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Книги по МРТ КТ на английском языке / MRI for Orthopaedic Surgeons Khanna ed 2010

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Preface

Although the ability to evaluate MRI studies is critical to the practice of orthopaedic surgery, most orthopaedic surgeons learn this skill in an informal fashion and with experience throughout their training and in clinical practice. As a result, we may not have a thorough understanding of the science and physics of MR imaging and the various pulse sequences that are available for obtaining the images. Many of us—those in general orthopaedic surgery practice as well as those in subspecialties such as sports medicine, spine surgery, hand and upper extremity surgery, foot and ankle surgery, and orthopaedic oncology—prefer to read our patients’ MR imaging studies ourselves rather than rely solely on the “o cial” radiologist’s report. We learn to make preoperative, intraoperative, and postoperative decisions based on those readings. However, unlike radiologists who are trained to evaluate MRI studies in a systematic fashion, we may be more likely to rely on our anatomic expertise and experience, which may not be the most e ective method.

MRI for Orthopaedic Surgeons will help teach orthopaedic surgeons how to systematically evaluate and interpret MR imaging studies of the musculoskeletal system. Although there are many excellent books that focus on MR imaging of the musculoskeletal system, this one is unique in that it is written by orthopaedic surgeons and radiologists specifically for orthopaedic surgeons. As such, it is clinically oriented and presents the information from a perspective and at a level that an orthopaedic surgeon will appreciate. It is also an excellent reference for radiologists and others—such as physical medicine and rehabilitation clinicians, rheumatologists, and nonoperative musculoskeletal care specialists— who read musculoskeletal MR images and who would like to gain a better appreciation of the associated clinical aspects.

My desire to create this book stems from my interest and background in musculoskeletal imaging and from my recognition of the fact that the ability to accurately evaluate MR imaging studies is critical to the practice of orthopaedic surgery. Along these lines, my colleagues and I have developed

instructional materials and lectures for the orthopaedic surgery residents at our institution to teach them how to systematically evaluate MR imaging studies of the musculoskeletal system. In doing so, we realized that many of the textbooks and other resources on the topic of musculoskeletal MRI are written by radiologists and directed toward radiologists and radiologists in training. This perceived void of imaging resources for orthopaedic surgeons led me to compile and edit this textbook.

MRI for Orthopaedic Surgeons is organized into five sections: 1) core concepts, 2) upper extremity, 3) lower extremity, 4) spine, and 5) special considerations. Each of these five sections, or each chapter, can be read independently, but the textbook is best read in sequential chapter order. In particular, before reading the chapters on individual anatomic areas, the clinician should review Chapter 2, Normal MRI Anatomy of the Musculoskeletal System. That chapter provides a moderately comprehensive evaluation of the key anatomic structures and concepts with which one should be familiar when reviewing an MR imaging study of a particular region; it also serves as a reference point when evaluating the pathology images in a region-specific chapter.

The book features two di erent types of chapters: regionspecific and concept-specific. The region-specific chapters (for example, The Shoulder and The Cervical Spine) share a common organization, with sections on specialized pulse sequences and protocols, traumatic pathology, degenerative pathology, infectious conditions, and postoperative findings. The concept-specific chapters (for example, Advanced Techniques in Musculoskeletal MRI) are organized in a fashion that best suits the individual chapter’s content and the goal of providing orthopaedic surgeons with the information they need to maximize their proficiency in evaluating and interpreting MR imaging studies.

MRI for Orthopaedic Surgeons contains more than 700 MR images and 130 artist’s drawings that have been carefully selected and created to help illustrate and teach the essential anatomy and pathology that an orthopaedic surgeon,

xi

xii Preface

other clinician, or radiologist should be able to recognize and

has been specifically designed with an orthopaedic surgeon

define when evaluating an MRI study of the musculoskeletal

audience in mind. The collaboration between orthopaedic

system. As such, much of the material can be learned e ec-

surgeons and radiologists that we have used to produce this

tively by reviewing the images and illustrations along with

textbook emulates the optimal relationship between these

the associated figure legends.

two subspecialties in clinical practice.

