationship normal; no widening of the incisura. (medium)\n\n**Tendons**\n- Achilles tendon (slices ~19–24): mildly plump ovoid contour with a few internal foci of intermediate signal in the distal free tendon; borderline for mild tendinosis, no discontinuity. (low confidence)\n- Peroneus longus/brevis: normal size and low signal in the retromalleolar groove, no split or subluxation. (medium–high)\n- Tibialis posterior, FDL, FHL: normal calibre and signal; no tenosynovial thickening evident on T1. (medium)\n- Anterior compartment tendons (tibialis anterior, EHL, EDL): normal. (medium)\n- Plantar fascia (slices 3–6): normal thickness at the calcaneal origin. (medium)\n\n**Joint fluid / soft tissues**\n- No large T1‑hypointense collection to suggest a large effusion or ganglion; small effusions cannot be excluded on T1. (low)\n- Kager's fat pad and subcutaneous fat: normal; no mass or focal fluid collection. (medium)\n- Muscles (abductor hallucis, quadratus plantae, flexor digitorum brevis, peroneals, posterior compartment): normal bulk and signal, no fatty atrophy. (medium–high)\n\n**Impression**\n1. Anterolateral gutter soft‑tissue thickening consistent with chronic capsuloligamentous scarring after prior lateral ankle sprain/arthroscopy – possible anterolateral impingement (medium).\n2. Mild anterior tibial/talar neck osteophytic remodelling, likely residual/recurrent after 2018 resection (low–medium).\n3. Possible mild chronic deltoid scarring; borderline distal Achilles tendinosis (low).\n4. No marrow‑replacing lesion, fracture or tendon tear identified. Correlation with PD/T2 fat‑suppressed sequences is required to assess oedema, effusion and cartilage."
}