Musculoskeletal MRI

Front Cover
Inside Front Cover
Musculoskeletal MRI
Copyright
Dedication
Preface
Contents
Chapter 1: Basic Principles of Musculoskeletal MRI
	What Makes a Good Image?
		Lack of Motion
		Signal and Resolution (Table 1.1)
		Tissue Contrast
			Pulse Sequences (Tables 1.2 and 1.3)
				Spin Echo
					T1
					T2
					Proton Density
				Fast Spin Echo
				Inversion Recovery
				Gradient Echo
			Fat Saturation
				Frequency-Selective
				Inversion Recovery
			Gadolinium (Box 1.1)
				Cystic Versus Solid
				Tumor
				Infection
				Spine
	MR Arthrography
	Musculoskeletal Tissues
		Bone
			Normal Appearance
			Most Useful Sequences
			Pitfalls
		Articular Cartilage
			Normal Appearance
			Most Useful Sequences
		Fibrocartilage
			Normal Appearance
			Useful Sequences: Meniscus
			Pitfalls
			Useful Sequences: Glenoid or Acetabular Labrum (Fig. 1.22)
		Tendons and Ligaments
			Normal Appearance
			Most Useful Sequences (Fig. 1.23)
			Pitfalls
		Muscle
			Normal Appearance
			Useful Sequences (Fig. 1.25)
		Synovium
			Normal Appearance
			Useful Sequences (Fig. 1.26)
			Pitfalls
	Applications
	Suggested Reading
Chapter 2: Marrow
	How to Image Bone Marrow
		Normal Marrow Anatomy and Function (Box 2.1)
			Trabecular Bone
			Red Marrow (Table 2.1)
			Yellow Marrow
			Marrow Conversion (Table 2.2)
			Variations in Normal Red Marrow (Box 2.2)
		MRI of Normal Marrow
			Yellow Marrow
			Red Marrow
			Marrow Heterogeneity (Box 2.3)
		Marrow Pathology
			Marrow Proliferative Disorders (Box 2.4)
				Benign
					Reconversion of Yellow to Red Marrow (Box 2.5)
					Monoclonal Gammopathies
				Malignant
					Leukemias
					Aggressive Gammopathies (Plasma Cell Dyscrasias)
			Marrow Replacement Disorders (Box 2.8)
				Skeletal Metastases
				Osteoporotic Versus Pathologic Vertebral Compression Fracture (Table 2.4)
				Lymphoma
				Benign and Malignant Primary Bone Tumors
			Marrow Depletion (Box 2.10)
				Aplastic Anemia
				Chemotherapy
				Radiation
			Bone Marrow Edema (Hyperemia and Ischemia)
				Transient Osteoporosis of the Hip/Painful Bone Marrow Edema Syndrome
				Regional Migratory Osteoporosis
				Ischemia (Box 2.13)
			Miscellaneous Marrow Diseases
				Gauchers Disease
				Pagets Disease
				Osteopetrosis
				Hemosiderin Deposition (Box 2.14)
				Serous Atrophy (Gelatinous Transformation)
	Suggested Reading
Chapter 3: Tendons and Muscles
	How to Image Tendons
		Normal Tendons
			Anatomy
			MRI of Normal Tendons
		Tendon Abnormalities (Box 3.2)
			Degeneration
			Tenosynovitis (Box 3.3)
			Tendon Tears (Box 3.4)
			Tendon Subluxation/Dislocation (Box 3.5)
			Miscellaneous Tendon Lesions
	How to Image Muscles
		Normal Muscle
			MRI Appearance
		Muscle Abnormalities
		Muscle Trauma
			Indirect Muscle Injuries (Box 3.6)
				Delayed-Onset Muscle Soreness
				Muscle Strains
			Direct Muscle Injuries (Box 3.7)
				Intramuscular (Intraparenchymal or Interstitial) Hemorrhage
				Hematoma (Table 3.1)
				Hemorrhage Into Tumor
				Myositis Ossificans
