Radiology Cases

SLAP Tears and Glenohumeral Instability

2012-02-09T10:01:00.001+10:00

http://www.radsource.us/clinic/0909

SLAP Tears and Glenohumeral Instability, courtesy Radsource.

Bankart and Bankart variant lesion

2012-02-06T14:16:00.001+10:00

http://myradnotes.wordpress.com/2010/12/12/bankart-and-bankart-variant-lesion/

Ankle MRI Approach

2012-02-06T14:15:00.002+10:00

http://www.raddaily.com/whitepaperarticle.php?articleTitle=Ankle+MRI+Approach

Shoulder MRI Approach

2012-02-06T14:14:00.003+10:00

http://www.raddaily.com/whitepaperarticle.php?articleTitle=Shoulder+MRI+Approach

Adrenal Adenoma vs Met

2011-12-02T10:11:00.001+10:00

Practical differential diagnosisfor CT and MRI By Eugene Lin

Lateral Medullary Syndrome (Wallenberg)

2011-11-21T16:43:00.001+10:00

Idiopathic Bullous Emphysema (Vanishing Lung Syndrome)

2011-10-10T13:44:00.000+10:00

Thanks MG.

QR Codes

2011-09-14T16:05:00.000+10:00

QR Codes could be used in Radiology as follows:
1. added to posters and other marketing paraphenalia
2. add to the bottom of reports to communicate any info
3. use it to give patients directions to practices via google maps
4. use for roster links

If you (like me) need some more info, here it is:

---Generate a QR code (pretty easy)
http://qrcode.kaywa.com/
http://invx.com/

---Read a QR code
your Android or iOs device may have a QR scanner built in, otherwise head to the Android market or iPhone app store and search for QR code scanner

---More info
http://www.labnol.org/internet/tools/qr-codes-share-text-inside-images/3867/
http://www.wisegeek.com/what-is-qr-code.htm

--Marketing Advantages:
http://www.socialmediaexaminer.com/how-qr-codes-can-grow-your-business/

Gd Guidelines

2011-08-18T13:30:00.003+10:00

http://radiologymri.blogspot.com/2011/08/gadolinium-guidelines.html

Radiology May 17, 2011

Thanks, Robert.

Calcaneal Osteomyelitis

2011-08-15T09:48:00.001+10:00

Grade II Sprain Interosseous component of Lisfranc Ligament

2011-08-15T09:27:00.003+10:00

Reference: Lisfranc Ligament Tears, Radsource

Bipartite Medial Cuneiform, Fibrous Coalition, Stress Reaction

2011-08-03T10:03:00.002+10:00

Tibial Tunnel Cyst post ACL Recon (II)

2011-07-30T17:14:00.001+10:00

Bertolotti Syndrome

2011-06-20T13:35:00.000+10:00

Nice description here:

http://roentgenrayreader.blogspot.com/2011/06/bertolotti-syndrome.html

Costovertebral Arthritis ? Septic

2011-06-09T14:56:00.003+10:00

Balo's Concentric Sclerosis (MS) "Fried Egg" Appearence

2011-06-09T14:47:00.003+10:00

http://en.wikipedia.org/wiki/Balo_concentric_sclerosis

Reverse Hill Sachs

2011-06-09T14:44:00.002+10:00

Peripheral Vertical Longitudinal Tear Posterior Labrum

2011-06-09T14:41:00.000+10:00

Quadrilateral Space Syndrome

2011-06-09T14:37:00.000+10:00

Pearls from Stoller Macau April 2011 - 9. Elbow

2011-05-16T14:26:00.000+10:00

Anatomical Variants

pseudo defect of trochlea
transverse trochlea ridge
pseudo defect of capitellum (post on coronal)

Valgus injury (throwing) - tension medial side, compression lateral side
"T sign" - partial tear anterior bundle MCL distally
Medial Anatomy - PT, FCR, FDS
Lateral Anatomy - ECRB (most common tendon involved), EDC, ECU
Lateral - 3 ligaments - LCL, LUCL (attaches to supinator crest of ulna distally), annular ligament
Biceps tear - if partial need to state wether under or over 50%
Lacertus fibrosis - medial to biceps on axial; prevents proximal "slingshot" of torn biceps
Anconeus epitochlearis

