The iliotibial band syndrome : MR Imaging findings

Transcription

1 The iliotibial band syndrome : MR Imaging findings Poster No.: P-0081 Congress: ESSR 2013 Type: Scientific Exhibit Authors: W. Harzallah-Hizem, M. MAATOUK, A. Zrig, R. Salem, W. Mnari, B. Hmida, M. GOLLI; Monastir/TN Keywords: Athletic injuries, Imaging sequences, MR, Musculoskeletal system, Musculoskeletal joint, Anatomy DOI: /essr2013/P-0081 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 11

2 Purpose The purpose of this work is to define magnetic resonance (MR) imaging findings in the iliotibial band friction syndrome. Methods and Materials Iliotibial band syndrome is a common cause of lateral knee pain in the athletic patient population. The diagnosis is usually made based on a characteristic history and physical examination with imaging studies to rule out other pathologic entities. Magnetic resonance (MR) imaging is superior to US in the detection of IT band friction syndrome. We report a case of a 18 year-old boy who presents with a lateral knee pain related to the ITB syndrome. A 18 year-old boy presented with a history of a lateral knee pain. Plain radiographs revealed no abnormalities. MR imaging was performed and revealed fluid collection on both sides of the IT band (Fig.1 and 2). There was no relation of the lesion with the lateral collateral ligament. These findings are indicative of a bursitis of the IT band. The ITB signal intensity is normal. The patient underwent an arthroscopy to remove the collection surrounding the IT band. Images for this section: Page 2 of 11

3 Fig. 1: Coronal T2-weighted image with fat saturation showed a multilocular fluid collection located on both side of the iliotibial tract. Page 3 of 11

4 Fig. 2: Axial T2-weighted image with fat saturation showed high signal intensity of the cystic lesion. The signal of the iliotibial tract is normal. Page 4 of 11

5 Results ITB syndrome is a common cause of lateral side knee pain in the active and athletic population. The etiology of ITB is a subject of debate. Theories include friction of the ITB against the lateral femoral epicondyle during repetitive flexion and extension activities, compression of the fat and connective tissue deep to the ITB, and chronic inflammation of the ITB bursa. The diagnosis of the ITB friction syndrome is based on clinical examination. In some patients, however, ITB friction syndrome can be misdiagnosed as some other derangement of the knee, such as a lateral meniscal tear, lateral collateral ligament sprain or popliteal tendon strain. The ITB is formed proximally at the level of the greater trochanter by the coalescence of the fascial investments of the tensor fascia latae, the gluteus maximus muscle, and the gluteus medius muscle (Fig.3). Proximal to the knee joint, the ITB is attached to the supraondylar tubercle of the femoral condyle and the intermuscular septum, and it continues distally to attach to the Gerdy tubercle at the anterolateral aspect of the tibia (Fig.4). Proximal to the lateral femoral epicondyle, the ITB is separated from the femur by a wide layer of fatty tissue that extends to the vastus lateralis muscle (Fig.5). At the level of the lateral femoral condyle, the iliotibial tract contacts the lateral femoral epicondyle and the inserting fibers of the lateral collateral ligament. Ultrasonography (US) can be used for detection of soft-tissue abnormalities in patients with the ITB. The findings, however, are not specific. Bone scintigraphy may show abnormal radionucleotide uptake about the lateral femoral condyle or near the lateral tibial tubercle in patients with this syndrome. Magnetic resonance (MR) imaging is superior to US and bone scintigraphy in the detection of ITB friction syndrome. Poorly defined signal intensity alterations is observed in the fatty tissue deep to the ITB. The signal intensity abnormalities were located within a compartment-like space demarcated laterally by the ITB and distally and medially by the meniscocapsular junction of the lateral meniscus, the lateral collateral ligament, and the lateral femoral epincondyle. Proximal to this epicondyle, the signal intensity alterations extended into the fatty tissue distal to the vastus lateralis muscle (Fig.6). Circumscribed fluid collections at MR imaging were found rarely. These well-defined fluid collection had the same compartmentlike distribution as the poorly defined soft-tissue edema described previously (Fig.7). Anatomic investigations suggest the well-defined fluid collections are more likely to arise from chronic inflammation with formation of a secondary or adventitious bursa, rather than from inflammation of a primary bursa. Images for this section: Page 5 of 11

6 Fig. 3: Lateral view of the thigh. Page 6 of 11

7 Fig. 4: The ITB continue to attach to the Gerdy tubercle at the anterolateral aspect of the tibia. Page 7 of 11

8 Fig. 5: The ITB is separated from the femur by a wide layer of fatty tissue that extends to the vastus lateralis muscle. Page 8 of 11

9 Fig. 6: Coronal T2-weighted fat saturated fast spin-echo MR image reveals poorly defined high-signal-intensity alterations (straight arrows) medial to the ITB (arrowheads) that extend into the fatty layer distal to the vastus lateralis muscle (curved arrow). Page 9 of 11

10 Fig. 7: Coronal T2-weighted fat saturated fast spin-echo MR image demonstrates a high-signal-intensity large cystic fluid collection (straight arrows) medial to the ITB and extending to the iliotibial plateau. The lesion extends proximal to the lateral femoral epicondyle with soft-tissue edema (open arrow) adjacent to the vastus lateralis muscle (curved arrow). Page 10 of 11

11 Conclusion In summary, with MR imaging, poorly defined signal intensity abnormalities or a circumscribed fluid collection located in a compartment-like space medial to the ITB with obliteration to the fatty layer distal to the vastus lateralis muscle may allow the diagnosis of ITB friction syndrome. References 1- J.Strauss E, Kim S, G.Calcei J, Park D. Iliotibial band syndrome : Evaluation and management. J Am Acad Orthop Surg 2011;19: Muhle C, M.Ahn J, Yeh L et al. Iliotibial band friction syndrome : MR imaging findings in 16 patients and MR arthrographic study of sx cadaveric knees. Radiology 1999;212: Terry GC, Hughston JC, Norwood LA. The anatomy of the iliopatellar band and iliotibial tract. Am J Sports Med 1986;14: Grana WA, Larson RL. Functional and surgical anatomy. In : Larson RL, Grana WA, eds. The knee : form, function, pathology, and treatment. Philadelphia, Pa : Saunders ; 1993; Martens M, Libbrecht P, Burssens A. Surgical treatment of the iliotibial band frictio syndrome. Am J Sports Med 1989;17: DeGreter F, De Neve J, VanSteelandt H. Bone scan in iliotibial band syndrome. Clin Nucl Med 1995;20: Ekman EF, Pope T, Martin DF, Curl WW. Magnetic resonance imaging of iliotibial band syndrome. Am J Sports Med 1994;22: Murphy BJ, Hechtman KS, Uribe JW, Selesnick H, Smith RL, Zlatkin MB. Iliotibial band friction syndrome : MR imaging findings. Raiology1992; Nishimura G, Yamato M, Tamal K, Takahashi J, Uetani M. MR findings in iliotibial band syndrome. Skeletal Radiol 1997;26: Personal Information Page 11 of 11