Reading and understanding MRI Stephen T Sweriduk, MD This workshop - - PowerPoint PPT Presentation

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Reading and understanding MRI Stephen T Sweriduk, MD This workshop - - PowerPoint PPT Presentation

Feb 22, 2023 28 likes •449 views

Reading and understanding MRI Stephen T Sweriduk, MD This workshop will cover basic MRI anatomy of the musculoskeletal system followed by examples of common sports related injuries. Musculoskeletal MRI Knee MRI Knee pain of undetermined

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Reading and understanding MRI

Stephen T Sweriduk, MD

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SLIDE 2

This workshop will cover basic MRI anatomy of the musculoskeletal system followed by examples of common sports related injuries.

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SLIDE 3

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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SLIDE 5

MENISCAL TEAR

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SLIDE 6

Bone Infarct

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SLIDE 7

Stress fracture

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SLIDE 8

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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SLIDE 9

Rotator Cuff Tear

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SLIDE 10

Hip MRI

  • AVN
  • CDH
  • Transient osteoporosis
  • Occult fracture
  • Stress fracture
  • Transient osteoporosis
  • Infection
  • bursitis
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SLIDE 11

April May

Regional Migratory Osteoporosis

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SLIDE 12

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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SLIDE 14

Achilles tendon tear

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SLIDE 15

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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SLIDE 21

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

  • f 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 PAIN RED 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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SLIDE 24

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 and radiculopathy will have a conus tumor

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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
  • f 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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SLIDE 35

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, 256 7 ½ min 7 min.

Courtesy Longmont United Hopsital

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Pre-op 1.5T

Compressive myelomalacia

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Metastatic breast carcinoma

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Questions?