1 Relevant Magnetic Resonance Imaging Techniques ............. 2
M. Vahlensieck, F. Traeber, and J. Gieseke
1.1 Introduction ............................................... 2
1.1.1 Longitudinal and Transverse Magnetization ........... 2
1.1.2 Measurement Time .................................... 2
1.1.3 Spatial Assignment .................................. 2
1.1.4 Sequence ............................................ 2
1.2 Spin-Echo Sequence ......................................... 2
1.2.1 Tl Contrast ......................................... 2
1.2.2 Proton Density-Weighted Image Contrast .............. 2
1.2.3 T2 Contrast ......................................... 2
1.3 Turbo/Fast Spin-Echo Sequence .............................. 2
1.4 Gradient-Echo Technique .................................... 4
1.5 Ultrafast Magnetic Resonance Imaging Techniques ............ 6
1.6 Fat Suppression ............................................ 6
1.6.1 Chemical-Selective Saturation ....................... 6
1.6.2 Chopper-Dixon Method ................................ 7
1.6.3 Modified Dixon Technique ............................ 7
1.6.4 Short-Tau Inversion Recovery ........................ 7
1.6.5 Water Excitation .................................... 7
1.7 Contrast Media and Contrast Dynamic Enhancement ............ 9
1.8 Magnetic Resonance Arthrography ............................ 9
1.8.1 Direct Magnetic Resonance Arthrography .............. 9
1.8.2 Indirect Magnetic Resonance Arthrography ............ 9
1.9 Cartilage Imaging and Parameter Maps (Quantitative
Magnetic Resonance Imaging) ............................... 11
1.10 Magnetization Transfer Contrast ........................... 11
1.11 Diffusion-Weighted Imaging and Diffusion-Weighted Body
Suppression ............................................... 13
1.12 Magnetic Resonance Angiography ............................ 13
1.12.1 Gated-Inflow Technique ............................. 13
1.12.2 Phase Contrast Angiography ......................... 14
1.12.3 Contrast Angiography ............................... 14
1.13 Relaxometry ............................................... 14
1.14 Three-Dimensional Reconstruction .......................... 14
1.15 Multiplanar Reformatting .................................. 15
1.16 Radial Acquisition ........................................ 16
1.17 Spectroscopy and Spectroscopic Imaging .................... 16
1.17.1 Hydrogen Spectroscopy .............................. 16
1.17.2 Phosphorus Spectroscopy ............................ 19
1.17.3 Carbon Spectroscopy ................................ 21
1.18 Cinematic Examinations .................................... 21
1.18.1 Cine Mode .......................................... 21
1.18.2 Very Fast Sequences ................................ 21
1.19 Magnetic Resonance Myelography ............................ 21
1.20 Magnetic Resonance Neurography ............................ 21
1.21 Magnetic Resonance Imaging of Prostheses .................. 21
2 The Spine
K.M. Friedrich and M. Breitenseher
2.1 Imaging ................................................... 28
2.1.1 Indications ........................................ 28
2.1.2 Hardware ........................................... 28
2.1.3 Examination Protocols .............................. 28
2.2 Anatomy and Physiology .................................... 30
2.2.1 Bone Marrow and Osseous Elements ................... 30
2.2.2 Neuroforamina ...................................... 37
2.2.3 Intervertebral Disks ............................... 39
2.2.4 Ligaments .......................................... 39
2.2.5 Durai Sac, Spinal Cord, and Spinal Nerves .......... 39
2.2.6 Imaging Artefacts .................................. 41
2.3 Degenerative Conditions of the Spine ...................... 41
2.3.1 Bone and Bone Marrow Changes along the Vertebral
Body End Plates .................................... 41
2.3.2 Intervertebral Disk Changes ........................ 44
2.3.3 Changes to the Zygapophysial Joints ................ 47
2.4 Spondylitis and Spondylodiscitis .......................... 49
2.4.1 Pyogenic and Specific Spondylitis .................. 52
2.4.2 Rheumatoid Arthritis ............................... 53
2.4.3 Seronegative Spondyloarthropathy ................... 55
2.5 Posttraumatic Spinal Changes .............................. 56
2.5.1 Posttraumatic Changes to the Intervertebral Disks
and Ligaments ...................................... 56
2.5.2 Posttraumatic Bone Changes ......................... 59
2.5.3 Posttraumatic Changes to the Spinal Canal .......... 62
2.6 Postoperative Spinal Changes .............................. 65
2.6.1 The Postoperative Intervertebral Disk .............. 65
2.6.2 The Postoperative Bony Spine ....................... 69
2.7 Tumors of the Spine ....................................... 71
2.7.1 Development of Spinal Tumors ....................... 71
2.7.2 Localization of Tumors ............................. 72
2.7.1 Common Benign Tumors and Tumorlike Lesions ......... 72
