Open full size image Open full size image Open full size image Open full size image Open full size image Saphenous Veins Clinical Note The superficial veins of the lower limb, including the saphenous veins, drain to deep veins via perforator veins with valves responsible for unidirectional flow to the deep system. When those valves are incompetent (often damaged by phlebitis), increased pressure in the superficial…
Open full size image Open full size image Open full size image Open full size image Open full size image Anterior View of the Shoulder Girdle Clinical Note The glenoid labrum is a fibrocartilaginous ring that surrounds and deepens the glenoid cavity. The long head of the biceps brachii tendon attaches to the top of the labrum at the supraglenoid tubercle (biceps anchor). A superior labrum…
Open full size image Open full size image Open full size image Open full size image Open full size image Pelvis Clinical Note The crest of the ilium is the most common site for the harvesting of red bone marrow for allogenic or autologous transplantation after loss of marrow due to disease, or chemotherapeutic or radiation treatments for cancer. It is also the site for obtaining…
Open full size image Open full size image Open full size image Open full size image Open full size image Rectus Abdominis Clinical Note Surgical incisions through the rectus abdominis can be made transversely because the abdominal nerves run in that direction and the healed scar appears very similar to one of the many tendinous intersections within the muscle. The rectus sheath is composed of the…
Open full size image Open full size image Open full size image Open full size image Open full size image Breast, Lateral View Clinical Note Dimpling of the skin of the breast over a carcinoma is caused by involvement and retraction of the suspensory ligaments (of Cooper), and obstruction of lymphatic drainage by carcinoma may cause edematous skin changes known as peau d'orange. Standard projections for…
Open full size image Open full size image Open full size image Open full size image Open full size image Thoracic Spine Clinical Note Excessive kyphosis is an abnormal increase in the thoracic curvature. This occurs frequently in osteoporotic women who develop anterior wedging–type compression fractures of thoracic vertebrae. The thoracic region of the vertebral column is the least mobile of the presacral vertebral column because…
Open full size image Open full size image Open full size image Open full size image Open full size image Skull, Basal View Clinical Note Maxillofacial three-dimensional (3-D) displays are very helpful in preoperative planning to correct deformities caused by trauma, tumor, or congenital malformations. 3-D volume reconstructions have been shown to be useful for detecting the extent and exact nature of fractures of the skull…
How to Image the Foot and Ankle See the protocols for foot and ankle magnetic resonance imaging (MRI) at the end of this chapter. The foot and ankle are among the most difficult anatomic sites to image, simply because of the angle formed between them. Even the terminology for plane orientation in the foot and ankle is confusing and certainly not universal. Coils and patient position:…
How to Image the Knee See the protocols for knee MRI at the end of this chapter. Magnetic resonance imaging (MRI) of the knee is the most frequently requested MRI joint study in musculoskeletal radiology. The reasons for this are simple: it works, and so referring physicians request it. MRI provides a comprehensive examination of the knee, giving surgeons information they could not otherwise obtain clinically…
How to Image the Hips and Pelvis See the hip and pelvis protocols at the end of the chapter. Coils and patient position: Generally, when evaluating the hips for entities such as avascular necrosis (AVN) or fractures, it is possible in many patients to use a torso phased array coil. For larger patients, the body coil is necessary. Both hips and the entire pelvis are imaged…
How to Image the Spine See spine protocols at the end of the chapter. Coils and patient position: Phased array spine coils should be used for all spine imaging. Patients are supine in the magnet. Image orientation ( Box 13.1 ): Sagittal and axial images are acquired in the cervical, thoracic, and lumbar regions. In the axial imaging plane, we obtain stacked cuts that cover an…
How to Image the Wrist and Hand See the wrist and hand protocols at the end of the chapter. Coils and patient position: Some type of surface coil is an absolute requirement for proper wrist imaging. Many different coils may be used depending on the size of the patient’s wrist, including dedicated wrist coils. Generally, the smaller the coil, the better the images. The challenge for…
How to Image the Elbow Coils and patient position: The elbow is typically scanned with the patient in a supine position with the arm at the side and palm up. A surface coil is imperative for obtaining high-quality images. The surface coil of choice depends on the size of the patient’s elbow being studied. The coil selection should allow for an optimum field of view. Occasionally,…
How to Image the Shoulder See the shoulder protocols at the end of the chapter. Coils and patient position: A surface coil is required to obtain high-resolution, detailed images. The patient is positioned supine with the arm at the side in neutral position or slight external rotation for a standard examination. The arm position influences how well anatomic structures can be identified on magnetic resonance (MR)…
How to Image the Temporomandibular Joint See the temporomandibular joint (TMJ) protocols at the end of the chapter. Coils and patient position: Small surface coils are used, generally with a diameter of about 3 inches. Bilateral simultaneous examinations of the TMJs can be done with coupled surface coils. The patient is supine in the bore of the magnet, with the coils centered over the TMJs just…
How to Image Osseous Trauma Coils and patient position: The patient should be placed in a comfortable position with passive restraints, such as tape or Velcro straps, applied to the region of interest to minimize motion. Pain medication also may be required in cases of acute trauma to improve patient comfort. Although the body coil may be used in cases where a large field of view…
Magnetic resonance imaging (MRI) plays a central role in the work-up of a patient presenting with a suspected musculoskeletal tumor. MRI can confirm the presence of a lesion, allow for a specific diagnosis in some cases, define the extent of tumor spread, provide biopsy guidance, and assist in the evaluation of recurrent disease after therapy. Therapeutic planning at the time of presentation is based primarily on…
How to Image Arthritis and Cartilage Magnetic resonance imaging ( MRI ) remains the ideal imaging technique for evaluating articular cartilage, as it allows for direct visualization of the cartilage and subchondral bone, and its multiplanar capability and exquisite soft tissue contrast provide unparalleled information about structures in and around the joint space. Although the diagnosis of the type of arthritis is made with conventional radiographs,…
How to Image Infection ( Box 5.1 ) Musculoskeletal infections affect bones, soft tissues, and joints. Infection is often considered a therapeutic emergency, and magnetic resonance imaging (MRI) is a valuable tool for demonstrating the presence or absence of disease and its extent. The MRI study should be directed to the site of involvement based on clinical grounds or where abnormalities on other imaging studies have…
How to Image Nerves Coils and patient position: High-resolution images of the small peripheral nerves require the use of phased array surface coils. The large sciatic nerve can be evaluated without a surface coil, but better resolution is possible if surface coils are used. Positioning of the patient is determined by which nerve is being evaluated. Generally, the nerve can be imaged with the same surface…