Pearls from Stoller Macau April 2011 - 8. Wrist

2011-05-16T14:09:00.000+10:00

Coronal plain most NB
GRE for TFCC
Extrinsic ligaments ["volar extrinsic ligaments"]- rarely torn (RSC, RLT, RSL)
SL Ligament complex - 3 components - dorsal (strongest), middle (weakest), volar
LT Ligament complex - 3 components - d, m , v(strongest)

Pearls from Stoller Macau April 2011 - 7. Muscle

2011-05-16T14:04:00.000+10:00

Direct Injury - contusion, laceration, haematoma
Indirect injury- strain or tear
Myositis Ossificans - peripheral calcification - do a CT
DOMS

Pearls from Stoller Macau April 2011 - 6. Hip

2011-05-16T14:01:00.001+10:00

Normal sulcus - Posteroinferior sublabral sulucs, Transverse Ligament Labral Sulcus, Perilabral Sulcus
Stellate Lesion - supra-acetabular fossa; more prom. in teens; normal thinning
GRE for chondrocalcinosis
AVN Grading - Ficat and Arlet
TOH -- actually all stress # (subchondral) or insufficiency; repeat MRI in 3 months to exclude AVN (<10%) and document resolution of oedema
Labral Tears - most are chondrolabral or longitudinal
Iliofemoral ligament - thickening = inflammatory response secondary to degeneration
Lig. teres hypertrophy = DDH
Labral hypertrophy = DDH

Grading of Disc Related Nerve Root Compression (Pfirrmann et al)

2011-05-05T16:25:00.000+10:00

Grade 0 (normal) - No compromise of the nerve root is seen. There is no evident contact of disk material with the nerve root, and the epidural fat layer between the nerve root and the disk material is preserved.
Grade 1 (contact) - There is visible contact of disk material with the nerve root, and the normal epidural fat layer between the two is not evident. The nerve root has a normal position, and there is no dorsal deviation.
Grade 2 (deviation) - The nerve root is displaced dorsally by disk material.
Grade 3 (compression) - The nerve root is compressed between disk material and the wall of the spinal canal; it may appear flattened or be indistinguishable from disk material.

February 2004 Radiology, 230, 583-588.

http://radiology.rsna.org/content/230/2/583.full

Pearls from Stoller Macau April 2011 - 5. Mid and Forefoot

2011-05-02T21:29:00.002+10:00

1st MTP Anatomy p166
Skimboarder's Toe - "reverse turf toe" - dorsal plate injury
Lisfrance ligament - medial cuneiform to 2nd MT base

dorsal, interosseus and plantar components - fail from dorsal to plantar
no interosseus ligament between 1st and 2nd MT bases

Baxter's Neuropathy

Ab. Digiti Mini Atrophy; check nerve entrapment foot

Adventitial Bursitis

no anatomic bursa in foot
at pts of frictional wear,
may present as mases
plantar 1st and 5th, hallux valgus common

Pearls from Stoller Macau April 2011 - 4. Ankle

2011-05-02T21:10:00.002+10:00

NB: anterior process talus; lateral process calcaneus (snowboarders)
Subtalar joint - anterior, middle, posterior facets
Lateral gutter -- a 3D space between AITFL/PITFL and ATFL/PTFL
Posterior ankle ligaments - Transverse Tib-Fib Lig, PITFL, Tibial Slip, PTFL
Anterolateral impingement (soft tissue related to antero-lat gutter) vs Ant. impingement (bony)
Soft Tissue Impingement

Anterolateral (ATFL and AITFL related to partial or completer tear)
Syndesmotic
Posterior (PTFL -- myxoid)

Spring (Calcaneonavicular ligament)

Lateral/Intermediate/Superomedial
Axial - int. and lat.; slice up - superomedial
Coronal - next to TP

POP Syndrome

# or displacement of Os peroneum
Ass. Peroneus Longus Tear

Tarsal Tunnel Syndrome

Post. Tibial N. compression

4 Plantar Muscles - (Med) Ab. Hallucis, Fl. Dig. Brevis, Quadratus Plantae, Ab. Digiti Minimi
Subtalar ligaments

subtalar interosseus - medial (coronal)
cervical - lateral and anterior (coronal and sag)
intermediate root extensor retinaculum - post. to cervical (sag)