2.7.4 Common Malignant Primary Tumors .................... 74
2.7.5 Common Malignant Secondary Tumors .................. 76
2.8 Clinical Significance of Magnetic Resonance Imaging ....... 78
2.8.1 Acknowledgment ..................................... 80
3 The Shoulder
M. Vahlensieck and C. Pfirrmann
3.1 Introduction .............................................. 84
3.2 Examination Technique ..................................... 84
3.2.1 Patient Positioning ................................ 84
3.2.2 Coil Selection ..................................... 84
3.2.3 Sequences and Parameters ........................... 84
3.2.4 Special Imaging Techniques ......................... 85
3.3 Anatomy ................................................... 87
3.3.1 General Anatomy .................................... 87
3.3.2 Specific Magnetic Resonance Anatomy and Variants ... 87
3.4 Disorders of the Rotator Cuff ............................. 94
3.4.1 Impingement ........................................ 94
3.4.2 Lesions of the Tendon Insertion (Insertion
Tendinopathy, Rim Rent Lesions) ................... 101
3.5 Disorders of the Proximal Biceps Tendons ................. 102
3.5.1 Tendinitis ........................................ 102
3.5.2 Tears ............................................. 104
3.5.3 Pulley Lesions .................................... 105
3.5.4 Chondromatosis and Osteochondromatosis ............ 106
3.6 Disorders of the Remaining Muscles (Including the
Sequelae of Nerve Compression Syndrome) .................. 107
3.6.1 Atrophy ........................................... 107
3.6.2 Insertion Tendinopathy ............................ 108
3.6.3 Fibrosis .......................................... 108
3.6.4 Muscle Fiber Tear ................................. 109
3.7 Disorders of the Bursae .................................. 109
3.7.1 Subacromial-Subdeltoid Bursa ...................... 109
3.7.2 Subcoracoid Bursa ................................. 110
3.8 Disorders and Instability of the Glenoid Labrum and
Capsular Ligaments ....................................... 110
3.8.1 Traumatic Lesions ................................. 110
3.8.2 Habitual Shoulder Dislocation ..................... 121
3.8.3 Labral Cysts ...................................... 122
3.9 Disorders of the Synovial Lining and Joint Capsule ....... 122
3.9.1 Arthritis ......................................... 122
3.9.2 Pigmented Villonodular Synovitis and Hemophilia ... 123
3.9.3 Synovial Chondromatosis ........................... 123
3.9.4 Lipoma Arborescens ................................ 124
3.9.5 Amyloid Arthropathy ............................... 124
3.9.6 Adhesive Capsulitis (Frozen Shoulder) ............. 124
3.10 Bone Disorders ........................................... 124
3.10.1 Aseptic Osteonecrosis ............................. 124
3.10.2 Impression Fractures of the Humeral Head .......... 125
3.10.3 Avulsion Injuries ................................. 127
3.10.4 Distal Clavicle Edema ............................. 127
3.10.5 Shoulder Arthrosis (Omarthrosis) .................. 127
3.10.6 Stress Reaction ................................... 128
3.10.7 Tubercle Cysts .................................... 129
3.10.8 Congenital Malformations .......................... 129
3.11 Disorders of the Acromioclavicular Joint ................. 129
3.12 Disorders of the Sternoclavicular Joint .................. 130
3.13 Tumors of the Shoulder ................................... 130
3.14 Post-Therapy Findings .................................... 131
3.14.1 Injection ......................................... 131
3.14.2 Shock Wave Lithotripsy ............................ 131
3.14.3 Surgical Procedures ............................... 131
3.15 Pitfalls in Interpreting the Images ...................... 136
3.15.1 Misinterpretation of Increased Signal Intensity ... 136
3.15.2 Misinterpreting Normal Variants ................... 136
3.15.3 Misinterpretation of an Effusion .................. 137
3.15.4 Misinterpretation of Bone Marrow Distribution ..... 137
3.15.5 Misinterpretation of a Persistent Acromion
Ossification Center ............................... 137
3.15.6 Misinterpretation of Muscle Insertions into Bone .. 138
3.16 Clinical Relevance of Magnetic Resonance Imaging ......... 138
4 The Elbow
M. Vahlensieck and M. D'Anastasi
4.1 Introduction ............................................. 146
4.2 Examination Technique .................................... 146
4.2.1 Patient Positioning ............................... 146
4.2.2 Coils ............................................. 146
4.2.3 Planes and Sequences .............................. 146
4.3 Anatomy .................................................. 149
4.3.1 Ligaments ......................................... 149
4.3.2 Muscles and Tendons ............................... 152
4.3.3 Bones ............................................. 154
4.3.4 Joint Cartilage ................................... 155
