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Musculoskeletal Radiology

Musculoskeletal RadiologyOur MSK section includes ten board certified, fellowship trained radiologists. With over 20,000 annual MR interpretations plus CT and Radiograph interpretations, we have achieved significant subspecialty expertise. Our specialists have been published in the leading peer reviewed journals in radiology, have presented scientific papers at regional, national and international conferences, and have received numerous awards for teaching and scientific merit. Our MSK radiologists utilize the full spectrum of imaging modalities to diagnose disorders of the musculoskeletal-system, and they are often called to be primary and secondary consultants on complex cases.

Interpretations include:

Hand/wrist
Spine
Hip
Foot/ankle
Shoulders
Knee
Neck
Elbow

 

Case Examples

Second MTP joint 1.5T

Secnd MTP joint 3.0T

Second MTP joint anatomy comparison using axial T1W images at 3.0T and 1.5T. The image obtained using the 3.0T scanner (right) shows improved resolution and delineation of anatomic structures when compared to that using a 1.5T scanner (left). On the image acquired at 3.0T the joint capsule can be distinguished from the adductor tendon whereas they cannot on the image acquired at 1.5T on the same volunteer.

Sample Reports


NORMAL/MRI OF THE RIGHT/LEFT ANKLE

TECHNQUE: MR images of the right/left ankle were obtained in the axial, sagittal and coronal planes using T1 weighted proton density, T2 weighted and inversion recovery pulse sequences.

Normal syndesmotic ligaments: The anterior-inferior tibiofibular ligament, interosseous membrane and posterior-inferior tibiofibular ligaments are normal.

Normal lateral collateral ligament complex: The anterior talofibular ligament, calcaneofibular ligament and posterior talofibular ligaments are linear in their course and normal in their contour and there is no abnormally increased signal associated with them and they are deemed to be normal. The posterior talofibular ligament is similarly normal.

Normal deltoid ligament complex: The superficial and deep components of the deltoid ligament complex are normal.

Normal sinus tarsi and spring ligament: The fat plug within the sinus tarsi is normal and the interosseous and cervical ligaments are normal. The navicular-calcaneal (Spring) ligament is normal.

Normal medial tendons: The posterior tibialis, flexor digitorum longus and flexor hallicus longus tendons are normal in position. They are also normal in caliber. No abnormally increased signal is seen associated with them. No accessory ossicle in the region of the navicular is evident.

Normal lateral tendons: The peroneus longus and brevis tendons are normally situated within the peroneal groove of the distal fibula and the superior peroneal retinaculum is normal. The peroneal tendons are normal in caliber, morphology and signal and there is no evidence for peroneal longus or brevis tear or tendinopathy. There is no osteophyte seen to be projecting about and impinging on the peroneal tendons.

Normal anterior tendons: The tibialis anterior, extensor hallicus longus and extensor digitorum longus tendons are normal in position, morphology and signal. There is no evidence for tendinopathy or tear of these extensor compartment tendons.

Normal Achilles tendon: The Achilles tendon is normal in position, morphology and signal. There is no evidence for increased thickness, abnormally increased T1 or T2 signal that may have been indicative of tendinopathy or tear. There is no fluid present within the paratenon surrounding the Achilles. There is no abnormally increased T2 signal present in the calcaneus subjacent to the Achilles enthesis. There is no accessory or low-lying soleus muscle present.

Normal plantar fascia: The medial and lateral bundles of the plantar fascia are normal in morphology and signal. There is no abnormally increased thickness or abnormally increased T1 or T2 signal to suggest the presence of medial or lateral cord plantar fasciitis or tear. There is no edema present in the calcaneus subjacent to the plantar fascial insertion. There is no calcaneal enthesophyte present. The subjacent flexor digitorum brevis muscle is normal.

Normal tarsal tunnel: The tarsal tunnel and its contents are normal. Specifically, there is no calcaneal fracture or bony excrescence projecting into the tarsal tunnel. The abductor hallicus muscle is normal. The posterior tibialis veins are normal. There is no vascular hypertrophy or lipoma, neuroma or other mass seen to be impinging on the posterior tibialis nerve or its medial or lateral plantar branches.

Normal os trigonum: The os trigonum and its synchondrosis to the underlying talus are normal. There is no evidence for edema within the os trigonum or its synchondrosis to indicate the presence of a fracture. There is no fluid surrounding the os trigonum to suggest the presence of os trigonum syndrome or posterior impingement.