OLT Stages
Tennis Leg - ruptured crura; fascia

Pearls from Stoller Macau April 2011 - 3. Knee

2011-04-17T22:03:00.004+10:00

Trochlear groove - assess on sag.
Meniscofemoral and meniscotibial (coronary) recesses.
Horizontal tear - must extend to apex (sag).
Flap tear - one type that looks horizontal but extends short of apex creating small inferior leaf.
Flap tear -- vertical configuration, but inner 1/3 (sag).
Vertical/longitudinal tear - outer 1/3 (sag).
Menisco-capsular separation -- two scenarios

ACL with tear of periph of post. horn lat. meniscus (fluid betw. capsule and periph. of post. horn).
MCL tear with meniscotibial lig. tear.

Posterolat. corner -- review on sag and axial.
SONK -- almost all cases are probably insufficiency fractures
CMP - MRI adaptation of Outerbridge classification; describe rather than classify; ICRS classification.
MPFL - slice above proximal origin of MCL, tears at femur
Patella tendinosis - best on GRE.

Pearls from Stoller Macau April 2011 - 2.Shoulder

2011-04-17T21:52:00.002+10:00

Anterior band of IGHL can have high attachment -- 3rd structure on axial (in addition to labrum and MGHL).
Sublabral foramen (antero-superior); sublabral sulcus (superior)
Hill-Sachs - position - where articular cartilage in NOT; at level of footprint on axial (1st two slices).
MGHL - "squiggly" on Sag.
Patterns of glenoid sclerosis.
Anteroinferior labrum -- assess 1st -- spectrum of injury

Perthes - labral tear, minimal displacement, intact periosteum
ALPSA - labral tear and medial displacement of IGLLC, medially stripped but intact periosteum (NB POLPSA)
GLAD - labral tear (partial), no detachment, chondral defect, intact periosteum
Bankart - avulsion of IGLLC (anterior and medial), disruption of scapula perisoteum

SGHL/CHL -- "Biceps pulley" -- look on Sag
HAGL -- anterior band IGHL tear (+BHAGL) aot RHAGL or PHAGL -- post. band
GAGL
"Wave Sign" -- massive RC tear - repairable acute tear without scarring

Pearls from Stoller Macau April 2011 - 1.Technique

2011-04-17T20:57:00.009+10:00

Zoom in to see detail.
Every series should contain a plain T1.
GRE/T2* -- for shoulders and knee at least -- useful for chondrocalcinosis, PVNS, blood
Hip -- should include sag
Hip - one large FOV series
Ankle -- NB ant. process of calcaneus and lateral process of talus

Normal Chondral Undercutting of Superior Labrum

2011-03-27T22:38:00.001+10:00

Caton Deschamps Index

2011-03-10T09:21:00.005+10:00

http://radiopaedia.org/cases/caton-deschamps-index

Methodology slightly different to "Patella Height Ratio" here:

MR Imaging of Patellar Instability: Injury Patterns and Assessment of Risk Factors, Radiographics July 2010

Baastrup's Disease

2011-03-02T14:21:00.004+10:00

I see this everywhere now!

Iliopsoas Muscle Tear

2011-03-02T12:19:00.001+10:00

High Bifurcation of SSS

2011-03-02T12:18:00.000+10:00

ITB Syndrome

2011-03-02T12:13:00.000+10:00

Diffuse Fatty Infiltration of the Liver

2011-03-02T11:53:00.000+10:00

Fractured Os Peroneum, Painful Os Peroneum Syndrome (POPS)

