MRI LOWER EXTREMITIES IMAGING FACT SHEET. MRI Lower Extremities

Transcription

1 MRI Lwer Extremities When calling Anthem ( ) r using the Pint f Care authrizatin system fr a Health Service Review, the fllwing clinical infrmatin may be needed t prcess yur request. Being prepared with cmplete infrmatin will help expedite ur respnse. Generally with all requests, we will need: Diagnsis r symptms that the patient is displaying and the duratin f symptms Any rule ut cnditins Any previus radilgical studies and results Any previus therapeutic treatment and the results f that treatment In sme instances we will nly need the diagnsis and symptms. Fr these cnditins, the fllwing infrmatin may be asked. Lwer Extremity MRI lwer extremity, ther than jint w/ cntrast MRI lwer extremity, ther than jint w cntrast MRI lwer extremity, ther than jint w/ cntrast fllwed by cntrast MRI lwer extremity, any jint w/ cntrast MRI lwer extremity, any jint w cntrast MRI lwer extremity, any jint w/ cntrast fllwed by cntrast Bne tumrs (all bnes) Suspect bne tumr with Abnrmal finding n x-ray r bne scan Palpable bny abnrmality with nrmal x-ray Knwn diagnsis f cancer lcated elsewhere assciated with unexplained signs and symptms Persistent pain f unclear etilgy Surveillance f benign tumrs Fllw up After treatment fr either primary r metastatic cancer, including single bne metastases f the bne Sft tissue tumr fllw up fr suspected metastasis pst therapy Differentiate between a benign and malignant prcess Primary bne tumrs suspected; Persistent symptms (particularly lcalized pain) with a negative radigraph Suspicius r malignant characteristics n radigraph Metastatic bne disease Breast cancer patient with ht lesin(s) t the spine fund n bne scan with n back pain and negative plain films Otherwise healthy elderly patient with knwn malignancy presenting with back pain and partially cllapsed vertebra n plain films Elderly female with knwn primary presenting with acute vertebral cllapse n plain x- ray and CT. Page 1 f 6 07/22/2005

2 Hip/Pelvic Bnes Suspected avascular necrsis f the femral head; Plain films shw mttled femral head Clinically suspect vascular necrsis with nrmal radigraphs Suspect intra r extra articular abnrmality (e.g. lse bdy) Suspect stemyelitis with Cnfirmatin f findings n bne scan Initial diagnsis with symptms suggesting stemyelitis such as lcalized pain, psitive bld culture and fever Differentiate fracture versus metastasis in lng bne with Nrmal plain films Ht nnspecific bne scan Suspect sft tissue neplasm Suspect ccult fracture; Symptms suggestive f hip r acetabular fracture which may include pain with weight bearing r rtatin, shrtening f the leg, and inability t bear weight Negative films f pelvis Pst p fllw up t hip arthrplasty (THR) Chrnic hip pain With negative x-rays and Suspect sseus r surrunding sft tissue abnrmality (excluding steid stema) Suspect stenecrsis in asymptmatic hip due t knwn predispsing factrs Suspect labral tear With psitive x-rays suggestive f ne f the fllwing Pigmented villndular synvitis Ostechndrmatsis Pediatric hip pain Diagnsis f slipped capital femral epiphyses Suspect avascular necrsis r stenecrsis when symptms persist Suspect tumr Limping withut explanatin n x-ray, bne scan, physical exam r labratry evaluatin Chrnic r persistent hip pain Suspect stemyelitis Suspect sft tissue neplasm Suspect ccult fracture with Symptms suggestive f hip r acetabular fracture that may include pain with weight bearing r rtatin, shrtening f the leg r inability t bear weight. Negative plain film f hip (AP, frg, lateral views) Leg Suspected stemyelitis with Pain assciated with chills r fever particularly after trauma r rthpedic surgery Overlying cellulitis that respnded prly t antibitics Chrnic skin ulcer Persistent r wrsening ulcer withut bvius bne expsure in patient with diabetes r severe PVD Fcal lesin seen n bne scan Limb pain Pain with unclear etilgy Indeterminate lesin n plain film r CT scan Fcal radilucency n plain film (suspected stenecrsis) Page 2 f 6 07/22/2005

