Imaging of knee by MR and USG

DR. Muhammad Bin Zulfiqar PGR III New Radiology Department SIMS/SHL

• USG TECHNIQUE

• MR TECHNIQUE

• COMPARATIVE STUDY

USG TECHNIQUE

Quadriceps tendon transverse

Anterior knee: Medial recess and patellar retinaculum transverse

Anterior knee: Lateral recess and patellar retinaculum transverse

Anterior knee: Proximal patellar tendon longitudinal

• Anterior knee: Distal patellar tendon longitudinal

• Anterior knee: Proximal patellar tendon transverse

Anterior knee: Distal patellar tendon transverse

• Medial side of the knee: Pes anserinus tendons longitudinal

Lateral side of the knee: Iliotibial band longitudinal

Iliotibial band longitudinal Distal insertion

Lateral side of the knee:Popliteal tendon and lateralcollateral ligament

Lateral side of the knee: Biceps femoris and lateral collateral ligament insertion longitudinal

• Posterior knee: Popliteal fossa with popliteal vessels and nerve transverse

Posterior knee: Popliteal fossa with popliteal vessels and nervelongitudinal

Posterior knee: Semimembranosogastrocnemia bursa region transverse

Posterior knee: Peroneal nerve transverse

Posterior knee: Peroneal nerve longitudinal

Posterior knee: Posterior horn of the medial meniscus

Posterior knee: Posterior horn of the lateral meniscus

Posterior knee: Posterior cruciate ligament insertion longitudinal

Posterior knee: Intercondylar fossa transverse

Quad tear??? No!!! - ANISOTROPY

Pulse Sequences Menisci Short TE sequence (<20 msec) ,Proton density / gradient

echo / (T1) Caution with FSE PD (blurring)

Tendons Ligaments Muscle Fluid

FSE T2 with fat saturation Inversion recovery (STIR)

Bone marrow

FSE T2 with fat saturation Inversion recovery (STIR)

Cartilage Good contrast between fluid , cartilage and subchondral bone

Imaging Planes

Axial

Coronal

Sagittal

MR PLANES

• Axial• Coronal• Sagittal

Anterior Compartment

Prepatellar Bursitis

Prepatellar Bursitis

Prepatellar Bursitis

Patellar Tendinosis

Normal Swollen

Partial Patellar Tendon Tear

Partial Patellar Tendon Tear

Patellar Tendon Rupture

Patellar Tendon Rupture

Top Images: Tendon RuptureBottom Images: Post operative

Patellar Tendon Rupture

• Complete Patellar tendon tear. Image on the right shows hemorrhagic bursitis ( low signal in bursa).

Medial Femoral Condyle Chondral Lesion

Ultrasound Medial Compartment

Medial Collateral Ligament Tear

Medial Collateral Ligament Tear

Medial Collateral Ligament Tear

Acute 6 months Later

Medial Meniscus Tear

Medial Meniscus Tear

Jumpers Knee

Jumpers Knee

Jumpers Knee

USG Lateral Compartment

Lateral Collateral Ligament Sprain

Ileotibial Band Friction Syndrome

Iliotibial Band Friction Syndrome

The T1-weighted coronal image demonstrates intermediate signal intensity (arrows) replacing normal fat signal intensity deep to the iliotibial band (arrowhead).

The STIR coronal image demonstrates ill defined increased signal intensity (arrows) deep to the iliotibial band (arrowhead). Subtle increased signal intensity (short arrows) is also present superficial to the iliotibial band.

Lateral Meniscus Tear

Lateral Meniscus Tear

Posterior Compartment

Posterior Meniscus Tear

Popliteal Artery Aneurysm

Popliteal Artery Aneurysm

T1 T2 fat sat PD fast

• Right, Axial sonogram of posterior knee shows Baker’s cyst (arrowheads) with fluid (solid straight arrow) between semimembranosus tendon (curved arrow) and medial gastrocnemius tendon (open arrow). Note subgastrocnemius component (asterisk) of Baker’s cyst. Note that top of image is posterior; right side of image is medial. M = medial gastrocnemius muscle.

• , Axial proton density–weighted MR image with fat saturation reveals Baker’s cyst (arrowheads ) with fluid (black arrow ) between semimembranosus tendon (curved white arrow ) and medial gastrocnemius tendon (open arrow ). Note subgastrocnemius component (asterisk ) of Baker’s cyst. M = medial gastrocnemius muscle.

• Right, Axial sonogram shows echogenic intraarticular body (arrow ) in Baker’s cyst (arrowheads ). Note that top of image is posterior.

• Left, Sagittal proton density–weighted MR image reveals intermediate signal intraarticular body (arrow ) in Baker’s cyst (arrowheads ).

• Right, Sagittal sonogram shows hypoechoic meniscal cyst (curved arrow) in contact with hyperechoic meniscus (open arrows) and hypoechoic meniscal tear (solid straight arrows). F = femur, c = hyaline cartilage.

• Left top, Sagittal proton density–weighted MR image reveals meniscal cyst (curved arrow ) in continuity with meniscal tear (straight arrow ).

• Left bottom, Axial proton density–weighted MR image with fat saturation reveals meniscal cyst (curved arrow ) with signal intensity of fluid without extension between semimembranosus tendon (undulating arrow ) and medial gastrocnemius tendon (arrowhead ).

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