629 PT1 Introduction What Plain Views and when to Order Advanced Imaging Lower Extremity скачать в хорошем качестве

629 PT1 Introduction What Plain Views and when to Order Advanced Imaging Lower Extremity

Essentials of Sports Medicine: From Sideline to the Clinic American College of Sports Medicine Presented by: Mary Lloyd Ireland Professor Dept. of Orthopaedic Surgery and Sports Medicine University of Kentucky Lexington KY www.marylloydireland.com 0:00 Introduction 0:28 Learning Objectives •Know the images and position of the patient to order for certain diagnoses •Understand when to order advanced images after plain X- Rays I have nothing to disclose. 0:57 WORKUP Algorithm for Evaluation and Treatment of Suspected High-Risk Stress Fractures 2:31 High Risk Tensile Side 4:20 Low Risk Compression Side 5:02 Plain Radiographs LE •Standardized Views •Create and Agree within your group/department •Special Views •Marked Cone •Stress •Comparison 5:49 Imaging - MRI scan, CT scan, Ultrasound •Special Studies •MRI scan •With or without gadolinium •CT scan •Ultrasound 6:36 When Should an MRI Exam Be Obtained?(Courtesy Martin L. Schwartz, MD Clinical Prof. of Radiology, UAB) •Recent Trauma •Difficult Physical Exam •Physical Exam that Does not Match Clinical Symptoms •Normal Radiographs with Significant Symptoms •Pre-Operative Planning •Recent MRI that was Technically Suboptimal 7:48 How Should The MRI Scan Be Performed(Courtesy Martin L. Schwartz, MD Clinical Prof. of Radiology, UAB) •Best Possible Equipment •Dedicated Coils for the Body Part •Contrast When Necessary •Correct Sequences to Define Appropriate Anatomy •Shortest Exam to Achieve Results and Keep Patient Comfortable 8:14 Contrast Administration(Courtesy Martin L. Schwartz, MD Clinical Prof. of Radiology, UAB) •Intraarticular Contrast Gives Superior Soft Tissue Contrast and Significantly Enhances Diagnostic Capability •Intravenous Contrast Useful for Post Operative Menisci and Tumors 9:08 IMAGING: MRI SCAN Communicate with radiologist skilled in hips. Now better results if intra-articular gadolinium Use of intra-articular injection is helpful •Lidocaine – if improves symptoms confirms intra-articular process •Gadolinium outlines labrum better Low resolution studies (small magnet; open scanner) •Unreliable except for obvious disease (i.e., AVN) High resolution MRI •1.5 Tesla magnet; surface coil •Reliability improving •Still up to 42% false negative •Indirect evidence most reliable (effusion; paralabral cyst; subchondral cyst) MRI helpful for: •Labrum tear •Articular cartilage defects •Ligamentum teres tears •Impingement •Capsule/ileofemoral injury 10:24 1.5 Tesla(Courtesy Martin L. Schwartz, MD Clinical Prof. of Radiology, UAB) 10:40 0.35 Tesla Open(Courtesy Martin L. Schwartz, MD Clinical Prof. of Radiology, UAB) 10:57 1.0 Tesla Extremity(Courtesy Martin L. Schwartz, MD Clinical Prof. of Radiology, UAB) 11:24 You Look for What You Know and Find What You Look For 12:17 The End