			Miscellaneous Traumatic Injuries
				Compartment Syndromes (Box 3.8)
				Fascial Herniation of Muscle
	Inflammatory Myopathies
		Pyomyositis (Box 3.9)
			Necrotizing Fasciitis
			Idiopathic Inflammatory Polymyopathies
		Primary Muscle Diseases
			Dystrophies and Myopathies
		Denervation (Boxes 3.11 and 3.12)
		Tumors (Table 3.2)
		Miscellaneous Muscle Abnormalities
			Rhabdomyolysis
			Muscle Infarction (Box 3.13)
			Accessory Muscles
			Radiation, Surgery, and Chemotherapy
	Suggested Reading
Chapter 4: Peripheral Nerves
	How to Image Nerves
	Normal and Abnormal
		Background
		Normal Anatomy and MRI Appearance
		Abnormalities of Nerves
			Traumatic Nerve Injury
			Nerve Tumors
				Neuromas
				Neurofibroma and Neurilemoma (Box 4.2)
				Fibrolipomatous Hamartoma
				Pseudotumors of Nerves
			Compressive Neuropathy and Entrapment Syndromes
			Miscellaneous Nerve Abnormalities
				Tumor Encasement/Radiation Changes
				Inflammatory Neuritis
				Unexplained Neuropathy
	Suggested Reading
Chapter 5: Musculoskeletal Infections
	How to Image Infection (Box 5.1)
	Osteomyelitis
		Definition of Terms (Box 5.2)
		Routes of Contamination (Box 5.3)
			Hematogenous Seeding
			Contiguous Spread
			Direct Implantation
		MRI of Osteomyelitis (Box 5.4)
			Acute Osteomyelitis
			Subacute Osteomyelitis
			Chronic Osteomyelitis
	Soft Tissue Infection
		Cellulitis (Box 5.5)
		Septic Tenosynovitis and Septic Bursitis
		Pyomyositis (Infectious Myositis)
		Necrotizing Fasciitis (Box 5.6)
	Septic Arthritis
	Miscellaneous Conditions
		Foreign Bodies
		Chronic Recurrent Multifocal Osteomyelitis
		AIDS
		Diabetic Foot Infection (Box 5.7 and Tables 5.1 and 5.2)
	Suggested Reading
Chapter 6: Arthritis and Cartilage
	How to Image Arthritis and Cartilage
	Rheumatoid Arthritis
	Ankylosing Spondylitis
	Gout
	Calcium Pyrophosphate Dihydrate Deposition
	Hemophilia
	Amyloid
	Tumors
	Synovial Chondromatosis
	Pigmented Villonodular Synovitis
	Loose Bodies
	Cartilage
	Summary
	Suggested Reading
Chapter 7: Tumors
	Staging of Musculoskeletal Tumors
		Principles of Staging
			Grade
			Local Extent
			Metastases
		Principles of Imaging
			Bone Tumors
			Soft Tissue Tumors
			Important MRI Features (Box 7.1)
				Intraosseous Tumor Extent
				Extraosseous Tumor Extent
				Neurovascular or Joint Involvement
				Nodes
		Evaluation of Tumor After Therapy
			Postchemotherapy
			Postsurgery and Postradiation
	How to Image Tumors
	Approach to Image Interpretation
		General Principles
		Bone Lesions
			Differential Features
				Increased Signal: T1W Images (Box 7.2)
					Intraosseous Lipoma
					Intraosseous Hemangioma
					Medullary Bone Infarct
					Pagets Disease
				Decreased Signal: T2W Images (Box 7.3)
					Sclerosis/Calcification/Matrix
					Fibrous Lesions
					Primary Lymphoma of Bone
				Fluid-Fluid Levels
				Cartilaginous Tumors (Box 7.4)
					Enchondroma/Chondrosarcoma
					Chondroid Tumor versus Medullary Bone Infarct
					Osteochondroma
		Soft Tissue Tumors
			General Principles
			Differential Features
