Berquist, T: MRI of the Musculoskeletal System

1182 Pages·2012·73.238 MB·English

by  Thomas H. Berquist

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MRI
of the
Musculoskeletal
System
SIXTH EDITION
EDITOR
Thomas H. Berquist, MD, FACR
Consultant,DepartmentofDiagnosticRadiology
MayoClinic
Jacksonville,Florida
ProfessorofDiagnosticRadiology
MayoMedicalSchool
CollegeofMedicine
MayoFoundation
Rochester,Minnesota
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PrintedinChina
LibraryofCongressCataloging-in-PublicationData
MRIofthemusculoskeletalsystem/editor,ThomasH.Berquist.–6thed.
p.;cm.
Includesbibliographicalreferencesandindex.
Summary: “MRI of the Musculoskeletal System is a classic one-volume textbook on all aspects of MR
msk imaging. It covers basic principles of interpretation, physics, and terminology before moving through
a systematic presentation of disease region of the body. The new edition will include new pulse sequences
and artifacts in the basics chapters; enhanced anatomy artwork; and new images and figures on greater
trochanteric pain syndrome and other new disorders in the hips and thighs. United VRG. It will also
include more arthrography in the hand and shoulder chapters, and more emphasis on shoulder acroniums
and injury patterns. The infection chapter will add new infection categories and will increase emphasis on
the diabetic foot”–Provided by publisher.
ISBN978-1-4511-0918-4(hardback:alk.paper)
I.Berquist,ThomasH.(ThomasHenry),1945-
[DNLM: 1.MusculoskeletalDiseases–diagnosis. 2.MagneticResonanceImaging–methods.
3.MusculoskeletalSystem–anatomy&histology.WE141]
616.7(cid:2)07548–dc23 2011050213
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Tomylovingwife,Mary,forhercontinuedsupportof
mywritingthroughouttheyears.
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Contents
Preface ix
Acknowledgments xi
Contributors xiii
CHAPTER1 BasicPrinciplesandTerminologyofMagneticResonanceImaging . . . . . 1
RobertA.Pooley,JoelP.Felmlee,andRichardL.Morin
CHAPTER2 InterpretationofMagneticResonanceImages . . . . . . . . . . . . . . . . . . 34
MarkS.CollinsandRichardL.Ehman
CHAPTER3 GeneralTechnicalConsiderationsinMusculoskeletalMRI . . . . . . . . . . 64
ThomasH.Berquist
CHAPTER4 TheTemporomandibularJoint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
ThomasH.Berquist
CHAPTER5 Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
DanielF.BroderickandThomasH.Berquist
CHAPTER6 Pelvis,Hips,andThigh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
ThomasH.Berquist
CHAPTER7 Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
ThomasH.Berquist
CHAPTER8 Foot,Ankle,andCalf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460
ThomasH.Berquist
CHAPTER9 ShoulderandArm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 597
ThomasH.BerquistandJeffreyJ.Peterson
CHAPTER10 ElbowandForearm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 706
ThomasH.BerquistandLauraW.Bancroft
CHAPTER11 HandandWrist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 777
ThomasH.Berquist
CHAPTER12 MusculoskeletalNeoplasms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 870
MarkJ.KransdorfandThomasH.Berquist
CHAPTER13 MusculoskeletalInfections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 996
ThomasH.Berquist
CHAPTER14 DiffuseMarrowDiseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1030
WilliamA.Murphy,Jr.andJamesB.VoglerIII
CHAPTER15 MiscellaneousConditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1093
ThomasH.Berquist
CHAPTER16 ClinicalSpectroscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1147
ThomasH.Berquist
Index 1153
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Preface
ThefiftheditionofMRIoftheMusculoskeletalSystemwas Chapters4to11areanatomicallyorientedasinthepast
published in 2006. Since the last edition, magnet configu- editionsofthistext.Therearenumerousnewanatomicillus-
rationshavebecomemorediverseandtheuseof3.0Tesla trations and expanded technical discussions related to the
and higher field systems have become more common for specific anatomic regions in these chapters. New applica-
clinicalimaging.Newmultichannelphasedarraycoilsand tionsareincludedineachchapteraswellaspediatriccondi-
pulsesequenceshavealsobeendevelopedtoimproveimag- tions,whereappropriate.Chapter5issignificantlydifferent
ingcapabilitiesformusculoskeletalimaging.Gadoliniumis comparedwiththelasteditioninthatthereismoreemphasis
morecommonlyusedforconventionalimaging,directMR on spondyloarthropathies and other spinal and perispinal
arthrography,andangiography.Theneedtoaddresspoten- musculoskeletal conditions. The non-degenerative neuro-
tialcomplicationsofthiscontrastagent,specificallynephro- radiologyemphasishasbeenreduced.