3 Bne scan demnstrates well lcalized, increased uptake Suspected stress fracture and Histry f veruse r excessive activity Lcalized pain Symptms persist r recur despite rest 2 nrmal plain films at least 3 weeks apart cncerns regarding infectin r inflammatry prcess make bne scan subptimal Suspected muscle tear Sft tissue mass with Deep r large mass Masses that crss anatmical bundaries Mass that affects the adjacent anatmical structures Vascular lesin with grwth r change in clr f verlying skin Sft tissue abscess r pymysitis (muscle abscess) Mass that is causing pain Mass that is prgressively enlarging Sprained leg Knee Meniscal tear, cruciate r multiligament injury with pain and instability evidence Pivtal shift, psitive McMurray s sign (meniscal tear), psitive Lachman s test (ALC injury), lcking. Suspected ligament tear with Psitive anterir r psterir drawer sign Psitive Lachman s test Pst traumatic effusin, usually bldy Inability t bear weight after injury Histry f tearing r ppping after acute injury Symptms f instability with chrnic injury Laxity with valgus r varus stresses t knee Meniscal tear withut instability, nn respnsive t physical therapy and medicatin Suspected meniscal injury; Restricted range f mtin, buckling r lcking Effusin with acute injury r with subsequent episdes f minr injury r vigrus activity Sensitivity t palpatin alng the medial r lateral jint line Psitive McMurray n physical exam Avascular necrsis, knee. Intra articular lse bdy. Persistent knee pain with persistent r recurrent swelling and/r jint tenderness refractry t cnservative treatment. Pst p fllw up fr knee arthrplasty (TKR) Nntraumatic knee pain Child r adlescent with Nnpatellfemral symptms and nn diagnstic (demnstrate nrmal findings r a jint effusin) initial AP and lateral radigraphs Patellfemral (anterir) symptms with nn diagnstic (demnstrate nrmal findings r a jint effusin) initial AP, lateral, and axial radigraphs Adult with nn trauma, nn tumr, and nn lcalized pain with Nn diagnstic (demnstrate nrmal findings r a jint effusin) initial AP and lateral radigraphs Initial AP and lateral radigraphs demnstrate evidence f internal derangement (e.g. Peligrini Stieda disease, jint cmpartment widening) Page 3 f 6 07/22/2005

4 Traumatic knee pain Ostearthritis Suspected ligament r meniscal tear Suspected stenecrsis Chrnic knee pain Nrmal x-ray Nrmal physical exam MRI LOWER EXTREMITIES IMAGING N ther explanatin fr the pain such as inflammatry arthritis, DJD, stress fracture, etc. Baker s cyst assciated with clinical evidence f meniscal r ligamentus injury and ultrasund is nn diagnstic Reginal sympathetic dystrphy Suspected stenecrsis; Fcal radilucency n plain x-ray Bne scan demnstrates well lcalized, increased uptake Knee pain and histry suggestive f increased risk fr stenecrsis due t Previus trauma Hemglbinpathy, particularly sickle cell anemia Chrnic crticsterid use Suspected stress fracture with Cncerns regarding infectin r inflammatry prcess make bne scan subptimal Histry f veruse r excessive activity Lcalized pain Symptms persist r recur despite rest 2 nrmal plain films at least 3 weeks apart Suspected tear f extensr mechanism (e.g. quadriceps r patellar tendns) Suspected stemyelitis with Pain assciated with chills and fever particularly after trauma r rthpedic surgery Overlying cellulitis that respnds prly t antibitics Persistent leg pain in patients with diabetes r severe PVD Persistent r wrsening ulcer (withut bvius bne expsure) in patient with diabetes r severe PVD Fcal lesin seen n bne scan Dislcatin f patella preperatively fr patients with recurrent dislcatin Sprained knee Ankle Suspected avascular necrsis Suspected tendn rupture Suspected intra articular lse bdy Acute injury with ligament instability Sprained ankle Chrnic ankle pain with Suspected stechndral injury with nrmal plain films Suspected tendinpathy with nrmal plain films Unexplained ankle pain with Suspected Achilles rupture with Acute rupture where diagnsis is equivcal Chrnic rupture, t differentiate between cmplete r partial tears Persistent pain with uncertain etilgy with nrmal x-rays Indeterminate lesin n plain film r CT scan Fcal radilucency (suspected stenecrsis) n plain film Bne scan demnstrates well lcalized, increased uptake Page 4 f 6 07/22/2005

