Your SlideShare is downloading. ×
0
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Knee 2
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Knee 2

986

Published on

0 Comments
7 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
986
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
195
Comments
0
Likes
7
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. MRI of the .knee joint DR.ABD-ELLAH NAZER. MD
  • 2. INDICATIONS  Knee joint complaint • Pain • Trauma • Swelling • Osteoarthritis  Suspected Examination] • Inflammation • Tumors pathology [previous
  • 3. Protocol of examination  Axial T1 localizer  Sagittal T1, PD, T2  Coronal gradient echo, STIR  If contrast is injected [ Axial, Sagittal ,coronal T1 WIs ]
  • 4. How to know the pulse sequence?! T1 T2 Gradient STIR
  • 5. Items to be evaluated  Menisci (medial & lateral)  Ligaments - Cruciate (ACL, PCL) - Collateral - Retinacular  Tendons ( Quadriceps, Pattelar)  Bones  Synovial effusion Where?! Sagittal PD Coronal. Sagittal,cornal and axial. Coronal Axial Sagittal PD Sagittal T1& T2 Sagittal T2
  • 6. Meniscus Medial meniscus  Semilunar - shaped Posterior horn wider, longer, taller than anterior horn Posterior horn tightly attached to the capsule
  • 7. Lateral meniscus  C- shape  Posterior and anterior horns are symmetric  Anterior horn may be hypo plastic, extremely thin  Discoid meniscus and meniscal cysts more common
  • 8. B A C B A C
  • 9. Lateral meniscus
  • 10. Medial meniscus
  • 11. .Medial and lateral meniscus
  • 12. .Medial and lateral meniscus
  • 13. Patellar retinacular ligaments
  • 14. Collateral Ligaments
  • 15. Proton density coronal image shows the normal medial collateral ligament as a thin, taut, well-defined, low-signal structure extending from the medial femoral epicondyle to the medial tibial metaphysis
  • 16. Coronal and sagittal proton density image demonstrating the normal lateral collateral ligament in its entirety, from the femoral condyle origin to the fibular head insertion.
  • 17. Meniscal Lesions Degeneration  Tear  Cyst Discoid
  • 18. Type I Normal Type II Simple Tear Complex Tear
  • 19. Types of Meniscal degeneration Grade I  Grade II  Meniscal fraying 
  • 20. Tear
  • 21.  Grade 11 degeneration  Grade 1 degeneration
  • 22. Meniscal degeneration with free edge fraying
  • 23. Meniscal degeneration with free edge fraying
  • 24. Types of Meniscal Tears Simple  Complex  Special types 
  • 25. Simple Meniscal Tears Horizontal  Vertical  Radial 
  • 26. Horizontal tear
  • 27. Horizontal tear
  • 28. Horizontal tear
  • 29. Vertical tear Occurs typically in the outer 1/3 of the posterior horn or body of the meniscus [rare in the anterior horn]
  • 30. Vertical tear
  • 31. Vertical tear
  • 32. Radial tear [ Vertical tear of the free edge of the meniscus [ Root tear Ghost meniscus
  • 33. If there is no history of Meniscal surgery and the posterior horn is absent near the intercondylar notch Ghost meniscus
  • 34. Special Meniscal Tears Flap  Bucket handle  MC separation 
  • 35. [ Flap tear [Oblique Should have tow components , horizontal and Vertical common in the medial meniscus
  • 36. [Flap tear [Oblique
  • 37. Bucket handle tear
  • 38. [Small sized posterior horn [ sagittal [Medially displaced fragment[ coronal [Double PCL sign [ sagittal
  • 39. Bucket Handel tear
  • 40. Bucket Handel tear
  • 41. Bucket Handel tear , Lateral meniscus Flipped meniscus : Double Delta Sign
  • 42. Flipped meniscus : Double Delta Sign
  • 43. Flipped meniscus : Double Delta Sign
  • 44. Flipped meniscus : Double Delta Sign
  • 45. MENISCOCAPSULAR SEPARATION
  • 46. Post-traumatic contusion of the lateral femoral and tibial condyles
  • 47. Discoid meniscus .Dysplastic meniscus with loss of normal semi lunar shape .or more coverage of the tibial plateau 50% Meniscal body segment seen in 3 or more sagittal images
  • 48. Discoid meniscus
  • 49. Discoid meniscus
  • 50. Meniscal cyst A Cyst extending from a meniscal tear Common sites : Anterior horn LM , Posterior horn MM
  • 51. Meniscal cyst
  • 52. Meniscal cyst
  • 53. Ligamentous Lesions  ACL  PCL  Collateral  Retinacular
  • 54. Anterior cruciate ligament
  • 55. Anterior cruciate ligament
  • 56. MRI shows the normal linear low signal intensity ACL adjacent to the lateral bony wall of the upper intercondylar notch (arrow). The normal ACL moves away from the wall and diverges into multiple fascicles on more distal images.