Most of the chapters have been authored by both ortho-

This book was envisioned to be a practical aid to develop

paedic surgeons and radiologists. Some, such as the region-

and/or refine the skills needed to e ectively and system-

specific chapters, have orthopaedic surgeons as the primary

atically evaluate MR imaging studies of the musculoskeletal

authors, with radiologists as co-authors for accuracy and

system. I hope that it accomplishes this goal for you.

clarity from their standpoint. Others (for example, Essen-

 

tials of MRI Physics and Pulse Sequences) have been written

 

solely by radiologists, but the presentation of the material

A. Jay Khanna, MD, MBA

Acknowledgments

First and foremost, I would like to thank the many contributors to this text for their time, patience, and hard work. They have made this undertaking infinitely easier and allowed all of us to benefit from their years of experience.

Special thanks go to Kay Conerly, Dominik Pucek, and Torsten Scheihagen at Thieme for their expertise and outstanding e orts in bringing this book through the publishing process. Thanks also go to Tony Pazos, medical illustrator extraordinaire, for his skill, attention to detail, and willingness to work through many rounds of revisions.

Finally, I would like to express my greatest appreciation to Elaine Henze, Medical Editor for The Johns Hopkins University’s Department of Orthopaedic Surgery. She, with the support of Sara Cleary, has spent countless hours at work and on her own time helping me edit the first and second (and fifth!) iterations of every chapter, table, image, and legend. Without her commitment to accuracy, focus on quality, and resolution in handling innumerable e-mails, telephone calls, and personal visits with me and the contributors, this book would never have been completed.

