Introduction What Plain Views and When to Order Advanced Imaging Lower Extremity

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Introduction What Plain Views and When to Order Advanced Imaging Lower Extremity

By Mary Ireland 48 Videos FEATURING Mary Ireland

518 views

February 9, 2018

Introduction

WORKUP Algorithm for Evaluation and Treatment of Suspected High-Risk  Stress Fractures  (Reprinted with permission ...
read more ↘ from Boden BP, Osbabr DC. High-risk stress fractures: Evaluation and treatment. J Am Acad Ortho Surg 2000; 8(6):344-353, Fig. 1, p. 347.)

High Risk Tensile Side

Low Risk Compression Side

Plain Radiographs LE

Standardized Views
Create and Agree within your group/department
Special Views
Marked Cone
Stress
Comparison

Imaging
Special Studies
MRI scan
With or without gadolinium
CT scan
Ultrasound

When Should an MRI Exam Be Obtained?
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

Contrast Administration
Intraarticular Contrast Gives Superior Soft Tissue Contrast and Significantly Enhances Diagnostic Capability
Intravenous Contrast Useful for Post Operative Menisci and Tumors

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

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