Imaging of Bones and Joints. A Concise, Multimodality Approach

536 Pages·2016·59.99 MB·English

by  Klaus Bohndorf, Mark W. Anderson, Mark Davies, Herwig Imhof, Klaus Woertler

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Imaging of Bones and Joints
A Concise, Multimodality Approach
KlausBohndorf,MD
ProfessorofRadiology
MRHighfieldCenter
DepartmentofBiomedicalImagingandImage-guidedTherapy
MedicalUniversityofVienna
Vienna,Austria
MarkW.Anderson,MD
ProfessorofRadiology
MSKImaging
DepartmentofRadiology
UniversityofVirginia
Charlottesville,Virginia,USA
MarkDavies,MRCP,FRCR
ProfessorofRadiology
DepartmentofRadiology
RoyalOrthopaedicHospital
Birmingham,UK
HerwigImhof,MD
ProfessorofRadiology
FormerlyDepartmentofBiomedicalImagingandImage-guidedTherapy
MedicalUniversityofVienna
Vienna,Austria
KlausWoertler,MD
ProfessorofRadiology
DepartmentofRadiology
TechnicalUniversityofMunich
Munich,Germany
2181illustrations,including338ontheThiemeMediaCenter
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Contents
1 AcuteTraumaandOveruseInjuries:Essentials ...........................................2
1.1 NormalSkeletalDevelopment,Variations, 1.6 FractureHealing ........................ 24
andTransitionstoPathologicConditions 1.6.1 PrimaryFractureHealing
(W.Michl) ................................. 2 (DirectCorticalReconstruction)
1.1.1 NormalSkeletalDevelopment ............... 2 (K.Bohndorf) ............................. 24
1.1.2 VariationsandDisturbancesofSkeletal 1.6.2 SecondaryFractureHealing(FractureHealing
Development .............................. 3 byCallusFormation)(K.Bohndorf) .......... 24
1.1.3 TransitionstoPathologicStates .............. 4 1.6.3 RadiologicalAssessmentafterFracture
FixationofthePeripheralSkeleton
1.2 Fractures:Definition,Types, (E.Knoepfle) .............................. 26
andClassifications(K.Bohndorf) ............ 4 1.6.4 RadiologicalAssessmentafterImplantation
1.2.1 DefinitionandClassification ................. 4 ofaJointProsthesisinthePeripheralSkeleton
1.2.2 FractureTypes ............................. 6 (E.Knoepfle) .............................. 32
1.2.3 Classifications .............................. 6
1.7 ComplicationsafterFractures ........... 36
1.3 FracturesinChildren(W.Michl) ............ 8 1.7.1 DelayedUnion,Nonunion,and
1.3.1 SpecialFeaturesofFracturesinChildren ...... 8 PosttraumaticBoneCystFormation
1.3.2 Battered-ChildSyndrome ................. 10 (K.Bohndorf) ............................. 36
1.7.2 PosttraumaticDisturbancesofGrowth
1.4 FracturesoftheArticularSurfaces: inChildrenandAdolescents(W.Michl) ...... 40
Subchondral,Chondral, 1.7.3 DisuseOsteoporosis(K.Bohndorf) ........... 40
andOsteochondralFractures 1.7.4 ComplexRegionalPainSyndrome
(K.Bohndorf,S.Trattnig) ................... 12 (K.Bohndorf) ............................. 40
1.4.1 SubchondralFracture ..................... 14 1.7.5 PosttraumaticOsteoarthritis(K.Bohndorf) ... 42
1.4.2 ChondralFracture ........................ 14
1.4.3 OsteochondralFracture ................... 14 1.8 TraumaticandOveruseInjuries
toMuscles,Tendons,andTendon
