AHMAD AMER Al-BOUKAI

Clinical Associate Professor & Senior Consultant Radiologist

Radiology & Medical Imaging Department
King Saud University Medical city

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The main focus and objective of this lecture is to help student to be competent in looking at
MSK images and interpreting findings, by learning:
 Normal radiological anatomic landmarks
 System of analyzing findings
“Where to look & What to look for”
 Recognize features of certain disease entity

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 Introduce the different imaging modalities utilized in imaging MSK system

 Define Imaging anatomical landmarks seen in each modality

 Introduce simplified approach to the interpretation of image findings

 Identify Imaging findings, importance and correlation in different pathology, trauma

 Identify Imaging findings, importance and correlation in different pathology, arthritis

 Identify Imaging findings, importance and correlation in different pathology, metabolic

 Identify Imaging findings, importance and correlation in different pathology, neoplastic

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 CONVENTIONAL RADIOGRAPHY Corner Stone

COMPUTED TOMOGRAPHY
MAGNATIC RESONANCE IMAGING Useful in evaluating bone texture

ULTRASOUND Useful in bone

marrow and
NUCLEAR MEDICINE soft tissue
• Tendons/ligaments/muscles.
• Detect fluid collections around joints or within bone scan is very sensitive but is relatively
muscles. non-specific
• Soft tissue masses and cysts.

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AA
1
1
22 3
3
5 4
5 4

BB

A- Acromio-Clavicular joint
B- Gleno-Humeral joint
1- Clavicle
2- Acromiom process
3- Coracoid process
4- Glenoid process
5- Humerus
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 Clavicle

Humerus

ISM
SSCM
SSC Scapula
DM

Clavicle
Acromion process

Humerus

COMPUTED TOMOGRAPHY

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1- Supraspinatus Muscle T1WI T2 FSWI
CORONAL PLANE
2- Infraspinatus Muscle
3- Teres Minor Muscle
4- Scapular plate
5- Clavicle
5
6- Glenoid process
7- Humerus 1
8- Glenohumeral joint

4 7
6

3
8

MAGNATIC RESONANCE IMAGING

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1- Subscapularis Muscle AXIAL PLANE
2- Infraspinatus Muscle
3- Scapular plate
4- Glenoid process T1WI T2 FSWI
5- Humeral head Subscapularis Tendon
6- Glenohumeral joint

5 5
4 4

1 1

3 2 3 2 Infraspinatus Tendon

6 6

MAGNATIC RESONANCE IMAGING

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 Subscapularis Muscle

SAGITTAL PLANE

T1WI T2 FSWI

8 8
6 2 6
7 2 7

5
1- Subscapularis Muscle 5
1
2- Supraspinatus Muscle 3 1 3
3- Infraspinatus Muscle
4- Teres Minor Muscle 4 4
5- Scapular plate
6- Coracoid process
7- Acromion process
8- Clavicle

MAGNATIC RESONANCE IMAGING

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 3

4
1

2 5

1- Lateral Epicondyle
2- Capitulum
3- Olecranon Fossa
4- Medial Epicondyle
5- Trochlea
6- Coronoid Process
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 CORONAL PLANE
3 T2WI T2 FSWI

4
1
3 4
1
2 5 5
2
6
6 7

1- Lateral Epicondyle
2- Capitulum
3- Olecranon Fossa
4- Medial Epicondyle
5- Trochlea
6- Coronoid Process
7- Radius Head A A Al-BOUKAI-12
Child 5-Year old Child 11-Year old Adult

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 1- Ulna
2- Radius
3- Scaphoid
8
4- Lunate
7
5- Triquetrum
10 9
6 6- Pisiform
3 7- Trapezium
5
8- Trapezoid
4
9- Capitate
10- Hamate

1
2
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 1- Ulna
2- Radius
3- Scaphoid
4- Lunate
T1WI T2 FSWI 5- Triquetrum
6- Pisiform
7- Trapezium
8- Trapezoid
MC2 MC3 9- Capitate
MC1 MC4
MC5 10- Hamate
7 8
9 10

3 6
5
4

2
1

CORONAL PLANE

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Three carpal arcs should be traced:
• along the proximal row of carpal bones; proximal aspect.
• along the proximal row of carpal bones; distal aspect.
• along the capitate and hamate proximally.
These three lines should remain unbroken
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 SACRO-ILIAC JOINT

A
SUPERIOR ANTERIOR ILIAC SPINE

ILIAC BONE

INFERIOR ANTERIOR ILIAC SPINE

HIP JOINT
FEMUR HEAD
SUPERIOR PUBIC RAMUS
FEMUR HEAD NECK

ISCHIUM
GREATER TROCHANTER

LESSER TROCHANTER SYMPHYSIS PUBIS

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 ADULT CHILD

ILIAC BONE ILIAC BONE

TRIRADIATE CARTILLAGE

FEMUR EPIPHYSIS

FEMUR HEAD SUPERIOR PUBIC RAMUS

SUPERIOR PUBIC RAMUS
FEMUR HEAD NECK FEMUR HEAD NECK
ISCHIUM

ISCHIUM

FEMUR SHAFT FEMUR SHAFT

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 8
1

1- Patella 2
3
2- Lateral condyle
3- Medial condyle
5 4
4- Lateral tibial plateau
6
5- Medial tibial plateau
6- Tibial eminence
7- Fibula 9 7
8- Femur
9- Tibia
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CHILD ADULT
Diaphysis

Diaphysis
Diaphysis
Metaphysis
Metaphysis

Metaphysis

Epiphysis Growth Plate

Epiphysis
Epiphysis

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 CORONAL PLANE

PDFSWI

1
2
5
4 3
8

6 8 8
6

1- Lateral condyle 5- Tibial eminence

2- Medial condyle 6- Fibula
3- Lateral tibial plateau 7- Femur
4- Medial tibial plateau 8- Tibia
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Sagittal plane at mid part (A&B) (A) (B)
2
2

1
1
1- Patella
2- Femur 4 5
3- Tibia
4- ACL
5- PCL
3
3

Sagittal plane at medial & lateral part (C&D) (C) (D)

Normal outline of the meniscus is bow tie with homogeneous low signal (two opposing triangular horns)
Anterior Posterior

SAGITTAL PLANE

NORMAL MEDIAL MENISCUS NORMAL LATERAL MENISCUS

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 Diaphysis

Metaphysis

Epiphysis

Growth Plate

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 IMPORTANT SITES
“Where to look & What to look for”
• BONE DENSITY
• BONE TEXTURE
• DISTORTION / DISPLACEMENT
Cupping
OF NORMAL STRUCTURES

Metaphysis

Epiphysis
Widening of
Fraying Growth Plate
Growth Plate

Cupping
Normal Rickets
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 Diaphysis Diaphysis

Cupping
Metaphysis
Metaphysis

Epiphysis
Epiphysis
Widening of
Fraying Growth Plate
Growth Plate

Cupping

Normal Rickets
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“Where to look & What to look for”

H
Y
P
E
R
N P
O A
R R
M A
A T
L H
Y
R
O
I
D
I
S
M

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Normal Fracture Humerus

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Normal Heterogeneous texture with old humeral
fracture

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 Heterogeneous texture with old humeral fracture
Computed Tomography
Axial cut

Computed Tomography
Coronal Reformat
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