2011-03-02T11:28:00.003+10:00

Schatzker Classification for Tibial Plateau Fractures

2011-02-28T22:45:00.001+10:00

http://uwmsk.org/schatzker/

Enchondroma Protuberans of the Hand

2011-02-21T16:56:00.003+10:00

http://www.ajronline.org/cgi/content/full/190/1/40

Normal Facial Nerve Enhancement

2011-02-15T11:05:00.000+10:00

Courtesy Radiopedia

Lateral Ulnar Collateral Ligament/Posterolateral Rotatory Instability

2011-02-10T17:12:00.001+10:00

See Radsource Article

Os Peroneum Fracture

2011-01-31T17:02:00.002+10:00

Acute Calcific Capsultis

2011-01-31T17:01:00.001+10:00

Reference: http://www.ajronline.org/cgi/content/full/195/6_Supplement/S76

Facial Nerve Anatomy

2011-01-26T11:57:00.000+10:00

Facial Nerve Anatomy on CT (radsmd.com)

"7-UP, Coke Down"

2011-01-07T19:40:00.000+10:00

Source:
http://www.radswiki.net/main/index.php?title=Internal_auditory_canal_mnemonic

Also:
http://radiopaedia.org/articles/seven_up_coke_down

IAC Anatomy

2011-01-07T17:53:00.003+10:00

BB = Bill's Bar (bony)
TC = Transverse Crest, aka Falciform Crest (bony)
FN = Facial Nerve (also shown is Nervus Intermedius)
SVN = Superior Vestibular Nerveinntervates superior & horizontal canals & utricle
IVN = Inferior Vestibular Nerve to posterior canal and saccule
CN = Cochlear Nerve

"7 Up Coke Down"

Source:
http://www.thefullwiki.org/Ossicle/Otology

Osgood Schlatter Disease

2011-01-06T13:33:00.001+10:00

Capitellar OCD

2011-01-06T13:26:00.001+10:00

FAI on Arthrogram

2011-01-06T13:18:00.002+10:00

Anterosuperior Labral Tear with Paralabral Cyst

2010-12-23T14:38:00.002+10:00

Lipoma Aborescens

2010-12-23T14:22:00.002+10:00

Right Vth Schwannoma or Neuritis

2010-12-23T14:20:00.000+10:00

Giant Cell Tumour

2010-12-23T14:12:00.002+10:00

Prominent VR Spaces in Cryptococcal Meningitis

2010-12-23T13:55:00.000+10:00

VR spaces at MR: RG July 2007
Imaging of CNS in HIV: Imaging 14:48-59 (2002)

Osteochondroma

2010-12-11T15:32:00.002+10:00

Cartilage cap thickness normally <1cm in adults.
http://www.learningradiology.com/archives2007/COW%20243-Osteochondroma/osteochondromacorrect.html

ITB Outer Lip Iliac Crest

2010-11-12T19:34:00.000+10:00

FMD Right Renal Artery

2010-11-12T19:30:00.000+10:00

Quadratus Femoris Muscle Strain/Tear

2010-11-12T19:22:00.002+10:00

POLPSA

2010-11-12T19:21:00.002+10:00

Osteochondritis / AVN of Bipartite Lateral Sesamoid

2010-11-12T19:20:00.005+10:00

Relationship to Zumba:

http://musculoskeletalmri.blogspot.com/2011/02/zumba-and-painful-toe.html

Tibial Tunnel Cyst post ACL Reconstruction

2010-10-27T12:26:00.000+10:00

Screw Fractures and Tibial Tunnel Cyst extruded into pretibial area.

MR Imaging of Complications of Anterior Cruciate Ligament Graft Reconstruction Radiographics November 2009 29:2115-2126; doi:10.1148/rg.297095036

Haglund's Syndrome

2010-10-27T11:49:00.000+10:00

Gluteal Aponeurotic Tear

2010-10-27T11:46:00.000+10:00

PIN Syndrome (2)

2010-10-27T11:45:00.000+10:00

Mondini malformation

2010-10-27T11:44:00.000+10:00

Roof Impingement

2010-10-09T20:14:00.000+10:00

Semimembranosus Tibial Collateral Bursitis

2010-10-09T20:10:00.001+10:00

Oblique menisco-meniscal ligament

2010-10-09T20:04:00.001+10:00

Not to be mistaken for Double PCL sign. Note incidental ACL rupture.