				High Signal on T1W Images (Box 7.5)
					Lipomatous Masses
					Vascular Malformations
					Hematoma
					Melanoma
				Low Signal on T2W Images (Box 7.6)
					Pigmented Villonodular Synovitis
					Giant Cell Tumor of the Tendon Sheath
					Fibrous Lesions
					Amyloid
					Gout
					Melanoma
				Cystic-Appearing Masses (Box 7.7)
					Cyst
					Intramuscular Myxoma
					Cystic-Appearing Malignant Tumors
					Nerve Sheath Tumors
	Suggested Reading
Chapter 8: Osseous Trauma
	How to Image Osseous Trauma
		Anatomy
		Overview of Osseous Trauma
		Imaging Options
	Acute Osseous Trauma
		Impaction Injuries
			Contusion
			Contusion Patterns
				Anterior Cruciate Ligament Tear
				Lateral Patellar Dislocation
			Radiographically Occult Fracture
		Avulsion Injuries
			Common Sites (Table 8.1)
			MRI Appearance
	Repetitive Trauma
		Insufficiency Fractures
			MRI Appearance
		Fatigue Fractures
			MRI Appearance
			MRI Grading System
		Chronic Avulsive Injuries
			Shin Splints
			Thigh Splints
			Post-Traumatic Osteolysis
	Trauma to the Immature Skeleton
		Epiphysiolysis
		Post-Traumatic Physeal Bridges
		Avulsion Fractures
	Differential Diagnosis
		Epiphyseal/Subchondral Marrow Edema (Box 8.4)
		Fatigue Fracture Versus Tumor
	Osteochondritis Dissecans
	Suggested Reading
Chapter 9: Temporomandibular Joint
	How to Image the Temporomandibular Joint
	Normal Temporomandibular Joint
		Osseous Structures
		Disk
	Abnormal Temporomandibular Joint (Box 9.1)
		Internal Derangements
		MRI of Internal Derangements and Degeneration
	Suggested Reading
Chapter 10: Shoulder
	How to Image the Shoulder
	Tendons and the Coracoacromial Arch
		Normal Anatomy
			Tendons
			Coracoacromial Arch
		Shoulder Impingement
			Causes
				Acromial Configuration
				Acromial Slope
				Acromial Position
				Os Acromiale
				Acromioclavicular Joint Degenerative Changes
				Coracoacromial Ligament
				Post-traumatic Deformity
				Instability
				Muscle Overdevelopment
			Effects of Impingement (Box 10.4)
				Tendons
				Degenerative Osseous Cysts
				Subacromial/Subdeltoid Bursitis
		Tendon Tears, Degeneration, and Dislocation
			Supraspinatus (Box 10.5)
				Degeneration and Partial-Thickness Tendon Tears
				Full-Thickness Tears
			Long Head of the Biceps (Box 10.6)
				Tears
				Dislocation
			Infraspinatus and Teres Minor
				Posterosuperior Impingement (Internal Impingement) or GIRD (Box 10.7)
			Subscapularis (Box 10.8)
			Massive Cuff Tears
		Rotator Interval Abnormalities (Box 10.9)
	Instability
		Anatomy Relating to Instability
			Capsule
			Glenohumeral Ligaments (Box 10.11)
			Labrum
				Normal Variants of the Labrum (Box 10.12)
		Instability Lesions
			Capsule
			Glenohumeral Ligaments
			Bones
			Labrum
		Noninstability Labral Lesions
			SLAP Lesions
			Paralabral Cysts
			GLAD Lesions
	Postoperative Shoulder
		Impingement and Rotator Cuff Surgery
		Surgery for Instability
	Miscellaneous Capsular, Bursal, and Tendon Abnormalities
		Adhesive Capsulitis
		Synovial Cysts
		Calcific Tendinitis and Bursitis