4.3.5 Recess and Bursae ................................. 155
4.3.6 Nerves ............................................ 155
4.3.7 Bloodvessels ...................................... 156
4.4 Epicondylitis ............................................ 158
4.4.1 Epicondylitis of the Radial Humerus ............... 158
4.4.2 Epicondylitis of the Ulnar Humerus ................ 158
4.5 Lesions of the Collateral Ligaments ...................... 159
4.5.1 Ulnar Collateral Ligament ......................... 159
4.5.2 Radial Collateral Ligament ........................ 160
4.5.3 Annular Ligament .................................. 161
4.6 Distal Biceps Tendon Rupture ............................. 161
4.7 Rupture of the Triceps Tendon ............................ 161
4.7.1 Insertion Tendinopathy of the Triceps Tendon ...... 161
4.7.2 Snapping Triceps .................................. 161
4.8 Traumatic Lesions ........................................ 162
4.9 Arthrosis ................................................ 163
4.10 Apophysitis .............................................. 165
4.11 Osteochondritis .......................................... 166
4.11.1 Osteochondritis Dissecans ......................... 166
4.11.2 Panner's Disease .................................. 167
4.11.3 Loose Joint Bodies ................................ 168
4.12 Radioulnar Synostosis .................................... 168
4.13 Cartilage Damage ......................................... 168
4.14 Plicae ................................................... 168
4.15 Bursitis ................................................. 168
4.16 Neuropathies ............................................. 168
4.17 Neoplasms and Neoplasmlike Changes ....................... 171
4.18 Posttherapy Findings ..................................... 173
4.19 Potential Sources of Mistakes When Interpreting Images ... 173
4.20 Clinical Relevance of Magnetic Resonance Tomography ...... 173
5 The Wrist and Fingers
M. Vahlensieck and M. Richter
5.1 Examination Technique .................................... 182
5.1.1 Patient Positioning ............................... 182
5.1.2 Coil Selection .................................... 182
5.1.3 Sequences and Parameters .......................... 182
5.2 Anatomy .................................................. 182
5.2.1 General Anatomy of the Carpal Rows ................ 182
5.2.2 Special Magnetic Resonance Anatomy ................ 186
5.3 Spontaneous Avascular Necrosis ........................... 191
5.3.1 Avascular Necrosis of the Lunate (Kienbock's
Disease) .......................................... 191
5.3.2 Spontaneous Avascular Necrosis of the Scaphoid
(Preiser's Disease, Köhler-Mouchet's Disease) ............ 194
5.4 Ulnocarpal Impaction Syndrome ............................ 194
5.5 Ulnar Impingement Syndrome ............................... 196
5.6 Hamatolunate Impingement ................................. 197
5.7 Arthrosis (Osteoarthritis) ............................... 197
5.8 Carpal Coalition ......................................... 198
5.9 Traumatic Lesions of the Carpal Bones .................... 199
5.9.1 Bone Contusion (Bone Bruise) and Occult Fracture .. 199
5.9.2 Fracture .......................................... 200
5.9.3 Dislocation and Subluxation ....................... 200
5.9.4 Traumatic Lesions and Findings of the
Postoperative Scaphoid ............................ 200
5.10 Diseases of the Ligaments ................................ 205
5.10.1 Interosseous (Intrinsic) Ligaments ................ 205
5.10.2 Capsular Ligaments of the Wrist (Extrinsic
Ligaments) ........................................ 206
5.10.3 Collateral and Annular Ligaments of Fingers ....... 208
5.10.4 Triangular (Ulnar) Fibrocartilage Complex ......... 208
5.11 Nerve Compression Syndrome ............................... 209
5.11.1 Carpal Tunnel ..................................... 209
5.11.2 Guyon's Canal ..................................... 211
5.11.3 Bowling Thumb...................................... 212
5.11.4 Wartenberg's Syndrome ............................. 212
5.12 Tumors ................................................... 212
5.12.1 Subungual Tumors .................................. 212
5.12.2 Giant Cell Tumors of the Tendon Sheath ............ 213
5.12.3 Rheumatoid Nodules ................................ 214
5.13 Ganglion Cysts and Other Cysts ........................... 214
5.13.1 Ganglion Cysts .................................... 214
5.13.2 (Pure) Cysts ...................................... 216
5.14 Disorders of the Synovial Membranes Including
Chronic Polyarthritis .................................... 217
5.15 Disorders of Tendons ..................................... 218
5.15.1 The Radial Wrist .................................. 219
5.15.2 The Dorsoradial Wrist ............................. 219
5.15.3 Distal Dorsoradial Forearm ........................ 219
5.15.4 The Ulnar Wrist ................................... 220
