Rationale for fluoroscopic guidance in spine injections.

Spine injections are commonly performed in the treatment of back pain. The purpose of this article is to review the current literature surrounding image guided spine injections focusing on scenarios where fluoroscopic guidance can be advantageous in addition to discussing similarities among the different modalities.

US for Traumatic Nerve Injury, Entrapment Neuropathy, and Imaging-guided Perineural Injection.

US is commonly performed to help diagnose traumatic peripheral nerve injury and entrapment neuropathy, particularly with superficial nerves, where higher spatial resolution provides an advantage over MRI. Other advantages of US include dynamic evaluation, easy contralateral comparison, fewer implant contraindications, less artifact from ferromagnetic debris, and facile needle guidance for perineural injections. The authors review peripheral nerve US for traumatic peripheral nerve injury with an emphasis on injury grading and entrapment neuropathy and describe best-practice techniques for US-guided perineural injections while highlighting specific techniques and indications.

Magnetic Resonance of Normal Variants of the Pediatric Knee.

Accurate diagnosis and management of pediatric patients undergoing magnetic resonance (MR) imaging necessitates familiarity with the normal changes of skeletal maturation and the spectrum of normal variation seen in children. This article reviews key patterns of normal bone and cartilage development. The most common and important variants of bone, cartilage, and soft tissue structures encountered on pediatric MR studies are discussed.

Pre-treatment MRI of leukaemia and lymphoma in children: are there differences in marrow replacement patterns on T1-weighted images?

Objectives: To investigate the prevalence and distribution of specific marrow patterns on pre-treatment magnetic resonance imaging (MRI) examinations in children with leukaemia and lymphoma and with respect to the anatomic location.

Materials And Methods: This retrospective IRB-approved and HIPAA-compliant study included children with leukaemia or lymphoma who underwent pre-treatment MRI examinations over 18 years (between 1 January 1995 and 31 August 2013). Two radiologists blinded to the clinical diagnosis reviewed each study to determine the presence or absence of abnormal marrow signal and, when present, sub-categorised the pattern into diffuse, patchy, or focal abnormal marrow.

Primary Rosai-Dorfman Disease of Bone: A Report of Two Cases.

Rosai-Dorfman disease (RDD), sometimes known as sinus histiocytosis with massive lymphadenopathy, is a rare histiocytic disorder that most commonly presents as painless, massive cervical lymphadenopathy in young adults. Extranodal disease can occur in up to 40% of patients but primary involvement of bone is rare. We present two cases of primary RDD of bone: one case of multifocal osseous RDD presenting as a painful lesion in the elbow, and one case of a solitary osseous lesion presenting as a painful lesion in the wrist.

Orthopaedic Fixation Devices Used in Children: A Radiologist's Guide.

Fractures are common in children with some requiring surgical reduction and fixation to maintain anatomical alignment. Although various surgical techniques and principles are shared between children and adults, certain unique considerations in children can influence the surgical approach and device selection. In particular, for skeletally immature children, it is of utmost importance to protect certain critical open growth plates because permanent injury can produce severe growth disturbances.

Sports and the Growing Musculoskeletal System: Sports Imaging Series.

Increased youth participation in sports has resulted in increased injury tolls due to shifts toward participation in competitive sports at earlier ages, increased training intensity and competition schedules, as well as specialization into one sport. The physiology of the growing musculoskeletal system makes the growing athlete particularly vulnerable to specific types of injuries. Radiologists must understand the differences between pediatric and adult athletes to recognize the particular injuries to which these young athletes are prone.

Fundamentals of Joint Injection.

Objective: Using image guidance for joint access is a valuable fundamental skill. The purpose of this article is to review fluoroscopic and ultrasound-guided techniques and the medications used for injection into the glenohumeral, elbow, wrist, hip, knee, and ankle joints.

Conclusion: Thorough understanding of basic injection principles, knowledge of the underlying anatomy, and consideration of the advantages and disadvantages of the imaging approaches should facilitate selection of the most appropriate technique for any clinical scenario.

Magnetic resonance imaging of the pediatric knee.

In pediatric patients, the high resolution and excellent soft-tissue contrast of magnetic resonance (MR) imaging allows for complete evaluation of osseous and soft-tissue structures around the knee joint, and its lack of ionizing radiation makes it a preferred modality for advanced imaging. Older children and adolescents are most commonly imaged to evaluate athletic and traumatic injuries, whereas in infants and school age children MR imaging is used to evaluate developmental conditions such as Blount disease or assess for causes of atraumatic pain such as infection or inflammatory arthritis. A thorough understanding of normal skeletal development is necessary to avoid misdiagnoses.

A biomechanical approach to interpreting magnetic resonance imaging of knee injuries.

This article discusses common injury mechanisms and the subsequent constellation of magnetic resonance (MR) imaging findings in the knee following trauma in the context of instability, as distinguished by the degree of knee flexion and tibial rotation at the time of initial injury, in addition to the direction and magnitude of the responsible force vectors. Using 3-dimensional imaging, common injury mechanisms are illustrated and correlated with MR imaging findings of the resulting osteochondral, ligamentous, meniscal, and musculotendinous lesions. The most common classification and grading systems for these individual lesions and their subsequent treatment implications are discussed.

Imaging of traumatic injuries to the hip.