		Subcoracoid Bursitis
	Nerve Abnormalities
		Suprascapular Nerve Entrapment (Box 10.18)
		Quadrilateral Space Syndrome (Box 10.19)
		Parsonage-Turner Syndrome
	Bone Abnormalities
		Post-Traumatic Osteolysis of the Clavicle
		Occult Fractures
		Avascular Necrosis
		Tumors (Box 10.21)
	Soft Tissue Abnormalities
		Benign and Malignant Tumors
		Pectoralis Muscle Injuries
	Suggested Reading
Chapter 11: Elbow
	How to Image the Elbow
	Normal and Abnormal
		Bones
			Normal Relationships
			Osseous Disorders
				Osteochondritis Dissecans (Osteochondral Lesion) and Panners Disease (Box 11.2)
				Fractures
		Ligaments
			Radial Collateral Ligament Complex (Box 11.3)
				Normal Radial Collateral Ligament Complex
				Abnormal Radial Collateral Ligaments
			Ulnar Collateral Ligament Complex (Box 11.4)
				Normal Ulnar Collateral Ligament
				Abnormal Ulnar Collateral Ligament
			Synovial Fringe
		Muscles and Tendons (Box 11.5)
			Anterior Compartment
				Normal Anatomy
				Abnormal Anatomy (Box 11.6)
			Posterior Compartment
				Normal Anatomy
				Abnormal Anatomy
			Medial Compartment (Box 11.7)
				Normal Anatomy
				Abnormal Anatomy
			Lateral Compartment
				Normal Anatomy
				Abnormal Anatomy (Box 11.8)
		Nerves (Box 11.9)
			Ulnar Nerve (Box 11.10)
				Normal Ulnar Nerve
				Abnormal Ulnar Nerve
			Median Nerve (Box 11.11)
				Normal Median Nerve
				Abnormal Median Nerve
			Radial Nerve (Box 11.12)
				Normal Radial Nerve
				Abnormal Radial Nerve
		Articular Disorders
			Arthropathies/Loose Bodies
			Masses
			Epitrochlear Adenopathy
			Bursae
	Suggested Reading
Chapter 12: Wrist and Hand
	How to Image the Wrist and Hand
	Normal and Abnormal
		Ligaments
			Intrinsic Ligaments (Box 12.2)
				Normal Scapholunate and Lunotriquetral Ligaments
				Abnormal Scapholunate and Lunotriquetral Ligaments
			Extrinsic Ligaments
				Volar and Dorsal Ligaments
		Triangular Fibrocartilage Complex (Box 12.3)
			Triangular Fibrocartilage
				Normal Triangular Fibrocartilage
				Abnormal Triangular Fibrocartilage
			Radioulnar Ligaments
				Normal Radioulnar Ligaments
				Abnormal Radioulnar Ligaments
			Meniscus Homologue
			Extensor Carpi Ulnaris Sheath
				Normal Extensor Carpi Ulnaris
				Abnormal Extensor Carpi Ulnaris Sheath
			Ulnar Collateral Ligament (Wrist)
		Ulnar Collateral Ligament of the Thumb
			Normal Ulnar Collateral Ligament of the Thumb
			Gamekeepers Thumb (aka Skiers Thumb)
		Tendons
			Normal Anatomy
			Tendon Pathology
				de Quervains Syndrome (Box 12.4)
				Intersection Syndrome
				Extensor Carpi Ulnaris
				Bowstringing
				Other Tendons
		Carpal Tunnel
		Nerves
			Median Nerve
				Carpal Tunnel Syndrome (Box 12.5)
			Fibrolipomatous Hamartoma
			Ulnar Nerve
				Ulnar Tunnel Syndrome
		Osseous Structures
			Normal Relationships
			Osseous Abnormalities
				Os Styloideum
				Carpal Instability (Box 12.7)
				Ulnolunate Impaction
				Stylocarpal Impaction
				Occult Fractures
				Physeal Injuries
				Osteonecrosis (Box 12.8)
				Congenital Osseous Lesions