5 Lse bdy in jint space Instability n physical exam (suspected ligament tear) Recurrent sprains (suspected ligament tear) Suspected stemyelitis with Lcalized ankle pain assciated with chills and fever particularly after trauma r rthpedic surgery Overlying cellulitius with pr respnse t antibitics Persistent r wrsening ulcer (withut bvius bne expsure) in patient with diabetes r severe PVD Fcal lesin seen n bne scan Suspected sinus tract infectin frm ulcer Suspected stress fracture with Histry f veruse r excessive activity Lcalized pain Symptms persist r recur despite rest 2 nrmal plain films at least 3 weeks apart Cncerns regarding infectin r inflammatry prcess make bne scan subptimal Sft tissue mass with Deep r large mass Masses that crss anatmical bundaries Mass that affects the adjacent anatmical structures Vascular lesin with either grwth r change in clr f verlying skin Mass that is causing pain Mass that is prgressively enlarging Ft Unexplained ft pain Persistent pain f unclear etilgy Intermediate lesin n plain x-ray r CT scan Suspected stechndral injury with nrmal plain film Suspected stenecrsis due t fcal radilucency n plain x-ray Bne scan demnstrates well lcalized, increased uptake Persistent unexplained ft pain, particularly after trauma Tarsal tunnel syndrme, nly when suspicin f space ccupying lesins present Chrnic ft pain Pain/tenderness ver navicular tubersity unrespnsive t cnservative therapy Plain radigraphs shwed accessry navicular Athlete with pain/tenderness ver tarsal navicular with unremarkable plain radigraphs Middle aged wman with burning pain and paresthesia alng plantar surface f the ft and tes (suspect tarsal tunneling syndrme) Pain in the 3-4 web space with radiatin t the tes (suspect Mrtn s neurma) Yung athlete with lcalized pain at the plantar aspect f the heel (suspect plantar fasciitis) Suspected stemyelitis with Persistent pain in patients with diabetes r severe PVD Persistent r wrsening ulcer particularly when sinus tract infectin r abscess present Pain assciated with chills and fever particularly after trauma r rthpedic surgery Overlying cellulitis that respnds prly t antibitics Fcal lesin seen n bne scan Suspected sinus tract infectin frm ulcer Suspected stress fracture with Histry f veruse r excessive activity Lcalized pain Symptms persist r recur despite rest 2 nrmal plain films at least 3 weeks apart Page 5 f 6 07/22/2005

6 Cncerns regarding infectin r inflammatry prcess make bne scan subptimal Sft tissue mass with Deep r large mass Masses that crss anatmical bundaries Mass that affects the adjacent anatmical structures Vascular lesin with either grwth r change in clr f verlying skin Sft tissue abscess r pymysitis (muscle abscess) Mass that is causing pain Mass that is prgressively enlarging Mrtn s r Interdigital Neurma with Suspected Mrtn s neurma by findings such as pain in 3 rd and 4 th space and numbness radiating t tes Failure f cnservative care such as rthtics, eliminatin f ffending shes and lcal sterid injectin Intermediate diagnsis r previus prcedures dne Te Te pain with suspected stemyelitis; Pain assciated with chills and fever Overlying cellulitis with pr respnse t antibitics Persistent pain withut ulcers present in patient with diabetes r severe PVD Persistent r wrsening ulcer withut bne expsure in patient with diabetes r severe PVD Fcal lesin seen n bne scan Pre-prcedure, prcedure r treatment Fr preperative evaluatin (identifies extensin f infectin int bne, peritneum, crd and nerve rts) Pst-prcedure Hip arthrscpy Knee arthrscpy Screening Asymptmatic patients withut a diagnsis Other prvide clinical infrmatin Page 6 f 6 07/22/2005