Bubbly or Lytic Lesions (Fegnomashic) Fibrous dysplasia Enchondroma, eosinophilic granuloma Giant cell tumor Nonossifying fibroma Osteoblastoma Mets and myeloma Aneurysmal bone cyst Solitary bone cyst Hyperparathyroidism (brown tumor), hemangiomas Infection Chondroblastoma; chondromyxoid fibroid Multiple Lytic Lesions (FEEMHI) Fibrous dysplasia Enchondromas, eosinophilic granuloma Mets and myeloma Hyperparathyroidism (brown tumor), hemangiomas Infection Lytic Epiphyseal Lesion Chondroblastoma Giant cell tumor Infection Geode Lytic Lesion in a Patient Younger Than…

There are several additional areas in which magnetic resonance (MR) imaging is useful but should be covered in detail in texts devoted to musculoskeletal (MSK) MRI. They will be only superficially mentioned here. Included in this group are MR of the wrist, hip, elbow, and bone marrow. Wrist MR imaging of the wrist has been slower to develop than that of other joints. Similarly, wrist arthrography…

I have always found topics on the foot and ankle to be exceedingly boring. This is mainly because I was never called on to use any of the information I learned; hence I quickly forgot all that I was told. I learned early in my residency that during lectures on the foot and ankle, I could find better use of my time—like running or playing golf.…

Imaging the lumbar spine for disc disease and stenosis has evolved in the past 30 years from predominantly myelography-oriented exams to plain computed tomography (CT) and magnetic resonance (MR) imaging exams. Although few differences between CT and MR imaging have been noted concerning diagnostic accuracy in the lumbar spine, MR imaging will give more information and a more complete anatomic depiction than will CT. There are…

Magnetic resonance (MR) imaging of the shoulder has been shown to have a high degree of accuracy, especially when performed with arthrography. Although most texts divide the shoulder into either cuff or labral abnormalities, it is important to know that cuff and labral pathology often coexist, causing great confusion in the clinical presentation and the physical exam. Most surgeons are aware that failure to address a…

Magnetic resonance (MR) imaging of the knee has developed into one of the most frequently requested exams in radiology. This is not just because many people injure their knees, but because of its high accuracy in depicting internal derangements. Accuracy reports of knee MR imaging vary from 85% to 95%, with many investigators feeling that MR imaging of the knee is, in fact, more accurate than…

There are a host of bony conditions, diseases, and syndromes that do not fit conveniently into any of the preceding chapters yet should be given some mention in an attempted overview of musculoskeletal radiology. Many of these are simply “Aunt Minnies” and only require you to have seen them once or twice to recognize them. I have severely limited the things I have included in this…

Most of the literature on metabolic bone disease is steeped in biochemistry, physiology, histology, internal medicine, and other arcane pursuits that can be quite confusing for a poor radiology resident who just wants a few pearls and illustrations. Frankly, it’s a tough topic. I will, by necessity, keep it simple, but this is an important topic about which every radiologist should have at least a superficial…

The radiologic study of arthritis can be extremely difficult for the inexperienced because of the wide variety of patterns of disease, which produces a tremendous amount of overlap among the various diseases. What at first seems to be simple characterization of disease entities is found by the more experienced observer to be broad generalizations that may or may not fit into any one category of disease.…

Radiology of trauma to the skeletal system is such a large topic that entire volumes have been devoted to it. Lee Rogers has written the definitive work in his excellent book entitled Radiology of Skeletal Trauma , and Jack and William Harris’ outstanding book on Radiology of Emergency Medicine is a must read for anyone dealing with a large emergency department population. The leading orthopedic treatise…

Skeletal “don’t touch” lesions are those processes that are so radiographically characteristic that a biopsy or additional diagnostic tests are unnecessary. Not only does the biopsy result in unnecessary morbidity and cost, but in some instances a biopsy also can be frankly misleading and lead to additional unnecessary surgery. Most of our radiology training teaches us to give a differential diagnosis of a lesion, leaving it…

Radiology residents have difficulty dealing with malignant bone tumors, and the difficulty gets worse in the years after residency. This is simply because malignant bone tumors, thankfully, are not very common. Nevertheless, every radiologist will encounter one or two a year in most practices and should be able to recognize them and give a good differential diagnosis. First, how do you recognize a malignant tumor and…

A benign, bubbly lytic lesion of bone is probably one of the most common skeletal findings a radiologist encounters. The differential diagnosis can be quite lengthy and is usually given on an “Aunt Minnie” basis (I know that’s Aunt Minnie because she looks like Aunt Minnie); in other words, the differential diagnosis is structured on how the lesion looks to the radiologist, using his or her…

Before beginning to learn how to interpret pathologic skeletal films, it is important to briefly consider unnecessary skeletal radiographic examinations. Dr. Ferris Hall from Boston first brought to my attention the idea that just because we could x-ray something didn’t mean that we should . His article entitled “Overutilization of Radiologic Examinations” in the August 1976 issue of Radiology details many examples of overuse and misuse…