  • 57. Anterior cruciate ligament Posterior cruciate ligament
  • 58. Anterior cruciate ligament injury Primary signs [ In the ligament ] In te rc on d yl a r ro of Total discontinuity Abnormal signal Abnormal configuration Abrupt angulation Wavy appearance Abnormal axis
  • 59. Anterior cruciate ligament injury
  • 60. Anterior cruciate ligament injury
  • 61. Normal ACL
  • 62. Normal ACL Non visualization of the ACL with a cloud of edema and hemorrhage
  • 63. Anterior cruciate ligament injury Secondary signs [ Outside the ligament ] • • • • • • • • Blumensaat angle sign. Bone contusions [Pivot- shift bruises ] Anterior translocation of the tibia Uncovered meniscus sign Avulsion fracture of the tibial insertion Segond fracture 70-100% with ACL tear PCL buckling Hyperextension ACL tear with ." "kissing bone bruises PCL line sign
  • 64. .Negative Blumensaat angle
  • 65. .Positive Blumensaat angle
  • 66. .ACL Graft with negative Blumensaat angle
  • 67. The probability of an ACL tear is very high if both such bone bruises are present, only slightly lower if the tibial bone bruise is present in isolation, and still slightly lower with an isolated femoral bone bruise of this appearance.
  • 68. Anterior tibial translocation
  • 69. ”Anterior tibial translocation with” uncovered meniscus sign
  • 70. Segond fracture An elliptical vertically 3x10mm bone fragment parallel to the lateral tibial cortex, about 4mm distal to the plateau. Best seen on AP or tunnel radiographic views association with ACL tear 100% -75
  • 71. Segond fracture in patient with ACL tear. T1- weighted coronal MRI shows a small, lowsignal elongated fracture fragment that is parallel to the lateral tibia. The association of Segond fractures with ACL tears approaches 100%.
  • 72. ACL injury
  • 73. ve+ PCL LINE SIGN
  • 74. PCL redundancy as a secondary sign of ACL tear. This is a relatively unreliable secondary sign of ACL tear.
  • 75. Partial ACL tear  Common about 10-43% of ACL tears  Suboptimal accuracy of MRI  Subtle 1ry and 2ry signs  Focal angulations  Focal increase T2 signal [non specific ]  Single bundle sign Sagittal MRI shows an abruptly angulated mid-ACL (arrow) .A wavy or sharply angulated appearance is abnormal.
  • 76. Partial ACL tear T1-weighted sagittal MRI shows a normalappearing ACL. T1-weighted sagittal MRI image immediately adjacent to the previous image shows a partially disrupted ACL
  • 77. Partial ACL tear
  • 78. Partial ACL tear with thickening, angulations and abnormal bright signal . inside. The tibial and femoral attachment is preserved
  • 79. .Partial ACL tear with thickening and abnormal bright signal inside
  • 80. .Partial ACL tear with diffuse thickening and abnormal signal inside
  • 81. Chronic ACL Tear     Fragmented ACL [ common finding ] Absent bone edema and contusions Empty notch sign ACL attached to PCL
  • 82. Empty notch sign ACL tear on axial image showing nonvisualization of the anterior cruciate ligament (ACL) in the upper intercondylar notch A large knee effusion and a Baker cyst are noted incidentally.
  • 83. Chronic ACL tear, empty notch sign. T1-weighted coronal MRI shows fat in the lateral intercondylar notch, ACL is absent. This is a frequent MRI appearance of a chronic ACL tear after resolution of acute edema and hemorrhage.
