(BQ) Part 1 book Basic musculoskeletal imaging presents the following contents: Imaging modalities used in musculoskeletal radiology, axial skeletal trauma, pediatric skeletal trauma, arthritis and infection, metabolic bone diseases, bone infarct and osteochondrosis,...
a LANGE medical book BASIC MUSCULOSKELETAL IMAGING Editor Jamshid Tehranzadeh, MD Director of Musculoskeletal Imaging Chief of Radiology and Nuclear Medicine Imaging/Radiation Therapy Veterans Affairs Long Beach Healthcare System Long Beach, California Emeritus Professor and Vice Chair of Radiology University of California, Irvine Irvine, California New York Chicago San Francisco Athens London Madrid Mexico City Milan New Delhi Singapore Sydney Toronto Copyright © 2014 by McGraw-Hill Education All rights reserved Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher ISBN: 978-0-07-178791-8 MHID: 0-07-178791-7 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-178702-4, MHID: 0-07-178702-X E-book conversion by codeMantra Version 1.0 All trademarks 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in contract, tort or otherwise This book is dedicated to Donald Resnick, MD, a living legend in radiology who is my role model and a great source of inspiration for thousands of radiologists in the world This page intentionally left blank Contents Contributors Foreword Preface Imaging Modalities Used in Musculoskeletal Radiology 11 Signs in Musculoskeletal Radiology vii ix x Amilcare Gentili and Shazia Ashfaq 12 Shoulder MRI 13 Knee MRI 15 14 Spine MRI 29 15 Elbow MRI 41 16 Wrist MRI 57 17 Hip MRI 69 18 Ankle MRI 117 19 Musculoskeletal Ultrasound 169 407 Sabrina Véras Britto, Juan Manuel Cepparo, Laurent Vandenbusche, Ramon Gheno, Jader José da Silva, and Anne Cotten Quazi Al-Tariq, Benjamin D Levine, Kambiz Motamedi, and Leanne L Seeger Bone Infarct and Osteochondrosis 379 Shahla Modarresi, Daria Motamedi, and Cecilia M Jude Aydin Soheili, Maryam Golshan Momeni, and Jamshid Tehranzadeh Metabolic Bone Diseases 363 Rajeev K Varma and Ben Plotkin Michael E Cody and Jamshid Tehranzadeh Tumors 349 Maryam Golshan Momeni and Hiroshi Yoshioka Marcia F Blacksin and Cornelia Wenokor Arthritis and Infection 335 Rajeev K Varma and Alya Sheikh Marcia F Blacksin and Cornelia Wenokor Pediatric Skeletal Trauma 311 Samuel Song and Jason Handwerker Cornelia Wenokor and Marcia F Blacksin Axial Skeletal Trauma 289 Arash David Tehranzadeh Cornelia Wenokor and Marcia F Blacksin Skeletal Trauma: Lower Extremity 275 Farzad Rezai Joseph E Burns Skeletal Trauma: Upper Extremity 233 193 20 Musculoskeletal Scintigraphy David T Nakamura and Jamshid Tehranzadeh 425 Mark Chambers 10 Orthopedic Hardware and Complications 211 Index Reza Dehdari and Minal Tapadia Color insert appears between pages 438 and 439 v 457 This page intentionally left blank Contributors Quazi Al-Tariq, MD Reza Dehdari, MD Radiology Resident, Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California Radiologist, Department of Radiology, University of California, Irvine, Irvine, California Amilcare Gentili, MD Shazia Ashfaq, MD Research Fellow, University of California, San Diego, La Jolla, California Chief of Radiology, San Diego VA HCS, Professor of Clinical Radiology, University of California, San Diego School of Medicine, San Diego, California Marcia F Blacksin, MD Ramon Gheno, MD Professor of Radiology, Department of Radiology, University of Medicine & Dentistry – New Jersey Medical School, University Hospital, Newark, New Jersey Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultation et d’Imagerie de l’Appareil Locomoteur, CHRU de Lille, Lille, France Sabrina Véras Britto, MD Jason Handwerker, MD Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultation et d’Imagerie de l’Appareil Locomoteur, CHRU de Lille, Lille, France, Serviỗo de Radiologia Mỳsculo Esquelộtica, Santa Casa de Misericúrdia de São Paulo, São Paulo, Brasil Assistant Professor of Radiology, University of California Irvine, Orange, California Cecilia M Jude, MD Health Sciences Associate Clinical Professor, David Geffen School of Medicine at University of California, Los Angeles, Olive