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Musculoskeletal Radiology

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

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Musculoskeletal Radiology

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  1. Musculoskeletal Radiology Nizar A. Al-Nakshabandi MD, FRCPC

  2. Part one • ImagingTechniques in Orthopaedics • Conventional Radiography • Fluoroscopy • Computed Tomography • Arthrography • Angiography • Ultrasound • Scintigraphy • Magnetic Resonance Imaging

  3. Part two • Upper limb MSK anatomy • Lower limb MSK anatomy

  4. 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

  5. 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

  6. 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

  7. AP & lat

  8. 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.

  9. FLUOROSCOPY: • Many radiologic procedures • Arthrography • Tenography • Versography • Arteriography • Percutaneous Bone or Soft Tissue Biopsy.

  10. COMPUTED TOMOGRAPHY: COMPONENTS: -X ray source -Detectors - Computer data processing system

  11. Uses of CT • Trauma • Intraarticular abnormalities • Detection of small bony fragements

  12. Complex hip fractures

  13. Advantages: Excellent contrast resolution. Measures the tissue attenuation coefficient Obtain transaxial images Reformation Disadvantages: Radiation Inability to make a specific diagnosis CT Vs. Xray

  14. Uses -Tumors • Delineates tumors extent • Soft tissue extension. • Presence of Calcification • Biopsy

  15. 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

  16. Arthrography • Any joint • Shoulder • Ankle • Elbow • Knee

  17. Angiography • Advantages: • Map-out bone lesions • Demonstrate the vascularity of the lesion. • Demonstrate the vascular supply of a tumor • Locate vessels suitable for pre operative intraarterial chemotherapy. • Demonstrating the area suitable for open biopsy.

  18. 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

  19. 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

  20. Shoulder US

  21. 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.

  22. Prostate Mets

  23. MRI • Magnet • RF coils • Computer

  24. 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

  25. MRI-uses • Traumatic & non-traumatic conditions • Bone • Soft tissue • Contusions • Microfractures

  26. Relation to neurovascular bundle

  27. Tumor composition

  28. MRI Contraindications • ABSOLOUTE • Patients with cardiac pacemakers • Cerebral aneurysm clips • RELATIVE: • Claustrophobia.

  29. Summary • ImagingTechniques in Orthopaedics • Conventional Radiography • Fluoroscopy • Computed Tomography • Arthrography • Angiography • Ultrasound • Scintigraphy • Magnetic Resonance Imaging

  30. Radiologic Anatomy of the Musculoskeletal System Upper limb

  31. 1

  32. B A C

  33. 2

  34. B A

  35. 3

  36. C A D B

  37. 4

  38. A B C

  39. 5

  40. D A B C

  41. 6

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