Traumatic injuries of the hip are an increasingly common cause of morbidity and mortality. These injuries can be grouped into fairly discrete patterns including femoral head fractures and hip dislocations, femoral neck fractures, greater trochanteric fractures, intertrochanteric fractures, subtrochanteric fractures, and soft tissue injuries. For each of these entities, specific features provide helpful diagnostic, prognostic, and therapeutic information.

Magnetic resonance imaging and arthroscopic appearance of the menisci of the knee.

The menisci are critical for normal function of the knee, providing shock absorption and load transmission that reduce stress on the articular cartilage. When torn, a meniscus may require surgery to restore function, reduce pain, and eliminate mechanical symptoms. Patterns of meniscal tears include longitudinal and bucket-handle, which are often reparable; and horizontal, radial, vertical flap, horizontal flap, and complex.

Is there an association between superolateral Hoffa fat pad edema on MRI and clinical evidence of fat pad impingement?

Objective: Patients with symptomatic Hoffa fat pad impingement often exhibit fat pad edema on MRI. We studied two patient groups to determine the association between MRI fat pad edema and clinical symptoms of Hoffa fat pad impingement.

Materials And Methods: We studied 34 consecutive patients with an MRI diagnosis of fat pad edema and no injury in the prior year (group 1) and 47 consecutive patients with a knee MRI examination and no injury in the prior year (group 2).

Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial.

Background: This study sought to describe the results of a single-arm multicenter clinical trial using image-guided percutaneous cryoablation for the palliation of painful metastatic tumors involving bone.

Methods: Over a 44-month period, 61 adult patients with 1 or 2 painful bone metastases with a score of 4 or more on a scale of 0 to 10 (≥4/10) worst pain in a 24-hour period who had failed or refused conventional treatment were treated with percutaneous image-guided cryoablation. Patient pain and quality of life was measured using the Brief Pain Inventory prior to treatment, 1 and 4 days after the procedure, weekly for 4 weeks, and every 2 weeks thereafter for a total of 6 months.

Upper extremity injuries in young athletes.

Injuries are becoming increasingly prevalent in pediatric athletes. Many of these injuries are diagnosed clinically and do not require imaging for diagnosis, but the sheer increase in numbers of injuries means that radiologists are evaluating more of them. Some injuries that young athletes sustain are simply due to trauma, such as falls, and may be experienced outside sports just as easily; however, others are peculiar to athletic activities.

MR arthrography of the hip: comparison of IDEAL-SPGR volume sequence to standard MR sequences in the detection and grading of cartilage lesions.

Purpose: To compare the diagnostic performance of iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL)-spoiled gradient-recalled echo (SPGR) with that of standard magnetic resonance (MR) arthrography sequences for detecting and grading cartilage lesions within the hip joint during MR arthrography.

Materials And Methods: Following institutional review board approval, 67 consecutive hip MR arthrograms were retrospectively reviewed independently by three musculoskeletal radiologists and one musculoskeletal fellow. IDEAL-SPGR images and the two-dimensional images, the latter from the routine MR arthrography protocol, were evaluated at separate sittings to grade each articular surface of the hip joint.

Evaluation of the menisci of the knee joint using three-dimensional isotropic resolution fast spin-echo imaging: diagnostic performance in 250 patients with surgical correlation.

Objective: To compare the diagnostic performance of FSE-Cube, a three-dimensional isotropic resolution intermediate-weighted fast spin-echo sequence, with a routine magnetic resonance (MR) protocol at 3.0 T for detecting surgically confirmed meniscal tears of the knee joint in a large patient population.

Methods: FSE-Cube was added to a routine MR protocol performed at 3.

Musculoskeletal mnemonics: differentiating features.

Mnemonics are often used in musculoskeletal radiology to help radiologists remember long differential diagnoses. However, unless the specific appearance of each entity on a differential is also recalled, mnemonics become useless. This article presents 8 mnemonics with their corresponding differential diagnoses and distinguishing features.

Imaging pediatric sports injuries: lower extremity.

Injuries to pediatric athletes, which are becoming increasingly common, take the form of acute injuries and chronic overuse injuries. Acute injuries of the lower extremity include avulsions of the pelvic apophyses, muscle-tendon injuries, transient dislocation of the patella, ankle sprains, and acute tears of the anterior cruciate ligament and menisci. Magnetic resonance (MR) imaging of the latter 2 injuries should approach the accuracy of MR imaging of the adult knee.

Imaging pediatric sports injuries: upper extremity.

With increasing youth participation in organized sports, more injuries in this age group are being treated by primary care and sports medicine physicians. Overuse injuries are much more common now than in past decades, with Little League shoulder, Little League elbow, and gymnast wrist being particular concerns. Rotator cuff tears and glenoid labral injuries, once thought to be rare in this age group, are also more common now.

Cartilage morphology at 3.0T: assessment of three-dimensional magnetic resonance imaging techniques.

Purpose: To compare six new three-dimensional (3D) magnetic resonance (MR) methods for evaluating knee cartilage at 3.0T.

Materials And Methods: We compared: fast-spin-echo cube (FSE-Cube), vastly undersampled isotropic projection reconstruction balanced steady-state free precession (VIPR-bSSFP), iterative decomposition of water and fat with echo asymmetry and least-squares estimation combined with spoiled gradient echo (IDEAL-SPGR) and gradient echo (IDEAL-GRASS), multiecho in steady-state acquisition (MENSA), and coherent oscillatory state acquisition for manipulation of image contrast (COSMIC).