A 32-year-old male imaged for left ankle pain. (A) Coronal SPAIR MR image demonstrates a medial osteochondral lesions of the talus (OLT) manifest by a sub-chondral cyst (arrow) with associated bone marrow oedema (arrowhead). (B) Coronal SPECT-CT MPR demonstrates the cyst with a sclerotic margin (arrow) and increased uptake in the surrounding bone.