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Musculoskeletal Imaging – The Basics. Laurie Lomasney, MD Department of Radiology Loyola University Medical Center. Musculoskeletal Imaging. Technology. Advances in Imaging. CONFUSION. MSK Imaging – Imaging Modalities. Plain Radiographs Nuclear Scintigraphy Ultrasound

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musculoskeletal imaging the basics

Musculoskeletal Imaging – The Basics

Laurie Lomasney, MD

Department of Radiology

Loyola University Medical Center

musculoskeletal imaging
Musculoskeletal Imaging

Technology

Advances in Imaging

CONFUSION

msk imaging imaging modalities
MSK Imaging – Imaging Modalities
  • Plain Radiographs
  • Nuclear Scintigraphy
  • Ultrasound
  • Computed Tomography
  • Magnetic Resonance Imaging
plain radiographs
Plain Radiographs
  • Widely available
  • Reproducible
  • Patient friendly
  • ‘Inexpensive’
  • Usually the indicated primary imaging modality
plain radiographs1
Plain Radiographs
  • Standard protocols available
  • Consider the pathology in question
    • Image area of question, not the vicinity
  • “One view is No view”
  • Supplemental views possible in most locations
plain radiographs 2 views1
Plain Radiographs – 2 views

Posterior Dislocation

nuclear scintigraphy
Nuclear Scintigraphy
  • Most common = Bone Scan
  • Very sensitive for skeletal pathology
  • Mildly sensitive for soft tissue pathology
  • Usually nonspecific as an isolated test
  • Mostly patient friendly; no significant environmental exposure
  • Small-moderate expense
nuclear scintigraphy1
Nuclear Scintigraphy
  • Excellent for specific pathologies
    • Osteomyelitis
    • Metastases – Not Multiple myeloma
    • Occult fracture
  • Reasonably reassuring
    • Normal is usually normal
nuclear scintigraphy bone scan
Nuclear scintigraphy – Bone Scan
  • IV injection radioisotope (Tc-99m) bound to phosphate +/- dynamic imaging
  • Approx 3 hour delay
  • Delayed static imaging with a superficial detector
nuclear scintigraphy2
Nuclear Scintigraphy

2nd MT stress fracture

ultrasound
Ultrasound
  • Not available at all institutions
  • Reproducible in trained hands
  • Excellent for superficial soft tissue elements including tendons and muscle
  • Patient friendly
  • Small to moderate expense
ultrasound1
Ultrasound
  • Routine exam room equipped with adequate imaging devices
  • Superficial gel (standard or aseptic) application with touch with transducer
  • Usually static exam of architecture +/- vascularity assessment
  • Potential for dynamic imaging
ultrasound2
Ultrasound

Cephalad

Ceph

Caud

Calcaneus

Caudad

ultrasound patellar tendon
Ultrasound – Patellar tendon

Proximal patellar tendonitis –

Jumper’s Knee

computed tomography ct
Computed Tomography (CT)
  • Widely available
  • Reproducible, although variety of techniques
  • Excellent bone assessment
  • Occasionally useful for soft tissue assessment
  • Patient friendly
  • Moderate expense
  • Interventional options
computed tomography
Computed Tomography
  • Usually supine axial exam, with some alternative positioning options
  • Can develop reformatted images after exam for alternative views
  • Imaging time in seconds, rarely minutes
  • Usually without IV or oral contrast
ct fractures
CT - Fractures

Scaphoid fracture

ct dislocation
CT - Dislocation

Lis Franc Fx/Dislocation

ct bony anomalies
CT – Bony anomalies

Midsubtalar coalition

magnetic resonance imaging
Magnetic Resonance Imaging
  • Widely available, but non-standardized imaging techniques
  • Reproducible
  • Excellent for soft tissue pathology
  • Good-excellent for bone pathology
  • NOT patient friendly
  • Large expense
mri absolute contraindications
MRI – Absolute Contraindications
  • Cardiac Pacemakers
  • Electronic stimulators
  • Metallic foreign bodies in the orbit
  • Body habitus beyond limits of physical unit
  • Huge listing maintained in MRI facility
mri relative contraindications
MRI - Relative Contraindications
  • Penile prostheses
  • IUD’s
  • Cardiac valves
  • Berry aneurysm clips
  • Retained bullet fragments
  • Claustrophobia
  • Huge listing in MRI facility
slide33
MRI
  • Usually performed with patient supine
  • Multiplanar imaging obtained without changing position
  • One exam = one body part
  • Average exam time 45 minutes; most patients can’t last >2 hours
  • Strict guidelines for sedation
  • Optional contrast – Rad usually decides for body imaging
slide34

OPEN

CLOSED

mri trauma
MRI – Trauma

Osteochondritis dissecans

mri trauma1
MRI – Trauma

Femoral Neck Fracture

mri trauma2
MRI - Trauma

Tear vastus medialis

mri internal derangement1
MRI – Internal Derangement

Supraspinatus tear= Full thickness, Full width

Coronal PD

Coronal T2

mri internal derangement2
MRI – Internal Derangement

Sagittal NL

Sagittal FT, FW Supra

mri internal derangement3
MRI – Internal Derangement

Sagittal, Meniscus NL

Posterior Horn Tear

mri internal derangement4
MRI – Internal Derangement

Bucket handle meniscal tear

mri internal derangement5
MRI – Internal Derangement

Sagittal – Intact ACL

Torn ACL

imaging
Imaging
  • Plain radiographs are usually the starting point
  • Most x-ray protocols work for most situations; Consider suppl. Views
  • Secondary imaging techniques have specific advantages and disadvantages
  • A specific question is more likely to get you a direct answer
  • When in doubt, ask a Radiologist
thank you

THANK YOU

Laurie Lomasney, MD