1.5 StressandInsufficiencyFractures Insertions(K.Bohndorf,A.Seifarth) ......... 44
(K.Bohndorf) ............................. 16 1.8.1 Muscles .................................. 44
1.5.1 Classification ............................ 16 1.8.2 Tendons ................................. 44
1.5.2 InsufficiencyFracturesandDestructive 1.8.3 TendonInsertions(Enthesopathy) .......... 48
Arthropathy ............................. 20
1.5.3 PathologicFractures ...................... 20 1.9 PracticalAdviceonDiagnostic
1.5.4 TransientOsteoporosisandTransient RadiographyinTraumatology
BoneMarrowEdema ..................... 22 (K.Bohndorf) ............................. 52
1.9.1 ReportofFindings ........................ 52
1.9.2 Follow-UpReviews ........................ 53
1.9.3 WhattoAvoid ............................ 53
2 AcuteTraumaandChronicOveruse
(AccordingtoRegion) ....................................................................... 54
2.1 CranialVault,FacialBones, 2.2.2 MechanismsofInjuryandClassifications
andSkullBase(H.Imhof,N.Jorden) ........ 54 (T.Grieser) ............................... 60
2.1.1 FracturesoftheCranialVault .............. 54 2.2.3 SpecialTraumatologyoftheCervicalSpine
2.1.2 BasilarSkullFractures ..................... 54 andtheCraniocervicalJunction(T.Grieser) .. 70
2.1.3 FracturesofthePetrousBone .............. 55 2.2.4 InjuryPatternsofthe“Stiff”Spine(T.Grieser) 74
2.1.4 FacialBoneFractures ..................... 56 2.2.5 StableorUnstableFracture?(T.Grieser) ...... 76
2.2.6 FreshorOldFracture?(T.Grieser) ........... 77
2.2 Spine ................................... 59 2.2.7 DifferentialDiagnosis“OsteoporoticVersus
2.2.1 Anatomy,Variants,Technique, PathologicFracture”(T.Grieser) ............. 78
andIndications(T.Grieser) ................. 59
v
Contents
2.2.8 StressPhenomenaintheSpine: 2.8.2 RadialHeadandNeckFractures ........... 136
StressReactionandStressFracture 2.8.3 ShaftFracturesoftheForearm ............ 138
(Spondylolysis)oftheNeuralArches 2.8.4 DistalForearmFractures .................. 140
(T.Grieser) ............................... 78 2.8.5 InstabilityoftheDistalRadioulnarJoint .... 144
2.2.9 ValueofMRIinAcuteTrauma(T.Grieser) .... 78 2.8.6 UlnarImpingementSyndrome ............ 145
2.2.10 RadiologicalAssessmentafterSurgery 2.8.7 RadiologicalAssessmentafterSurgery
oftheSpine(R.Fessl) ...................... 82 oftheForearm(E.Knoepfle) ............... 146
2.3 Pelvis .................................. 86 2.9 TheWrist(J.Zentner) .................... 147
2.3.1 FracturesofthePelvicRing(E.J.Mayr) ...... 86 2.9.1 Anatomy,Variants,Technique,
2.3.2 AcetabularFractures(E.J.Mayr) ............ 88 andIndications .......................... 147
2.3.3 FatigueFracturesofthePelvis(E.J.Mayr) .... 91 2.9.2 FracturesandDislocationsand
2.3.4 HipDislocation/FractureDislocations TheirComplications ...................... 148
oftheHip(E.J.Mayr) ..................... 92 2.9.3 CarpalInstabilitiesandMalalignments ..... 152
2.3.5 Pubalgia(OsteitisPubis)(K.Bohndorf) ....... 92 2.9.4 TriangularFibrocartilageComplex ......... 156
2.9.5 UlnocarpalImpactionSyndrome .......... 158