View – UCLA Medical Center, Sylmar, California Joseph E Burns, MD, PhD Associate Clinical Professor, Department of Radiological Sciences, University of California, Irvine School of Medicine, Orange, California Benjamin D Levine, MD Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultation et d’Imagerie de l’Appareil Locomoteur, CHRU de Lille, Lille, France Assistant Professor Musculoskeletal Imaging, Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, Santa MonicaUCLA Medical Center and Orthopedic Hospital, Santa Monica, California Mark Chambers, DVM, PhD, MD Shahla Modarresi, MD Health Sciences Assistant Professor of Radiology, University of California Irvine, Radiology/Nuclear Medicine Imaging Service, Veterans Affairs Long Beach Healthcare System, Long Beach, California Health Sciences Associate Clinical Professor, David Geffen School of Medicine at University of California, Los Angeles, West Los Angeles VA Medical Center, Los Angeles, California Michael E Cody, MD Maryam Golshan Momeni, MD Radiology Resident, University of California, Irvine Medical Center, Orange, California Clinical Instructor/Musculoskeletal Fellow, University of California, Irvine, Orange, California Anne Cotten, MD, PhD Daria Motamedi, MD Professor of Radiology and Head of the Department of Musculoskeletal Radiology, Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultation et d’Imagerie de l’Appareil Locomoteur, CHRU de Lille, Lille, France Musculoskeletal Fellow, University of California San Diego, San Diego, California Juan Manuel Cepparo, MD Kambiz Motamedi, MD Associate Professor of Radiology, University of California, Los Angeles, California vii viii ᮡ CONTRIBUTORS David T Nakamura, MD Minal Tapadia, MD, JD, MA Radiology Resident, University of California, Irvine, Orange, California Orthopedic Resident, Department of Orthopedic Surgery, University of California, Irvine, Orange, California Ben Plotkin, MD Arash David Tehranzadeh, MD Assistant Professor of Radiological Sciences at University of California, Los Angeles, Harbor-UCLA Medical Center, Torrance, California Attending Radiologist, Kerlan-Jobe Integrated Facility/ Centinela Radiology Medical Group, Los Angeles, California Farzad Rezai, MD Jamshid Tehranzadeh, MD Attending Radiologist, VA Long Beach, Long Beach, California Director of Musculoskeletal Imaging, Chief of Radiology and Nuclear Medicine Imaging/Radiation Therapy at VA Long Beach Healthcare System, Long Beach, California, Emeritus Professor and Vice Chair of Radiology at University of California, Irvine Leanne L Seeger, MD Professor and Chief Musculoskeletal Imaging, Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California Alya Sheikh, MD Assistant Professor of Radiological Sciences at University of California, Los Angeles, Body Imaging at Harbor-UCLA Medical Center, Torrance, California Jader José da Silva, MD Serviỗo de Radiologia Mỳsculo Esquelộtica Hospital Coraỗóo, Sóo Paulo, Brasil Laurent Vandenbusche, MD Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultation et d’Imagerie de l’Appareil Locomoteur, CHRU de Lille, Lille, France Rajeev K Varma, MD Associate Professor of Radiological Sciences at University of California, Los Angeles, Section Chief, Musculoskeletal Imaging at Harbor-UCLA Medical Center, Torrance, California Cornelia Wenokor, MD Aydin Soheili, MD Radiology Resident PGY3, University of California, Irvine, Orange, California Assistant Professor of Radiology, Department of Radiology, University of Medicine & Dentistry – New Jersey Medical School, University Hospital, Newark, New Jersey Samuel Song, MD Hiroshi Yoshioka, MD, PhD Neuroradiology Fellow, University of California, Irvine, Orange, California Professor of Radiology, Musculoskeletal Section Chief, University of California, Irvine, Orange, California Foreword My own desire to become a radiologist took shape during my time as a medical student years ago, when I first began reading some of the basic texts in radiology My decision to specialize in bone imaging occurred during my radiology residency, once again based in part on reading some of the classic texts in musculoskeletal radiology So