Magnetic Resonance Imaging of the Knee

Magnetic Resonance Imaging of the Knee


This abundantly illustrated atlas of MR imaging of the knee documents normal anatomy and a wide range of pathologies.
In addition to the high-quality images, essential clinical information is presented in bullet point lists and
diagnostic tips are included to assist in differential diagnosis. Concise explanations and guidance are also provided
on the MR pulse sequences suitable for imaging of the knee, with identification of potential artifacts. This book will
be an invaluable asset for busy radiologists, from residents to consultants. It will be ideal for carrying at all
times
for use in daily reading sessions and is not intended as a reference to be read in the library or in non-clinical
settings.



xv
1 Anatomy of the Knee . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Sagittal Views . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 Coronal Views . . . . . . . . . . . . . . . . . . . . . . . . 6
1.3 Axial Views . 8
2 MRI Technical Considerations . . . . . . . . . . . . . . 11
2.1 Positioning and Fixation of the Knee . . . . . . 11
2.2 Acquisition of Images in the Sagittal Plane . . 11
2.3 T1-Weighted and Proton Density-Weighted Fast Spin-Echo Sequences. . . . . 12
2.4 Magic Angle Effect . . . . . . . . . . . . . . . . . . . . 14
2.5 In-Phase and Out-of-Phase Imaging . . . . . . . 16
2.6 Usefulness of Axial Images . . . . . . . . . . . . . . 16
2.7 Techniques for Fat Suppression . . . . . . . . . . . 16
2.8 Metallic Artifacts . . . . . . . . . . . . . . . . . . . . . . 17
2.9 Magnetization Transfer Contrast (MTC) Method, MT Effect . . . . . . . . . . . . . 19
2.10 Imaging Techniques for Cartilage . . . . . . . . . 19
3 Anterior Cruciate Ligament (ACL) . . . . . . . . . . 25
3.1 Anatomy . . . 25
3.2 Image Acquisition . . . . . . . . . . . . . . . . . . . . . 27
3.3 MRI Findings of Normal ACL . . . . . . . . . . . 29
3.4 Characteristics of ACL Tear . . . . . . . . . . . . . 29
3.5 Complete Tear of ACL . . . . . . . . . . . . . . . . . . 30
3.6 Partial Tear of ACL . . . . . . . . . . . . . . . . . . . . 31
3.7 Acute Tear of ACL . . . . . . . . . . . . . . . . . . . . . 32
3.8 Chronic Tear of ACL . . . . . . . . . . . . . . . . . . . 32
3.8.1 Loss of ACL . . . . . . . . . . . . . . . . . . . . 32
3.8.2 Discontinuous Band . . . . . . . . . . . . . . 34
3.8.3 Continuous Band with Elongation . . . 36
3.9 Degeneration of ACL . . . . . . . . . . . . . . . . . . . 37
3.10 Secondary Signs Suggesting ACL Tear . . . . . 38
3.11 Fracture of the Intercondylar Eminence . . . . 41
3.12 ACL Reconstruction . . . . . . . . . . . . . . . . . . . 42
3.13 MRI Findings of Reconstructed ACL . . . . . . 44
3.14 ACL Graft Tear and Its Complications . . . . . 45
3.15 Post-arthroscopic Changes of Infrapatellar Fat Pad . . . . . . . . . . . . . . . . . . . . 49
3.16 Conservative Therapy of Torn ACL . . . . . . . . 51
Contents
xvi Contents
4 Posterior Cruciate Ligament (PCL) . . . . . . . . . . 53
4.1 Anatomy . . . 53
4.2 PCL Tear . . . 55
4.3 MRI Findings of PCL Tear . . . . . . . . . . . . . . 56
5 Medial Collateral Ligament (MCL) . . . . . . . . . . 63
5.1 Anatomy . . . 63
5.2 MCL Tear . . . 65
5.3 Pellegrini-Stieda Syndrome . . . . . . . . . . . . . . 68
6 Lateral Supporting Structures Including Lateral
Collateral Ligament (LCL) . . . . . . . . . . . . . . . . . 71
6.1 Anatomy . . . 71
6.2 LCL Tear . . . 78
6.3 Avulsion Fracture of the Fibular Head . . . . . . 79
6.4 Segond Fracture . . . . . . . . . . . . . . . . . . . . . . . 81
6.5 Avulsion Fracture of the Gerdy’s Tubercle . . 82
6.6 Iliotibial Band Friction Syndrome . . . . . . . . . 83
6.7 Popliteus Musculotendinous Injury . . . . . . . . 84
7 Meniscus . . . . . . . . 85
7.1 Anatomy . . . 85
7.2 Medial and Lateral Menisci . . . . . . . . . . . . . . 85
