reading and understanding mri · 2019. 7. 9. · mri anatomy of the musculoskeletal system followed...
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Reading and understanding MRI
Stephen T Sweriduk, MD
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This workshop will cover basic MRI anatomy of the
musculoskeletal system followed by examples of common sports
related injuries.
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Musculoskeletal MRI
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Knee MRI
• Knee pain of undetermined etiology• Suspected internal derangement• Meniscal tear, discoid meniscus• Bone contusion, occult fracture• Cruciate and collateral ligament injury• Chondromalacia, patellar tracking disorder• Popliteal cyst, mass• Post-op• bursitis
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MENISCAL TEAR
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Bone Infarct
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Stress fracture
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Shoulder MRI
• Shoulder pain of undetermined etiology• Rotator cuff tendinosis, tear• Labral tear, instability• Biceps tendon tear, slap lesion• Nerve impingement• Bursitis• Fracture• Impingement syndrome
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Rotator Cuff Tear
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Hip MRI
• AVN• CDH• Transient osteoporosis• Occult fracture• Stress fracture• Transient osteoporosis• Infection• bursitis
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April
May
Regional Migratory Osteoporosis
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Avascular Necrosis
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Foot and ankle MRI
• Ankle and foot pain of undetermined etiology• Tendon and ligament injuries• Sinus tarsi syndrome• Tarsal tunnel syndrome• Plantar fasciitis• Neuroma• Diabetic foot• Infection• Foreign body
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Achilles tendon tear
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Osteomyelitis
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Stress fracture
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TMJ MRI
• Internal derangement• Closed lock• clicking
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Left closed lock Right reduced
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ACUTE LOW BACK PAIN
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ACUTE LOW BACK PAIN
• DURATION LESS THAN 3 MONTHS• MOST COMMON CAUSE OF DISABILITY
FOR PERSONS UNDER AGE 45• UNCOMPLICATED ACUTE LOW BACK PAIN
IS A BENIGN, SELF-LIMITED CONDITION WHICH DOES NOT WARRANT ANY IMAGING STUDIES (ACR APPROPRIATENESS CRITERIA 2000)
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LOW BACK PAIN CHALLENGE
• DISTINGUISH SMALL SEGMENT WITHIN LARGE POPULATION WHICH SHOULD BE EVALUATED FURTHER
• Relationship between degenerative disc disease and low back pain not firmly established
• Presence of disc abnormalities in asymptomatic population well known
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• 1956: McRae performed post mortem studies on entire spine in pts presumed free of symptoms. 40% had HNP at autopsy.
• In asymptomatic pts, 24% of myelograms and 36% of CT scans show disc extension beyond interspace
• Jensen: 52% asyptomatic pts have disc bulge, 27% have protrusion
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LOW BACK PAINRED FLAGS
• RECENT SIGNIFICANT TRAUMA, OR MILDER TRAUMA > AGE 50
• UNEXPLAINED WEIGHT LOSS• UNEXPLAINED FEVER• IMMUNOSUPPRESSION• HISTORY OF CANCER• IV DRUG USE• PROLONGED USE OF STEROIDS, OSTEOPOROSIS• AGE>70
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X-RAYS
• RECOMMENDED WHEN ANY RED FLAG PRESENT• LS X-RAY MAY BE SUFFICIENT FOR
– TRAUMA– PROLONGED STEROID USE– OSTEOPOROSIS– AGE>70
• FURTHER IMAGING NEEDED IF SUSPECT CANCER OR INFECTION
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BONE SCAN
• LIMITED ROLE IN ACUTE LOW BACK PAIN
• YIELD VERY LOW IN PRESENCE OF NORMAL X-RAY
• HIGHEST YIELD IN PTS WITH KNOWN MALIGNANCY
• CONTRAINDICATED IN PREGNANCY
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CT, MRI, MYELOGRAPHY, CT MYELOGRAPHY
• NO ROLE FOR ANY OF THESE STUDIES IN UNCOMPLICATED ACUTE LOW BACK PAIN
• RESERVE STUDIES FOR RED FLAGS SUCH AS TUMOR, INFECTION
• MRI FOR RADICULOPATHY, CAUDA EQUINA SYNDROME (BILATERAL LEG WEAKNESS, URINARY RETENTION, SADDLE ANESTHESIA)– USUALLY DUE TO HERNIATED DISC OR CANAL
STENOSIS
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L2-L3
Extruded HNP at 0.3T
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@ 1:10,000 pts with LBP andradiculopathy will have a conustumor
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Non-discogenic causes of back pain
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Metastatic disease
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Infection
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Diskitis and Osteomyelitis
• Pyogenic disc space infection usually result of blood borne agent, lung or urinary tract
• begins in end plate• organisms: staph>>strep, Ecoli, • MRI; T1 dark, T2 bright (involved disk
brightest), disc space, disc, and paravertebral tissues if involved will enhance
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CONGENITAL
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Lipoma and tethered cord
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Chronic neck pain:imaging recommendations
• AP, LATERAL OPEN MOUTH X-RAY• IF NORMAL AND NO NEURO SIGNS OR SXS, NO
FURTHER IMAGING• IF NORMAL AND HAVE NEURO SIGNS OR SXS,
PERFORM MR• IF X-RAY POSITIVE FOR SPONDYLOSIS, NO
NEURO SIGNS OR SXS, NO FURTHER IMAGING• IF X-RAY POSITIVE FOR SPONDYLOSIS, POSITIVE
NEURO SIGNS AND SXS, PERFORM MR• IF X-RAY SHOWS BONE OR DISC MARGIN
DESTRUCTION, PERFORM MR
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Cervical: Herniation, Syrinx C6-7
TR 4500, TE 138, 4mm, 2562 TR 6850, TE 134, 4mm, 2567 ½ min 7 min.
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Pre-op 1.5T
Compressive myelomalacia
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Metastatic breast carcinoma
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Questions?