Mri knee and ankle anatomy presentation pk1
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This document provides details on MRI imaging of the knee and ankle, including: - Muscles and ligaments relevant to the knee and ankle - Imaging modalities used including MRI sequences and technical considerations - Anatomy and normal appearances of structures like the menisci, ACL, PCL, MCL, LCL - Descriptions and diagrams of MRI slices in the sagittal, coronal, and axial planes - Checklist for evaluating ankle MRI focusing on bones, joints, ligaments, and tendons
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Mri knee and ankle anatomy presentation pk1
- 1. MRI KNEE AND ANKLE Dr. Pradeep Kumar MD. Radiodiagnosis
- 4. Muscles: • Anteriorly: • Quadriceps femoris muscle on proximal pole of patella anteriorly: most important muscle for stabilisation
- 5. • Laterally: • Tensor fascia lata and iliotibial tract– Gerdy’s tubercle at anterolateral tibia
- 10. • Posteriorly: • Semitendinosus • Semimembranosus • Biceps femoris • Gastrocnemius • Plantaris: Longest tendon • Popliteus
- 12. IMAGING MODALITIES • Plain radiograph • CT • USG • MRI • Arthrography
- 13. MRI- technical consideration • Pt positioning: Supine with leg in full extension (10-15 ext rotn) • Surface coil: Dedicated knee coil is mandatory as it improves the signal to noise ratio • Small FOV of 14-16 cm • Slice thickness 3-4 mm • At least 256x192 matrix
- 14. • Sagittal: along long axis of lat femoral condyle (to obtain good view of ACL) • Menisci & cruciate ligament– sagittal; coronal for confirmation of pathology. • PD most sensitive in detection of meniscal tears • MCL & LCL- coronal images. • Marrow & bone contusions, MR arthrography- STIR & fat saturated FSE. • T1 – Bone marrow pathology and subtle # (not obscured by edema as in T2)
- 15. Sequences • T1- Coronal • T2- Sag, Coronal, Axial • STIR- Coronal • PD- Sag
- 16. MRI appearance • Uniformly low T1 & T2 SI (avascular portion) • Peripheral 3mm excellent vascularity. • Bow tie appearance in sag.
- 17. Menisci • Fibrocartilage disc • 2 “C” shaped • Thick peripherally & thin centrally • Divided into: • Ant horn • Body • Post horn • Divided as: • Red zone: peripheral 1/3rd , vascularised & innervated • White zone: inner 2/3rd, strictly fibrocartilage
- 19. Medial meniscus • Both horns are triangular in shape and have very sharp points. • The posterior horn is always larger than the anterior horn • The posterior root is immediately anterior to the posterior cruciate ligament. • If it is missing on the sagittal images, then there is a meniscal root tear
- 21. Lateral meniscus • On sagittal images the posterior horn is higher in position than the anterior horn. • Both horns are about the same size.
- 22. ACL-Anatomy • Lateral femoral condyle to anterior intercondylar region of the tibia
- 23. • Coronal T1WI -lateral position of the ACL in the intercondylar notch (arrow), surrounded by high-signal fat. • Axial fat-saturated neutral-weighted fast spin-echo (FSE) MRI shows the normal, linear hypointense ACL adjacent to the lateral bony wall of the upper intercondylar notch (arrow) Axial fat-saturated fast spin-echo (FSE) MRI shows the normal, linear hypointense ACL adjacent to the lateral bony wall of the upper intercondylar notch (arrow)
- 24. PCL - Anatomy • Medial femoral condyle (lat aspect) • Posterior surface of the intercondylar region of tibia
- 25. MCL- Anatomy 3 functional units Superficial to deep Superficial layer 1 Consists deep crural fascia. Anteriorly fuses with layer 2 to form medial patellar retinaculum. • Intermediate layer 2 Superficial layer of MCL • Deep layer 3 Consist joint capsule and deep layer of MCL
- 26. LCL- anatomy
- 27. Normal MRI appearance- best on coronal image- uniformly low signal intensity. • Coronal proton density image demonstrating the lateral collateral ligament in its entirety, from the femoral condyle origin to the fibular head insertion.
