Musculoskeletal radiology curriculum guide. The Education Committee of the American Society of Musculoskeletal Radiology.
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Curriculum↗
Biomedical subjects
M H Kathol
Publications and source records attributed to M H Kathol.
An easy linear estimation of the mechanical axis on long-leg radiographs.
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Adolescent↗
MRI diagnosis of diabetic muscle infarction: report of two cases.
Diabetic muscle infarction (DMI) is a rare complication of diabetes mellitus occurring in patients with poorly controlled insulin-dependent diabetes. In previous reports, the diagnosis of this condition was based on the pathologic studies, although MRI examinations were performed in a few patients as part of the diagnostic work-up. In this report, we describe two additional cases of DMI where the diagnosis was based on the MRI findings in conjunction with the clinical picture and laboratory studies. The patients usually present with thigh or calf pain and swelling, are afebrile, and have normal white blood cell count. MRI examination typically shows diffuse swelling and increased signal intensity on T2-weighted images in the affected muscles, with no focal fluid collections. In the proper clinical setting, these findings are diagnostic of DMI and patients should be spared unnecessary invasive diagnostic examinations such as lower extremity venograms and biopsies.
Adult↗
Cervical spine trauma. What is new?
To a large extent, what is new in cervical spine trauma relates to evolving indications for the use of various imaging modalities and expanded understanding of conditions that may influence traumatic sequelae. The American College of Radiology Appropriateness Criteria now provide guidelines for decisions concerning imaging in various clinical situations. This article reviews many of the publications of the past 6 to 7 years that may contribute to a radiologist's understanding of cervical spine injuries.
Aged↗
Acute and chronic avulsive injuries.
Avulsive injuries are common traumatic lesions, especially in young athletes. They can be acute, resulting from excessive tensile forces, or chronic, due to overuse. Avulsion injuries can resemble osteomyelitis or neoplasm and, therefore, familiarity with the radiographic patterns as well as the different muscle attachments is helpful for the clinician to arrive at the correct diagnosis. This article discusses acute and chronic avulsive injuries in the pelvis, knee, elbow, shoulder, and foot.
Acute Disease↗
Imaging of muscle injuries.
Although skeletal muscle is the single largest tissue in the body, there is little written about it in the radiologic literature. Indirect muscle injuries, also called strains or tears, are common in athletics, and knowing the morphology and physiology of the muscle-tendon unit is the key to the understanding of these injuries. Eccentric muscle activation produces more tension within the muscle than when it is activated concentrically, making it more susceptible to tearing. Injuries involving the muscle belly tend to occur near the myotendinous junction. In adolescents, the weakest link in the muscle-tendon-bone complex is the apophysis. Traditionally, plain radiography has been the main diagnostic modality for evaluation of these injuries; however, with the advent of MRI it has become much easier to diagnose injuries primarily affecting the soft tissues. This article reviews the anatomy and physiology of the muscle-tendon unit as they relate to indirect muscle injuries. Examples of common muscle injuries are illustrated.
Adolescent↗
Patellar fatigue fractures.
Three cases of patellar fatigue fracture are reviewed. Two fractures presented with acute displacement and were initially thought to represent pathological fractures. Histological appearances in one case, and the clinical course in another, subsequently indicated that these were fatigue fractures. A third patient developed a chronic undisplaced fracture and followed the typical clinical course of fatigue fractures at other sites. The importance of recognizing patellar fatigue fractures and of differentiating spontaneously displaced fatigue fractures from pathological fractures is emphasized.
Adolescent↗
Peroneus longus and brevis tendon tears: MR imaging evaluation.
PURPOSE: To evaluate magnetic resonance (MR) findings of surgically proved peroneal tendon tears. MATERIALS AND METHODS: MR images, medical records, and surgical findings were retrospectively reviewed in the cases of 12 patients who underwent surgery because of suspected peroneal tendon tear (14 tendons). Sagittal and oblique axial T1-weighted spin-echo and T2-weighted fast spin-echo images were obtained in all patients. RESULTS: At surgery, isolated peroneus longus tendon tears were seen in four patients, isolated peroneus brevis tendon tears in five, and both peroneus brevis and peroneus longus tendon tears in two. When correlated with surgical findings, findings at MR imaging were correct in 12 tendons. Findings were false-positive in two patients and false-negative in one, who underwent surgery anyway because unrelated abnormal MR findings were present. The most common MR finding was increased intra-substance signal intensity on T1- and T2-weighted images (11 tendons), in linear or rounded areas on oblique axial images (n = 11) and in linear areas along the longitudinal axis of the tendons on sagittal images (n = 7). Tendon distortion was noted in severe cases (five tendons). The most frequent surgical finding was a longitudinal tendon tear (split) (10 tendons). CONCLUSION: MR imaging enabled detection of peroneus brevis and peroneus longus tendon tears.
Adolescent↗
Seronegative spondyloarthropathies.
The seronegative spondylarthropathies are a group of multisystem inflammatory disorders that share a variety of clinical, radiologic, and genetic features. They include ankylosing spondylitis, psoriatic arthritis, Reiter's disease, and arthritis associated with inflammatory bowel disease. This article reviews these multisystem inflammatory disorders.
Adolescent↗
Hamstring injuries: radiographic, conventional tomographic, CT, and MR imaging characteristics.
