Musculoskeletal Ultrasound Fundamentals Fund US APMA 2017.pdf · Musculoskeletal Ultrasound Image...
Transcript of Musculoskeletal Ultrasound Fundamentals Fund US APMA 2017.pdf · Musculoskeletal Ultrasound Image...
Musculoskeletal Ultrasound Fundamentals
Benjamin D. Levine, M.D.Associate Professor of Radiology
Musculoskeletal Imaging
Dept. of Radiological Sciences
UCLA Health System
Musculoskeletal UltrasoundI. Image Optimization
II. Image Interpretation Artifacts
III. Applications Soft Tissue Foreign bodies
Peripheral nerves
Dynamic imaging
Imaging around hardware
Guided procedures
Focal tendon abnormality
Evaluation of cyst/fluid collection
Image Optimization
Musculoskeletal UltrasoundImage Optimization
Equipment:
• High frequency (> 10 MHz) linear transducers
• Knobology Depth
Focal zone
Gain
Doppler
Extended Field of View
Cine
Image Interpretation
Artifacts
Musculoskeletal UltrasoundImage Interpretation
Artifacts
• Anisotropy
• Variation of ultrasound interaction with fibrillar tissue
• Sound beam not perpendicular to long axis of a structure
• Small degrees (5°) of beam angulation can result in anisotropy
• Tendons and ligaments
Rutten JC, et al. Radiographics 2006; 26:589-604
Musculoskeletal UltrasoundImage Interpretation
Artifacts
• Anisotropy
Applications
Musculoskeletal UltrasoundApplications
• Ideal alternative or complement to MRI for imaging superficial structures
• MRI standard of care for• Ligament (most)
• Cartilage
• Intraosseous/marrow abnormalities
Musculoskeletal UltrasoundForeign Bodies
• FB as small as 0.5 mm
• Non radioopaque wood and plastic
• Identifies FB and complications
• Can mark skin for surgical removal
Musculoskeletal UltrasoundPeripheral Nerves
• Hypoechoic individual nerve fascicles
• Honeycomb in short axis
Musculoskeletal UltrasoundDynamic Imaging
Specific maneuver needed to elicit the pathology
• Tendon or nerve subluxation/dislocation
• Snapping syndromes
• Muscle hernia
• Impingement syndromes
• Partial vs. complete tears
Musculoskeletal UltrasoundImaging around Hardware
• Reverberation artifact is deep to metal
• Can image overlying tendons/ligaments
• Dynamic imaging of soft tissues over hardware
• Ultrasound guided aspiration
Musculoskeletal UltrasoundGuided Procedures
Iliopsoas bursal/peritendinousinjection
• Safe and effective
• Useful in excluding the tendon as the cause of pain
• Guides surgical decision making (tendon release)
Adler RS, et al. AJR 2005; 185:940-43
Musculoskeletal UltrasoundFocal Tendon Abnormality
Tenosynovitis
Musculoskeletal UltrasoundFocal Tendon Abnormality
Tendinopathy
• Loss of fibrillar echotexture
• Heterogeneous
• Thickened
• Hypoechoic
• Smooth subcortical bone
Musculoskeletal UltrasoundFocal Tendon Abnormality
Tear• Non visualization
• Focal hypoechoic tendon defect
• Flattening of bursal surface
• Secondary Signs Cortical irregularity
Bursal fluid
Joint effusion
Musculoskeletal UltrasoundFocal Tendon Abnormality
Partial Thickness Tear
• Articular
• Intrasubstance
• Bursal
Musculoskeletal UltrasoundFocal Tendon Abnormality
Full Thickness Tear
• Articular/intrasubstance/bursal
• Loss of superior convexity
• Retraction
Musculoskeletal UltrasoundEvaluation of a Benign Cyst/Fluid Collection
Popliteal (Baker’s) cyst
• Communication to joint between medial gastroc and semimembranosus tendons
• Leaking/rupture can present as complex mass in calf
Musculoskeletal UltrasoundI. Image Optimization
II. Image Interpretation Artifacts
III. Applications Soft Tissue Foreign bodies
Peripheral nerves
Dynamic imaging
Imaging around hardware
Guided procedures
Focal tendon abnormality
Evaluation of cyst/fluid collection
Musculoskeletal Ultrasound Fundamentals
Benjamin D. Levine, M.D.Associate Professor of Radiology
Musculoskeletal Imaging
Dept. of Radiological Sciences
UCLA Health System