Musculoskeletal diseases diagnostic imaging and interventional techniques - 37th International Diagnostic Course in Davos (IDKD), Davos, April 2-8, 2005, including the Pediatric Satellite Course ''Kangaroo''

197 Pages·2005·5.42 MB·English

by  Gustav K. von Schulthess

Musculoskeletal Diseases
Diagnostic Imaging and Interventional Techniques
III
G.K. von Schulthess • Ch.L. Zollikofer (Eds)
MUSCULOSKELETAL
DISEASES
DIAGNOSTIC IMAGING AND INTERVENTIONAL
TECHNIQUES
37th International Diagnostic Course
in Davos (IDKD)
Davos,April 2-8, 2005
including the
Pediatric Satellite Course “Kangaroo”
Davos, April 2-3, 2005
presented by the Foundation for the
Advancement of Education in Medical Radiology, Zurich
IV
J. HODLER G. K. VON SCHULTHESS
Department of Radiology Universitätsspital
University Hospital Balgrist Nuklearmedizin
Zurich, Switzerland Zurich, Switzerland
CH. L. ZOLLIKOFER
Kantonsspital
Institut für Radiologie
Winterthur, Switzerland
Library of Congress Control Number: 2005922183
ISBN 88-470-0318-0Springer Milan Berlin Heidelberg New York
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V
IDKD 2005
Preface
The International Diagnostic Course in Davos (IDKD) offers a unique learning
experience for imaging specialists in training as well as for experienced radi-
ologists and clinicians wishing to be updated on the current state of the art and
the latest developments in the fields of imaging and image-guided interventions.
This annual course is focused on organ systems and diseases rather than on
modalities. This year’s program deals with diseases of the musculoskeletal sys-
tem. During the course, the topics are discussed in group seminars and in plenary
sessions with lectures by world-renowned experts and teachers. While the semi-
nars present state-of-the-art summaries, the lectures are oriented towards future
developments.
This syllabus represents a condensed version of the contents presented under
the 20 topics dealing with imaging and interventional therapies in the muscu-
loskeletal radiology. The topics encompass all the relevant imaging modalities in-
cluding conventional x-rays, computed tomography, nuclear medicine, ultrasound
and magnetic resonance angiography, as well as image-guided interventional tech-
niques.
The volume is designed to be an “aide-mémoire” for the course participants so
that they can fully concentrate on the lectures and participate in the discussions
without the need of taking notes. Additional information is found on the web page
of the IDKD (http//:www.idkd.ch).
J. Hodler00ii00
G.K. von Schulthess
Ch.L. Zollikofer00
VII
IDKD 2005
Table of Contents
Seminars
Shoulder
J. Beltran, M. Recht . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Magnetic Resonance Imaging of the Elbow
C. Chung, L. Steinbach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Radiology of Hand and Wrist Injuries
A.J. Wilson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Wrist and Hand
L.A. Gilula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Imaging of the Painful Hip and Pelvis
C.W.A. Pfirrmann, C.A. Petersilge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Imaging of the Knee
D.A. Rubin, W.E. Palmer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Imaging of the Foot and Ankle
Z.S. Rosemberg, M. Zanetti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Magnetic Resonance Imaging of Muscle
M.N. Pathria, R.D. Boutin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Soft Tissue Tumors and Tumo-Like Masses:A Systematic Approach
to Diagnosis
M.J. Kransdorf, M.D. Murphey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Tumors and Tumor-Like Lesions of Bone
M. Sundaram, D. Vanel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Imaging of Bone Marrow Disorders
B. Vande Berg, J. Malghem, F. Lecouvet, B. Maldagu . . . . . . . . . . . . . . . . . 68
Bone Marrow Disorders
A. Stäbler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Metabolic and Systemic Bone Diseases
J. Freyschmidt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Metabolic Bone Disease
J.E. Adams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
VIII Table of Contents
The Radiology of Hip and Knee Joint Prostheses
I. Watt, B.N. Weissman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Traumas of the Axial Skeleton
H. Imhof, G.Y. El-Khoury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Trauma of the Appendicular Skeleton
J.J. Kaye, M.K. Dalinka . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Inflammatory Diseases of the Spine
V. Jevtic, V. Pullicino . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Degenerative Diseases of the Spine
D. Weishaupt, I. McCall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Osteomyelitis and Septic Arthritis
D. Forrester, R.F. Kilcoyne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Peripheral Arthritis
L.F. Rogers, C.S. Resnik . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Special Aspects of Musculoskeletal Imaging in Children
D. Jaramillo, G. Sebag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Musculoskeletal Sonography
S. Bianchi, S. Marcelis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Pediatric Satellite Course “Kangaroo”
The Spectrum of Non-Accidental Injury and Its Imitators in Children
P.K. Kleinman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Contrast Enhancement of the Growing Skeleton:Rationale and
Optimization in Pediatric MRI
G. Sebag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Imaging the Osseous and Soft Tissue Tumors in the Child
A. Geoffray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Imaging the Child’s Inflammatory and Infectious Musculoskeletal
Pathology
S.G.F. Robben . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
1
SEMINARS
IDKD 2005
Shoulder
J. Beltran1, M. Recht2
1Department of Radiology, Maimonides Medical Center, Brooklin, NY, USA
2Department of E-Radiology, The Cleveland Clinic Foundation, Cleveland, OH, USA
Introduction of the humerus as well as small impaction fractures and
posterosuperior labral lesions. The coracoid impingement
This seminar places special emphasis on the MRI mani- syndrome may occur when the distance between the pos-
festations of shoulder pathology. The discussion includes terior aspect of the coracoid process and the humerus is
