Table Of ContentMRI for Orthopaedic Surgeons
MRI for Orthopaedic Surgeons
Edited by
A. Jay Khanna, MD, MBA
Associate Professor
Departments of Orthopaedic Surgery and Biomedical Engineering
The Johns Hopkins University School of Medicine
Co-Director
Division of Spine Surgery
Johns Hopkins Orthopaedic Surgery at Good Samaritan Hospital
Baltimore, Maryland
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Library of Congress Cataloging-in-Publication Data
MRI for orthopaedic surgeons / [edited by] A. Jay Khanna.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-60406-022-5 (alk. paper)
1. Musculoskeletal system—Diseases. 2. Magnetic resonance imaging. I. Khanna, A. Jay.
[DNLM: 1. Musculoskeletal Diseases—diagnosis. 2. Magnetic Resonance Imaging—methods. WE 141 M9388 2009]
RC925.M75 2009
617.4’707548—dc22
2009016354
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Printed in China
5 4 3 2 1
ISBN 978-1-60406-022-5
To my parents, Mona and Surinder, who have
always helped me achieve my dreams.
To my wife, Roma, the woman of my dreams.
To my children, Rajan and Priya, for whom
I have so many dreams.
Contents
Foreword ....................................................................................................................................................................................................ix
Frank J. Frassica
Preface .........................................................................................................................................................................................................xi
Acknowledgments .................................................................................................................................................................................xiii
Contributors .............................................................................................................................................................................................xv
Abbreviations ..........................................................................................................................................................................................xix
I Initial Concepts
1. Essentials of MRI Physics and Pulse Sequences ..................................................................................................................3
Rick W. Obray, Douglas P. Beall, John D. Reeder, John A. Carrino, and Laura M. Fayad
2. Normal MRI Anatomy of the Musculoskeletal System ....................................................................................................17
J. Dana Dunleavy, A. Jay Khanna, and John A. Carrino
3. A Systematic Approach to the Review of Musculoskeletal MRI Studies ......................................................................77
A. Jay Khanna
II Upper Extremity
4. The Shoulder ..............................................................................................................................................................................97
Adam J. Farber, A. Jay Khanna, Laura M. Fayad, Timothy S. Johnson, and Edward G. McFarland
5. The Elbow .................................................................................................................................................................................118
Lance M. Brunton, Mark W. Anderson, and A. Bobby Chhabra
6. The Wrist and Hand ...............................................................................................................................................................129
Lance M. Brunton, Mark W. Anderson, and A. Bobby Chhabra
III Lower Extremity
7. The Hip ......................................................................................................................................................................................147
Michael K. Shindle, Bryan T. Kelly, Luis E. Moya, and Douglas N. Mintz
8. The Knee ...................................................................................................................................................................................164
Brett M. Cascio, A. Jay Khanna, Sergio A. Glait, Andrew J. Cosgarea, Timothy S. Johnson, and John D. Reeder
9. The Foot and Ankle ................................................................................................................................................................202
Daniel J. Durand, John A. Carrino, Meena W. Shatby, Ali Moshirfar, and John T. Campbell
viii Contents
IV Spine
10. The Cervical Spine .................................................................................................................................................................229
Lukas P. Zebala, Jacob M. Buchowski, Aditya R. Daftary, Joseph R. O’Brien, John A. Carrino, and A. Jay Khanna
11. The Lumbar and Thoracic Spine ........................................................................................................................................269
Gbolahan O. Okubadejo, Aditya R. Daftary, Jacob M. Buchowski, John A. Carrino, and A. Jay Khanna
12. Tumors of the Spine ..............................................................................................................................................................316
Daniel M. Sciubba, Bruce A. Wasserman, and Ziya L. Gokaslan
13. The Pediatric Spine ...............................................................................................................................................................338
A. Jay Khanna, Bruce A. Wasserman, and Paul D. Sponseller
V Special Considerations
14. Articular Cartilage ................................................................................................................................................................353
Michael K. Shindle, Li Foong Foo, Bryan T. Kelly, and Hollis G. Potter
15. Soft-Tissue and Bone Tumors .............................................................................................................................................370
Derek F. Papp, A. Jay Khanna, Edward F. McCarthy, Laura M. Fayad, Adam J. Farber, and Frank J. Frassica
16. Advanced Techniques in Musculoskeletal MRI ..............................................................................................................397
Douglas E. Ramsey, Rick W. Obray, Priya D. Prabhakar, and John A. Carrino
17. Correlation of MRI with Other Imaging Studies ............................................................................................................414
Uma Srikumaran, Laura M. Fayad, and A. Jay Khanna
18. MRI Safety ...............................................................................................................................................................................425
Monica D. Watkins and Bruce A. Wasserman
Index .........................................................................................................................................................................................................431
Foreword
The ability to accurately interpret an MRI study of a given in radiology and orthopaedic surgery. His knowledge comes
anatomic region is essential to the practice of orthopaedic from seeing patients every day and teaching students and
surgery. Until now, we have taught orthopaedic surgeons- residents. Dr. Khanna has assembled an experienced team of
in-training how to evaluate such studies in a rather informal orthopaedic surgeons and radiologists from within our insti-
manner: in the offi ce, in conferences, and in the operating tution and throughout the country who have the expertise
room. In most cases, the orthopaedic surgeon learns the and passion to make this book the standard for educating
skill of interpreting MRI studies through his or her own ex- individuals interested in the musculoskeletal system.
perience, through interaction with the radiologists who in- The book is organized into fi ve focused sections: ini-
terpret the studies, and perhaps by attending a continuing tial concepts, upper extremity, lower extremity, spine, and
medical education conference or reviewing a textbook on special considerations. The region-specifi c chapters have a
the topic. At our institution, the orthopaedic surgeons work common format that very eff ectively teaches the reader how
closely with the Department of Radiology and, specifi cally, to evaluate imaging studies of that section of the musculo-
the Division of Musculoskeletal Imaging. For example, for skeletal system. The many MR images are of superb quality,
a patient with a musculoskeletal tumor, I review all of the and the numerous line drawings illustrate key anatomy and
imaging studies with an experienced musculoskeletal radi- pathology principles very clearly.
ologist and pathologist before proceeding with a treatment This text will not only benefi t orthopaedic surgeons and
plan of observation, biopsy, or resection. This interaction oc- radiologists but will also serve as an excellent resource for
curs in our daily clinic sessions and during our weekly MRI everyone who cares for the musculoskeletal system: pri-
conference, at which orthopaedic surgeons, musculoskeletal mary care physicians, emergency department physicians,
radiologists, pathologists, and other clinicians evaluate the physiatrists, neurologists, physical therapists, and nurses.
studies and review the clinical history together. We make This wonderful textbook will be well worn with daily use.
fewer mistakes when we work together.
MRI for Orthopaedic Surgeons is written by orthopaedic
Frank J. Frassica, MD
surgeons and radiologists for the purpose of providing a
Chairman and Robert A. Robinson Professor
more formal process of teaching the technique and the fund Department of Orthopaedic Surgery
of knowledge necessary to accurately interpret various MRI The Johns Hopkins University
pulse sequences. This textbook is edited by Dr. Jay Khanna, School of Medicine
who is a passionate educator and clinician with a background Baltimore, Maryland
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