Adrenal Adenoma vs Met

Practical differential diagnosis for CT and MRI By Eugene Lin

Lateral Medullary Syndrome (Wallenberg)

Idiopathic Bullous Emphysema (Vanishing Lung Syndrome)

Thanks MG.

QR Codes

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

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

Radiology May 17, 2011

Thanks, Robert.

Calcaneal Osteomyelitis

Grade II Sprain Interosseous component of Lisfranc Ligament

Reference: Lisfranc Ligament Tears, Radsource

Bipartite Medial Cuneiform, Fibrous Coalition, Stress Reaction

Tibial Tunnel Cyst post ACL Recon (II)

Bertolotti Syndrome

Nice description here:

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

Costovertebral Arthritis ? Septic

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

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

Reverse Hill Sachs

Peripheral Vertical Longitudinal Tear Posterior Labrum

Quadrilateral Space Syndrome

Pearls from Stoller Macau April 2011 - 9. Elbow

1. Anatomical Variants
• pseudo defect of trochlea
• transverse trochlea ridge
• pseudo defect of capitellum (post on coronal)
2. Valgus injury (throwing) - tension medial side, compression lateral side
3. "T sign" - partial tear anterior bundle MCL distally
4. Medial Anatomy - PT, FCR, FDS
5. Lateral Anatomy - ECRB (most common tendon involved), EDC, ECU
6. Lateral - 3 ligaments - LCL, LUCL (attaches to supinator crest of ulna distally), annular ligament
7. Biceps tear - if partial need to state wether under or over 50%
8. Lacertus fibrosis - medial to biceps on axial; prevents proximal "slingshot" of torn biceps 
9. Anconeus epitochlearis

Pearls from Stoller Macau April 2011 - 8. Wrist

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

Pearls from Stoller Macau April 2011 - 7. Muscle

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

Pearls from Stoller Macau April 2011 - 6. Hip

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

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

• 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

1. 1st MTP Anatomy p166
2. Skimboarder's Toe - "reverse turf toe" - dorsal plate injury
3. 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
4. Baxter's Neuropathy
• Ab. Digiti Mini Atrophy; check nerve entrapment foot
5. 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

1. NB: anterior process talus; lateral process calcaneus (snowboarders)
2. Subtalar joint - anterior, middle, posterior facets
3. Lateral gutter -- a 3D space between AITFL/PITFL and ATFL/PTFL
4. Posterior ankle ligaments - Transverse Tib-Fib Lig, PITFL, Tibial Slip, PTFL
5. Anterolateral impingement (soft tissue related to antero-lat gutter) vs Ant. impingement (bony)
6. Soft Tissue Impingement
• Anterolateral (ATFL and  AITFL related to partial or completer tear)
• Syndesmotic
• Posterior (PTFL -- myxoid)
7. Spring (Calcaneonavicular ligament)
• Lateral/Intermediate/Superomedial
• Axial - int. and lat.; slice up - superomedial
• Coronal - next to TP
8. POP Syndrome
• # or displacement of Os peroneum
• Ass. Peroneus Longus Tear
9. Tarsal Tunnel Syndrome
• Post. Tibial N. compression
10. 4 Plantar Muscles -  (Med) Ab. Hallucis, Fl. Dig. Brevis, Quadratus Plantae, Ab. Digiti Minimi
11. Subtalar ligaments
• subtalar interosseus - medial (coronal)
• cervical - lateral and anterior (coronal and sag)
• intermediate root extensor retinaculum - post. to cervical (sag)
12. OLT Stages
13. Tennis Leg - ruptured crura; fascia

Pearls from Stoller Macau April 2011 - 3. Knee

1. Trochlear groove - assess on sag.
2. Meniscofemoral and meniscotibial (coronary) recesses.
3. Horizontal tear - must extend to apex (sag).
4. Flap tear - one type that looks horizontal but extends short of apex creating small inferior leaf.
5. Flap tear -- vertical configuration, but inner 1/3 (sag).
6. Vertical/longitudinal tear - outer 1/3 (sag).
7.  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.
8.  Posterolat. corner -- review on sag and axial.
9. SONK -- almost all cases are probably insufficiency fractures
10. CMP - MRI adaptation of Outerbridge classification; describe rather than classify; ICRS classification.
11. MPFL - slice above proximal origin of MCL, tears at femur
12. Patella tendinosis - best on GRE.

Pearls from Stoller Macau April 2011 - 2.Shoulder

1. Anterior band of IGHL can have high attachment -- 3rd structure on axial (in addition to labrum and MGHL).
2. Sublabral foramen (antero-superior); sublabral sulcus (superior)
3. Hill-Sachs - position - where articular cartilage in NOT; at level of footprint on axial (1st two slices).
4. MGHL - "squiggly" on Sag.
5. Patterns of glenoid sclerosis.
6. 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
7.  SGHL/CHL -- "Biceps pulley" -- look on Sag
8. HAGL -- anterior band IGHL tear (+BHAGL) aot RHAGL or PHAGL -- post. band
9. GAGL
10. "Wave Sign" -- massive RC tear  - repairable acute tear without scarring

Pearls from Stoller Macau April 2011 - 1.Technique

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

Normal Chondral Undercutting of Superior Labrum

Caton Deschamps Index

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

i

I see this everywhere now!

Iliopsoas Muscle Tear