PURPOSE: To review experience with the imaging features of hamstring injuries. MATERIALS AND METHODS: Imaging findings in 18 male and four female patients with clinically proved hamstring injuries were reviewed. The patients' ages ranged from 13 to 61 years (mean, 26 years). Radiography, conventional tomography, computed tomography (CT), and magnetic resonance (MR) imaging were performed. RESULTS: Plain radiographs obtained less than 1 week after injury were normal or showed avulsion of an ischial apophysis. Plain radiographs and conventional tomograms obtained more than 1 week but less than 3 months after injury were confusing, because callus and osteolysis were present. CT helped identify a healing avulsion of an ischial apophysis. MR imaging was helpful no matter how long after the injury it was performed. It provided a means to evaluate muscle, tendon, and bone. CONCLUSION: Familiarity with the variable appearance of hamstring injuries over time and with different modalities facilitates accurate characterization.
Adolescent↗
Imaging of acute injuries of the cervical spine: value of plain radiography, CT, and MR imaging.
Imaging of injuries of the cervical spine has undergone substantial changes in the past 10 years. The use of CT and MR imaging has been emphasized by many authors. Other studies have stressed the proper use and interpretation of plain radiographs in the emergency setting. There is confusion about whether plain films, CT, or MR imaging is best used to evaluate specific injuries. This review explores the usefulness of CT and MR imaging in the diagnosis and management of acute injuries of the cervical spine and emphasizes the continued importance of conventional radiography. Specific examples that illustrate the relative merits of plain radiography, CT, and MR imaging are shown.
Acute Disease↗
Unusual radiological features in Paget's disease of bone.
The radiological diagnosis of Paget's disease of bone is usually straightforward because most cases conform to well-established classic descriptions. Diagnosis becomes more difficult, however, when radiological appearances are not typical or other disease processes mask or alter the behavior of Paget's disease. Examples are presented to illustrate four categories of unusual radiological presentation of Paget's disease: (1) unusual disease progression, (2) massive post-immobilization lysis, (3) metastatic spread to pagetic bone, and (4) vertebral end-plate destruction that mimics infection.
Bone Diseases↗
Elastofibroma dorsi: a radiological diagnosis.
Elastofibroma dorsi is a rarely made radiological diagnosis. The rarity of the condition, lack of a suitable imaging modality, and an inconsistent clinical approach in evaluating indeterminate soft tissue tumors has contributed to this failure. With magnetic resonance imaging now being recognized as the examination of choice for all indeterminate soft tissue tumors, a prebiopsy diagnosis can frequently be made by radiologists familiar with the characteristic periscapular location, predilection for elderly females, and short T2 on magnetic resonance imaging.
Female↗
Comparison of a videodisc system with a conventional film file for medical student teaching.
PURPOSE: The authors assessed the effectiveness of a videodisc film file compared with a conventional film file for teaching radiology to medical students. METHODS: Fourth-year medical students (N = 134) studied 116 cases selected from the American College of Radiology Learning File. Half the students studied 58 skeletal cases using conventional films and half studied the same cases on a videodisc system. Student groups were then switched and those who studied skeletal cases on films studied 58 chest cases on videodisc and vice versa. Students received the same skeletal and chest tests and completed a questionnaire. RESULTS: For both skeletal and chest radiology, students studying films scored minimally higher than students using the videodisc. Students rated films superior to the videodisc for amount learned, convenience of use, and ability to detect lesions. CONCLUSIONS: Conventional film and videodisc methods resulted in similar levels of learning; however, students perceived conventional films to be a superior learning experience.
Education, Medical, Undergraduate↗
Gadolinium-enhanced MRI of soft tissue masses.
The efficacy of gadopentetate dimeglumine (Gd-DTPA) enhanced magnetic resonance (MR) imaging in the diagnosis and differentiation of soft-tissue, neoplastic and non-neoplastic lesion has not been well established. Thirty patients with soft tissue masses (18 neoplastic and 12 non-neoplastic) were studied, using MR imaging with and without administration of Gd-DTPA. Gd-DTPA proved helpful in characterisation of several entities, including differentiation of solid mass from proteinaceous cyst, demonstration of tumour nodules within haemorrhagic or necrotic masses, and delineation of tumour adjacent to oedema. The use of Gd-DTPA may provide additional information for tissue specificity and, in complicated cases, Gd-DTPA may also provide essential information that cannot be obtained using other methods. We recommend the use of contrast enhanced MR as an adjunct to conventional MR imaging in the initial assessment of musculoskeletal soft tissue masses. However, T2-weighted images show better tissue contrast of the lesions, and are equal to contrast enhanced images in delineation of tumour margins. Non-contrast enhanced images are, therefore, probably adequate for the delineation of lesions for surgical planning when a diagnosis has already been made.
Connective Tissue Diseases↗
The use of intravenous gadopentetate dimeglumine in magnetic resonance imaging of synovial lesions.
Spin echo T1- and T2-weighted images and intravenously administered gadopentetate dimeglumine-enhanced T1-weighted images were obtained in 4 normal volunteers and 11 patients (11 joints) with painful, intermittent, or persistent joint swelling of unknown etiology. These studies were retrospectively reviewed to assess the benefits of contrast-enhanced magnetic resonance imaging (MRI) in evaluating the synovium. Normal synovium and joint fluid showed no visually apparent enhancement on images obtained immediately after intravenous injection of gadopentetate dimeglumine. Abnormal synovium enhanced significantly, allowing the precise identification of equivocal or unsuspected synovial disease processes. These results suggest that, in selected cases, enhanced MRI can be a useful adjunct in the evaluation of suspected synovial disease processes.
Adult↗
Radiology of the thoracic spine.
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Diagnostic Imaging↗
Curriculum for musculoskeletal radiology.
Although general suggestions have been made regarding a radiology residency curriculum, no specific list of entities has been offered. Over the past ten years, we have developed a resident-run morning conference in musculoskeletal radiology that is supervised by faculty and covers a specific curriculum. We offer our curriculum as an example that may assist other departments in developing their own curricula.
Curriculum↗