52-year-old female with right fourth toe pain, history of rheumatoid arthritis Low T1, high T2/STIR signal within and replacing the fourth middle phalanx. Edema signal is noted within the fourth digit. The proximal phalanx and distal phalanx are normal in signal. No fluid collection to suggest abscess. The remainder of the osseous structures are normal in signal and appearance.The visualized tendons are normal in signal and appearance.
Low T1, high T2/STIR signal within and replacing the fourth middle phalanx with surrounding edema type signal may represent a fracture as clinically queried. A radiograph is recommended as this would demonstrate periosteal reaction at this time. Alternatively, this noncontrast imaging appearance may represent osteomyelitis in the correct clinical context. 