the following topics: decreased, producing compression of the rotator cuff,
1. Rotator cuff pathology and impingement lesions. mainly the subscapularis tendon.
2. Glenohumeral instability and related lesions. Inflammatory changes within the supraspinatus tendon
3. Miscellaneous shoulder conditions. can be seen during the early phases of the disease, along
with subacromial bursitis, but this can progress into rota-
tor cuff tear. Three histological stages of impingement
Rotator Cuff Pathology and Impingement syndrome have been described. In stage I, edema and he-
Lesions morrhage of the subacromial soft tissues are present. In
stage II, there is fibrosis and thickening, while in stage
Impingement syndrome is a clinical entity produced by III, partial or complete rotator cuff tears are seen.
compression of the supraspinatus tendon under the region Full-thickness rotator cuff tears involve most often the
of the acromial arch, and it can be related to abnormal supraspinatus tendon, but they can also extend to the in-
morphology of the acromion process, thickening of the fraspinatus and subscapularis tendons. Tear of the teres
coracoacromial ligament, subacromial spurring, or de- minor is very rare. Partial-thickness rotator cuff tears may
generative arthritis of the acromioclavicular joint. involve the articular or the bursal surfaces, or they may
Alternatively, it can be related to degeneration, repeated be located within the substance of the tendon.
trauma or overuse during overhead exercise, such as Delaminating tears of the rotator cuff can be partial or
swimming. Normal anatomical variants, such as type III full thickness. They extend in the longitudinal direction
undersurface of the acromion with a hooked configura- of the tendon fibers, and there may be different degrees
tion and os acromiale, have been described associated of retraction of the various layers. Delaminating tears
with rotator cuff impingement and tears. may be associated with fluid collections extending from
There are two types of impingement syndrome: pri- the tear into the muscle (sentinel cyst). Full-thickness
mary, associated with abnormalities in the coracoacromi- tears allow communication between the articular space of
al arch; and secondary to rotator cuff dysfunction. The the glenohumeral joint and the subacromial-subdeltoid
secondary form of rotator cuff impingement may be fur- bursa, unless the tear is covered by granulation or scar tis-
ther subdivided into two types: internal and external. The sue. On rare occasions, tears may involve the rotator cuff
internal type refers to the articular surface side of the ro- interval, with capsular disruption. Tears of the rotator cuff
tator cuff and it is often termed posterosuperior impinge- interval may be associated with lesions of the structures
ment syndrome. The external variety occurs as a result of present within this anatomical space, namely, the long
external compression of the anterior aspect of the cuff in head of the biceps tendon, the coracoacromial ligament,
the bursal side and includes the coracoid impingement the superior glenohumeral ligament and also the superior
syndrome. Posterosuperior impingement syndrome oc- labrum.
curs in the throwing athlete as a result of continuous
strain of the anterior capsular mechanism, which leads to
laxity and anterior subluxation of the glenohumeral joint Glenohumeral Instability and Related Lesions
with the arm in abduction and external rotation. This sit-
uation produces impingement of the supraspinatus ten- Restraints to anterior translation of the humeral head are
don at the level of its insertion in the greater tuberosity provided by the capsule and the glenohumeral ligaments
4 J. Beltran, M. Recht
(GHL). The labrum is torn as part of the avulsion forces sions were originally described based on arthroscopic
produced by the GHL at the time of the injury. findings. Type I is a partial tear of the superior part of
Anteroinferior dislocation is the most frequent cause of the labrum with fibrillation of the LHBT. Type II is an
anterior glenohumeral instability. A single event origi- avulsion of the LHBT with tear of the anterior and pos-
nates a constellation of lesions leading to other episodes terior labrum. Type III is a bucket-handle tear of the
of dislocation or subluxation. The lesions that may take labrum and type IV is a bucket-handle tear of the labrum
place during an anteroinferior dislocation include an- with longitudinal tear to the LHBT. More recently, up to
teroinferior labral tear, tear of the inferior GHL (IGHL) ten types of SLAP lesions have been described, repre-
and/or capsular-periosteal stripping, fracture of the an- senting a combination of superior labral tears with ex-
teroinferior glenoid margin and compression fracture of tension into different areas of the labrum and gleno-
the superior lateral aspect of the humeral head (Hill- humeral ligaments.