5.15.5 Flexor Tendons .................................... 220
5.16 Palmar Fibromatosis (Dupuytren's Disease) ................ 220
5.17 Examples of Vascular Diseases ............................ 220
5.18 Pitfalls in Interpreting Images .......................... 221
5.18.1 Incorrect Positioning of the Wrist ................ 221
5.18.2 Vascular Variants ................................. 221
5.18.3 Accessory Muscles and Muscles of Variant
Locations ......................................... 223
5.18.4 Chemical Shift Artefact ........................... 224
5.18.5 Magic Angle Phenomenon ............................ 224
5.18.6 Bone Variants ..................................... 225
5.18.7 Carpe Bossu ....................................... 225
5.18.8 Dorsal and Palmar Entry Points for Nutrient
Vessels in the Carpal Bones ....................... 225
5.18.9 Flexor Tendon Sheaths of the Wrist and Hand ....... 226
5.19 Clinical Relevance of Magnetic Resonance Imaging ......... 226
6 The Hip and Pelvis
M. Notohamiprodjo and M. Vahlensieck
6.1 Introduction ............................................. 234
6.2 Examination Technique .................................... 234
6.2.1 Patient Positioning ............................... 234
6.2.2 Coil Selection .................................... 234
6.2.3 Sequences and Parameters .......................... 234
6.3 Anatomy .................................................. 236
6.4 Avascular Necrosis of the Femoral Head ................... 238
6.5 Transient Osteoporosis ................................... 242
6.6 Perthes' Disease ......................................... 243
6.7 Slipped Capital Femoral Epiphysis ........................ 246
6.8 Hip Dysplasia ............................................ 251
6.8.1 Hip Dysplasia in Neonates and Small Children
(Congenital Hip Displacement) ..................... 251
6.8.2 Hip Dysplasia in Adults ........................... 251
6.9 Trauma, Stress, and Fatigue Fractures .................... 251
6.9.1 Posttraumatic Fractures ........................... 251
6.9.2 Stress and Fatigue Fractures ...................... 252
6.10 Impingement .............................................. 254
6.10.1 Cam Impingement ................................... 254
6.10.2 Pincer Impingement ................................ 254
6.10.3 Other Types of Impingement ........................ 256
6.11 Lesions of the Acetabular Labrum ......................... 257
6.11.1 Anatomic Variants ................................. 258
6.11.2 Labral Tears ...................................... 259
6.12 Degenerative Ligamentum Teres of the Femoral Head ........ 261
6.13 Early-Onset Osteoarthritis and Arthrosis ................ 261
6.14 Inflammatory Diseases .................................... 262
6.14.1 Osteomyelitis and Septic Arthritis ................ 262
6.14.2 Rheumatoid Arthritis .............................. 264
6.15 Diseases of the Capsule and Synovial Membranes ........... 266
6.15.1 Synovial Osteochondromatosis ..................... 266
6.15.2 Synovial Folds (Plicae and Retinacula) ........... 266
6.16 Amyloid Arthropathy ...................................... 267
6.17 Insertional Tendinopathy (Enthesopathy) .................. 267
6.17.1 Insertional Tendinopathy of the Gluteal Tendons ... 268
6.17.2 Insertional Tendinopathy of the Tendons of the
Knee Flexor Group of Muscles ...................... 269
6.17.3 Rare Types of Hip Enthesopathy .................... 270
6.18 Snapping Hip (Coxa Saltans) .............................. 270
6.19 Neurovascular Compression Syndrome ....................... 270
6.20 Tumors ................................................... 270
6.21 Pigmented Villonodular Synovitis ......................... 270
6.22 Pitfalls in Interpreting the Images ...................... 271
6.22.1 Hematopoietic Bone Marrow ......................... 271
6.22.2 Transcortical Synovial Herniation ................. 271
6.22.3 Supra-acetabular Fossa ............................ 272
6.22.4 Bursitis .......................................... 272
6.22.5 Accessory Iliacus Tendon .......................... 272
6.23 Clinical Relevance of Magnetic Resonance Imaging ......... 276
7 The Knee
M. Vahlensieck and A. Horng
7.1 Introduction ............................................. 282
7.2 Examination Technique .................................... 282
7.2.1 Patient Positioning and Coil Selection ............ 282
7.2.2 Sequences and Parameters .......................... 282
7.3 Anatomy .................................................. 282
7.3.1 General Anatomy ................................... 282
7.3.2 Specific Magnetic Resonance Imaging Anatomy ....... 284
7.4 Meniscal Lesions ......................................... 290
7.4.1 Degenerative Changes and Tears .................... 290
7.4.2 Postoperative Changes ............................. 297
7.4.3 Variant Discoid and Ring Meniscus ................. 298
7.4.4 Parameniscal Cysts ................................ 299
7.4.5 Meniscal Ossification and Calcification ........... 300