2.4 ShoulderJoint(K.Woertler) ............. 94 2.9.6 TendonsoftheWrist ..................... 158
2.4.1 Anatomy,Variants,andTechnique ......... 94
2.4.2 Impingement ........................... 96 2.10 MetacarpalsandFingers(J.Zentner) ..... 160
2.4.3 RotatorCuffPathologyandBiceps 2.10.1 Anatomy,Technique,andIndications ...... 160
Tendinopathy ........................... 98 2.10.2 Fractures ............................... 160
2.4.4 PathologyoftheRotatorInterval .......... 102 2.10.3 TendonandLigamentLesions ............. 160
2.4.5 ShoulderInstability ...................... 104
2.4.6 OtherLabralPathology ................... 110 2.11 HipJoint ............................... 164
2.4.7 PostoperativeComplications .............. 112 2.11.1 Anatomy,Variants,andTechniques
(C.W.A.Pfirrmann,R.Sutter) .............. 164
2.5 ShoulderGirdleandThoracicWall 2.11.2 Fractures(C.W.A.Pfirrmann,R.Sutter) ..... 166
(N.Jorden) .............................. 116 2.11.3 FemoroacetabularImpingement
2.5.1 SternoclavicularDislocation .............. 116 (C.W.A.Pfirrmann,R.Sutter) .............. 166
2.5.2 ClavicularFracture ...................... 116 2.11.4 LabralLesions(C.W.A.Pfirrmann,R.Sutter) . 168
2.5.3 AcromioclavicularDislocation ............ 116 2.11.5 ChondromalaciaandSynovitis
2.5.4 ScapularFracture ........................ 118 (C.W.A.Pfirrmann,R.Sutter) .............. 168
2.5.5 SternalandRibFractures ................. 118 2.11.6 MuscleandTendonInjuries
2.5.6 StressPhenomenaof (C.W.A.Pfirrmann,R.Sutter) .............. 170
theAcromioclavicularJoint ............... 118 2.11.7 SlippedCapitalFemoralEpiphysis
2.5.7 PosttraumaticConditionsSecondary (C.W.A.Pfirrmann,R.Sutter) .............. 172
toInjuriesoftheShoulderGirdle .......... 118 2.11.8 RadiologicalAssessmentafterFracture
FixationandJointReplacementoftheHip
2.6 UpperArm ............................ 120 (W.Michl) ............................... 172
2.6.1 ProximalHumeralFractures(N.Jorden) .... 120
2.6.2 HumeralShaftFractures(N.Jorden) ........ 120 2.12 FemurandSoftTissuesoftheThigh ... 174
2.6.3 DistalHumeralFractures(N.Jorden) ....... 122 2.12.1 AnatomyandTechnique(O.Ertl) ........... 174
2.6.4 RadiologicalAssessmentafterSurgery 2.12.2 Fractures(O.Ertl) ........................ 174
oftheUpperArm(E.Knoepfle) ............ 124 2.12.3 MuscleInjuriesoftheThigh(O.Ertl) ....... 177
2.12.4 RadiologicalAssessmentafterSurgery
2.7 ElbowJoint oftheThigh(E.Knoepfle) .................. 178
(E.McNally,O.Ertl,K.Bohndorf) ............ 126
2.7.1 MedialCompartment .................... 126 2.13 KneeJoint ............................. 180
2.7.2 LateralCompartment .................... 126 2.13.1 IndicationsandTechnique
2.7.3 AnteriorCompartment ................... 130 (S.Trattnig,K.M.Friedrich,K.Bohndorf) ..... 180
2.7.4 PosteriorCompartment .................. 130 2.13.2 CruciateLigaments
2.7.5 OsteochondralLesions:TraumaticLesions, (S.Trattnig,K.M.Friedrich,K.Bohndorf) ..... 180
PannerʼsDisease,andOsteochondritis 2.13.3 MedialSupportingStructures
Dissecans ............................... 132 (S.Trattnig,K.M.Friedrich,K.Bohndorf) ..... 184
