Orthopedic Imaging: Techniques and Applications

387 Pages·1998·32.361 MB·English

by  H. Pettersson MD, K. Jonsson MD (auth.), Dr. A. Mark Davies, Professor Dr. Holger Pettersson (eds.)

MEDICAL RADIOLOGY
Diagnostic Imaging and Radiation Oncology
Editorial Board
Founding Editors L.W. Brady, M.W. DonnerCtl,
H.-P. Heilmann, F.H.W. Heuck
Current Editors
Diagnostic Imaging A.L. Baert, Leuven
F.H.W. Heuck, Stuttgart
J.E. Youker, Milwaukee
Radiation Oncology L.W. Brady, Philadelphia
H.-P. Heilmann, Hamburg
Springer
Berlin
Heidelberg
New York
Barcelona
Budapest
Hong Kong
London
Milan
Paris
Santa Clara
Singapore
Tokyo
A.M. Davies· H. Pettersson (Eds.)
Orthopedic Imaging
Techniques and Applications
With Contributions by
T.H. Berquist· H. Bonel . J.A. Bouffard· M. Breitenseher . V.N. Cassar-Pullicino
N. Chemla· A. Chevrot· A.M. Davies· J.L. Drape· A.M. Dupont· N. Egund
H.K. Genant· F. Gires . D. Godefroy· J. Haller· J. Hodler· H. Imhof· K. Jonsson
F. Kainberger· J.J. Kaye· M.V. Maffey· C. Masciocchi . I.W. McCall· E.G. McNally
A. Minoui· J. Moutounet . W.R. Obermann . E. Pessis . H. Pettersson . M. Reiser
L. Sarazin· C. Schiepers . E.R. Tjin A Ton· S. Trattnig . D. Vanel . M. van Hoisbeeck
C. van Kujik . I. Watt
Foreword by
A.L. Baert
Preface by
A.M. Davies and H. Pettersson
With 366 Figures in 598 Separate Illustrations
Springer
Dr. A. MARK DAVIES
MRI Centre
Royal Orthopaedic Hospital
Bristol Road South
Birmingham B31 2AP
United Kingdom
Professor Dr. HOLGER PETTERSSON
Department of Radiology
University Hospital
University of Lund
S-22185 Lund
Sweden
MEDICAL RADIOLOGY· Diagnostic Imaging and Radiation Oncology
Continuation of
Handbuch der medizinischen Radiologie
Encyclopedia of Medical Radiology
JSBN-13: 978-3-642-64341-5 e-JSBN-13: 978-3-642-60295-5
DOT: 10.1007/978-3-642-60295-5
Library of Congress Cataloging-in-Publication Data. Orthopedic imaging: techniques and applicationsfA.M. Davies, H.
Pettersson (eds.); with contributions by T.H. Berquist ... let al.].; foreword by A.L. Baert. p. em. - (Medical radiology)
Includes bibliographical references and index. ISBN 3-540-63187-9 (alk. paper) 1. Orthopedics
Diagnosis. 2. Musculoskeletal system - Imaging. I. Davies, A.M. (Arthur Mark), 1954- . II. Pettersson, Holger,
1942- . III. Berquist, Thomas H. (Thomas Henry), 1945- . IV. Series. [DNLM: 1. Musculoskeletal
Diseases-diagnosis. 2. Diagnostic Imaging - methods. 3. Orthopedics. WE 141 0767 1998] RD734.078
1998 616.7'0754 - dc21 DNLMfDLC for Library of Congress 97-49118 CIP
This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned,
specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm
or in any other way, and storage in data banks, Duplication of this publication or parts thereof is permitted only under
the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must
always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law.
© Springer-Verlag Berlin Heidelberg 1998
Softcover reprint of the hardcover 15t edition 1998
The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the
absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and
therefore free for general use.
Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application con
tained in this book. In every individual case the user must check such information by consulting the relevant literature.
