Transcript Musculoskeletal Radiology Part I

Musculoskeletal Radiology
Nizar A. Al-Nakshabandi
MD, FRCPC
Part one
• Imaging Techniques in Orthopaedics
– Conventional Radiography
– Fluoroscopy
– Computed Tomography
– Arthrography
– Angiography
– Ultrasound
– Scintigraphy
– Magnetic Resonance Imaging
Part two
• Upper limb MSK anatomy
• Lower limb MSK anatomy
Imaging Techniques in
Orthopaedics.
• Use of Radiological Techniques methods
in evaluating the presence, type, and
extents of various bone, joints and soft
tissue abnormality.
• Indications
• Limitations
• Appropriate imaging approach
The question
• “What modalities should I use for this
particular problem” is frequently asked by
Radiologists and Orthopaedic Surgeons
alike.
• Conventional Radiograph
• The choice of imaging technique is
dictated by the type of suspected
abnormality
CONVENTIONAL RADIOGRAPHY:
• The most frequently used modality for
evaluation of bone and joint disorder
• The radiologist should obtain at least two
(2) views of the bone involved at 90°
angles to each other
• with each view including two adjacent
joints
AP & lat
Additional views
standard films compromised the
anterio-posterior and lateral views.
Occasionally, oblique and special
views
elbow, wrist, ankle, and pelvis
Cervical Spine X-ray, 3/4 (Left Neural
Foramina). 1, Rib. 2, Clavicle. 3, Neural
Foramina. 4, Pedicle. 5, Trachea.
FLUOROSCOPY:
• Many radiologic procedures
– Arthrography
– Tenography
– Versography
– Arteriography
– Percutaneous Bone or Soft Tissue Biopsy.
COMPUTED TOMOGRAPHY:
COMPONENTS:
-X ray source
-Detectors
- Computer data
processing system
Uses of CT
• Trauma
– Intraarticular
abnormalities
– Detection of small
bony fragements
Complex hip fractures
CT Vs. Xray
• Advantages:
– Excellent contrast
resolution.
– Measures the tissue
attenuation coefficient
– Obtain transaxial
images
– Reformation
• Disadvantages:
– Radiation
– Inability to make a
specific diagnosis
Uses -Tumors
• Delineates tumors
extent
• Soft tissue extension.
• Presence of
Calcification
• Biopsy
Arthrography
• Arthrography is introduction of contrast
agent positive contrast iodine iodide
solution negative contrast, air or
combination of both into the joint space.
• Advantages:
– Simple
– Effective
Arthrography
• Any joint
–
–
–
–
Shoulder
Ankle
Elbow
Knee
Angiography
• Advantages:
1.
Map-out bone lesions
2.
Demonstrate the vascularity of the lesion.
3.
Demonstrate the vascular supply of a tumor
4.
Locate vessels suitable for pre operative
intraarterial chemotherapy.
5.
Demonstrating the area suitable for open
biopsy.
ULTRASOUND:
• Rarely used
• Advantages:
– inexpensive
– allows comparison
with the opposite side,
normal side
– uses no ionizing
radiation,
– performed at bed side
or in the operating
room.
– It is a non invasive
modality
Applications
• Evaluation of the rotator cuff
• Injuries to various tendons, e.g. the
achilles tendons.
• Evaluation of the infant hip for which
ultrasound has become the imaging
modality of choice
Shoulder US
SCINTIGRAPHY RADIONUCLIDE
BONE SCAN
• image the entire skeleton at once.
• It provides a metabolic picture.
• It is particularly helpful in condition such as
fibrodysplasia, Langerhans Cell
Histocytosis or metastatic cancer.
Prostate Mets
MRI
• Magnet
• RF coils
• Computer
MRI
• The musculoskeletal
system is ideally suited
for evaluation by MRI
since different tissue
displayed different signal
intensities on T1 & T2
weighted images. The
images displayed may
have a low signal
intensity, intermediate
signal intensity, or high
signal intensity
MRI-uses
• Traumatic & nontraumatic conditions
– Bone
– Soft tissue
– Contusions
– Microfractures
Relation to neurovascular bundle
Tumor composition
MRI Contraindications
• ABSOLOUTE
– Patients with cardiac pacemakers
– Cerebral aneurysm clips
• RELATIVE:
– Claustrophobia.
Summary
• Imaging Techniques in Orthopaedics
– Conventional Radiography
– Fluoroscopy
– Computed Tomography
– Arthrography
– Angiography
– Ultrasound
– Scintigraphy
– Magnetic Resonance Imaging
Radiologic Anatomy of the
Musculoskeletal System
Upper limb
B
A
C
K
L
J
I
M
F
E
H
G
C
D
A
B
Radiologic Anatomy of the
Musculoskeletal System
Lower limb
D
E
A
B
C
F
G
H I
J
D E
B
A
F
C
A
D
C
B
F
E