7.4.6 Meniscal Subluxation (Extrusion) .................. 301
7.5 Cruciate Ligament Injuries ............................... 301
7.5.1 Anterior Cruciate Ligament Acute Tear ............. 301
7.5.2 Posterior Cruciate Ligament ....................... 306
7.5.3 Postoperative Changes to the Cruciate Ligaments ... 307
7.6 Collateral Ligament Injuries ........................ 310
7.6.1 Medial Collateral Ligament Injuries ............... 310
7.6.2 Lateral Collateral Ligament Injuries .............. 311
7.7 Lateral Capsular Ligament Injuries, Including
Popliteus Injuries ....................................... 311
7.8 lliotibial Tract (Band) Syndrome ......................... 311
7.9 Dyskinesia of the Femoropatellar Joint and Patellar
Dislocation .............................................. 312
7.9.1 Impaired Gliding Function ......................... 312
7.9.2 Patellar Dislocation .............................. 314
7.10 Patellar and Quadriceps Tendonitis ....................... 315
7.11 Chondropathy, Early-Onset Osteoarthritis, Arthrosis,
and Cartilage/Chondral Damage ............................ 317
7.11.1 Chondropathy ...................................... 317
7.11.2 Early-Onset Osteoarthritis and Arthrosis .......... 317
7.11.3 Chondral (Cartilage) and Osteochondral Damage ..... 318
7.11.4 Treatment of Cartilage Damage and Posttreatment
Follow-Up with Magnetic Resonance Imaging ......... 320
7.12 Bone Trauma .............................................. 322
7.12.1 Bone Bruises ...................................... 322
7.12.2 Fractures ......................................... 322
7.13 Transient (Regional) Migratory Osteoporosis and
Shifting Bone Marrow Edema of the Knee ................... 324
7.14 Osteochondritis Dissecans and Avascular Necrosis ......... 324
7.14.1 Osteochondritis Dissecans ......................... 324
7.14.2 Spontaneous Idiopathic Osteonecrosis of the
Femoral Condyle (Ahlbдck's Disease) ............... 325
7.14.3 Other Forms of Osteonecrosis in the Knee Region ... 328
7.15 Changes to the Synovial Membrane and Joint Capsule,
Sarcoidosis, and Gout .................................... 328
7.15.1 Rheumatoid Arthritis .............................. 328
7.15.2 Pigmented Villonodular Synovitis .................. 329
7.15.3 Hemophiliac Arthropathy ........................... 331
7.15.4 Sarcoidosis ....................................... 332
7.15.5 Lipoma Arborescens ................................ 332
7.15.6 Amyloid Arthropathy ............................... 333
7.15.7 Chondromatosis .................................... 333
7.15.8 Gout .............................................. 334
7.16 Synovial Plicae (Folds) .................................. 334
7.17 Synovial Popliteal Cysts and Bursitis .................... 336
7.17.1 Synovial Popliteal Cysts .............................. 336
7.17.2 Bursitis .......................................... 339
7.18 Lesions of Hoffa's Fat Pad and Other Fat Pads ............ 340
7.19 Ganglion Cysts (apart from Meniscal Ganglion
Cysts/Parameniscal Cysts) ................................ 341
7.19.1 Intra-articular Ganglion Cysts .................... 342
7.19.2 Extra-articular Ganglion Cysts .................... 342
7.20 Nerve Compression Syndrome and Periarticular Neuropathy .. 342
7.21 Vascular Diseases ........................................ 343
7.22 Special Features in Children ............................. 344
7.23 Common Tumors and Tumorlike Lesions in and around the
Knee ..................................................... 344
7.24 Pitfalls When Interpreting the Images .................... 345
7.24.1 Increased Signal Intensity at the Meniscus
Periphery ......................................... 345
7.24.2 Pulsatile Flow Artefacts of the Popliteal Artery .. 347
7.24.3 Line Artefacts .................................... 347
7.24.4 Bi-, Tri-, and Multipartite Patella ............... 347
7.24.5 Dorsal Defect of the Patella ...................... 347
7.24.6 Accessory Posterior Sesamoids ..................... 347
7.24.7 Calcification ..................................... 348
7.24.8 Meniscomeniscal Ligament .......................... 348
7.24.9 The Articularis (Muscle) .......................... 349
7.24.10 Absorption Cysts at the Insertion of the
Cruciate Ligaments on the Tibial Plateau .......... 349
7.24.11 Asymmetry of the Epiphyseal Plate ................ 349
7.25 Clinical Relevance of Magnetic Resonance Imaging ......... 350
8 The Lower Leg, Ankle, and Foot
M. Vahlensieck, A. Sikorski, and C. Claser
8.1 Introduction ............................................. 358
8.2 Examination Technique .................................... 358
8.2.1 Patient Positioning ............................... 358
8.2.2 Coil Selection .................................... 358
8.2.3 Magnetic Resonance Imaging Protocols with
Regard to Sequences and Parameters ................ 358
8.3 Anatomy .................................................. 359
8.3.1 General Anatomy ................................... 359