Cover design: de'blik, Berlin
Typesetting: Best-set Typesetter Ltd., Hong Kong
SPIN: 10546210 2113134 - 5 4 3 2 1 0 - Printed on acid-free paper
Foreword
Musculoskeletal studies account for an important proportion of the daily clinical practice
of most radiologists. For many years following Rontgen's discovery of x-rays in 1895, these
studies were confined to plain films and conventional tomography, which substantially
limited the contribution of radiology in achieving better diagnosis and treatment of ortho
pedic pathologic conditions. The advent of digital radiography, ultrasound, computer
tomography and especially magnetic resonance imaging has greatly enhanced the potential
of radiologic imaging in this field. Among the benefits to accrue from these techniques are
the detailed visualization of soft tissue anatomy and pathologic changes, progress in the
noninvasive study of joint pathology, and improved staging of primary bone tumors. The
need for an update of our knowledge in orthopedic imaging is therefore immense.
The editors, Dr. A.M. Davies and Prof. H. Pettersson, have been able to acquire the collabo
ration of a number of international leaders in bone and soft tissue imaging for the produc
tion of this book, which took an exceptionally brief period from the date of conception to
printing. Accordingly, readers will find in this work the latest developments in techniques
and radiologic interpretation. The up-to-date nature of the information provided, and the
expertise which it embodies, will undoubtedly be of great help in daily clinical practice, not
only to general radiologists and orthopedic surgeons but also to musculoskeletal radiolo
gists working in subspecialties.
I am very grateful to the editors and to the authors for their excellent contributions.
Leuven ALBERT 1. BAERT
Preface
Few can have envisaged the dramatic developments that have occurred in all aspects of
imaging in the past 20 years. The greatest impact has arguably been in the subject of
musculoskeletal imaging. There is therefore a continuous need to update radiologists,
orthopaedic surgeons and others working in this field. To this end the purpose of this book
is twofold. First, to acquaint the reader with the full range of techniques available for
imaging musculoskeletal problems, describing how they work and emphasising indications
and contraindications. Amongst the nine chapters in this first section are contributions on
computer tomography, magnetic resonance imaging, scintigraphy and bone densitometry.
The remaining ten chapters discuss the optimal application of these techniques to specific
clinical problems. These chapters are divided by either the anatomy involved or the under
lying pathological process and highlight practical solutions to everyday clinical problems.
The editors are grateful to all the authors for their contributions to this book, which aims
to offer a comprehensive overview of current musculoskeletal imaging applicable to all
specialties involved in this area of clinical practice.
Birmingham A.M. DAVIES
Lund H. PETTERSSON
Contents
Imaging Techniques and Procedures
Radiography
H. PETTERSSON and K. JONSSON 3
2 Arthrography
J.J. KAYE ........................................................ .. 13
3 Computed Tomography
V.N. CASSAR-PULLICINO 25
4 Magnetic Resonance Imaging
H. BONEL and M. REISER ................. .... ... .... ..... .... .. ...... 53
5 Scintigraphy
C. SCHIEPERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
6 Ultrasound
J.A. BOUFFARD and M. VAN HOLSBEECK 91
7 Interventional Radiological Techniques
A. CHEVROT, J.L. DRAPE, D. GODEFROY, A.M. DUPONT, F. GIRES,
N. CHEMLA, E. PESSIS, L. SARAZIN, A. MINOUl, and J. MOUTOUNET 109
8 Measurements and Related Examination Techniques
in Orthopedic Radiology
N. EGUND ...................... ........... ......................... 129
9 Bone Densitometry
C. v AN KUlJK and H.K. GENANT 143
Practical Clinical Problems
10 The Shoulder
J. HODLER ................................. ........................ 153
11 The Hand and Wrist
W.R. OBERMANN and E.R. TJIN A TON 175
12 The Hip
E.G. McNALLY. .. .. .. ..... ... ... ... . ... . ... ... .. . ... ... ... ... ... .. . . 195