Anomalous Biceps Femoris Tendon Insertion

2010-10-09T19:55:00.000+10:00

Salter Harris I

2010-10-09T19:42:00.000+10:00

Distal Bicipital Tendinosis/Tenosynovitis

2010-10-09T19:39:00.001+10:00

Coagulation in Interventional Radiology

2010-10-07T20:17:00.002+10:00

Based on AJR 2009;193:1656

Transient Osteoporosis of the Hip

2010-09-01T14:24:00.000+10:00

Note: characteristic sparing of medial femoral head and greater trochanter.

FAI Incidental

2010-09-01T14:14:00.001+10:00

FAI Incidental

2010-09-01T14:13:00.001+10:00

Increased T2 signal in Distal Clavicle

2010-08-31T15:49:00.002+10:00

Skeletal Radiol. 2000 Dec;29(12):697-702.

Increased T2 signal intensity in the distal clavicle: incidence and clinical implications.

Fiorella D, Helms CA, Speer KP.

http://www.ncbi.nlm.nih.gov/pubmed/11271550?dopt=Abstract

Voltage Gated Potassium Channel Limbic Encephalitis

2010-08-23T13:40:00.001+10:00

Fabellofibular ligament

2010-08-22T16:48:00.004+10:00

Posterolateral Corner courtesy Radsource

Rotator Interval

2010-08-18T17:57:00.002+10:00

MR Arthrography of Rotator Interval, Long Head of the Biceps Brachii, and Biceps Pulley of the ShoulderApril 2005 Radiology, 235, 21-30.

Pyogenic Liver Abscess

2010-08-18T16:17:00.000+10:00

Note: "Cluster Sign"

Rice Bodies in RA

2010-08-18T13:21:00.000+10:00

Voshell's Bursitis

2010-08-18T13:20:00.005+10:00

MCL Bursa: AJR 2001; 177 911

Radsource: Pes Anserine Bursitis

Popliteomeniscal Fascicles

2010-08-11T09:28:00.000+10:00

Popliteomeniscal Fascicles: Anatomic Considerations Using MR Arthrography in Cadavers: AJR 2008; 190:442-448

Abnormal Superior Popliteomeniscal Fascicle and Posterior Pericapsular Edema: AJR 2001; 176:63-66

Medial and Lateral Ankle Ligaments

2010-08-11T09:04:00.003+10:00

Facial Nerve Schwannoma

2010-08-07T11:28:00.001+10:00

ANJR 22:1368-1376 (8 2001) Dumbbell Schwannomas of the Internal Auditory Canal

Patella Alta and Lateral Subluxation

2010-08-07T11:22:00.001+10:00

Partial ACL Tear

2010-08-07T11:18:00.002+10:00

Reference: Radsource MRI Web Clinic March 2006

Rectus Femoris Partial Tear and Sub-Iliacus Haemorrhage

2010-08-07T11:11:00.000+10:00

Chronic ATFL Tear and Lateral Gutter Synovitis

2010-08-07T11:09:00.000+10:00

Chondrocalcinosis

2010-08-07T10:58:00.004+10:00

Subependymoma

2010-07-21T15:08:00.000+10:00

Rectus Abdominis-Adductor Aponeurotic Plate Injury

2010-07-21T15:07:00.001+10:00

Quadriceps/Anterior Suprapatella Impingement Syndrome

2010-07-21T14:56:00.001+10:00

Acute Patella Chondral Contusion

2010-07-21T14:44:00.000+10:00

Morel-Lavallee Lesion

2010-06-23T15:42:00.001+10:00

http://www.radsource.us/clinic/1006

Cam FAI

2010-06-23T10:52:00.002+10:00

Fatty Liver

2010-06-23T10:40:00.003+10:00

In-Phase

Out-of-Phase

Transient Patella Disclocation

2010-06-23T10:35:00.003+10:00

With torn medial patello-femoral ligament and medial patella retinaculum. Note that impaction injury can occur almost anywhere at the lateral femoral condyle (although commonly anterolaterally).

OA and MCL Oedema

2010-06-23T10:32:00.001+10:00

Giant Tumefactive Perivascular Spaces

2010-06-23T10:28:00.001+10:00

References:
http://www.ajnr.org/cgi/reprint/26/2/298.pdf
AJNR Am J Neuroradiol 26:298–305, February 2005

Thanks MG