genicsystemsclerosis,hasalsochangedtheuseofthisagent Chapter 12 provides a thorough discussion of staging
in specific clinical settings. Spectroscopy continues to lag and imaging of musculoskeletal neoplasms and tumorlike
behindasacommonlyusedtoolforclinicalstudies. conditions.Therearethoroughdiscussionsregardingtumor
The sixth edition of MRI of the Musculoskeletal System staging,imagingapproachestobenignandmalignantbone
providessignificantupdatesrelatedtoimagingapproaches and soft tissue lesions, and biopsy approaches. Chapter
andtheexpandedapplicationsofMRIformusculoskeletal 13 provides an in-depth discussion of osseous, articular,
disorders. There are approximately 50% new images and and soft tissue infections. Chapter 14 covers diffuse mar-
references in this edition. Chapter 1 continues to update row disorders. This chapter has also been updated signifi-
basic physics principles, pulse sequences, and terminol- cantlycomparedwiththefifthedition.Chapter15discusses
ogy providing an easy to read, clinically useful approach miscellaneous and evolving MR applications. The final
to these basic principles. Chapter 2 provides essentials of chapter,Chapter16,updatestheclinicalutilityofMRspec-
interpretation regarding tissue contrast, lesion conspicu- troscopy.
ity,andnecessaryapproachesforappropriateimageinter- The new and evolving techniques and applications for
pretation. Chapter 3 provides basic technology principles musculoskeletalMRIareaddressedinthisnewedition.New
to avoid redundancy in subsequent chapters. Discussions anatomic,technical,andclinicalapplicationsarereviewed.
includepatientselection,safetyissues,patientpositioning, The updated sixth edition of MRI of the Musculoskeletal
coil selection, pulse sequences, and the use of gadolinium Systemwillbeusefultostudents,residentsintraining,and
for conventional, arthrographic, and angiographic imag- all physicians responsible for requesting and interpreting
ing. Contrast reactions and concerns regarding the use of musculoskeletal MR examinations. Appropriate selection
gadolinium agents are also addressed. Chapter 3 also dis- ofMRIstudiesandoptimizationoftheiruseisincreasingly
cussessedationissuesinadultsandchildren. importantintheeraofhealthcarereform.
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Acknowledgments
Preparationofthistextcouldnothavebeenaccomplishedwithoutthesupportofmy
fellow faculty, fellows, and residents who assisted with case selection and technical
suggestions. I especially want to acknowledge Lisa Broddle and Tony Schroeder for
theirassistancewithcasesselection,photosdemonstratingpatientpositioning,andcoil
techniques.
My secretary, Kathryn Hatcher, was instrumental in obtaining permissions and
keepingmeontaskwithproductionissues.Asalways,aspecialthankstoJohnHagen
fortheartworkprovidedintheneweditionandallpreviouseditionsofthistext.