  • 84. ACL Degeneration    Intra ligamentous cyst May be mistaken for a tear Arthroscopic decompression
  • 85. Intercondylar notch cyst         1% of knee MRIs Usually an incidental finding Painful if erodes the bone Post-traumatic chronic partial cruciate ligament tear with internal degeneration More common in the ACL Oval , rounded may be multilocular Rim enhancement if inflamed Arthroscopic drainage Cruciate ligament cyst
  • 86. Intraligamentous ganglion cyst
  • 87. Posterior cruciate ligament     The major stabilizer of the knee Uniform low signal , no striations Twice strong as the ACL The menisco-femoral ligaments are intimately related to PCL. They connect the posterior horn of the lateral meniscus to the medial femoral condyle Ligament of Humphrey anterior to PCL Ligament of Wrisberg posterior to PCL
  • 88. Proton-dense sagittal image demonstrates the normal tibial insertion of the PCL. The insertion site is a vertically inclined posterior to the articular surface.
  • 89. Posterior cruciate ligament   PCL injuries represent about 12% of knee injuries Combined PCL injuries represent 97% With ACL 65% With MCL 50% With MM 30% TYPES OF PCL INJURES Complete tear 40% Partial tear 55% Avulsion tear 7%
  • 90. NORMAL PCL MR FINDINGS Increased signal due to hemorrhage and edema Diffuse enlargement of PCL TORN PCL
  • 91. COMPLETE PCL TEAR
  • 92. An enlarged, intermediate signal (obviously torn) PCL
  • 93. NORMAL PCL AVULSION TEAR • Involves the tibial insertion • Retracted bone fragment • Bone marrow edema at avulsion site • The actual PCL may be normal
  • 94. AVULSION PCL TEAR
  • 95. AVULSION PCL TEAR
  • 96. PARTIAL PCL TEAR
  • 97. PD sagittal image shows partial tear of the midsubstance of the PCL. The normal ligament of Humphrey (small arrow) is visualized better because it is adjacent to the high signal intensity edema of the torn PCL. PARTIAL PCL TEAR
  • 98. Collateral ligaments MCL is about 8-11 cm LCL is about 5-7 cm Isolated injuries are rare, usually with ACL and MM
  • 99. Collateral ligaments GRADING SYSTEM Grade I : microscopic tear Grade II :partial tear Grade III : complete tear Grade I,II and isolated grade III are treated conservatively, while grade III tears associated with ACL tears are treated by repairing ACL only
  • 100. Proton density coronal image shows the normal medial collateral ligament as a thin, taut, well-defined, low-signal structure extending from the medial femoral epicondyle to the medial tibial metaphysis
  • 101. Coronal and sagittal proton density image demonstrating the normal lateral collateral ligament in its entirety, from the femoral condyle origin to the fibular head insertion.
  • 102. Grade I medial collateral ligament tear with surrounding edema (straight arrows) on a T2WI Note the normal thickness and signal of the medial collateral ligament and continued close apposition to the femoral and tibial cortices.
  • 103. .Grade 1 sprain of the medial collateral ligament
  • 104. .Grade 11 sprain of the medial collateral ligament
  • 105. months after 7 conservative treatment Grade II medial collateral ligament tear seen on a coronal proton density image shows slight thickening of the medial collateral ligament and separation from the underlying cortices. Bone marrow edema of the lateral tibial plateau is seen due to valgus stress
  • 106. Grade II medial collateral ligament tear seen on a coronal T1 and STIR images showing slight thickening of the medial collateral ligament and separation from the underlying cortices.
  • 107. .Grade 111 tear of the MCL
  • 108. Grade III medial collateral ligament tear on a coronal fast spin-echo T2-weighted image demonstrates a disrupted ligament that is thickened and retracted with surrounding edema (black arrow).
  • 109. Acute grade III tear with a folded ligament (arrow) and surrounding edema on a coronal proton density image.
  • 110. Acute tear of the proximal portion of the lateral collateral ligament is seen on this coronal proton density image (white arrow). Note the associated grade II medial collateral ligament tear.