		Tumors
			Osseous Lesions
				Enchondromas
				Intraosseous Ganglion Cysts
			Soft Tissue Lesions
				Ganglion Cysts
				Giant Cell Tumors of the Tendon Sheath
				Glomus Tumors
				Anomalous Muscles
		Arthritis
			Synovial Cysts
		Infection
	Suggested Reading
Chapter 13: Spine
	How to Image the Spine
	Normal and Abnormal
		Degenerative Changes
			Disk Aging and Degeneration (Table 13.1)
				Normal Disk
				Abnormal Nucleus
				Abnormal Annulus (Box 13.2)
				Abnormalities in Disk Morphology (Box 13.3)
					Disk Bulge
					Disk Protrusion
					Disk Extrusion
					Sequestered Disk
				Location of Focal Disk Abnormalities (Box 13.4)
				Significance of Disk Contour Abnormalities (Box 13.5)
				Disk-Related Compressive Myelopathy and Epidural Hematoma
				Disk Mimickers (Box 13.6)
				Vacuum Disks and Vertebral Bodies
				Calcified Disks
			Osseous Degenerative Changes (Box 13.7)
				Vertebral Bodies
				Facet Joints
				Spinous Processes
		Spinal Stenosis (Box 13.8)
			Central Canal Stenosis
				Lateral Recess Stenosis
			Neural Foramen Stenosis
		Postoperative Changes
			Uncomplicated Postoperative MRI (Box 13.9)
			Failed Back Surgery
		Inflammatory Changes
			Spondylodiskitis (Box 13.10)
			Epidural Abscess
			Arachnoiditis
			Ankylosing Spondylitis
		Traumatic Changes
			Spondylolysis and Spondylolisthesis (Box 13.11)
			Intraosseous Disk Herniations
			Major Trauma (Box 13.12)
				Osseous
				Ligaments
				Traumatic Disks
				Epidural Fluid Collections
				Vascular Abnormalities
				Cord Injuries
				Other Soft Tissues
		Osseous Spine Tumors (Box 13.13)
			Benign Bone Tumors
				Intraosseous Hemangiomas
			Malignant Bone Tumors
				Metastases and Multiple Myeloma
				Chordomas
				Primary Bone Tumors
		Spinal Canal Contents
			Epidural Space (Box 13.14)
				Epidural Abscess
				Epidural Hematoma
				Epidural Lipomatosis
				Epidural Cysts
				Miscellaneous
			Intradural Space (Box 13.15)
				Nerve Sheath Tumors
				Meningioma
				Other Tumors
				Lipomas
				Intradural Cystic Lesions
				Metastases
			Spinal Cord Lesions (Box 13.16 and Table 13.3)
				Demyelination Abnormalities
				Cysts
				Infarction
				Tumors
			Tethered Cord (Box 13.17)
	Suggested Reading
Chapter 14: Hips and Pelvis
	How to Image the Hips and Pelvis
	Normal and Abnormal
		Osseous Structures
			Normal Osseous Structures
			Vascular Abnormalities of Bone
				Osteonecrosis (Avascular Necrosis) (Box 14.2)
				Idiopathic Transient Osteoporosis of the Hip (Transient Painful Bone Marrow Edema) (Box 14.5)
			Fractures (Box 14.6)
				Fatigue Fractures
				Insufficiency Fractures
				Salter Fractures (Box 14.7)
			Herniation Pits
			Osseous Tumors
				Benign Osseous Lesions (Box 14.8)
				Malignant Osseous Lesions
		Soft Tissues
			Muscle and Tendon Abnormalities
				Normal Capsule and Ligaments
				Normal Muscles (Box 14.9)
				Muscle Strains (Box 14.10)
				Gluteus Medius and Minimus Tendon Tears
				Athletic Pubalgia
				Hamstring Injuries
				Piriformis Syndrome
				Other Muscles and Tendons
