MUSCULOSKELETAL RADIOLOGY

Dr. Only One Taylor, SpOT

• Modalities of MSK

• Approach to bony lesions

Modalities
• plain film

• computed tomography

• ultrasound

• nuclear medicine

• interventional

• magnetic resonance imaging

 Plain Film
• mainstay of bone and joint
imaging, particularly in
trauma
• advantages
– fast
– inexpensive
– readily available
– good for assessing bones and joints
 Plain Film
• mainstay of bone and joint
imaging, particularly in
trauma
• disadvantages
– uses ionising radiation (x rays)
– limited information regarding soft
tissues
 Computed Tomography (CT)
• x ray tube rotated around the patient
• cross sectional imaging capability
• reformatting in other planes and 3D
• best for bony cortex and calcification
• good at evaluation of comminuted fractures to
complex structures
– pelvis
– calcaneus
– wrist
calcaneal fracture
coronal and sagittal reformatting
Computed Tomography (CT)

• disadvantages

– radiation dose to patient

– metal artefact

– poor soft tissue characterization

CT MRI
 Ultrasound
• relatively inexpensive
• sound waves reflecting from soft tissue interfaces
• no ionizing radiation
• MSK applications
– infants for DDH
– tendon injuries especially rotator cuff
– soft tissue masses
– US guided biopsy
normal supraspinatus tendon
longitudinal transverse
normal supraspinatus tendon
longitudinal transverse

full thickness supraspinatus tear

Nuclear Medicine

• entire skeleton at once

• bone scan is an indicator of bone turn over
• very sensitive, not specific
– fracture
– tumour
– arthritis
– infection
– metabolic bone disease
bone scan
normal multiple metastases
normal plain film
bone scan – multiple bony
metastases
Magnetic Resonance Imaging (MRI)

• patient in a strong magnetic field

• multiplanar imaging

• excellent soft tissue contrast

• ideally suited for MSK

 Kontraindikasi MRI:

•Aneurysmal clip.
•Pace maker.
PERSIAPAN PENDERITA
• Tidak memakai arloji,
gigi palsu ataupun
lensa kontak.
• Tidak membawa serta
uang logam, HP,
pager, kartu kredit,
kartu ATM .
• Tidak memakai
mascara.
Persiapan Penderita
• Sebelum masuk ke ruang
pemeriksaan, penderita
perlu diberi keterangan
bahwa selama pemeriksaan
timbul suara gaduh, agar
penderita tidak takut.
PERSIAPAN PENDERITA

• Penderita anak2 yang tidak kooperatif,

memerlukan anestesi.
• Penderita clautrophobia perlu diberi
anestesi.
• Letakkan penderita pada posisi yang
paling nyaman buat penderita.
• Bila penderita merasa nyeri, perlu diberi
analgetika atau anestesi.
Immobilisasi penderita mutlak.
PERSIAPAN ALAT

• Pilih coil yang sesuai

dengan regio anatomi
yang akan diperiksa.
 Sequences pada MRI
• T1W, T1FSE
• T2W, T2FSE, T2FRFSE
• Proton density
• FLAIR
• MR Diffusion
• FSE
• GE
• Fat suppression technique
• WF separation technique
Teratoma
T1W T2FSE T1C T1C
Flexion-Distraction Injury