Diagnostic Radiology: Musculoskeletal and Breast Imaging

558 Pages·2012·21.491 MB·English

by  Veena Chowdhury, Arun Kumar Gupta, Niranjan Khandelwal

DIAGNOSTIC RADIOLOGY
Musculoskeletal and Breast Imaging
PIONEERS OF AIIMS–MAMC–PGI IMAGING COURSE SERIES
Manorama Berry Sudha Suri Veena Chowdhury
PAST EDITORS
Sima Mukhopadhyay Sushma Vashisht
DIAGNOSTIC RADIOLOGY
Musculoskeletal and Breast Imaging
Third Edition
Editors
Veena Chowdhury MD Arun Kumar Gupta MD MNAMS FAMS
Director-Professor and Head Professor and Head
Department of Radiodiagnosis Department of Radiodiagnosis
Maulana Azad Medical College All India Institute of Medical Sciences
New Delhi, India New Delhi, India
Niranjan Khandelwal MD DNB FICR
Professor and Head
Department of Radiodiagnosis
Postgraduate Institute of Medical Education and Research
Chandigarh, India
Associate Editors
Anju Garg MD Anjali Prakash DMRD DNB MNAMS
Director-Professor Professor
Department of Radiodiagnosis Department of Radiodiagnosis
Maulana Azad Medical College Maulana Azad Medical College
New Delhi, India New Delhi, India
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Diagnostic Radiology: Musculoskeletal and Breast Imaging
First Edition : 1998
Second Edition : 2005
Reprint : 2011
Third Edition : 2012
ISBN 978-93-5025-883-5
Printed at
Contributors
Alpana Manchanda MD Deep Narayan Srivastava MD MBA FICR
Professor Professor
Department of Radiodiagnosis Department of Radiodiagnosis
Maulana Azad Medical College All India Institute of Medical Sciences
New Delhi, India New Delhi, India
Anjali Prakash DMRD DNB MNAMS Gaurav Shanker Pradhan DMRD DNB
Professor Professor
Department of Radiodiagnosis Department of Radiodiagnosis
Maulana Azad Medical College Maulana Azad Medical College
New Delhi, India New Delhi, India
Anju Garg MD Jyoti Kumar MD
Director-Professor Associate Professor
Department of Radiodiagnosis Department of Radiodiagnosis
Maulana Azad Medical College Maulana Azad Medical College
New Delhi, India New Delhi, India
Arun Kumar Gupta MD MNAMS FAMS Mahesh Prakash MD
Professor and Head Associate Professor
Department of Radiodiagnosis Department of Radiodiagnosis
All India Institute of Medical Sciences Postgraduate Institute of Medical Education
New Delhi, India and Research, Chandigarh, India
Arun Malhotra DRM PhD Manavjit Singh Sandhu MD
Professor and Head Professor
Department of Nuclear Medicine Department of Radiodiagnosis
All India Institute of Medical Sciences Postgraduate Institute of Medical Education
New Delhi, India and Research, Chandigarh, India
Ashu Seith Bhalla MD Mandeep Kang MD DNB
Additional Professor Additional Professor
Department of Radiodiagnosis Department of Radiodiagnosis
All India Institute of Medical Sciences Postgraduate Institute of Medical Education
New Delhi, India and Research, Chandigarh, India
Atin Kumar MD DNB MNAMS Manphool Singhal MD DNB
Associate Professor Assistant Professor
Department of Radiodiagnosis Department of Radiodiagnosis
All India Institute of Medical Sciences Postgraduate Institute of Medical Education
New Delhi, India and Research, Chandigarh, India
vi Diagnostic Radiology: Musculoskeletal and Breast Imaging
Mukesh Kumar Yadav MD Sanjay Thulkar MD
Assistant Professor Additional Professor
Department of Radiodiagnosis Department of Radiodiagnosis
Postgraduate Institute of Medical Education All India Institute of Medical Sciences
and Research, Chandigarh, India New Delhi, India
Niranjan Khandelwal MD DNB FICR Sapna Singh MD DNB MNAS
Professor and Head Associate Professor
Department of Radiodiagnosis Department of Radiodiagnosis
Postgraduate Institute of Medical Education Maulana Azad Medical College
and Research, Chandigarh, India New Delhi, India
Paramjeet Singh MD Shivanand Gamanagatti MD MNAMS
Professor Associate Professor
Department of Radiodiagnosis Department of Radiodiagnosis
Postgraduate Institute of Medical Education All India Institute of Medical Sciences
and Research, Chandigarh, India New Delhi, India
Punit Sharma MD Smriti Hari MD
Senior Resident Associate Professor
