Musculoskeletal Radiology

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 viewsstandard 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

tumor4. 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 & non-traumatic 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

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Radiologic Anatomy of the Musculoskeletal System

Lower limb

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B C

D E F

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