Normal bone marrow: The bone marrow signal in the ankle and hindfoot is normal. Specifically, there is no evidence for marrow edema in the areas that are injured and commonly radiographically occult, such as the anterior process of the calcaneus, medial process of the talus and talar neck to suggest the presence of trabecular microfracture or contusion. There is no evidence for a tarsal coalition. There is no evidence for Haglund’s deformity. No MR imaging evidence for avascular necrosis.

Normal synovium: There is no joint effusion present. There is no evidence for synovial thickening or proliferation that may have been a manifestation of an inflammatory arthropathy, gout, pigmented villonodular or other synovitis.

IMPRESSION: Normal MRI of the right/left ankle.


MRI OF THE RIGHT/LEFT SHOULDER

TECHNQUE: MR images of the right/left shoulder were obtained in the axial, sagittal oblique and coronal oblique planes using T1 weighted, proton density, T2 weighted gradient echo pulse sequences.

Normal acromioclavicular joint region: There is a Type II acromion present. There is no evidence for AC joint separation. There are no evident degenerative changes present at the AC joint region. Specifically, no evidence for subacromial or subclavicular osteophytes and no enthesopathic proliferation on the inferior surface of the acromion are present.

Normal acromiohumeral and coracohumeral space: The acromiohumeral space is normal. There is no mechanical deformation seen pertaining to the supraspinatus or muscles of the rotator cuff. The subacromial/subdeltoid bursa is neither fluid-filled nor inflamed to suggest the possibility of subacromial-subdeltoid bursitis. The coracoclavicular ligament does not appear to be either thickened or calcified. The coracohumeral distance is normal and there is no mechanical deformation seen on the subscapularis muscle.

Normal rotator cuff muscles: The muscles and tendons of the rotator cuff including the supraspinatus, infraspinatus, teres minor and subscapularis are normal. There is no evidence for abnormally increased thickness or abnormally increased T1 or T2 signal to suggest the presence of rotator cuff tendinosis, and there is neither partial nor full thickness tear present. There is no evidence for muscle strain or atrophy.

Normal biceps tendon: The superior portion of the labrum, biceps anchor and proximal biceps tendon are normal in position, morphology and signal. There is no abnormally increased thickness or T1 or T2 signal to suggest the possibility of biceps tendinosis or tear. The superior glenohumeral ligament and biceps pulley are normal.

Normal labrum: The superior, middle and inferior glenohumeral ligaments are normal. All portions of the glenoid labrum are normal in position and morphology and there is no evidence for glenoid labral tear or degeneration. There is no evidence for a paralabral cyst.

Normal glenohumeral joint: The articular cartilage overlying the glenoid fossa is normal. The synovium is normal. There is no glenohumeral joint effusion. There is no loose body or debris present within the glenohumeral joint.

Normal bone marrow: The bone marrow in the structures of the shoulder region is normal. There is no abnormally increased T2 signal to suggest the possibility of impingement, trabecular microfracture or contusion, compression fracture, avascular necrosis or other abnormality.

Normal outlet spaces: The suprascapular notch and quadrilateral space is normal and there is no ganglion or other mass seen to be impinging on the suprascapular nerve or the axillary nerve passing through the spaces.

IMPRESSION: Normal MRI of the right/left shoulder.


MRI OF THE RIGHT/LEFT KNEE:

TECHNQUE: MR images of the right/left knee were obtained in the axial, sagittal oblique and coronal oblique planes using T1 weighted proton density, T2 weighted and inversion recovery pulse sequences.

Normal lateral collateral ligament complex: The popliteus muscle, its myotendinous junction and tendinous attachment to the femur are normal. The biceps femoris tendon, fibular collateral ligament and iliotibial band are normal in position, morphology and signal.

Normal medial collateral ligament complex: The superficial and deep components of the medial collateral ligament are normal. There is no evidence for discontinuity, abnormally increased thickness or abnormally increased T2 signal to suggest the presence of MCL injury. The medial and lateral portions of the patellar retinaculum are normal.

Normal extensor mechanism: The quadriceps and patellar tendons are normal in position, morphology and signal. There is no evidence for abnormally increased thickness, discontinuity or abnormal signal to suggest the possibility of quadriceps or patellar tendinosis or tear.

Normal cruciate ligaments: The anterior-medial and posterior-lateral bands of the anterior cruciate ligament are normal in their course and linear in their contour. There is no abnormally increased T2 signal associated with it. Hence, the ACL is deemed to be normal. The posterior cruciate ligament is normal in position and morphology, although the anterior-lateral and posterior-medial bands cannot be separated from each other. There is no abnormally increased or decreased thickness or abnormal signal associated with the PCL and it is hence deemed to be normal. The alignment of the tibia with respect to the femur is normal. There is no marrow edema to indicate a previous pivot-shift or clipping type mechanism of injury.