Department of Nuclear Medicine Department of Radiodiagnosis
All India Institute of Medical Sciences
All India Institute of Medical Sciences
New Delhi, India
New Delhi, India
Raju Sharma MD MNAMS Sumedha Pawa MD
Professor
Director-Professor
Department of Radiodiagnosis
Department of Radiodiagnosis
All India Institute of Medical Sciences
Maulana Azad Medical College
New Delhi, India
New Delhi, India
Rakesh Kumar MD PhD
Veena Chowdhury MD
Additional Professor
Director-Professor and Head
Department of Nuclear Medicine
Department of Radiodiagnosis
All India Institute of Medical Sciences
Maulana Azad Medical College
New Delhi, India
New Delhi, India
Rashmi Dixit MD
Vivek Gupta MD
Professor
Associate Professor
Department of Radiodiagnosis
Department of Radiodiagnosis
Maulana Azad Medical College
Postgraduate Institute of Medical Education
New Delhi, India
and Research, Chandigarh, India
Sameer Vyas MD
Assistant Professor
Department of Radiodiagnosis
Postgraduate Institute of Medical Education
and Research, Chandigarh, India
Preface to the Third Edition
Musculoskeletal radiology has witnessed tremendous strides since Roentgen took the first X-ray of the hand in 1895.
Conventional radiology remains the mainstay in the initial evaluation of trauma and bone tumors. The limited resolution of
X-ray to delineate various components of the musculoskeletal system has now been overcome by advances in cross-
sectional imaging. Magnetic resonance imaging (MRI) and dual energy computed tomography (CT) demonstrate each
detail of ligament, tendon, muscle and bone.
The first edition of Musculoskeletal and Breast Radiology was published in 1998 followed by the second edition in 2005.
The present edition has been designed to provide an integrated approach to musculoskeletal disorders. The first section
deals with all imaging modalities in detail. There is also an updated section on MR imaging. All chapters have been
thoroughly revised. Being a developing nation, infections continue to be a health problem and an entire section is devoted
to it.
The importance of conventional radiography has been emphasized because all radiology services have an X-ray unit and
further the differential diagnosis of various bone lesions should not be made on CT and MRI alone without referring to
recent plain radiographs.
The text is intended to assist in the interpretation of imaging studies and in suggesting the appropriate imaging
technique to clinicians involved in patient care.
The second part of the book contains updated chapters on Breast imaging, including a new one titled A Systematic
Approach to Imaging of Breast Lesions. Breast interventions are being increasingly performed, and a new chapter on the
same has been added. The role of PET-CT in breast cancer is also included as a new chapter.
Dr Sumedha Pawa, the associate editor of the previous edition passed away in October 2011, just as preparations for
this edition were underway. We acknowledge her contribution and wish to place on record our heartfelt thanks to her. We
dedicate this edition to her.
The editors take this opportunity to thank the faculty of the three organizing institutions who have put their collective
experience in this book. We would also like to express our appreciation to Shri Jitendar P Vij (Chairman and Managing
Director), Mr Tarun Duneja (Director-Publishing), Ms Samina Khan and other staff of M/s Jaypee Brothers Medical Publishers
(P) Ltd, New Delhi, India, for their professionalism and dedication towards publication of this book.
Veena Chowdhury
Arun Kumar Gupta
Niranjan Khandelwal
Anju Garg
Anjali Prakash
Preface to the First Edition
There has been a significant increase in the awareness as well as in the actual incidence of detection of disorders related to
the musculoskeletal system and the breast over the years. At the same time, a continuous revolution, occurring in the field
of imaging over these years, has given a new insight in the proper diagnosis, management and follow-up of these disorders.