  • 111. Grade III MCL tear with retraction
  • 112. Grade III MCL tear with abnormal signal and edema
  • 113. .Grade 111 tear of the LCL
  • 114. Ilio-tibial band syndrome. Distal tendon of IT fascia and insert at gerdy,s .tubercle of the tibia. It occur in runner, cyclists, football players and weight lifter
  • 115. (Pre-patellar bursitis.(housemaid bursitis
  • 116. .Backer and Pes anserine cyst
  • 117. Patellar and quadriceps tendons
  • 118. Patellar tendons
  • 119. Complete tear of the patellar tendon with ACL tear
  • 120. Complete tear of the patellar tendon with ACL tear
  • 121. Partial tear of the patellar tendon
  • 122. Lateral pressure syndrome     Thickening of the lateral retinaculum Lateral knee pain Obese, athletic patients May be associated with chondromalacia
  • 123. Patella alta     Sequlae of patellofemoral dysplasia Lengthening of the infrapatellar tendon May be associated with chondromalacia Length of patellar tendon/ length of patella > 1.3
  • 124. Patella Baja    Poliomyelitis Achondroplasia JRA
  • 125. Hyaline cartilage
  • 126. Hyaline cartilage
  • 127. T2* MT Hyaline cartilage
  • 128. Articular cartilage
  • 129. MT STIR
  • 130. Chondromalacia patellae Degeneration of the hyaline cartilage Anterior knee pain in young adults Four stages Signal abnormalities Ulceration [ fraying , partial or full thickness defects ] Reactive bone changes [ edema , cyst formation , sclerosis ] Osteoartheritic changes
  • 131. Chondromalacia patella
  • 132. Chondromalacia patella
  • 133. Chondromalacia patella
  • 134. Loose bodies • Read with plain films • Low signal fragments Synovial osteochondromatosis
  • 135. Loose bodies
  • 136. Synovial osteochondromatosis Metaplasia of subsynovial soft tissues [Affects any joint [ knee , hip , elbow Age incidence 40 years M:F=2:1 FINDINGS Widening of the joint space Bone erosions Intra articular loose bodies Secondary osteoartheritic changes cartilage formation
  • 137. Synovial chondromatosis
  • 138. Synovial chondromatosis
  • 139. Lipoma arborescens Rare Idiopathic Fatty synovial infiltrations forming variable sized villous projections within the joint capsule commonly in the supra- patellar pouch Associated with joint effusion Painless swelling Treatment by synovectomy
  • 140. Lipoma arborescens Lipoma arborescence
  • 141. Pigmented villo-nodular synovitis  Idiopathic  Monoarticular disease 1% incidence  Hypertrophic synovial masses with hemosiderin     laden macrophages bone erosions Intermediate signal in T1 and low signal in T2 with enhancement after contrast injection Typical location posterior to Hoffa’s fat pad Painless swelling , pain with progressive disease Treatment by synovectomy
  • 142. PIGMENTED VELLONODULAR SYNOVITIS
  • 143. PIGMENTED VILLONODULAR SYNOVITIS
  • 144. PIGMENTED VILLONODULAR SYNOVITIS VERSUS LIPOMA ARBORESCENS
  • 145. Pigmented villonodular synovitis
  • 146. POPLITEAL CYST Fluid in the bursa which is usually communicating with the joint space Other names Baker’s cyst Gastrocnemius/semimembranosus bursa
  • 147. Medial plica syndrome  Inflamed synovial plica causing pain , crepitus and pseudolocking  Often in adolescents and athletics  No measurement for plica thickness Four types of plica Suprapatellar 90% Medial 15 -30% Infrapatellar Lateral [ rare]
  • 148. PLICA SYNDROME
  • 149. Medial plica Syndrome
  • 150. Osteochonddritis dissecans  Osteochondral fragment in a typical location  Young male  Lateral aspect of the medial femoral condoyle  Variable sized fragment attached or detached  Criteria of unstable fragment Large size more than 1cm Fluid between the fragment and donor bone Cystic changes at the donor site Enhancement of the separation line
  • 151. Osteochondritis Dissecans
  • 152. Osteochondritis Dissecans along the medial femoral condyle
  • 153. OSTEOCHONDRITIS DISSECANS
  • 154. Red marrow recon version / marrow lesion
  • 155. Bone marrow contusion
  • 156. Migratory osteoporosis
  • 157. Bone infarcts  Serpigenous lesions in the bone marrow  Variable in size [ Chinese figures ]  Double line sign is diagnostic [peripheral hyperintense with hypointense inner border on T2  CAUSES POSTTRAUMATIC STEROIDS COLLAGEN DISEASES ALCOHOLISM PANCREATITIS SPONTANEOUS
  • 158. BONE INFARCTS
  • 159. BONE INFARCTS
  • 160. BONE INFARCTS
  • 161. Enchondroma

×