Sachs lesion).
The classic Bankart lesion is the combination of ante-
rior labral tear and capsuloperiosteal stripping. On Miscellaneous Lesions
arthroscopy, the Bankart lesion is seen as a fragment of
labrum attached to the anterior band of the IGHL and to The following lesions are discussed:
the ruptured scapular periosteum, “floating” in the ante- a. Biceps tendon
rior-inferior aspect of the glenohumeral joint. Extensive b. Compressive neuropathies
bone and soft-tissue damage and persistent instability d. Inflammatory and other miscellaneous lesions
may lead to multidirectional instability, resulting in
episodes of posterior dislocation. Biceps Tendon
A number of variants of anterior labral tears have
been described. The Perthes lesion is similar to the Tendinosis or tenosynovitis of the LBT may occur in as-
Bankart lesion, but without the tear of the capsule. sociation with shoulder impingement syndrome and rota-
Anterior labroligamentous periosteal sleeve avulsion tor cuff tears, where the intracapsular portion of the LBT
(ALPSA) refers to a tear of the anteroinferior labrum, is compressed between the humeral head, the acromion,
with associated capsuloperiosteal stripping. The torn and the coracoacromial ligament during abduction and
labrum is rotated medially, and a small cleft or separa- rotation of the arm. Attritional tendinosis is associated
tion can be seen between the glenoid margin and the with a narrow bicipital groove and hence it affects the ex-
labrum. In contrast to the Bankart lesion, the ALPSA le- tracapsular portion of the tendon. Magnetic resonance
sion can heal, leaving a deformed and patulous labrum. imaging (MRI) may demonstrate fluid in the joint ex-
The glenoid labral articular disruption (GLAD) repre- tending into the bicipital grove, although this a non-spe-
sents a tear of the anteroinferior labrum, attached to a cific sign unless the fluid completely surrounds the ten-
fragment of articular cartilage, without associated cap- don, in the absence of a joint effusion. Trauma and de-
suloperiosteal stripping. generation may involve the LBT, producing swelling and
Posterior shoulder dislocation more often occurs as a increased signal intensity (SI) on T2 and T2* pulse se-
result of a violent muscle contraction, e.g., by electrical quences.
shock or seizures. After the acute episode of dislocation, Complete rupture of the LBT more often occurs prox-
the arm frequently remains locked in adduction and in- imally, at the level of the proximal portion of the extra-
ternal rotation. Posterior instability caused by repeated capsular segment, within the groove. MRI demonstrates
micro-trauma, without frank dislocation, may cause per- the absence of the LBT in the groove and its distal dis-
sistent shoulder pain in young athletes. Abduction, flex- placement. Intracapsular tears of the LBT are seen more
ion and internal rotation are the mechanism involved in often in patients with rotator cuff tears. Attritional tendi-
these cases (swimming, throwing, and punching). This nosis affecting the intertubercular portion of the LBT can
may be also associated with posterior capsular laxity. progress to longitudinal splits within the tendon, result-
Lesions that may occur during posterior dislocation or in ing in thickening of the LBT with increased intrasub-
cases of repeated micro-trauma include posterior labral stance SI on T2-weighted images. A bifid LBT (normal
tear, posterior capsular stripping or laxity, fracture, ero- variant) should not be confused with a partial longitudi-
sion, or sclerosis and ectopic bone formation of the pos- nal tear.
terior glenoid, and vertical impacted fracture of the ante- Biceps tendon dislocation occurs with tears of the sub-
rior aspect of the humeral head (reverse Hill-Sachs, scapularis tendon and coracohumeral ligament. Two types
McLaughlin fracture). of dislocation of the LBT have been described, depend-
Superior labral anterior and superior lesions (SLAP ing on whether the tendon is located in front or behind
lesions) are not as rare as originally thought. These le- the subscapularis tendon. In the first type, the insertional
sions involve the superior part of the labrum with vary- fibers of the subscapularis tendon are intact . In the sec-
ing degrees of biceps tendon involvement. Pain, click- ond type, the subscapularis tendon is detached and the
ing, and occasional instability in a young patient are the LBT is medially displaced, becoming entrapped intra-ar-
typical clinical manifestations. Four types of SLAP le- ticularly.