2.7.6 Neuropathies ........................... 134 2.13.4 LateralSupportingStructures
(S.Trattnig,K.M.Friedrich,K.Bohndorf) ..... 186
2.8 Forearm(A.Altenburger) ................. 136
2.8.1 ProximalFracturesoftheForearm ......... 136
vi
Contents
2.13.5 Patella,QuadricepsMuscle, 2.15.1 Anatomy,Variants,andTechnique(E.-M.
andAnteriorLigaments Wagner,W.Fischer,F.Sauerwald,N.Jorden) .. 204
(S.Trattnig,K.M.Friedrich,K.Bohndorf) ..... 186 2.15.2 Fracturesofthe(True)AnkleJoint
2.13.6 Menisci (E.-M.Wagner) ........................... 206
(S.Trattnig,K.M.Friedrich,K.Bohndorf) ..... 188 2.15.3 OsteochondralLesionsoftheTalus
2.13.7 Cartilage (K.Bohndorf) ............................ 206
(S.Trattnig,K.M.Friedrich,K.Bohndorf) ..... 194 2.15.4 FracturesoftheTalusandCalcaneus
2.13.8 BursaeandPlicae (E.-M.Wagner,F.Sauerwald) ............... 208
(S.Trattnig,K.M.Friedrich,K.Bohndorf) ..... 194 2.15.5 FracturesandDislocations
2.13.9 FindingsafterCartilageReplacement oftheTarsalBones(F.Sauerwald) .......... 212
Therapy 2.15.6 FracturesandDislocationsoftheForefoot
(S.Trattnig,K.M.Friedrich,K.Bohndorf) ..... 194 (F.Sauerwald) ............................ 214
2.13.10 RadiologicalAssessmentofKnee 2.15.7 RadiologicalAssessmentafterSurgery
ReplacementSurgery(E.Knoepfle) ......... 196 oftheAnkleandFoot(N.Jorden) ........... 216
2.15.8 AcquiredMalalignments(N.Jorden) ........ 216
2.14 LowerLeg ............................. 197 2.15.9 Ligaments(W.Fischer) .................... 218
2.14.1 Fractures(E.-M.Wagner) ................. 197 2.15.10 Tendons(W.Fischer,S.Seifarth) ............ 222
2.14.2 RadiologicalAssessmentofSurgery 2.15.11 ImpingementSyndromes(W.Fischer) ...... 224
oftheLowerLeg(E.Knoepfle) ............. 200 2.15.12 TarsalTunnelSyndrome(W.Fischer) ....... 226
2.14.3 SoftTissueInjuriesandStressReactions 2.15.13 SinusTarsi(W.Fischer) ................... 226
oftheLowerLeg(K.Bohndorf) ............. 202 2.15.14 PlantarFascia(W.Fischer) ................. 226
2.15.15 PlantarPlateandTurfToe(W.Fischer) ...... 226
2.15 AnkleJointandFoot ................... 204 2.15.16 MortonʼsNeuroma(W.Fischer) ............ 226
3 InfectionsoftheBones,Joints,andSofttissues ....................................... 228
3.1 OsteomyelitisandOsteitis ............. 228 3.2 SoftTissueInfections(T.Grieser) ........ 246
3.1.1 Terminology,Classification, 3.2.1 NecrotizingFasciitis ...................... 248
andInfectionRoutes
(K.Bohndorf,A.P.Erler,R.Braunschweig) .... 228 3.3 SepticArthritis(K.Bohndorf) ............ 250
3.1.2 HematogenousOsteomyelitis 3.3.1 NonspecificPathogens ................... 250
(K.Bohndorf,A.P.Erler,R.Braunschweig) .... 229 3.3.2 TuberculousArthritis ..................... 252
3.1.3 ChronicExogenousOsteomyelitis
(K.Bohndorf,A.P.Erler,R.Braunschweig) .... 234 3.4 MusculoskeletalInflammations
3.1.4 FormsofOsteomyelitis(SpecificPathogens) associatedwithHIVInfections
(K.Bohndorf) ............................ 238 (K.Bohndorf) ............................ 252
3.1.5 InfectionsoftheSpine(K.Bohndorf) ....... 242
4 TumorsandTumorlikeLesionsofBone,Joints,andtheSoftTissues ............... 256
4.1 GeneralAspectsofDiagnosticImaging 4.2.1 OsteogenicTumors ....................... 266
ofSkeletalTumors(B.Jobke,K.Bohndorf) . 256 4.2.2 ChondrogenicTumors .................... 274
4.1.1 TheRoleoftheRadiologistinAssessing 4.2.3 ConnectiveTissueandFibrohistiocytic
aSuspectedBoneTumor ................. 256 Tumors ................................. 282
4.1.2 GeneralApproachtoaSuspected 4.2.4 EwingʼsSarcomaandPrimitive
BoneTumor ............................. 257 NeuroectodermalTumor .................. 284
4.1.3 DescriptionofaFocalBoneLesion ......... 258 4.2.5 GiantCellTumor ......................... 286
4.1.4 AssessmentoftheAggressiveness 4.2.6 VascularTumors ......................... 288
ofaBoneLesion:GrowthRate ............ 262 4.2.7 LipogenicTumors ........................ 288
4.1.5 StagingofBoneTumors .................. 264 4.2.8 MiscellaneousTumors .................... 288