- 28. MRI AxialSection (lower to upper)
- 29. Tibial tuberosity Saphenous nerve Great saphenous vein Medial gastrocnemius Lateral gastrocnemius Soleus Tibia Tibialis anterior Fibula
- 31. Patellar tendon
- 37. Lateral tibial condyle Iliotibial tract Medial tibial condyle Sartorius tendon Gracilis tendon Semitendinosus tendon Semimembranosus tendon
- 42. Medial femoral condyle Lateral femoral condyle Infrapatellar fat pad Patellar tendon Popliteus tendon
- 45. Sartorius muscle Semimembranosus tendon Semitendinosus tendon Tibial nerve Popliteal vein Popliteal artery Lateral gastrocnemius Joint capsule
- 50. Superior medial geniculateartery Superior lateral geniculateartery Patella Synovial fluid
- 52. Popliteal artery and vein Semimembranosus muscle Biceps femoris Femur Vastus medialis Sartorius muscle Semitendinosus tendon Quadriceps tendon Suprapatellar bursa
- 53. SagittalSection( medial to lateral)
- 55. Vastus medialis Medial femoral condyle Medial meniscus Tibia Medial gastrocnemius Gracilis tendon Sartorius muscle
- 56. Vastus medialis Medial femoral condyle Medial meniscus Tibia Semitendinosus tendon Medial gastrocnemius muscle Medial gastrocnemius tendon Gracilis tendon
- 57. Posterior horn of medial meniscus Joint capsule Anterior horn of medial meniscus Semimembranosus tendon Semitendinosus tendon Semimembranosus muscle
- 61. Shaft of the tibia Shaft of the femur
- 63. Infrapatellar fat pad Patella Oblique popliteal ligament Posterior cruciate ligament Popliteus muscle
- 64. Posterior cruciate ligament Popliteal artery Anterior cruciate ligament Patellard tendon Quadriceps tendon
- 65. Tibial nerve Popliteal vein Anterior cruciate ligament Popliteal artery Popliteus muscle
- 66. Posterior horn of lateral meniscus
- 69. Popliteus muscle Posterior horn of lateral meniscus Popliteus tendon Head of fibula Anterior horn of lateral meniscus Lateral femoral condyle
- 70. Biceps femoris muscle Lateral head of gastrocnemius muscle Common peroneal nerve
- 71. Tendon of the lateral head of gastrocnemius Common peroneal nerve Lateralmeniscus Vastus lateralis muscle
- 76. CoronalSection( ant to posterior)
- 77. Biceps femoristendon Biceps femoris Popliteal artery Lateral head of gastrocnemius muscle Head of fibula Semimembranosus muscle Gracilis tendon Semimembranosus tendon Medial head of gastrocnemius muscle Semitendinosus tendon
- 78. Lateral superior geniculate artery Sartorius muscle Medial inferior geniculate artery Popliteal artery Popliteus muscle Biceps femoristendon
- 80. Lateral gastrocnemius tendon Medial gastrocnemius tendon Medial femoral condyle Sartorius tendon Gracilis tendon Posterior cruciate ligament Lateral tibial plateau Semimembranosus tendon Medial tibial plateau Great saphenous vein
- 81. Lateral meniscus Head of the fibula
- 82. Anterior cruciate ligament Lateral collateral ligament Medial collateral ligament
- 83. Medial femoral condyle Lateral femoral condyle Popliteus tendon
- 84. Lateral intermuscular septum Anterior cruciate ligament Lateral meniscus Lateral intercondylar tubercle Medial intercondylar tubercle Posterior cruciate ligament
- 85. Vastus medialis muscle Anterior cruciate ligament
- 86. Iliotibial band
- 88. Iliotibial band
- 89. Anterior horn of medial meniscus
- 90. Infrapatellar fat pad Vastus lateralis tendon
- 94. Patella Lateral retinaculum Infrapatellar fat pad Patellar tendon Medial retinaculum Quadriceps tendon
- 97. Ankle Anatomy Tendons and ligaments Anterior Posterior Lateral Medial
- 98. Anterior aspect Tendons: Ligaments: Tibialis anterior Extensor H. longus Extensor digitorum longus No
- 99. Posterior aspect Tendons: Achilles Tendon Ligaments: No
- 100. Lateral aspect Tendons: Peroneal tendons Ligaments : Tibiofibular syndesmotic complex Lateral collateral ligament
- 101. Medial aspect Tendon: Tibialis posterior Flexor digitorum longus Flexor H. longus Ligaments: Deltoid ligament
- 102. • We use a checklist when evaluating an MRI of the Ankle: • Bones: screen on fatsat images for bone marrow edema. • Joints: screen for effusion and look at the joint capsule for thickening. • Ligaments: check the syndesmosis, the lateral and medial ligaments. • Tendons: check the tendons using the four quadrant approach; • Flexors on the medial side. • Achilles tendon posteriorly. • Peroneal tendons on the lateral side. • Extensors on the anterior side. • When you have evaluated all these structures, combine your findings and try to make a specific diagnosis.
