MSK US vs MRI. Georgios E. Delimpasis MRI Dept., 251 HAF and VA Hospital
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2 MSK US vs MRI Georgios E. Delimpasis MRI Dept., 251 HAF and VA Hospital Elastography & Interventional US, Athens, Feb. 2014
3 SATISFACTION!
4 SATISFACTION! Most patients with shoulder pain prefer sonography to MRI. W. D. Middleton. Sonography and MRI of the Shoulder: Comparison of Patient Satisfaction. AJR 2004;183: The same is true for all MSK studies.
5 US: Advantages Patient comfort No contraindications as in MRI (claustrophobia, cardiac pacers, implants prostheses, Gd, pregnancy (?) Cost Time Multiple targeted examinations in a single appointment (e.g. both shoulder and ankle) Availability - mobility
6 US: Advantages Comparison Dynamic study (tendon or nerve sublaxation, impingement) Higher spatial resolution (tendons, nerves) CDI EFOV Elastography Learning curve (?)
7 US: Advantages Cystic (bursitis, cyst, abscess, joint effusion), vs solid lesion (tumor) Calcification (calcific tendinopathy, phleboliths, etc) M.O. Foreign bodies Nerves Muscle hernias Evaluation of soft tissues adjacent to orthopedic hardware (prostheses and screws) Interventional techniques
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9 US: Disadvantages Operator dependent No perspective review Limited use of c.m. Inability to see beyond bony cortex Unsuitable for deep and intraarticular structures(e.g. menisci, cruciate ligs, cartilage, labrum, TFC, ocl, etc)
10 US: Disadvantages Extensive masses tumors and local staging Limited reproducibility Learning curve (?) Clinicians prefer to have objective clues (images) which can possibly interpret themselves as well
11 MRI contraindications Cardiac pacer (?) Claustrophobia Metallic implants and hardware Metallic foreign bodies Pregnancy (?) Body habitus Renal insufficiency, allergies (c.m.)
12 MRI is best for: Soft tissue tumors, local staging and f.u. Internal derangement of joints Cartilage, labrum Bone (marrow)
13 Foreign bodies US as method of choice
14 US as method of choice Contralateral comparison
15 Muscle hernias US as method of choice
16 US as method of choice Cystic vs solid masses
17 Joint effusion US as method of choice
18 US US as as method method of of choice choice EFOV, spatial resolution
19 Extraarticular ligaments Extraarticular ligaments
20 US guided injections
21 Calcifications US as method of choice
22 Calcific tendinopathy
23 Calcific olecranon bursitis
24 Periostitis
25 Periosteal osteoid osteoma
26 Climber s finger A. Klauser et al. Finger Pulley Injuries in Extreme Rock Climbers: Depiction with Dynamic US. Rad
27 US as method of choice Dynamic evaluation of RC (impingement)
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29 US as method of choice Dynamic evaluation of ECU tendon.
30 Soft tissue mass PILOMATRICOMA SCHWANNOMA
31 Soft tissue mass PVNS THENAR LIPOMA
32 M.O.
33 US as method of choice Muscle or tendon tear
34 US as method of choice
35 Adductor tendinopathy
36 Rheumatic diseases Ps A PMR index flexor tenosynovitis
37 Sacroiliitis
38 Oncogenic Osteomalacia (54 YO Male)
39 NF I Courtesy V. Dermentzoglou
40 Cat scratch disease Courtesy V. Dermentzoglou
41 US as method of choice Entrapment neuropathies
42 MRI as method of choice Entrapment neuropathies (Quadrilateral space syndrome)
43 Mortons neuromachoic
44 US as method of choice?
45 MRI as method of choice Internal derangement of joints
46 MRI as as method of of choice Internal derangement of joints
47 Labrum
48 Local staging MRI as as method of of choice
49 Local staging MRI as method of choice
50 Bone marrow (MM) MRI MRI as as method method of of choice choice
51 TAKE HOME MESSAGES Both US and MRI are invaluable tools for assessing MSK system Their role is complementary rather than competing Both modalities have certain strengths US: f.b., m.o., peripheral nerves, hernias, fluid detection, orth. hardware, dynamic, interventional, tendons, time, area of investigation, patients comfort, MRI contraindications. MRI: deep structures, bone marrow, internal derangements, tumors and local staging, objective clues.
52 Keep in mind: US depicts everything but bone (beyond cortex) MRI depicts soft tissues and bone marrow NOT bone CT depicts bone BUT: US is an excellent first diagnostic approach tool
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58 Thank you for your attention! Fakir, by Jean Khatchadourian
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65 US as a method of choice Soft tissue adjacent to metallic hardware
66 US as a method of choice
67 US as a method of choice Tendon sublaxation (xoreytria, bt, pt) Nerve sublaxation (un) Impingement syndromes (bex)
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69 AT PERITENDINITIS LS
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71 US as a method of choice Tendons (literature)
72 US as a method of choice Ilizaroff technique D. Barron
73 MRI as a method of choice Parsonage Turner s.
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76 MRI as a method of choice Diffuse abnormalities ( diabetic foot, infection, myositis etc)
77 US as a method of choice Myositis ossificans MRI, US, RX Δωρα
78 US as a method of choice Peripheral nerves
79 Osgoogd Schlatter d.,ls
80 FHL tenosynovitis LS. Ballet dancer.
81 Deep structures MRI as a method of choice
82 Gout, 1 st MTPJ LS
83 PsA
84 RA, peroneal tenosynovitis TS PMR, index flexor tenosynovitis LS
85 Cystic vs solid masses US as method of choice
86 Extraarticular ligaments
87 US as method of choice Cystic vs solid masses
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