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Figure 3d: (a) Oblique radiographs of distal femora in a 44-year-old woman show diaphyseal and metaphyseal heterogeneous osteosclerosis. Distal femora are enlarged, and periostitis is visible as a wavy contour (arrows) of the outer cortex. (b) Coronal T1-weighted spin-echo (350/15) MR image of both knees demonstrates symmetric low signal intensity of diaphyses and metaphyses. (c) Fat-suppressed T2-weighted spin-echo (2000/80) and (d) fat-suppressed gadolinium-enhanced T1-weighted spin-echo (340/15) MR images show heterogeneous signal intensity in the same areas. Epiphyses are partially involved with persistent fatty areas. Periostitis is visible as a line of high signal intensity at the outer aspect of femoral cortices (arrow). Osteoarthritis was also present and responsible for joint effusion and synovitis.