8.3.2 Specific Magnetic Resonance Imaging Anatomy ....... 361
8.4 Disorders of Bones ....................................... 367
8.4.1 Osteochondral Injuries, Osteochondritis
Dissecans, and Osteonecrosis of the Talus ......... 367
8.4.2 Apo-and Epiphysitis ............................... 370
8.4.3 Sesamoids and Accessory Bones ..................... 370
8.4.4 Stress Reactions, Stress Fractures, and Occult
Fractures ......................................... 371
8.4.5 Bone Marrow Edema Syndrome of the Foot and
Transient Osteoporosis ............................ 374
8.4.6 Osteomyelitis ..................................... 374
8.4.7 Shin Splint Syndrome .............................. 375
8.4.8 Pediatric Fractures ............................... 375
8.4.9 Tarsal Coalitions ................................. 376
8.4.10 Cartilage Deformity ............................... 379
8.5 Disorders of the Tendons ................................. 379
8.5.1 Achilles Tendon ................................... 382
8.5.2 Plantaris Tendon .................................. 387
8.5.3 Peroneal Tendons .................................. 388
8.5.4 Deep Flexor Tendons ............................... 390
8.5.5 Anterior Muscle Group (Extensor Group) ............ 394
8.6 Ligament Injuries and Impingement Problems following
Ligament Damage .......................................... 395
8.6.1 Talocrural Joint .................................. 395
8.6.2 Lisfranc Injury ................................... 398
8.6.3 Sinus Tarsi Ligament Injuries and Sinus Tarsi
Syndrome .......................................... 398
8.6.4 Plantar Calcaneonavicular Ligament ................ 399
8.6.5 Impingement Syndrome .............................. 399
8.7 Diseases of the Plantar Fascia (Plantar Aponeurosis) ..... 400
8.7.1 Plantar Fasciitis ................................. 401
8.7.2 Plantar Fibromatosis (Ledderhose's Disease) ....... 401
8.7.1 Diseases of the Fat Pads of the Feet and Plantar
Vein Thrombosis ................................... 402
8.9 Disorders of the Nerves and Compression Syndrome ......... 402
8.9.1 Tarsal Tunnel Syndrome ............................ 403
8.9.2 Other Compression Syndromes of the Foot ........... 406
8.10 Osteoarthritis ........................................... 406
8.11 Arthritis ................................................ 406
8.12 Other Form of Synovitis .................................. 406
8.13 Diabetic Foot Syndrome ................................... 406
8.13.1 Diabetic Neuro-Osteoarthropathy .................. 406
8.13.2 Nondiabetic Neuropathy ........................... 409
8.14 Hemophilic Osteoarthropathy .............................. 409
8.15 Bursitis and Haglund's Heel .............................. 409
8.16 Pseudobursae ............................................. 411
8.17 Typical Foot Tumors ...................................... 411
8.17.1 Xanthomas ......................................... 411
8.17.2 Ganglion Cysts .................................... 411
8.17.3 Bone Tumors ....................................... 411
8.17.4 Calcaneal Tumors .................................. 412
8.17.5 Giant Cell Tumors of the Tendon Sheath ............ 412
8.17.6 Malignant Soft Tissue Tumors ...................... 413
8.17.7 Subungual Tumors .................................. 413
8.17.8 Epidermal Inclusion Cysts ......................... 413
8.18 Disorders of the Toes .................................... 414
8.18.1 Trauma ............................................ 414
8.18.2 Sesamoids ......................................... 415
8.18.3 Gout .............................................. 415
8.18.4 Hallux Valgus and Metatarsalgia ................... 415
8.19 Pitfalls in Interpreting Images .......................... 415
8.19.1 Signal Patterns of Anatomic Structures ............ 415
8.19.2 Accessory Bones and Sesamoids ..................... 416
8.19.3 Accessory Muscles ................................. 416
8.20 Clinical Relevance of Magnetic Resonance Imaging ......... 417
9 The Temporomandibular Joint
S. Robinson and R. Fischbach
9.1 Introduction ............................................. 426
9.2 Examination Technique .................................... 426
9.2.1 Patient Positioning ............................... 426
9.2.2 Coil Selection .................................... 426
9.2.3 Sequences and Parameters .......................... 426
9.2.4 Special Examination Techniques .................... 427
9.2.5 Dynamic Studies ................................... 427
9.3 Anatomy .................................................. 428
9.3.1 General Anatomy ................................... 428
9.3.2 Special Magnetic Resonance Imaging and Variants ... 428
9.4 Disorders of the Articular Disk .......................... 430
9.4.1 Abnormal Changes in the Structure and Shape of
the Disk .......................................... 430
9.4.2 Disk Displacement ................................. 431
9.4.3 Disk Adhesion ..................................... 434