I know firsthand the importance of books to many medical students and radiology residents as they try to find the specialty or subspecialty that is right for them Because of this, I am excited to write a foreword for a book that, I believe, will fill a void in the literature and is long overdue Jamshid (Jim) Tehranzadeh has edited a masterpiece, Basic Musculoskeletal Imaging, that is filled with useful information, pearls, and pitfalls and is ideally suited to medical students and residents in many different fields who want to learn more about this subspecialty He and his contributors are to be congratulated for recognizing the need for such a publication and for filling this void All the necessary information is here Chapters are written by both internationally recognized experts in the field and young enthusiastic “bone-lovers,” and these chapters cover a wide range of subjects The reader can find material dealing with the axial and appendicular skeleton and the ways in which it reacts to trauma, tumor, ischemia, infection, surgical intervention, and other processes This skeletal reaction is displayed vividly with a variety of imaging techniques that include conventional radiography, CT scanning, ultrasonography, and MR imaging Indeed, separate chapters summarize the role of MR imaging in the assessment of disorders of the shoulder, elbow, wrist, hip, knee, ankle, and spine Each chapter is focused and concise, emphasizing information that is critical to accurate diagnosis, containing pearls of wisdom and employing highly appropriate illustrations In addition, the material is easy to read and to digest, with “take-home” messages in every chapter This is a book that is stimulating as well as informative, and it is one that, once opened, will be hard to put down I want to personally congratulate Jim and the contributors for taking on this task They and the publisher correctly saw the need for a text dedicated to medical students and residents (in radiology, orthopedic surgery, and other fields) that would serve as an easy-to-read source for information related to musculoskeletal imaging As an author myself, I fully recognize that considerable thought and effort went into this project to ensure that the book contained information that is highly organized and essential to such imaging Yes, a void has been filled with the publication of this work Now, as was the case early in my medical education, there exists a text that will stimulate many medical students and residents and, for some, may prove influential in the choice of a specific career A job well done and one for which I am indeed honored to write this foreword Donald Resnick, MD Professor of Radiology Chief, Musculoskeletal Imaging University of California, San Diego School of Medicine San Diego, California September 2013 ix BONE INFARCT AND OSTEOCHONDROSIS A ᮡ 207 B ᮡ Figure 9-19 Transient osteoporosis of the left hip A 63-year-old man with left hip pain (A) AP radiograph shows left hip osteoporosis and bilateral hip joint narrowing due to osteoarthritis (B) MRI T2 fat-saturated image shows marrow edema of the femoral head and neck on the left side with small joint effusion consistent with transient osteoporosis of the left hip period between the infarction and the onset of malignancy In the following section, a few of the more commonly seen osteonecrotic sites will be discussed ᮣ Idiopathic AVN of Adult Femoral Head Osteonecrosis that occurs without a discernable risk factor or predisposing condition is termed idiopathic/primary/ spontaneous osteonecrosis Most commonly, this type of osteonecrosis involves the femoral head At this site, spontaneous osteonecrosis is also known eponymously as Chandler disease Spontaneous osteonecrosis of the femoral head occurs most commonly in middle-aged and elderly men and is radiographically indistinguishable from other causes of osteonecrosis ᮣ Spontaneous Osteonecrosis of the Knee (SONK) When spontaneous osteonecrosis occurs about the knee (SONK), there is traditionally sudden onset of pain, typically in elderly women This type of osteonecrosis is usually unilateral and involves femoral