Imaging of knee by mr and usg DR. MUHAMMAD BIN ZULFIQAR

1. Imaging of knee by MR and USG
DR. Muhammad Bin Zulfiqar
PGR III New Radiology Department
SIMS/SHL

2. • USG TECHNIQUE
• MR TECHNIQUE
• COMPARATIVE STUDY

3. USG TECHNIQUE

5. Quadriceps tendon transverse

6. Anterior knee: Medial recess and patellar retinaculum transverse

7. Anterior knee: Lateral recess and patellar retinaculum transverse

8. Anterior knee: Proximal patellar tendon longitudinal

9. • Anterior knee: Distal patellar tendon longitudinal

10. • Anterior knee: Proximal patellar tendon transverse

11. Anterior knee: Distal patellar tendon transverse

13. • Medial side of the knee: Pes anserinus tendons longitudinal

14. Lateral side of the knee: Iliotibial band longitudinal
Iliotibial band longitudinal Distal insertion

15. Lateral side of the knee:
Popliteal tendon and lateral
collateral ligament

16. Lateral side of the knee: Biceps femoris and lateral collateral ligament
insertion longitudinal

17. • Posterior knee: Popliteal fossa with popliteal vessels and nerve transverse

18. Posterior knee: Popliteal fossa with popliteal vessels and nerve
longitudinal

19. Posterior knee: Semimembranosogastrocnemia bursa region transverse

20. Posterior knee: Peroneal nerve transverse

21. Posterior knee: Peroneal nerve longitudinal

22. Posterior knee: Posterior horn of the medial meniscus

23. Posterior knee: Posterior horn of the lateral meniscus

24. Posterior knee: Posterior cruciate ligament insertion longitudinal

25. Posterior knee: Intercondylar fossa transverse

26. Quad tear??? No!!! - ANISOTROPY

27. Pulse Sequences
Menisci Short TE sequence (<20 msec) ,Proton density / gradient echo
/ (T1) Caution with FSE PD (blurring)
Tendons
Ligaments
Muscle
Fluid
FSE T2 with fat saturation
Inversion recovery (STIR)
Bone
marrow
FSE T2 with fat saturation
Inversion recovery (STIR)
Cartilage Good contrast between
fluid , cartilage and subchondral bone

28. Imaging Planes
Axial
Coronal
Sagittal

29. MR PLANES
• Axial
• Coronal
• Sagittal

30. Anterior Compartment

31. Prepatellar Bursitis

32. Prepatellar Bursitis

33. Prepatellar Bursitis

34. Patellar Tendinosis
Normal Swollen

35. Partial Patellar Tendon Tear

36. Partial Patellar Tendon Tear

37. Patellar Tendon Rupture

38. Patellar Tendon Rupture
Top Images: Tendon Rupture
Bottom Images: Post operative

39. Patellar Tendon Rupture
• Complete Patellar tendon tear. Image on the right shows
hemorrhagic bursitis ( low signal in bursa).

40. Medial Femoral Condyle Chondral Lesion

41. Ultrasound Medial Compartment

42. Medial Collateral Ligament Tear

43. Medial Collateral Ligament Tear

44. Medial Collateral Ligament Tear
Acute 6 months Later

45. Medial Meniscus Tear

46. Medial Meniscus Tear

47. Jumpers Knee

48. Jumpers Knee

49. Jumpers Knee

50. USG Lateral Compartment

51. Lateral Collateral Ligament Sprain

52. Ileotibial Band Friction Syndrome

53. Iliotibial Band Friction Syndrome
The T1-weighted coronal image demonstrates intermediate signal intensity
(arrows) replacing normal fat signal intensity deep to the iliotibial band
(arrowhead).
The STIR coronal image demonstrates ill defined increased signal intensity
(arrows) deep to the iliotibial band (arrowhead). Subtle increased signal
intensity (short arrows) is also present superficial to the iliotibial band.

54. Lateral Meniscus Tear

55. Lateral Meniscus Tear

56. Posterior Compartment

57. Posterior Meniscus Tear

58. Popliteal Artery Aneurysm

59. Popliteal Artery Aneurysm
T1 T2 fat sat PD fast

60. • Right, Axial sonogram of posterior knee shows Baker’s cyst (arrowheads) with fluid (solid
straight arrow) between semimembranosus tendon (curved arrow) and medial
gastrocnemius tendon (open arrow). Note subgastrocnemius component (asterisk) of Baker’s
cyst. Note that top of image is posterior; right side of image is medial. M = medial
gastrocnemius muscle.
• , Axial proton density–weighted MR image with fat saturation reveals Baker’s cyst
(arrowheads ) with fluid (black arrow ) between semimembranosus tendon (curved white
arrow ) and medial gastrocnemius tendon (open arrow ). Note subgastrocnemius component
(asterisk ) of Baker’s cyst. M = medial gastrocnemius muscle.

61. • Right, Axial sonogram shows echogenic intraarticular body
(arrow ) in Baker’s cyst (arrowheads ). Note that top of
image is posterior.
• Left, Sagittal proton density–weighted MR image reveals
intermediate signal intraarticular body (arrow ) in Baker’s
cyst (arrowheads ).

62. • Right, Sagittal sonogram shows hypoechoic
meniscal cyst (curved arrow) in contact with
hyperechoic meniscus (open arrows) and
hypoechoic meniscal tear (solid straight arrows).
F = femur, c = hyaline cartilage.
• Left top, Sagittal proton density–weighted MR
image reveals meniscal cyst (curved arrow ) in
continuity with meniscal tear (straight arrow ).
• Left bottom, Axial proton density–weighted
MR image with fat saturation reveals meniscal
cyst (curved arrow ) with signal intensity of fluid
without extension between semimembranosus
tendon (undulating arrow ) and medial
gastrocnemius tendon (arrowhead ).

63. THANK YOU