Rad Tech 4643 MRI Torso and
Extremities
Positioning is still important !
Make sure anatomy is in middle of coil.
Mark pathologies.
Pad, Pad, Pad.
Explain the importance of holding still to
patient.
Use your x-ray skills.
Take Pride In Your Scan
Use correct scan planes to get anatomic
symmetry.
Know your anatomy.
Cover anatomy and pathology.
Use 3 plane locator to set up first scan, then
use that scan to set up the rest of you scans.
The Fundamental Tenets of
Musculoskeletal MRI for any joint are
Two-Fold.
- Define the Anatomy.
- Detect “abnormal” Fluid (Edema).
- Remember that “Chronic” injuries may not
have edema, thus detection of pathology may
solely depend on detection of aberrations in
anatomy.
Tendons and Ligaments
- Tendons – Connect Muscles to Bones
- Achilles…
- Ligaments- Connect Bones to Bones.
- ACL, PCL….
Knee - Anatomy
Knee - Anatomy
1.
Femur
6.
Anterior cruciate ligament
2.
Posterior cruciate ligament
7.
Infrapatellar fat pad
3.
Intercondylar eminence
8.
Articular cartilage
4.
Gastrocnemius muscle
9.
Medial patella
5.
Tibia
Knee -Anatomy
1.
Intercondylar notch
6.
Tibial intercondylar eminence
2.
Lateral epicondyle
7.
Medial meniscus
3.
Lateral collateral ligament
8.
Medial collateral ligament
4.
Popliteal ligament
9.
Medial condyle
5.
Lateral meniscus
10. Posterior cruciate ligament
Knee - Meniscus
Knee – Meniscus (Torn)
Diagram of meniscal tear patterns: (A) Vertical or
longitudinal (Bucket-handle), (B) Flap or
Oblique, (C) Radial or Transverse,
(D)Horizontal, (E) Complex degenerative
Knee
What
pathology is
shown?
* Meniscal tear *
Meniscal Tear
Knee
The optimal plane to use when
evaluating patients for cruciate
ligament tears of the knee is the:
* Oblique Sagittal *
Knee
What
pathology is
shown?
* ACL tear with bone contusion *
Knee
What
pathology
is shown?
* PCL tear with bone contusion *
Knee – Bone Contusion
Look for “kissing” contusions.
Look for ACL on Axial.
Another ACL Tear
Knee – Positioning
T1 = Anatomy and bone
issues.
T2 Fatsat= Pathology,
edema.
PD Fatsat= Cartilage,
meniscus.
ACL on Axial
If no ACL then plan off of lateral condyle.
What is this ?
MCL
Lateral Meniscus Tear
Old Knee.
Medial meniscus is worn out.
Bone Infarct ?
Foreign Body
Meniscus Tear
Knee – Baker’s Cyst
Synovial fluid has no place to go, so it ends up
between muscles in the Bakers Pocket. Named
after the British surgeon William Baker.
Same patient: medial meniscal tear with
Baker’s cyst.
Baker Cyst
Also known as a Popliteal cyst.
Etiology – herniation of the synovial
membrane or leakage of synovial fluid from
the bursa.
Epidemiology – meniscal injuries, articular
damage, collateral or cruciate injuries,
rheumatoid arthritis, loose bodies, and
internal derangement of the knee.
Osteomyelitis (infection)
Hamstring- Must cover
Ischial Tuberosity
Hamstring = group of tendons contracted by three posterior
thigh muscles (semitendinosus, semimembranosus and biceps
femoris) that make up the borders of the space behind the knee,
or their corresponding tendons.
Proximal attachment to Ischial
Tuberosity
Distal retraction of
hamstring
How old is Patient?
Meniscal tear and LCL strain.
Lateral Meniscal Tear
Biceps
Femoris
Attaches to the head of
the Fibula. The “long
head” arises from the
Ischial Tuberosity.
Ankle - Anatomy
1.
Achilles tendon
6.
Second cuneiform
2.
Calcaneous
7.
Third cuneiform
3.
Cuboid
8.
Navicular
4.
3rd metatarsal
9.
Talus
5.
2nd metatarsal
10. Tibia
Pertinent Ankle Anatomy to look for.
-
Talar Dome
Achilles Ligament
Peroneal Tendons
LisFranc
Flexor Tendons
Ankle - Anatomy
LisFranc Injury
Usually caused by trauma
(MVA). Dislocation or separation
of the Metatarsal bone from the
Tarsus.
Ankle - Achilles
Ankle
Ankle
TaloFibular Ligament
Osteomyelitis
Tenosynovitis
Inflammation of fluid filled sheath
which surrounds a tendon.
Common in the ankle post sprain.
Scanning the Foot
We usually scan either the fore foot or the
hind foot.
Fore foot is for ulcers, tumors, osteomyelitis.
Hind foot is same as Ankle protocol.
Benign Bone Tumors
1. Enchondroma- Cartilage cyst. Tend to show
scalloping of bone.
2. Chondroblastoma- Cartilage and bone. Rare,
seen in young people. Grows in growth plate,
epiphyseal. “Cartilage Cap” Tumor.
3. Intraosseous Lipoma- Most common
lipogenous lesion. Mostly found in proximal
femur and calcaneus.
Benign Bone Tumors
4. Bone cyst- Very common.
Fluid filled lesion. Can be filled with water
based fluid or blood (aneurysmal).
Usually bright on T2 and dark on T1.
Intraosseous Lipoma
Bone filler
Malignant Bone Tumors
1. Multiple Myeloma- CA of blood plasma.
2. Osteosarcoma- Most common bone cancer in
young people. Usually in large bones that have
under gone rapid growth.
3. Chondosarcoma- Most common in older
people. “Soft tissue” cancer.(Sarcoma).
Formed from cartilage.
Malignant Bone Tumors
4. Ewing’s Sarcoma- Usually occurs during
puberty. Can show up anywhere in body. Ten
times more common in caucasians. Often
metastasizes before diagnosis.(30%)
Osteosarcoma
Imaging Parameters
1.
2.
3.
4.
T1 Ax, Cor, Sag
T2 Fatsat or Stir Ax, Cor, Sag
Opt. PD Fatsat
Opt. 2D or 3D GRE T2*
5. Arthrograms- T1 FS and T2 FS all 3 planes.
Thanks.
Questions ?