Musculoskeletal Radiology Dr Bashar Adnan College of Medicine

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 • 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 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.

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 tumor 4. 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 • 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.

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 T 1 & T 2 weighted images. The images displayed may have a low signal intensity, intermediate signal intensity, or high signal intensity

MRI-uses • Traumatic & nontraumatic conditions – Bone – Soft tissue – Contusions – Microfractures

Relation to neurovascular bundle

Tumor composition

MRI Contraindications • ABSOLUTE – 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

B A C

K L J I M F E H G C D B A

Radiologic Anatomy of the Musculoskeletal System Lower limb

D E A B C

F G H I D E B A F C J

A D C B F E