- 107. THANK YOU
Notas del editor
- Semitendinous : ischial spine, inserted in pes. Anesernius Semimembrnous: ischial tuberosity, inserted in medial ascpect of tibia Popliteus-lateral femoral condyle Proximal surface o tibia
- Peripheral 3rd particularly of posterior horn of medial meniscus – neurovascular and fatty tissue- low to medium in T1 and medium to high in T2
- The lateral meniscus posteriorly comes up high over the tibial spine to insert near the posterior cruciate ligament. This upward position of the posterior horn may be the reason for the higher signal intensity of the posterior horn in all planes due to magic angle effect.
- anteromedial and posterolateral bundles: anteromedial bundle tightens with flexion of the knee, thus resists anterior translation of the tibia in flexion. The posterolateral bundle tightens with knee extension & resists hyperextension Best- sagittal oblique - slices parallel to cortex of lateral femoral condyle. Solid low signal band or 3 or 4 separate low signal bundles. Criteria for the normal ACL are: 1. Fiber-orientation as steep or steeper than the intercondylar roof.(Blumensaat’s line) 2. Fibers all the way from the tibia to the femur. Not as strong as the PCL. Is less strong at its femoral origin than at its tibial insertion PD fat sat
- Sagittal-best Band like with low signal intensity Arcuate shape on sag: Horizontal take off at femoral origin Abrupt descent at 45 degree to tibia.
- Better seen in coronal The superficial medial collateral ligament (MCL) extends from the medial epicondyle to insert not just near the joint but 7 cm below the joint space. At that point there are three landmarks: the inferomedial geniculate artery and paired veins (figure). The deep part of the MCL, even when it is normal, you may not be able to see. It is closely applied to the medial meniscus and the superficial MCL.
- Posterolateral corner contains seven or eight structures. Only three of them are important to us because they are visible on MR and because the surgeon might want to fix them. These structures are: 1. Fibular collateral ligament 2. Biceps femoris muscle and tendon. 3. Popliteal tendon The fibular collateral ligament together with the tendon of the biceps femoris form the letter V on sagittal images. They inserts on the fibula head as the conjoined tendon. 5-7 cm long Lateral epicondyle of the femur to the fibular head Forms conjoined tendon with biceps femoris
- Anatomy in the axial plane The tendons can be divided into four compartments: Medial: (from medial to lateral: Tom-Dick-Harry) Tibialis Posterior (PTT) Flexor Digitorum Flexor Hallucis Longus Posterior Achilles Plantaris Lateral Peroneus Longus Peroneus Brevis Anterior (from medial to lateral: Tom-Hates-Dick) Tibialis Anterior Extensor Hallucis Longus Extensor Digitorum
- Tibiofibular syndesmotic complex Lateral collateral ligament Anterior talofibular Posterior talofibular Calcaneofibular Seen at the level of the malleolar fossa (Indentation on the medial surface of the fibula)
- ant. Tibiotalar Tibio navicular Tibio spring Tibio calcaneal Post. Tibiotalar Springs