9.4.4 Disk Perforation .................................. 434
9.4.5 Malpositions of the Condyle ....................... 434
9.5 Arthritis and Other Synovial Disorders ................... 435
9.5.1 Arthritis ......................................... 435
9.5.2 Other Synovial Disorders .......................... 436
9.6 Bone Disorder ............................................ 436
9.6.1 Osteoarthritis .................................... 436
9.6.2 Trauma ............................................ 437
9.7 Treatment Outcomes ....................................... 438
9.8 Clinical Relevance of Magnetic Resonance
Imaging .................................................. 439
10 The Muscles
A.J. Hoeink, T.-U. Niederstadt, and M. Vahlensieck
10.1 Introduction ............................................. 444
10.2 Examination Technique .................................... 444
10.2.1 Magnetic Resonance Imaging ........................ 444
10.2.2 Special Magnetic Resonance Spectroscopy of the
Muscles ........................................... 444
10.3 Anatomy .................................................. 446
10.3.1 General Anatomy ................................... 446
10.3.2 Specific Magnetic Resonance Imaging and
Functional Anatomy ................................ 453
10.4 Neuropathy ............................................... 455
10.5 Myotonic Disorders ....................................... 456
10.6 Muscular Dystrophy .................................. 456
10.7 Inflammatory Myopathy .................................... 457
10.7.1 Polymyositis, Dermatomyositis, and Inclusion
Body Myositis ..................................... 457
10.7.2 Viral and Bacterial Myositis ...................... 458
10.7.3 Pyomyositis ....................................... 458
10.7.4 Sarcoidosis ....................................... 458
10.8 Muscle Changes after Radiotherapy and Local
Chemotherapy ............................................. 460
10.8.1 Radiotherapy ...................................... 460
10.8.2 Local Chemotherapy ................................ 460
10.9 Traumatic Myopathy ....................................... 461
10.9.1 Acute Muscle Overload ............................. 461
10.9.2 Chronic Overload .................................. 464
10.10 Muscle Fibrosis ......................................... 465
10.11 Compartment Syndrome .................................... 467
10.12 Rhabdomyolysis .......................................... 467
10.13 Secondary Myopathy ...................................... 467
10.14 Muscle Tumors ........................................... 468
10.15 Pitfalls in Interpreting the Images ..................... 468
10.15.1 Signal Variations in Superficial Muscles ......... 468
10.15.2 Inversion Recovery Sequences ..................... 468
10.15.3 Misinterpretation of Findings in Association
with Denervation ................................. 468
10.16 Clinical Relevance of Magnetic Resonance Imaging ........ 469
11 Bone Marrow
M. D'Anastasi, M. Vahlensieck, and A. Baur-Melnyk
11.1 Examination Technique .................................... 474
11.2 Anatomy .................................................. 475
11.2.1 General Anatomy ................................... 475
11.2.2 Specific Magnetic Resonance Imaging Anatomy ....... 476
11.3 Generalized Disorders .................................... 478
11.3.1 Reconversion and Hyperplasia ...................... 479
11.3.2 Cell Infiltration, Displacement, Uncontrolled
Hyperplasia, and Skeletal Dysplasia ............... 481
11.3.3 Sclerotic Skeletal Dysplasia ...................... 492
11.3.4 Hypoplasia and Fatty Replacement .................. 492
11.3.5 Bone Marrow Fibrosis .............................. 493
11.3.6 Serous Atrophy .................................... 493
11.3.7 Storage Diseases .................................. 494
11.3.8 Posttransplant Bone Marrow Changes ................ 495
11.4 Focal Diseases ........................................... 496
11.4.1 Edema ............................................. 496
11.4.2 Ischemia .......................................... 497
11.4.3 Postradiation Changes ............................. 497
11.4.4 Inflammation ...................................... 500
11.4.5 Trauma ............................................ 504
11.5 Clinical Relevance of Magnetic Resonance Imaging ......... 509
12 Bone and Soft Tissue Tumors
M. Vahlensieck and A. Baur-Melnyk
12.1 Introduction ............................................. 516
12.2 Examination Technique .................................... 516
12.3 Tumo: General Information ................................ 516
12.3.1 Comparison of Benign and Malignant Tumors ......... 516
12.3.2 Characteristic Signal Intensity Patterns .......... 518
12.3.3 Staging ........................................... 520
12.3.4 Biopsy Planning ................................... 527
12.3.5 Monitoring the Response to Chemotherapy ........... 527
