1. LOUISIANA STATE UNIVERSITY MEDICAL CENTER School of Medicine in New Orleans LOUISIANA STATE UNIVERSITY MEDICAL CENTER School of Medicine in New Orleans Michael Maristany, MD Prepared by Carlos R. Giménez, MD, FACP Professor of Radiology Michael Maristany, MD Prepared by Carlos R. Giménez, MD, FACP Professor of Radiology Former Director MRI Body Division and MSK Section

2. DIAGNOSIS & TREATMENT CLINICAL HISTORY RADIOLOGYRADIOLOGY PATHOLOGYPATHOLOGY DIAGNOSISBONELESION

3. Diagnostic modalities

4. DIAGNOSTIC IMAGING SKELETAL PLAIN RADIOGRAPH NUCLEAR MEDICINE CT MRI ANGIOGRAPHY BIOPSY PLAIN RADIOGRAPH NUCLEAR MEDICINE CT MRI ANGIOGRAPHY BIOPSY

5. Diagnostic algorithm Yes>>>stopYes>>>stop nono CT for assessing matrix Composition Composition MRI for assessing bone & soft tissue Component Component Nuclear medicine for Assessing asymptomatic Multiplicity or activity Nuclear medicine for Assessing asymptomatic Multiplicity or activity MRI/CTCHARACTERIZATIONMRI/CTCHARACTERIZATION Radiographs Radiographs of the symtomatic area of the symtomatic area >>> diagnosis >>> diagnosis Radiographs Radiographs of the symtomatic area of the symtomatic area >>> diagnosis >>> diagnosis

6. CONVENTIONAL Rx IT REMAINS AS THE MOST RELIABLE IN THE HISTOLOGIC NATURE OF A SPECIFIC LESION 4 DETECTION 4 LOCALIZATION 4 CHARACTERIZATION IT REMAINS AS THE MOST RELIABLE IN THE HISTOLOGIC NATURE OF A SPECIFIC LESION 4 DETECTION 4 LOCALIZATION 4 CHARACTERIZATION

7. Tid bits 3 It is always a good idea to start with a radiograph of the area in question. Proceed with MRI if you are concern with ligaments or soft tissue problems, occult fracture or characterization A CT if you are more concern with bony problems Sometimes you need both. 3 It is always a good idea to start with a radiograph of the area in question. Proceed with MRI if you are concern with ligaments or soft tissue problems, occult fracture or characterization A CT if you are more concern with bony problems Sometimes you need both.

10. Case 1 3 28 yo male complains of arm pain

12. Hx: unable to lift arm. Shoulder X-Ray (-) Hx: unable to lift arm. Shoulder X-Ray (-) SUPRASPINATUSSUPRASPINATUS

13. RUPTURE ACL PARTIAL PCL RUPTURE ACL PARTIAL PCL

14. PCLPCL FxFx RETINACULUM RUPTURE ACL RUPTURE MCL RUPTURE

15. Ligament injuries 3 CT is more optimal than MRI 3 True or False 3 CT is more optimal than MRI 3 True or False

17. 3 For the evaluation of Disc disease, ligamentous or spinal cord injury in trauma MRI is preferred 3 For the evaluation of vertebral fractures in spine trauma CT is preferred. 3 Point: Both are use in evaluation of the spine in trauma.! 3 For the evaluation of Disc disease, ligamentous or spinal cord injury in trauma MRI is preferred 3 For the evaluation of vertebral fractures in spine trauma CT is preferred. 3 Point: Both are use in evaluation of the spine in trauma.!

18. UNILATERAL FACET LOCK

19. BILATERAL FACET LOCK

21. Fx POSTERIOR ARCH AXIS - ANTERIOR SUBLUXATION AXIS

22. Indirect Signs of Thoracic Indirect Signs of Thoracic Spine Injury Spine Injury 3 Paravertebral hematoma 3 Mediastinal widening 3 Pleural fluid (hemothorax) 3 Sternal fracture 3 Rib fractures & costovertebral dislocations dislocations 3 The double spinous process sign

23. BURST FRACTURE C # 8005

25. Medullary compression by disc degeneration

26. 5 2 Extruded disc

27. L 5 - S 1 HERNIA