Rad Tech 4643 MRI Torso and Extremities

Rad Tech 4643 MRI Torso and Extremities

Positioning is still important! Make sure anatomy is in middle of coil. Mark pathologies. Pad, Pad, Pad. Explain the importance of holding still to patient. Use your x-ray skills.

Take Pride In Your Scan Use correct scan planes to get anatomic symmetry. Know your anatomy. Cover anatomy and pathology. Use 3 plane locator to set up first scan, then use that scan to set up the rest of you scans.

Knee - Anatomy

Knee - Anatomy 1. Femur 2. Posterior cruciate ligament 3. Intercondylar eminence 4. Gastrocnemius muscle 5. Tibia 6. Anterior cruciate ligament 7. Infrapatellar fat pad 8. Articular cartilage 9. Medial patella

Knee -Anatomy 1. Intercondylar notch 2. Lateral epicondyle 3. Lateral collateral ligament 4. Popliteal ligament 5. Lateral meniscus 6. Tibial intercondylar eminence 7. Medial meniscus 8. Medial collateral ligament 9. Medial condyle 10. Posterior cruciate ligament

Knee - Meniscus

Knee Meniscus (Torn)

Diagram of meniscal tear patterns: (A) Vertical or longitudinal (Bucket-handle), (B) Flap or Oblique, (C) Radial or Transverse, (D)Horizontal, (E) Complex degenerative

Knee What pathology is shown? * Medial meniscal tear *

Knee

Knee When imaging the knee, the technologist is required to film the images twice when evaluating for meniscal tears * Once with regular window and level settings, then once with wider settings *

Knee The optimal plane to use when evaluating patients for cruciate ligament tears of the knee is the: * Oblique Sagittal *

Knee What pathology is shown? * ACL tear with bone contusion *

Knee What pathology is shown? * PCL tear with bone contusion *

Knee Bone Contusion Look for kissing contusions. Look for ACL on Axial.

Another ACL Tear

Knee To better evaluate the anterior cruciate ligament, positioning for knee imaging may require: * 15 degrees external rotation *

Knee Positioning T1 = Anatomy and bone issues. T2 Fatsat= Pathology, edema. PD Fatsat= Cartilage, meniscus.

ACL on Axial If no ACL then plan off of lateral condyle.

What is this? MCL Lateral Meniscus Tear

Old Knee. Medial meniscus is worn out. Bone Infarct?

Foreign Body

Meniscus Tear

ACL Tear

Knee Baker s Cyst

Baker Cyst Also known as a popliteal cyst. Etiology herniation of the synovial membrane or leakage of synovial fluid from the bursa. Epidemiology meniscal injuries, articular damage, collateral or cruciate injuries, rheumatoid arthritis, loose bodies, and internal derangement of the knee.

Wrist 1. Navicular 2. Capitate 3. Hamate

Wrist When imaging the wrist, the optimal plane in which to visualize the carpal tunnel is the: * Axial *

TFCC The triangular fibrocartilage complex (TFCC) is a small piece of cartilage and ligaments on the medial side of the wrist.

TFCC tear + bone cyst

Wrist When scanning the wrist in MRI, to achieve high spatial resolution often means using: * Small FOV *

Flexor Pollicus Longus Tendon Pathology dictated Imaging Plane.

Specialty Scans Imaging plane is to the ligament

TMJ To evaluate range of motion, temperomandibular joints can be studied with MRI by using a surface coil and acquiring T1 weighted images in the sagittal plane with: * The patient s mouth opened and then closed *

TMJ Meniscus shifts when opening mouth Closed mouth

Extremities What imaging sequence differentiates ischemic necrosis from other pathologic processes? * T1 Weighted *

Hip - Orientation

Avascular Necrosis

Enchondroma vs. Bone Cyst

T1 Axial, hips are symmetric, fluid dark, Edema isointense to muscle. Best sequence for bone abnormalities

Common bone cyst. Dark on T1, Bright on T2. This patient has a congenital issue that has exacerbated. GRE T2*

Enchondroma

Hip Arthrogram Labrum

Shoulder - Anatomy

Shoulder - Anatomy 1. Acromion process of scapula 2. Head of humerus 3. Glenoid of scapula 4. Glenohumeral joint 5. Subclavicle vein 6. Teres major muscle 7. Surgical neck of humerus 8. Deltoid muscle 9. Greater tubercle

Shoulder - Orientation

Shoulder Labrial Tears

SLAP Superior Labrum Anterior Posterior

Labrum

Bone Contusion, Blunt Trauma

Rotator cuff Group of muscles and their tendons that act to stabilize the shoulder. Supraspinatus muscle Infraspinatus muscle Teres minor muscle Subscapularis muscle

teres minor infraspinatus supraspinatus subscapularis

Supraspinatus muscle Infraspinatus muscle Teres minor muscle Subscapularis muscle

Scanning the Foot We usually scan either the fore foot or the hind foot. Fore foot is for ulcers, tumors, osteomyelitis. Hind foot is same as Ankle protocol.

Ankle - Anatomy

Ankle - Anatomy 1. Achilles tendon 2. Calcaneous 3. Cuboid 4. 3 rd metatarsal 5. 2 nd metatarsal 6. Second cuneiform 7. Third cuneiform 8. Navicular 9. Talus 10. Tibia

Ankle

Ankle

Ankle - Achilles

Elbow 1. Triceps brachi muscle 2. Humerus 3. Lateral epicondyle 4. Capitulum 5. Radial head 6. Ulna 7. Coronoid process 8. Trochlea 9. Medial epicondyle 10. Olecranon fossa

Line up Coronal and Sagittal views with the distal Humerus

Distal Biceps Tendon Rupture

The distal biceps tendon attaches to a small bump on the radius bone of the forearm. This small bony bump is called the radial tuberosity.

Benign Bone Tumors 1. Enchondroma- Cartilage cyst. Tend to show scalloping of bone. 2. Chondroblastoma- Cartilage and bone. Rare, seen in young people. Grows in growth plate, epiphyseal. Cartilage Cap Tumor. 3. Intraosseous Lipoma- Most common lipogenous lesion. Mostly found in proximal femur and calcaneus.

Benign Bone Tumors 4. Bone cyst- Very common. Fluid filled lesion. Can be filled with water based fluid or blood (aneurysmal). Usually bright on T2 and dark on T1.

Enchondroma

Intraosseous Lipoma Bone filler

Malignant Bone Tumors 1. Multiple Myeloma- 2. Osteosarcoma- Most common bone cancer in young people. Usually in large bones that have under gone rapid growth. 3. Chondosarcoma- Most common in older people. Soft tissue cancer.(sarcoma). Formed from cartilage.

Malignant Bone Tumors 4. Ewing s Sarcoma- Usually occurs during puberty. Can show up anywhere in body. Ten times more common in caucasians. Often metastasizes before diagnosis.(30%)

Osteosarcoma

Imaging Parameters 1. T1 Ax, Cor, Sag 2. T2 Fatsat or Stir Ax, Cor, Sag 3. Opt. PD Fatsat 4. Opt. 2D or 3D GRE T2* 5. Arthrograms- T1 FS and T2 FS all 3 planes.

Thanks for letting me Gab. Questions?