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Musculoskeletal Radiology

Musculoskeletal Radiology. Dr.Bashar Adnan College of Medicine Almuthanna University. Part one. Imaging Techniques in Orthopaedics Conventional Radiography Fluoroscopy Computed Tomography Arthrography Angiography Ultrasound Scintigraphy Magnetic Resonance Imaging. Part two.

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Musculoskeletal Radiology

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  1. Musculoskeletal Radiology Dr.Bashar Adnan College of Medicine Almuthanna University

  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 • Evaluation of certain abnormalities of the joints. • Injuries to various tendons, e.g. the achilles tendons. • Evaluation of the infant hip for which ultrasound has become the imaging modality of choice • Guiding the intra articular injections.

  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 • ABSOLUTE • 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

  42. D A B C

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