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1、Practical Interpretation of Knee MRI,Routine MRI protocol,Sagittal,Coronal,AxialSpin echo(SE)FSE,STIRT1, T2, PD,JST,Coronal: T2FFE T2 STIRSaggital: T1 T2 T2FFE T2 STIR,TR和TE决定成像加权,短TE 长TE短TR T1 无用途 长TR PD T2,T1 weighted image (TR1000msec,TE40msec) “anatomy”,T2 weighted image (TR1500msec,TE60msec) “p
2、athology”,Fat suppression Chemical saturation Short tau inversion recovery (STIR),Tissue characterization,T1 T2Adipose tissue Fat white gray Yellow marrowWater dark whiteCortical bone black blackCartilage gray grayTendon / ligament/meniscus black/gray black/grayMuscle gray grayHematoma white white C
3、hronic hemorrhage dark dark,Anterior Cruciate Ligament,extension ER 15 20,Normal MR appearance,direct sign of torn ACL,discontinuity,abnornal orientation (fallen ACL),nonvisualization,Avulsion fx,Indirect,Bone bruise signDeep sulcus signSegond fxgeneralized increase in signal intensity thickness inc
4、reaseAnterior drawer signAcute hemarthrosisBuckling of PCL,pivot-shift pattern,Kissing sign,Segond sign,Deep sulcus sign, 2mm,generalized increase in signal intensity thickness increase,Buckling of PCL,nonspecific,Ant.drawer sign,Associated soft tissue injuries,Posterior horn of medial meniscusBucke
5、t handle tearMCL,Posterior Cruciate Ligament,Normal MR appearance,Meniscus-Femoral ligament,Primary sign of PCL,complete tear partial tear “peel off ” injury,Complete tear,Grade1,Grade3,Grade2,partial tear,Secondary sign of PCL injury,bone marrow edema(BME)avulsion fx,Dashboard injury sign,Bone Marr
6、ow Edema,Tibial avulsion fx,Associated ligament injury,ACL injuryMCL injuryPLC/LCL injury,Collateral ligament,Normal Anatomy of MCL,Grading MCL Injuries,Grade 1 (sprain),Grade 2 (partial tear),Grade 3 (complete tear),Normal Anatomy of the LCL Complex/Posterolateral Corner Complex,Iliotibial band,LCL
7、,Popliteal plex,Biceps tendon,Visible disruption of one of the posterolateral capsule structuresExtensive surrounding soft tissue edemaAvulsion fracture or marrow edema involving the medial aspect of the fibular head,Signs of Posterolateral Corner Injury,Menisci,bow ties 2,triangular,rectangular,Cri
8、terial to detect meniscal tear,grade 3 signalabnormal meniscal morphologydisplaced or missing meniscal tissuemeniscocapsular separation,Grade III meniscus tear,missing fragment,Displaced fragment,small PHMM,MRI signs,absent bow ties sign(1 or fewer)double PCL signlarge anterior horn signtoo many bow
9、 ties(3 or more)notch sign,Large & degeneration ant.horn,3 or more bow-ties,Bucket handle tear,double PCL sign,discoid meniscus,3 or more bow-ties,Pitfalls in meniscus diagnosis,Grade II signalTransverse meniscus lig. Popliteal hiatus Meniscofemoral lig.Bursa or fat plane of MCL,Popliteal hiatus,内侧半
10、月板后角的上隐窝 垂直 光滑 不连通,Postoperative Meniscus, Grade 3 signal on T1-weighted images only is indeterminate for tear: it may represent postoperative change or retear of the meniscus Grade 3 signal on a T1-weighted image that is bright as fluid on a T2-weighted image is diagnostic of retear. A displaced me
11、niscal fragment is diagnostic of retear. Grade 3 signal in new a location is diagnostic of retear,Bone Marrow Edema(BME),pivot-shift injurydashboard injuryhyperextension injury: ”kissing sign”clip injurypatellar dislocation,clip injury,patellar dislocation,OCD,popliteal cyst,Meniscus cyst,PVNS,cruciate cyst,ACL cyst,Patellar dislocation,patellar tendon,Jumpers knee,Housemaids kneeDeep & Superficail infrapatellar bursa,