x
Contents
13 The Knee
C. MASCIOCCHI and M.V. MAFFEY 221
14 The Ankle and Foot
H. IMHOF, M. BREITENSEHER, S. TRATTNIG, F. KAINBERGER,
and J. HALLER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
15 The Spine
1.W. MCCALL 267
16 Polyarthritis
1. WATT........................................................... 303
17 Bone and Joint Infections
K. JONSSON ........................................................ 323
18 Joint Prostheses
T.H. BERQUIST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
19 Musculoskeletal Tumours
A.M. DAVIES and D. V ANEL 359
Subject Index ......................................................... 379
List of Contributors .................................................... 383
Imaging Techniques
and Procedures
1 Radiography
H. PETTERSSON and K. JONSSON
CONTENTS When using x-rays as a diagnostic tool, it should
always be borne in mind that sending a patient for x
1.1 Introduction 3
ray means that the patient will be exposed to ionizing
1.2 Physics 3
radiation, with its potential hazards. The benefits of
1.3 Radiographic Techniques 4
1.4 Positioning of the Patient 4 the examination should therefore always be weighed
1.5 Fluoroscopy 5 against the possible damage caused by the radiation.
1.6 Magnification Radiography 5
However, using modern equipment, with highly
1.7 Low Kilovolt Technique 7
sensitive film-screen combinations, or using digital
1.8 Conventional Tomography 7
1.9 Digital Radiography 8 radiography, the radiation doses are very small for
1.9.1 Potential Advantages and Limitations 8 all routine examinations.
1.9.2 Clinical Use 9
References 11
1.2
1.1 Physics
Introduction
The x-rays are generated in an x-ray tube, which
fundamentally consists of a vacuum tube, with a
For the evaluation of musculoskeletal lesions, any
cathode and an anode (minus- and plus-poles, res
combination of the different diagnostic imaging
modalities may be appropriate, as will be discussed pectively) (Fig. 1.1). The cathode is an electrically
in the following chapters. However, the classical x heated filament from which electrons are emitted
ray examination, which has now been used in medi when a high potential (voltage) is applied between
cal practice for 100 years, is still important. Indeed, the poles. Because of the high potential, the electrons
are drawn to the anode, made up of a metal plate -
for the diagnostic imaging workup of most muscu
loskeletallesions, it is the primary examination. usually molybdenum, tungsten, or wolfram, to resist
The advantage of radiography is that it provides the high temperature. The accelerated electrons are
an overview of the bony anatomy. Thus, all major concentrated to a narrow beam, which hits a small
pathology concerning trauma, joint disease, and area of the anode plate, the so-called focus. Upon
structural changes within bone is well diagnosed hitting the focus, most of the energy of the electrons
with radiography. However, subtle changes may is transformed into heat, but approximately 1% is
need complementary examination with computed instead transformed into x-rays. These x-rays are
tomography (CT), magnetic resonance imaging directed through a window out of the tube, which for
(MRI), or isotope scans. The choice of one or more radiation protection is encapsulated in a lead cover.
complementary modalities is then dependent on the X-rays are electromagnetic waves, part of the
clinical status and the findings at the radiographic nonvisible spectrum, with a very short wavelength
examination. and a high frequency (KWRU 1995). They have a very
high energy and can penetrate most types of tissue in
the human body. The penetration ability depends
on the potential (voltage) between the anode and
the cathode. The higher the potential, the shorter
H. PETTERSSON, MD, Professor, Department of Radiology, the wavelength of the x-rays, and the stronger the
University Hospital, University of Lund, S-22185 Lund,
penetration. If the voltage is lower, the x-rays have
Sweden
K. JONSSON, MD, Department of Radiology, University Hospi a longer wavelength with less penetration ability.
tal, University of Lund, S-22185 Lund, Sweden When the primary x-rays hit the body, the rays inter-