condylar flattening on radiographs (Figure 9-20), sometimes weeks or months after the initial event SONK usually affects the weight-bearing surface of the condyle This condition is actually an insufficiency subchondral fracture and is highly associated with meniscal surgery, which suggests an association between meniscal pathology and underlying osseous vascularity Classically, the differential for SONK includes OCD, but OCD tends to occur in younger patients and at the non-weight-bearing surface of the medial femoral condyle ᮡ Figure 9-20 Spontaneous osteonecrosis of the knee (SONK) The AP view (A) of the knee shows mild sclerosis of the medial femoral condyle (incidentally noted is chondrocalcinosis) T1-weighted coronal image (B) shows low signal edema of the marrow in the medial femoral condyle T2weighted fat saturated coronal image (C) shows bone marrow edema in the medial femoral condyle with linear dark signal in the subchondral bone suggesting subchondral insufficiency fracture (arrow) (continued) A B 208 ᮡ CHAPTER ᮣ Kümmell Disease Post-traumatic osteonecrosis of a vertebral body may result in its delayed collapse Gas may be collected in the collapsed bone This type of osteonecrosis of a vertebral body typically occurs in the thoracic or lumbar spine and is termed Kümmell disease8 (Figure 9-21) Gas within a vertebral body is virtually pathognomonic for this entity and should be differentiated from vacuum disc phenomenon, wherein gas is noted within an intervertebral disc space The later entity is degenerative in nature Other relatively common sites of post-traumatic osteonecrosis include the talus, humerus, and the scaphoid, commonly in the presence of fracture PEARLS ᮣ ᮣ ᮣ C ᮡ Figure 9-20 (Continued) A ᮡ Osteonecrosis is synonymous with avascular necrosis (AVN) A multitude of conditions may result in solitary or multiple regions of osteonecrosis A good mnemonic is PLASTIC RAGS Radiographically osteonecrosis may appear as a bizarre mixed-density lesion with so-called “geographic” margins B Figure 9-21 Kümmell disease of the thoracic vertebra Lateral view (A) of the thoracic spine shows collapse of the vertebral body of the thoracic spine (arrow) The axial CT image at this level (B) shows gas (vacuum phenomenon) in the collapsed vertebra Images from Bush C Vertebral osteonecrosis (Kümmell Disease) In: Tehranzadeh J, ed Musculoskeletal Imaging Cases New York, NY: McGraw-Hill; 2009:846-847 BONE INFARCT AND OSTEOCHONDROSIS REFERENCES Edge A, Porter K Osteochondritis dissecans: a review Trauma 2011;13:23-33 Kim H Legg-Calve-Perthes disease: etiology, pathogenesis and biology J Pediatr Orthop 2011;31:S141-S146 DeVries G, Amiot R, Cummings P, Sockrider N Freiberg’s infraction of the second metatarsal treated with autologous osteochondral transplantation and external fixation J Foot Ankle Surg 2008;47:565-570 Lesley N, Lichtman D Classification and treatment of Kienbock’s disease: a review of the past 100 years and a look at the future HandchirMikrochirPlastChir 2010;42:171-176 ᮡ 209 Stoane J, Poplausky M, Haller J, Berdon W Panner’s disease: X-Ray, MR imaging findings and review of the literature Comput Med Imaging Graph 1996;19:473-476 Gholve P, Scher D, Khakaria S, et al Osgood Schlatter syndrome Curr Opin Pediatr 2007;19:44-50 Schoenecker P, Meade W, Pierron R, et al Blount’s disease: a retrospective review and recommendations for treatment J Pediatr Orthop 1985;5:181-186 Swartz K, Fee D Kummell’s disease: a case report and literature review SPINE 2008;33:E152-E155 This page intentionally left blank ... in Musculoskeletal Radiology 11 Signs in Musculoskeletal Radiology vii ix x Amilcare Gentili and Shazia Ashfaq 12 Shoulder MRI 13 Knee MRI 15 14 Spine MRI 29 15 Elbow MRI 41 16 Wrist MRI 57 17 ... 978-0-07 -17 87 91- 8 MHID: 0-07 -17 87 91- 7 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07 -17 8702-4, MHID: 0-07 -17 8702-X E-book conversion by codeMantra Version 1. 0... Knee MRI 15 14 Spine MRI 29 15 Elbow MRI 41 16 Wrist MRI 57 17 Hip MRI 69 18 Ankle MRI 11 7 19 Musculoskeletal Ultrasound 16 9 407 Sabrina Véras Britto, Juan Manuel Cepparo, Laurent Vandenbusche,