12.3.6 Tumor Recurrence and Postoperative Fibrosis and
Edema ............................................. 528
12.3.7 Effects of Radiochemotherapy on Healthy Bone ...... 528
12.4 Tumors: Specific Section ................................. 529
12.4.1 Bone Tumors ....................................... 529
12.4.2 Soft Tissue Tumors ................................ 549
12.4.3 Solid Tumors with Cyst-Isointense Signal Pattern .. 564
12.4.4 Metastases ........................................ 566
12.4.5 Pseudotumors and Tumorlike Substance Deposits,
Paget's Disease ................................... 567
12.4.6 Extramedullar Hematopoiesis ....................... 568
12.4.7 Chloroma (Granulocytic Sarcoma) ................... 568
13 Osteoporosis
S. Crampp, M. Vahlensieck, and H.K. Cenant
13.1 Introduction ............................................. 574
13.2 Examination Technique .................................... 574
13.2.1 Magnetic Resonance Imaging ........................ 574
13.2.2 Relaxation Time Measurements and Spectroscopy ..... 579
13.3 Clinical Relevance of Magnetic Resonance Imaging ......... 581
14 The Sacroiliac Joints
M. Bollow, J. Braun, and K.-G. Hermann
14.1 Introduction ............................................. 586
14.2 Examination Technique .................................... 586
14.2.1 Patient Positioning and Coil Selection ............ 586
14.2.2 Imaging Planes .................................... 586
14.2.3 Sequences ......................................... 586
14.3 Anatomy .................................................. 587
14.3.1 General Anatomy ................................... 587
14.3.2 Special Magnetic Resonance Imaging Anatomy ........ 588
14.3.3 Variants .......................................... 590
14.3.4 Enthesis Organ .................................... 590
14.4 Causes of Sacroiliitis ................................... 595
14.5 Inflammatory Rheumatoid Disorders of the Sacroiliac
Joints ................................................... 595
14.5.1 Spondyloarthritis ................................. 595
14.5.2 Juvenile Spondyloarthritis ........................ 598
14.5.3 Magnetic Resonance Imaging Findings for
Inflammatory Rheumatoid Sacroiliitis .............. 598
14.5.4 Staging and Scoring ............................... 608
14.6 Osteoarthrosis Deformans and Juxta-Articular
Pneumatocysts ............................................ 611
14.7 Disseminated Idiopathic Skeletal Hyperostosis ............ 611
14.8 Osteitis Condensans Ilii and Sacri as well as
Triangular Hyperostosis Ilii and Sacri .................. 613
14.9 Osteomalacia ............................................ 619
14.10 Pyogenic, Septic Sacroiliitis ........................... 619
14.11 Tuberculous Sacroiliitis ................................ 621
14.12 Traumatic Changes ....................................... 621
14.13 Tumor and Tumorlike Conditions of the Joint ............. 621
15 The Jaws and Periodontal Apparatus
S. Robinson
15.1 Introduction ............................................. 634
15.2 Examination Technique .................................... 634
15.2.1 Equipment and Coils ............................... 634
15.2.2 Imaging Plane ..................................... 634
15.2.3 Sequences ......................................... 635
15.3 Anatomy .................................................. 635
15.3.1 General Anatomy ................................... 635
15.3.2 Special Magnetic Resonance Imaging ................ 635
15.4 Special Disorders ........................................ 636
15.4.1 Periodontitis ..................................... 636
15.4.2 Osteitis and Osteomyelitis ........................ 637
15.4.3 Osteoradionecrosis and Bisphosphonate-Induced
Osteonecrosis of the Jaw .......................... 638
15.4.4 Dentogenic Sinusitis .............................. 639
15.4.5 Pulp Vitality ..................................... 640
15.4.6 Implantology ...................................... 640
15.4.7 Differentiation between Solid and Cystic Changes .. 640
15.5 Clinical Relevance of Magnetic Resonance
Imaging .................................................. 643
16 Appendix
M. Vahlensieck
16.1 Other Disorders and Diagnoses ............................ 648
16.1.1 Differential Diagnosis of Swollen Extremities on
Magnetic Resonance Imaging ........................ 648
16.1.2 The Skin, Subcutaneous Tissues, and Fascia ........ 648
16.1.3 Chronic Sports Injuries ........................... 652
16.2 Other Aspects of Magnetic Resonance
Imaging of the Musculoskeletal System .................... 654
16.2.1 Magic Angle Phenomenon ............................ 654
16.2.2 Use of Dedicated Systems .......................... 656
16.2.3 Use of 3Tesla Systems ............................. 656
16.2.4 Use of Open High Field Systems .................... 657
16.2.5 Use of Open Spinal Systems for Upright Imaging .... 658
Index ......................................................... 661
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