			Nerves
				Normal Nerves
				Abnormal Sciatic Nerve
			Bursae (Box 14.11)
				Iliopsoas Bursa
				Greater Trochanteric Bursitis
			Soft Tissue Tumors (Box 14.12)
				Benign Soft Tissue Tumors
				Malignant Soft Tissue Tumors (see Box 14.12)
		Joints
			Normal Ligamentum Teres
			Labrum (Box 14.13)
				Labral Tears
			Normal Articular Cartilage
			Abnormal Articular Cartilage
			Femoroacetabular Impingement (Box 14.14)
			Inflammatory Arthritides
			Degenerative Joint Disease
			Developmental Dysplasia (Box 14.15)
			Intra-articular \"Tumors\" (Synovial Processes) (Box 14.16)
				Pigmented Villonodular Synovitis
				Primary Synovial Chondromatosis
				Amyloid Arthropathy
		Imaging of Hip Arthroplasty (Box 14.17)
	Suggested Reading
Chapter 15: Knee
	How to Image the Knee
	Normal and Abnormal
		Menisci
			Normal
			Abnormal
			Tears
				Oblique or Horizontal Tears
				Bucket-Handle Tears
				Radial or Free Edge Tears
				Medial Flipped Meniscus
				Description of Meniscal Tears
			Cysts
			Discoid Meniscus
			Pitfalls
				Transverse Ligament
				Speckled Anterior Horn Lateral Meniscus
				Meniscofemoral Ligament Insertion
				Pulsation From Popliteal Artery
				Magic Angle Phenomenon
				Popliteus Tendon Pseudotear
		Ligaments
			Anterior Cruciate Ligament
			Posterior Cruciate Ligament
			Medial Collateral Ligament
			Lateral Collateral Ligament Complex
		Patella
		Synovial Plicae
		Patellar Tendon
			Fat Pad Impingement
		Bursae
			Popliteal (Bakers Cyst)
			Prepatellar Bursa
			Pes Anserinus Bursa
			Semimembranosus-Tibial Collateral Ligament Bursa
			Medial Collateral Ligament Bursa
		Bones
		Soft Tissues
		Cartilage
	Suggested Reading
Chapter 16: Foot and Ankle
	How to Image the Foot and Ankle
	Normal and Abnormal
		Tendons
		Posterior Ankle Tendons
			Achilles and Plantaris (Box 16.2)
		Medial Ankle Tendons
			Posterior Tibial Tendon (Box 16.3)
			Flexor Digitorum Longus
			Flexor Hallucis Longus (Box 16.4)
		Lateral Ankle Tendons
			Peroneal Tendons (Boxes 16.5 and 16.6)
		Anterior Ankle Tendons
			Anterior Tibial Tendon (Box 16.7)
		Ankle Ligaments
			Medial Ankle Ligaments
			Lateral Ankle Ligaments (Box 16.8)
		Miscellaneous Inflammatory Conditions
			Anterolateral Impingement Syndrome in the Ankle (Box 16.9)
			Sinus Tarsi Syndrome (Box 16.10)
			Plantar Fasciitis (Box 16.11)
		Nerve Abnormalities
			Tarsal Tunnel Syndrome (Boxes 16.12 and 16.13)
			Mortons Neuroma (Box 16.14)
		Bone Abnormalities
			Tarsal Coalition
			Accessory Bones and Sesamoids (Box 16.15)
				Os Trigonum Syndrome
				Accessory Navicular
				Hallux Sesamoids
		Fractures
			Osteonecrosis of the Foot and Ankle (Box 16.17)
			Osseous Tumors (Box 16.18)
		Bone Marrow Edema Syndrome
		Soft Tissue Tumors (Box 16.19)
			Benign
				Plantar Fibromatosis
			Malignant
				Synovial Sarcoma
				Other Sarcomas
			Soft Tissue Tumor Mimickers
				Accessory Muscles
				Pressure Lesions (Box 16.20)
		Diabetic Foot (Boxes 16.21 and 16.22)
		Foreign Bodies
	Suggested Reading
Index
Inside Back Cover