Finally,IwouldliketothankRyanShawandthestaffatWoltersKluwer/Lippincott
Williams&Wilkinsforassistanceinthedevelopmentandeditingofthistext.
xi
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Contributors
LauraW.Bancroft,MD MarkJ.Kransdorf,MD
ClinicalProfessorofRadiology Consultant
FloridaStateUniversitySchoolofMedicine DepartmentofDiagnosticRadiology
Tallahassee,Florida MayoClinic
AdjunctProfessorofRadiology Jacksonville,Florida
UniversityofCentralFloridaSchoolofMedicine ProfessorofDiagnosticRadiology
Orlando,Florida MayoMedicalSchool
CollegeofMedicine
ThomasH.Berquist,MD Rochester,Minnesota
Consultant
RichardL.Morin,PhD
DepartmentinDiagnosticRadiology
ConsultantinRadiologicPhysics
MayoClinic,Jacksonville,Florida
MayoClinic
ProfessorofDiagnosticRadiology
Jacksonville,Florida
MayoMedicalSchool
Brooks-HollernProfessor
CollegeofMedicine
ProfessorofRadiologicPhysics
Rochester,Minnesota
MayoMedicalSchool
CollegeofMedicine
DanielF.Broderick,MD
Rochester,Minnesota
ConsultantinDiagnosticRadiology
WilliamA.Murphy,Jr.,MD
MayoClinic
Jacksonville,Florida ProfessorofRadiology
AssistantProfessorofDiagnosticRadiology DepartmentofDiagnosticRadiology
MayoMedicalSchool UniversityofTexas
CollegeofMedicine MDAndersonCancerCenter
Rochester,Minnesota Houston,Texas
JeffreyJ.Peterson,MD
MarkS.Collins,MD Consultant
Consultant DepartmentofDiagnosticRadiology
DepartmentofDiagnosticRadiology MayoClinic
Rochester,Minnesota Jacksonville,Florida
AssistantProfessorofDiagnosticRadiology ProfessorofDiagnosticRadiology
MayoMedicalSchool MayoMedicalSchool
CollegeofMedicine CollegeofMedicine
Rochester,Minnesota Rochester,Minnesota
RobertA.Pooley,PhD
RichardL.Ehman,MD
ConsultantinRadiologicPhysics
Consultant
DepartmentofDiagnosticRadiology
DepartmentofDiagnosticRadiology
MayoClinic
Rochester,Minnesota
Jacksonville,Florida
ProfessorofDiagnosticRadiology
AssistantProfessorofRadiologicPhysics
MayoMedicalSchool
MayoMedicalSchool
CollegeofMedicine
CollegeofMedicine
Rochester,Minnesota
Rochester,Minnesota
JoelP.Felmlee,PhD JamesB.VoglerIII,MD
Consultant ClinicalAssociateProfessorofRadiology
DepartmentofDiagnosticRadiology DepartmentofRadiology
Rochester,Minnesota UniversityofFloridaCollegeofMedicine
ProfessorofDiagnosticRadiology Gainesville,Florida
MayoMedicalSchool Co-directorInvisionOutpatientImagingCenter
CollegeofMedicine NorthFloridaRegionalMedicalCenter
Rochester,Minnesota Gainesville,Florida
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1
Basic Principles and Terminology of
Magnetic Resonance Imaging
• •
RobertA.Pooley JoelP.Felmlee RichardL.Morin
THENUCLEARMAGNETICRESONANCEEXPERIMENT PurcellatHarvard.In1952,theysharedtheNobelPrizein
THENUCLEARMAGNETICRESONANCESIGNAL physicsfortheirwork.Theimportanceofthistechniquelies
intheabilitytodefineandstudythemolecularstructureof
MAGNETICRESONANCEIMAGING
thesampleunderinvestigation.Inthe1970s,theprincipleof
MAGNETICRESONANCEIMAGINGPULSESEQUENCES
NMRwasutilizedtogeneratecross-sectionalimagessimilar
MOTIONEFFECTS
in format to X-ray computed tomography (CT). By 1981,
FLOWANDMOTIONCOMPENSATIONTECHNIQUES clinicalresearchwasunderway.