Normal menisci: The medial meniscus is normal in position, morphology and signal. There is no evidence for meniscal extrusion. There is no discoid meniscus. There is no evidence for meniscal degeneration. There is no evidence for a meniscal tear. No meniscal cyst is present. No meniscal flounce or meniscal-capsular separation is evident. The lateral meniscus is similarly normal in position, morphology and signal.

Normal knee joint: The cartilage overlying the patella is normal. The cartilage overlying the medial femorotibial compartment is normal. The cartilage in the lateral femorotibial compartment is normal. There is no effusion or hemorrhage present. There is no intraarticular loose body present. There is no evidence for pigmented villonodular or other inflammatory synovitis. No evidence for synovial osteochondromatosis. No effusion or hemorrhage is present. There is no popliteal cyst evident.

Normal bone marrow: The bone marrow about the knee is normal. Specifically, there is no marrow edema in either a pararticular distribution to suggest the possibility of osteoarthritis, or in a band-like pattern or geographic pattern to suggest the possibility of a stress fracture or osteochondral injury. No incidental tumor such as non-ossifying fibroma or enchondroma is present.

IMPRESSION: Normal MRI of the right/left knee.


NORMAL MRI OF THE RIGHT/LEFT HIP

TECHNQUE: MR images of the right/left hip were obtained in the axial, sagittal oblique and coronal oblique planes using T1 weighted, T2 weighted and inversion recovery pulse sequences.

Normal bone marrow: There is no evidence for avascular necrosis or marrow edema that may have been secondary to trabecular microfracture or contusion. There is no evidence for a stress fracture in either the hip or the sacrum. There is no edema to suggest the possibility of a transient or regional osteoporosis.

Normal hip joint: The hyaline cartilage overlying the acetabulum and femoral head is normal. There is no evident acetabular cyst present. There is no evidence for femoral-acetabular impingement syndrome. No synovial herniation pit is identified. There is no joint effusion. No intraarticular loose body is evident.

Normal labrum: To the extent that it is visualized, the acetabular labrum is normal. There is no evidence for a labral tear, chondrolabral separation or paralabral cyst.

Normal bursi: There is no evidence for iliopsoas or trochanteric bursitis.

Normal sciatic nerve: The course of the sciatic nerve is normal and there is no abnormal mass seen impinging on it.

Normal surrounding muscles: The muscles in all four compartments about the hip are normal. Specifically, the anterior muscles (quadriceps, sartorius, iliopsoas) are normal. The medial compartment muscles (short and long adductor muscles, gracilis, pectineus) are normal. The lateral compartment muscles (gluteus maximus/medius/mimimus and tensor fascia lata) are normal. The posterior compartment muscles (biceps femoris, semimembranosis and semitendinosis) are normal. There is no evidence for a tear involving either the muscular portion, myotendinous junction or tendinous insertion of these muscles. There is no abnormal hemorrhage or mass present within the muscles.

IMPRESSION: Normal MRI of the right/left hip.


MRI OF THE RIGHT/LEFT FOREFOOT:

TECHNQUE: MR images of the right/left forefoot were obtained in the axial, sagittal and coronal planes using T1 weighted proton density, T2 weighted and inversion recovery pulse sequences

Normal Lisfranc joint: Lisfranc’s ligament is visualized and is normal. The alignment of the tarsal-metatarsal joint is anatomic.

Normal bone marrow: The bone marrow signal present in the visualized portion of the forefoot is normal. Specifically there is no evidence for marrow edema that may have been indicative of stress fracture, trabecular microfracture or contusion. There is no evidence for avascular necrosis or osteochondral injury.

Normal great and lesser MTP joints: The tibial and fibular sesamoids are normal in position and signal. There is no evidence for sesamoid fracture, sesamoiditis or metatarsal-sesamoid osteoarthritis. The extent that the plantar plate is visualized and can be distinguished from the underlying flexor tendon, it is deemed to be normal. To the extent that they are visualized, the medial and lateral collateral ligaments at the first MTP joint are normal. There is no evidence for osteoarthritis. No synovitis or erosion is evident. No adjacent soft tissue mass is present. The lesser MTP joints are similarly normal.

Normal soft tissues: The soft tissue spaces are normal. Specifically, there is no abnormal mass seen in the region of the inter-metatarsal heads to suggest the presence of a neuroma or ganglion.

Normal tendons: The flexor and extensor compartment tendons are normal.

IMPRESSION: Normal MRI of the right/left forefoot.