Fig. 2

Fifty eight year-old diabetic male patient presented with chronic right heel ulcer with suspected diabetic foot osteomyelitis. A Sagittal T2 SPAIR shows diffuse bone marrow edema-like changes involving the calcaneus (circle) with inferior calcaneal fluid signal abscess (white arrows) which contains a small low signal focus likely air bubble (yellow arrow), note the skin ulcer (dashed arrow). B–D Short axis IP, OP and fluid only images show persistent signal of the inferior calcaneal abscess demonstrate by visual and quantitative assessments of OP and IP with high signal intensity ratio = 1.09. The remaining upper portion of the calcaneus demonstrates diffuse visual and quantitative signal nulling on OP image (C) compared to IP image (B) (signal intensity ratio = 0.65). Note that the marrow edema signals show faint hyperintensity on fluid only image (D) compared with that on T2 SPAIR (A) due the T1 weighting of Dixon sequence. Features are consistent with calcaneal osteomyelitis with adjacent reactive edema signals