about monitoring stress injury of the talar dome with dynamic MRI and CBCT exam
Today I present you the clinical picture of a medial talar bone edema and spongious impaction of an elite runner; I’d like to remind you that a bone bruise is a subchondral osseous fracture of the cancellous microarchitecture with accompanied local hemorrhage and edema, so less indication for ultrasound imaging in this case. Yes, with ultrasound we can perfectly see the cortical irregularity but nothing about the definitive staging of the disease, so don’t forget: MRI is the method of choice (Stress Fracture in Runners).
Three months after the study was completed with Cone-Beam Ct scan; try to identify risk factors and training errors predisposing to stress fractures is mandatory.
I always use the dynamic MRI-CBCT examination before the return to activity.
About diagnostic imaging of postoperative complication of anterior cruciate ligament (ACL) reconstruction.
This is the case of a patient the came to my observation for a palpable mass into the anterior-medial pretibial region, two years after ACL reconstruction.
Tunnel cyst formation is a rare complication after ACL reconstruction, usually occurring 1-5 years post-operatively, which may occasionally be symptomatic. The ultrasound exam in this case is not enough. The study is completed with MRI and Cone-Beam CT examination.
Why Cone-Beam CT? Same diagnostic capability of total-body CT but low radiation dose!
The computed tomography dose index (CTDI) is a commonly used radiation exposure index in X-ray computed tomography (CT); in this case 4,74 mGy was the value detected. 16.98 mGy is the estimated absorbed dose by using a total-body CT scan for the same examination.
about dynamic cone-beam ct imaging of TFCC wrist injury
It’s always difficult to combine clinical aspects and diagnostic imaging, approaching wrist joint pathology; in many circumstances the orthopaedic surgeon needs to directly visualize what’s happened during the joint motion, especially in a complex region such as the wrist.
I show you an example in which a complex tear of the triangular fibrocartilage complex (TFCC) is evident, togheter with a positive ulnar variance. TFCC is a complex of a fibrocartilaginous disk in association with several ligamentous structures, acting as a stabilizers of the distal radioulnar joint, and transmitting axial loading from carpus to the ulna.
Coronal T1w (left) and 3D SHARC (right) Mri scans (0.3 Tesla).
The dedicated Mri examination (0.3 Tesla), depicts the pathologic picture; the ulnar plus defines the reduction of the quadrilateral ulno-carpal space, and the consequent complex tear of the TFCC at its ulnar attachment; but what happens during the active movements? I usually perform also the dynamic evaluation, both with ultrasound and Mri exams. In this case the Cone-beam CT (CBCT) dynamic acquisitions give the answer.
About dynamic msk imaging modalities in the study of post-traumatic metacarpal fracture
Acute 4th metacarpal spiroid fracture of a professional football goalkeeper; first diagnosis was made directly on pitch with an ultrasound examination. Plain radiographs and Mri exam were performed just one hour after trauma.
One month after surgical fixation the fracture is studied with dynamic US, Mri and Cone-Beam CT imaging. The US and MR dynamic evaluations, show a regular tendon sliding over the fixation devices.
No metal-induced artifacts were seen, allowing a perfect visualization of the implanted devices.
Cone-Beam CT Sagittal (left) and Coronal (right) reconstructions.
The study was completed with dynamic Mri (0.3 Tesla) and Cone-Beam CT scans, performed with active flexion-extension of carpal-metacarpal joint structures.
Have you seen my recent post Anterior Talo-Fibular Ligament (ATFL) Injury? In this new post you can see the changes of Mri and Ultrasound imaging after one month; it’s very important the monitoring with both modalities but…. don’t forget to consider also the evolution of clinical presentation and if possible, go on the playing field to directly see the real situation.
Axial T2 weighted an Fast Stir Mri scans (0.3 Tesla) 1 month after a complete rupture of the ATFL