7.3 Delineation of Meniscal Lesions by MRI . . . 87
7.4 Meniscal Tear 88
7.5 Bucket-Handle Tear of the Meniscus . . . . . . . 99
7.6 Meniscal Lesions in the Elderly . . . . . . . . . . 102
7.7 Peripheral Meniscal Tear and Meniscocapsular Separation . . . . . . . . . . . . . . 104
7.8 Discoid Meniscus . . . . . . . . . . . . . . . . . . . . . . 108
7.9 Meniscal Calcification, Ossicles, and Vacuum Phenomenon . . . . . . . . . . . . . 110
7.9.1 Meniscal Calcification . . . . . . . . . . . . 110
7.9.2 Ossicles . . . . . . . . . . . . . . . . . . . . . . . 111
7.9.3 Vacuum Phenomenon . . . . . . . . . . . . . 112
7.10 MRI Findings of Postoperative Menisci . . . . 113
7.11 Pitfalls for Imaging of Meniscal Lesions . . . . 117
8 Fracture, Subluxation, and Muscle Injury . . . . . 123
8.1 Tibial Plateau Fracture . . . . . . . . . . . . . . . . . . 123
8.2 Patellar Fracture . . . . . . . . . . . . . . . . . . . . . . . 126
8.3 Patellar Dislocation . . . . . . . . . . . . . . . . . . . . 127
8.4 Tangential Osteochondral Fracture . . . . . . . . 130
8.5 Patellar Sleeve Fracture . . . . . . . . . . . . . . . . . 131
8.6 Osteochondritis Dissecans . . . . . . . . . . . . . . . 132
8.7 Traumatic Hemarthrosis . . . . . . . . . . . . . . . . 135
8.8 Stress Fracture and Fatigue Fracture . . . . . . . 135
8.9 Bone Bruise . 136
8.10 Musculotendinous Injury . . . . . . . . . . . . . . . . 137
Contents xvii
9 Pediatric and Adolescent Disorders of the Knee 141
9.1 Distal Femoral Cortical Irregularity . . . . . . . 141
9.2 Femoral Condylar Irregularity . . . . . . . . . . . . 143
9.3 Painful Patella Partita . . . . . . . . . . . . . . . . . . . 145
9.4 Dorsal Defect of the Patella . . . . . . . . . . . . . . 148
9.5 Osgood-Schlatter Disease . . . . . . . . . . . . . . . 149
9.6 Sinding-Larsen-Johansson Disease . . . . . . . . 151
9.7 Jumper’s Knee . . . . . . . . . . . . . . . . . . . . . . . . 152
9.8 Blount Disease . . . . . . . . . . . . . . . . . . . . . . . . 153
9.9 Congenital Absence of the ACL . . . . . . . . . . 155
10 Osteoarthritis and Bone Marrow Signal Changes . . . . . . . . . . . . . . . . . . . . . . . . 157
10.1 Osteoarthritis 157
10.2 Spontaneous Osteonecrosis/Subchondral Insufficiency Fracture . . . . . . . . . . 159
10.3 Bone Marrow Reconversion . . . . . . . . . . . . . 163
11 Disorders of Synovium and Plica . . . . . . . . . . . . . 165
11.1 Pigmented Villonodular Synovitis (PVS) . . . 165
11.2 Giant Cell Tumor of Tendon Sheath . . . . . . . 166
11.3 Synovial Osteochondromatosis . . . . . . . . . . . 167
11.4 Synovial Hemangioma . . . . . . . . . . . . . . . . . . 168
11.5 Lipoma Arborescens . . . . . . . . . . . . . . . . . . . 169
11.6 Hoffa’s Syndrome . . . . . . . . . . . . . . . . . . . . . 169
11.7 Amyloidosis . 174
11.8 Plica Syndrome . . . . . . . . . . . . . . . . . . . . . . . 175
11.8.1 Suprapatellar Plica . . . . . . . . . . . . . . 176
11.8.2 Mediopatellar Plica . . . . . . . . . . . . . 177
11.8.3 Infrapatellar Plica . . . . . . . . . . . . . . . 179
12 Cystic and Cyst-Like Lesions of the Knee . . . . . 181
12.1 Intra-articular Ganglion . . . . . . . . . . . . . . . . . 181
12.2 Meniscal Cyst . . . . . . . . . . . . . . . . . . . . . . . . 183
12.3 Popliteal Cyst (Baker’s Cyst) . . . . . . . . . . . . . 185
12.4 Posterior Capsular Area of the Knee . . . . . . . 188
12.5 Bursa and Bursitis . . . . . . . . . . . . . . . . . . . . . 191
12.5.1 Prepatellar Bursa . . . . . . . . . . . . . . . 192
12.5.2 Superficial Infrapatellar Bursa . . . . . 193
12.5.3 Deep Infrapatellar Bursa . . . . . . . . . 194
12.5.4 Pretibial Bursa . . . . . . . . . . . . . . . . . 195
12.5.5 Pes Anserine Bursa . . . . . . . . . . . . . 196
12.5.6 Iliotibial Bursa . . . . . . . . . . . . . . . . . 197
12.6 Periarticular Ganglion . . . . . . . . . . . . . . . . . . 198
Index . . . . . . . . . . . . . . 199