Samuel R. Ward. Associate Professor in the Departments of Radiology, Orthopaedic Surgery and Bioengineering at the University of California, San Diego.
Similar a Samuel R. Ward. Associate Professor in the Departments of Radiology, Orthopaedic Surgery and Bioengineering at the University of California, San Diego.
Similar a Samuel R. Ward. Associate Professor in the Departments of Radiology, Orthopaedic Surgery and Bioengineering at the University of California, San Diego. (20)
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Samuel R. Ward. Associate Professor in the Departments of Radiology, Orthopaedic Surgery and Bioengineering at the University of California, San Diego.
1. 10/10/13
Imaging Musculoskeletal InjuriesStrengths and Weaknesses of Different Modalities
Samuel R. Ward, PT, PhD
Associate Professor
Muscle Physiology Lab
Departments of Radiology, Orthopaedic Surgery, and Bioengineering
University of California San Diego
VA Medical Center San Diego
MuscleTech Network, Barcelona, Oct 14, 2013
Ultrasound
Plain film x-ray
Computed tomography
Bone Scan (scintigraphy)
Magnetic resonance imaging
Positron emission tomography
Safety / easy of use
Cost / Complexity
Imaging Modalities
1
4. 10/10/13
Bone Scan (Scintigraphy)
Detector (2D or 3D)
http://www.saintlukeshealthsystem.org
Patient = radiation source
Metabolic/Remodeling activity contrast
Fracture, tumor- 99mTC-MDP- Osteoblasts
Infection- Induim-111 or Galium-neutrophils
Magnetic resonance imaging
http://www.magnet.fsu.edu
Proton imaging (H2O)
Contrast = intrinsic properties of soft tissues
Very good at imaging water
Very flexible imaging technique
Gadolinium or Iron- based contrast agents
4
7. 10/10/13
MRI Physiology and Microarchitecture
High-Res Structure
IDEAL
High-Res DTI
Skiing Injury with Epimysial Hematoma
Gas
Tib
Tib
Sol
Sol
Gas
Sol
Sag US
Ax T1 MRI
Gas
Ax T2 MRI
Isointense = acute
7
8. 10/10/13
Intramuscular Hematoma from a Kick
Sag US
Ax T2 MRI
Heterogeneous intensity = Subacute
Chronic Subperiosteal Hematoma
RF
RF
VL
Ax T2 MRI
RF
VL
VL
Fat Sup Ax T2 MRI
Ax CT
8
9. 10/10/13
Rhabdomyolysis from Fall
G Med
G Max
Ax CT
Ax MRI
Professional Soccer Player
Kick Injury after 5-6 weeks
Ax T1 MRI
Differential diagnosis- neoplasm?
Ax CT
Myositis Ossificans
9
11. 10/10/13
ACL Tear with Bone Bruise
Sag T1 MRI
Sag Fat Sup T2 MRI
Quadriceps Tendon Tear
Sag T1 MRI
Sag Fat Sup T2 MRI
11
12. 10/10/13
TE
100 µs
TE
500 µs
TE
2 ms
Achilles Tendon
TE
300 µs
TE
3 ms
TE
5 ms
TE
1 ms
MRI UTE T2* Quantification
TE
10 ms
UCSD MSK Imaging Research Group
cbchung@ucsd.edu
Case 1
• A young talented player
with symptoms in the
patella tendon (on and off
pain during warm up or
after training, better
during activity) during the
preseason training
• what to do?
• continue training? adjust
training? add treatment?
12
13. 10/10/13
Case 2
• A very important player
during season experience
increasing symptoms
(pain and stiffness in the
morning) in the Patellar
Tendon weeks before an
important match
• What to do ??
Case 3
• One of you players
experiences sudden
unset of pain in the
Insertional Achilles
tendon during
training but only
during high loading.
• What to do ?
13
15. 10/10/13
Grade Radiography
Scintigraphy
MR Imaging
0
Normal
Normal
Normal
I
Gray cortex sign; margin is
indistinct, density lower
Linear increased cortical
activity
Mild to moderate periosteal
edema on T2-w images with
normal marrow
II
Acute periosteal reaction,
density differs from rest of
cortex showing incomplete
mineralization
Small focus of increased
activity
Periosteal edema and bone
marrow edema on only T2-w
images
III
Lucent areas in cortex, illdefined foci at site of pain
Larger focal lesion with highly
increased activity in cortical
region
Marrow edema on T1-w and
T2-w images with/without
periostitis and loss of cortical
signal void, intracortical
increased intensity and
intracortical linear
hyperintensity
IV
Fracture line present
Very large focal region of
highly increased activity
Low signal intensity fracture
line on all sequences,
periosteal and marrow
edema, may show muscle
edema
Beck BR, Bergman G, Miner M et al, Radiology 263:811, 2012
15