4.1.6 ImagingModalitiesforTissueDiagnosis,
AssessmentofBiologicalActivityand 4.3 TumorlikeLesions ..................... 291
StagingofBoneTumors .................. 264 4.3.1 Osteoma,BoneIslands,andOsteopoikilosis
(K.Bohndorf,H.Rosenthal) ................. 291
4.2 PrimaryBoneTumors 4.3.2 FibrousCorticalDefectandNonossifying
(B.Jobke,K.Bohndorf) .................... 266 Fibroma(K.Bohndorf,H.Rosenthal) ......... 292
vii
Contents
4.3.3 Simple(Juvenile)BoneCyst 4.5.2 ClinicallyImportantSoftTissueTumors,
(K.Bohndorf,H.Rosenthal) ................ 294 alsoPartiallyAmenabletoClassification
4.3.4 AneurysmalBoneCyst UsingImagingProcedures
(K.Bohndorf,H.Rosenthal) ................ 294 (B.Jobke,K.Bohndorf) ..................... 312
4.3.5 LangerhansCellHistiocytosis 4.5.3 Follow-upReviewsandDiagnostics
(K.Bohndorf,H.Rosenthal) ................ 296 forRecurrencesofSoftTissueTumors
4.3.6 FibrousDysplasia(K.Bohndorf,H.Rosenthal) 298 (B.Jobke,K.Bohndorf) ..................... 316
4.3.7 VascularMalformationsoftheBone 4.5.4 VascularMalformations(W.A.Wohlgemuth) . 318
(so-calledHemangioma)
(W.A.Wohlgemuth,K.Bohndorf) ........... 300 4.6 Intra-articularTumorsandTumorlike
4.3.8 LessCommonTumorlikeLesions Lesions ................................ 320
(K.Bohndorf,H.Rosenthal) ................ 304 4.6.1 LooseJointBodies(K.Bohndorf) ........... 320
4.6.2 SynovialChondromatosis(K.Bohndorf) ..... 322
4.4 Metastases(K.Bohndorf) ................ 306 4.6.3 GanglionandSynovialCyst(M.Gebhard) .... 322
4.4.1 Monitoring ............................. 308 4.6.4 LipomaArborescens(K.Bohndorf) .......... 326
4.6.5 PigmentedVillonodularSynovitis/
4.5 SofttissueTumors .................... 310 GiantCellTumoroftheTendonSheath
4.5.1 Introduction(B.Jobke,K.Bohndorf) ........ 310 (K.Bohndorf) ............................ 326
5 BoneMarrow ................................................................................. 328
5.1 NormalBoneMarrow 5.3.4 FatAccumulationSecondarytoOsteoporosis 332
(I.M.Noebauer-Huhmann) ................ 328
5.1.1 DistributionandAge-dependent 5.4 ChronicMyeloproliferativeDiseases
PhysiologicalConversionofRed (I.M.Noebauer-Huhmann) ................. 332
toYellowMarrow ....................... 328 5.4.1 MyelodysplasticSyndrome(AlsoKnown
5.1.2 ReconversionofYellowtoRedMarrow/ asPreleukemia) ......................... 332
BoneMarrowHyperplasia ................ 328 5.4.2 PolycythemiaVera ....................... 332
5.4.3 Myelofibrosis/Osteomyelofibrosis .......... 332
5.2 AnemiasandHemoglobinopathies 5.4.4 EssentialThrombocythemia ............... 332
(I.M.Noebauer-Huhmann) ................ 330 5.4.5 SystemicMastocytosis .................... 332
5.2.1 Anemias ................................ 330
5.2.2 Hemoglobinopathies(Thalassemia, 5.5 MalignantDisordersoftheBoneMarrow
SickleCellAnemia) ...................... 330 (I.M.Noebauer-Huhmann) ................. 334
5.5.1 MultipleMyeloma/SolitaryPlasmacytoma .. 334
5.3 MetabolicBoneMarrowAlterations 5.5.2 Lymphoma .............................. 336
(I.M.Noebauer-Huhmann) ................ 330 5.5.3 Leukemia ............................... 338
5.3.1 HemosiderosisandHemochromatosis ..... 330
5.3.2 LipidosesandLysosomalStorageDiseases .. 330 5.6 Therapy-relatedBoneMarrow
5.3.3 SerousAtrophy ......................... 332 Alterations(I.M.Noebauer-Huhmann) ..... 338
6 Osteonecrosesof theSkeletalSystem ................................................... 340
6.1 Anatomy,Etiology,andPathogenesis 6.3.2 OsteonecrosisoftheLunate ............... 350
(K.Bohndorf,R.Whitehouse) ............... 340 6.3.3 OsteonecrosisoftheScaphoid ............. 350
6.3.4 OsteonecrosisoftheVertebrae ............ 350
6.2 BoneInfarction
(R.Whitehouse,K.Bohndorf) ............... 341 6.4 SequelaeofRadiotherapy(B.Jobke) ..... 352
6.3 Osteonecrosis 6.5 Pseudo-osteonecroses
(R.Whitehouse,K.Bohndorf) ............... 344 (K.Bohndorf,R.Whitehouse) ............... 354
6.3.1 OsteonecrosisoftheFemoralHead ........ 344
viii