Rad Tech 4643 MRI Torso and Extremities

Transcription

1 Rad Tech 4643 MRI Torso and Extremities

2 Prostate Cancer

3 Leiomyoma

4 Retroverted Anteverted

5 Ovarian Cyst Gone Wrong Fibroid (Leiomyoma)

6 IUD Ovary

7 Hysterectomy? What are we to see when imaging a female pelvis post hysterectomy? - May still have ovaries. - Bladder. - Muscles, Ligaments and Bones.

8 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 positioning skills.

9 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.

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

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

12 Avascular Necrosis

13 Fluid in hip joint Bursitis T2 FatSat PELVIS

14 T1 Axial

15 Hip Imaging

16 Position axials from Iliac Crest to Lesser Trochanter

17 Hip - Orientation

18 Hip Arthrogram Labrum

19 Include top of iliac crest to below lesser trochanter

20 Piriformis Syndrome The Piriformis muscle entraps, compresses or irritates the sciatic nerve (tibial + common fibular) causing radiculopathy (radiating pain, numbness) from the buttock and down the leg. This can happen when an athlete rotates their leg while utilizing the gluteus muscle. It is also common when a person has an atrophied or weak gluteus which shifts responsibility to other muscle such as the Piriformis. MRN Magnetic Resonance Neurography

21 Enchondroma vs. Bone Cyst

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

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

24 Shoulder

25 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

26 teres minor infraspinatus supraspinatus subscapularis

27 Rotator Cuff = Teres minor, Infraspinatus Supraspinatus, Subscapularis Attaches the humerus to the scapula

28 Shoulder - Anatomy

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

30 Labrum Biceps Tendon

31 Shoulder Labrial Tears

32 SLAP Tear Superior Labrum from Anterior to Posterior

33 Bankart Lesion (Tear) - inferior glenohumeral ligament.

34 Hill-Sachs Fracture Shoulder joint is shallow causing instability-dislocation.

35 Bone Contusion, Blunt Trauma

36 Bone Contusion

37 Acromioclavicular joint injuries are the most common acute injury of the shoulder. #2 Glenohumeral dislocation Supraspinatus muscle Acromioclavicular Joint

38 Shoulder - Orientation

39 Enchondroma

40 Enchondroma

41 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

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43 Elbow Biceps Tendon

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45 ELBOW POSITIONING

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47 Biceps Tendon torn off the radius Distal Biceps Tendon Rupture

48 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.

49 Distal Biceps Tendon Rupture Humeral Head Biceps tendon Ulna Radius (thumb side)

50 Tennis Elbow = Lateral Epicondylitis (racket sports) Golfers Elbow = Medial Epicondylitis (throwing sports, bowlers, archers)

51

52 Line up Coronal and Sagittal views with the distal Humerus

53 The positioning of the elbow joint is more difficult compared to CT. Surface coils are obligatory required. Ideal storage is possible with elevation of the arm at the isocenter of the magnet. It can occur that a prolonged storage of the arm towards cranial triggers shoulder impingement symptoms. Depending on the available equipment and technology examination with the arm positioned alongside of the body is possible. But that occasionally involves limitations in spectral fat saturation. A storage of the elbow joint on the belly is inappropriate. Protocol: Coronar T1 SE Coronar water-sensitive sequence (PD FSE FS, STIR) Axial PD FSE FS Facultative also sagittal PDw FSE FS. As a parameter, a layer of 2mm thickness and a FOV of mm is recommended. Basically, an investigation of musculo-skeletal problems in an extended matrix (320, 384, 448, 512) should be sought. The goal should be a pixel size of 0.4 mm. It has to be added that the sagittal plane is at an eventual postero-lateral rotary instability, for example after dislocation, a good choice to illustrate the centering of the radius head or changes at the olecranon. An injection of contrast agent can be helpful in epicondylitis or rare overuse syndromes.

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55 Wrist 1. Navicular 2. Capitate 3. Hamate

56 Triangular fibrocartilage discus Radioulnar ligaments Ulnocarpal ligaments

57 TFCC Triangular Fibrocartilage Complex

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

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

60 TFCC tear + bone cyst

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62 Wrist When scanning the wrist in MRI, to achieve high spatial resolution often means using: * Small FOV * If 14cm 10cm then matrix = 192 x cm / 192 = 0.72mm Pixel 12cm = 0.62mm 10 cm = 0.52mm

63 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 *

64 TMJ Meniscus shifts when opening mouth Closed mouth

65 Flexor Pollicus Longus Tendon Pathology dictated Imaging Plane.

66 Specialty Scans Imaging plane is to the ligament

67 Questions?