With the availability of a large number of imaging techniques today, including conventional radiology, computed tomography
(CT), magnetic resonance imaging (MRI), ultrasonography (USG), interventional procedures and radioisotope studies,
each having its own merits and limitations, it has become essential on the part of the present day radiologist to be able to
advise and use the most cost-effective methodology in a given clinical situation. Such a need assumes even a greater
importance in the limited resources situation of a developing country. It is necessary for a radiologist of today to learn the
basic aspects and role of various imaging modalities in a given clinical situation for taking the fullest advantage of these
modalities. The need for a closer cooperation and understanding of each other’s role between the radiologist and a
clinician had never been felt greater before.
The present book on Musculoskeletal and Breast Imaging, the fifth in the series of AIIMS-MAMC-PGI imaging courses,
is a further attempt in this direction. The book has been broadly divided into two sections, i.e. the musculoskeletal disorders
and the breast disorders, each section dealing at length with the relevant imaging techniques and their interpretations in
various disease processes. There are 19 chapters, dealing with all important aspects of these systems.
The multimodality imaging approach to bone, soft tissue and joint diseases is presented while retaining the major
emphasis on conventional radiological findings. There are separate sections devoted to imaging modalities for infections
and inflammations, metabolic bone disorders and tumors. The text is intended to assist in the interpretation of imaging
studies of patients with these disorders and in suggesting the appropriate imaging technique to the clinicians involved in
their care.
The role of mammography in early diagnosis of breast cancer and in helping in breast conservation need not be
overemphasized. The section on breast imaging deals in detail with the role of screening mammography, its relevance as
it pertains to our country, the current status of various other imaging modalities and future directions in the imaging of
breast. The purpose of this book is to provide the reader with essential information in all important aspects of the subspecialty
of musculoskeletal and breast imaging, and we hope that it serves as a compliment to the AIIMS-MAMC-PGI course,
through its concise, comprehensive and current survey on the subject.
We are grateful to all our faculty staff and other eminent teachers for contributing their experiences through their
excellent write-ups in all these volumes providing a balanced view on the modern day practice of Radiology in various
clinical situations. We also thank the series publishers M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India,
Shri Jitendar P Vij (Chairman and Managing Director) and other staff, for timely publication of all these volumes in an
excellent form. But for their active and persistent involvement, such a gigantic task would not have been a reality. We do
sincerely hope that all these volumes, including the present one published under the AIIMS-MAMC-PGI imaging course
series, shall be able to fulfill the desired aims and shall continue to guide the readers in their daily office practice of
radiology. Readers response shall always remain the ultimate guiding spirit in this direction.
Manorama Berry
Veena Chowdhury
Sudha Suri
Sima Mukhopadhyay
Contents
Part One: MUSCULOSKELETAL IMAGING
IMAGING MODALITIES
1. Diagnostic Approach to Focal Bone Lesions: Conventional Radiography,
Computed Tomography and Magnetic Resonance Imaging .................................................................... 3
Shivanand Gamanagatti, Raju Sharma
2. Basic Principles and Current Concepts of Musculoskeletal Magnetic Resonance Imaging.................... 20
Raju Sharma, Shivanand Gamanagatti
3. Nuclear Medicine Imaging for Musculoskeletal Disorders................................................................... 35
Rakesh Kumar, Punit Sharma, Arun Malhotra
4. Angiography and Interventions in Musculoskeletal Lesions ................................................................ 49
Deep Narayan Srivastava
INFECTIONS/INFLAMMATIONS
5. Tuberculosis of Bones and Joints ......................................................................................................... 64
Gaurav Shanker Pradhan, Veena Chowdhury
6. Nontubercular Bone and Joint Infections............................................................................................. 80
Manphool Singhal, Niranjan Khandelwal
7. Tuberculosis of the Spine..................................................................................................................... 94
Rashmi Dixit
8. Noninfective Inflammatory Arthritis...................................................................................................113
Mandeep Kang, Mahesh Prakash
9. Nontubercular Infections of the Spine................................................................................................133
Sameer Vyas, Manavjit Singh Sandhu
10. Degenerative Disease of the Spine and Joints ....................................................................................149
Jyoti Kumar, Sumedha Pawa
METABOLIC BONE DISEASES
11. Skeletal Disorders of Metabolic and Endocrine Origin........................................................................177
Alpana Manchanda, Arun Kumar Gupta
12. Osteoporosis ......................................................................................................................................212
Mukesh Kumar Yadav, Vivek Gupta, Niranjan Khandelwal