ANGIOGRAPHICTECHNIQUES The intense enthusiasm and the rapid introduction of
FASTSCANNINGTECHNIQUES MRIintotheclinicalenvironmentstemfromtheabundance
ofdiagnosticinformationpresentinMRimages.Although
PARALLELIMAGINGTECHNIQUES
theimageformatissimilartothatofCT,thefundamental
CHEMICALSHIFTIMAGINGTECHNIQUES
principles are quite different; in fact, an entirely different
MAGNETICRESONANCEIMAGINGARTIFACTS
partoftheatomisresponsiblefortheimageformation.In
RFCOILS MRIitisthenucleusthatprovidesthesignalusedingener-
RECEIVERCOILINTENSITY/UNIFORMITYCORRECTION atinganimage.Wenotethatthisdiffersfromconventional
3TAND1.5TACQUISITIONS diagnostic radiology in which the electrons are responsi-
ble for the imaging signal. Furthermore, it is not only the
PRACTICALASPECTSOFMAGNETICRESONANCEIMAGING
nucleusoftheatombutalsoitsstructuralandbiochemical
BiologicalEffects
environmentsthatinfluencethesignal.
SAFETY
Currently, fast imaging techniques are increasing as
OPERATIONALASPECTS
importantclinicalmethods.Echoplanarimaging(EPI),as
SITINGREQUIREMENTS wellasfastspinechoandgradientechobasedacquisitions,
SUMMARY allows image acquisition in the sub-second to breath hold
REFERENCES (15second)range.Thesetechniquesholdthepotentialfor
high-resolutionstudiesacquiredquickly,thereby“freezing”
APPENDIX
manyphysiologicmotions.Usingthesefastacquisitiontech-
niques,encodingfunctionalandflowinformationintothe
Thischapterispresentedtoacquaintthosenewtomag- imageareareasofclinicalinterestandresearch.
netic resonance imaging (MRI) with the fundamental Throughout this discussion we illustrate the underly-
conceptsandbasicprinciplesresponsibleforthenuclear ingphysicsprincipleswithanalogiesanddiscussthenature
magneticresonance(NMR)phenomenonandMRI.Atthe of the physics from a “classical” rather than a “quantum
outset, it is important to understand that this chapter is mechanical”pointofview.Bothapproachesresultinaccu-
intended to be tutorial in nature. In addition to the fun- rateexplanationsoftheNMRphenomenon;however,they
damental concepts of the physical phenomenon of NMR differintheirmathematicalconstructsandvisualizationof
itself,techniquesrelevanttoclinicalimagingarediscussed theunderlyingphysicalprinciples.
in the context of a tutorial presentation of fundamentals
forthosenewtoMRI.Itisimportanttoappreciatethatthe
physicsprinciplesassociatedwithMRIoftentakeawhileto THE NUCLEAR MAGNETIC RESONANCE
assimilate.Therearemanyapproachestothediscussionand
EXPERIMENT
presentationofthefundamentalphysicsofMRI.Technical
detailsandin-depthcoveragecanbefoundinMRItextsand Whencertainnuclei(thosewithanoddnumberofprotons,
reviewarticles.1−5 Theappendixliststermsthathavebeen anoddnumberofneutrons,oranoddnumberofboth)are
selected from the American College of Radiology glossary placedinastrongmagneticfield,theyalignthemselveswith
ofMRterms6andareprovidedforthesakeofcompleteness themagneticfieldandbegintorotateatapreciserateorfre-
andreference. quency(Larmorfrequency).Ifaradiotransmissionismade
A chronology of the historical development of MRI is at this precise frequency, the nuclei will absorb the radio
listedinTable1.1.TheprincipleofNMRwasfirstelucidated frequency(RF)energyandbecome“excited.”Aftertermi-
inthelate1940sbyProfessorBlochatStanfordandProfessor nationoftheradiotransmission,thenucleiwillcalmdown
1