xiii

Contributors

EDITOR

A. Jay Khanna, MD, MBA

Associate Professor

Departments of Orthopaedic Surgery

and Biomedical Engineering

The Johns Hopkins University School of Medicine

Baltimore, Maryland

Co-Director

Division of Spine Surgery

Johns Hopkins Orthopaedic Surgery at Good

Samaritan Hospital

Baltimore, Maryland

CONTRIBUTORS

Mark W. Anderson, MD

Professor

Departments of Radiology and Orthopaedic Surgery

University of Virginia

Charlottesville, Virginia

Chief

Division of Musculoskeletal Radiology

University of Virginia

Charlottesville, Virginia

Douglas P. Beall, MD

Chief of Radiology Services

Clinical Radiology of Oklahoma

Oklahoma City, Oklahoma

Clinical Professor

Department of Orthopaedic Surgery and Rehabilitation

University of Oklahoma College of Medicine

Oklahoma City, Oklahoma

Lance M. Brunton, MD

Assistant Professor

Department of Orthopaedic Surgery

University of Pittsburgh School of Medicine

University of Pittsburgh Medical Center

Division of Hand, Upper Extremity, and Microsurgery

Pittsburgh, Pennsylvania

Jacob M. Buchowski, MD, MS

Assistant Professor of Orthopaedic and Neurological

Surgery

Washington University in St. Louis

St. Louis, Missouri

Director

Center for Spinal Tumors

Washington University in St. Louis

St. Louis, Missouri

John T. Campbell, MD

Attending Orthopaedic Surgeon

Institute for Foot and Ankle Reconstruction Mercy Medical Center

Baltimore, Maryland

John A. Carrino, MD, MPH

Associate Professor

Russell H. Morgan Department of Radiology

and Radiological Science

Department of Orthopaedic Surgery

The Johns Hopkins University School of Medicine

Baltimore, Maryland

Section Chief

Musculoskeletal Radiology

Russell H. Morgan Department of Radiology

and Radiological Science

The Johns Hopkins Hospital

Baltimore, Maryland

Brett M. Cascio, MD

Head Team Physician

McNeese State University

Lake Charles, Louisiana

Medical Director

Lake Charles Memorial Sports Medicine

Lake Charles, Louisiana

Gratis Faculty

Louisiana State University

Baton Rouge, Louisiana

Major

U.S. Army Reserve

xv

xvi Contributors

A. Bobby Chhabra, MD

Associate Professor and Vice Chair

Department of Orthopaedic Surgery

University of Virginia Health System

Charlottesville, Virginia

Chief

Division of Hand and Upper Extremity Surgery

University of Virginia Health System

Charlottesville, Virginia

Andrew J. Cosgarea, MD

Professor

Department of Orthopaedic Surgery

The Johns Hopkins University School of Medicine

Baltimore, Maryland

Division Chief

Sports Medicine and Shoulder Surgery

The Johns Hopkins Hospital

Baltimore, Maryland

Aditya R. Daftary, MBBS

Consultant Radiologist

Innovision Imaging

Mumbai, India

J. Dana Dunleavy, MD

Resident

Russell H. Morgan Department of Radiology

and Radiological Science

The Johns Hopkins University School of Medicine

The Johns Hopkins Hospital

Baltimore, Maryland

Daniel J. Durand, MD

Senior Resident

Russell H. Morgan Department of Radiology

and Radiological Science

The Johns Hopkins University School of Medicine

Division of Musculoskeletal Radiology

The Johns Hopkins Hospital

Baltimore, Maryland

Adam J. Farber, MD

Orthopaedic Surgeon

Arizona Orthopedic Surgical Specialists

Chandler, Arizona

Laura M. Fayad, MD

Associate Professor

Russell H. Morgan Department of Radiology

and Radiological Science

Department of Orthopaedic Surgery

The Johns Hopkins University School of Medicine

Baltimore, Maryland

Radiologist

The Johns Hopkins Hospital

Baltimore, Maryland

Li Foong Foo, MD

Assistant Professor

Radiology

Weill Medical College

Cornell University

New York, New York

Assistant Attending Radiologist

New York Presbyterian Hospital

New York, New York

Frank J. Frassica, MD

Chairman and Robert A. Robinson Professor

Department of Orthopaedic Surgery

The Johns Hopkins University School of Medicine

Baltimore, Maryland

Sergio A. Glait, MD

Resident

Department of Orthopaedic Surgery

New York University Hospital for Joint Diseases New York, New York

Ziya L. Gokaslan, MD, FACS

Donlin M. Long Professor

Professor of Neurosurgery, Oncology, and Orthopaedic

Surgery

Vice-Chair

Department of Neurosurgery

Director

Neurosurgical Spine Program

Department of Neurosurgery

The Johns Hopkins University School of Medicine

Baltimore, Maryland

Timothy S. Johnson, MD

Assistant Professor

Department of Orthopaedic Surgery

The Johns Hopkins University School of Medicine

Baltimore, Maryland

Orthopaedic Surgeon

National Sports Medicine Institute

Lansdowne, Virginia

Bryan T. Kelly, MD

Assistant Professor

Orthopaedic Surgery

Weill Medical College

Cornell University

New York, New York

 

Contributors xvii

Assistant Attending

Joseph R. O’Brien, MD, MPH

 

Department of Orthopaedic Surgery

Assistant Professor

Hospital for Special Surgery

Departments of Orthopaedic Surgery and Neurosurgery

New York Presbyterian Hospital

The George Washington University School of Medicine

New York, New York

Washington, District of Columbia

Edward F. McCarthy, MD

Associate Director of Orthopaedic Spine Surgery

The George Washington University Hospital

Professor

Washington, District of Columbia

Departments of Pathology and Orthopaedic Surgery

 

 

The Johns Hopkins University School of Medicine

Gbolahan O. Okubadejo, MD

Baltimore, Maryland

Orthopaedic Spine Surgeon

 

Attending Orthopaedic Surgeon and Pathologist

Active Joints Orthopaedics

The Johns Hopkins Hospital

Englewood Hospital

Baltimore, Maryland

Englewood, New Jersey

Edward G. McFarland, MD

Orthopaedic Spine Surgeon

Holy Name Hospital

Wayne H. Lewis Professor of Orthopaedics

Teaneck, New Jersey

and Shoulder Surgery

 

 

Vice-Chairman

Orthopaedic Spine Surgeon

Department of Orthopaedic Surgery

Meadowlands Hospital

The Johns Hopkins University School of Medicine

Secaucaus, New Jersey

Baltimore, Maryland

 

 

Douglas N. Mintz, MD

Derek F. Papp, MD

Chief Resident

Associate Professor

Department of Orthopaedic Surgery

Clinical Radiology

The Johns Hopkins University School of Medicine

Weill Medical College

The Johns Hopkins Hospital

Cornell University

Baltimore, Maryland

New York, New York

 

 

Attending Physician

Hollis G. Potter, MD

Hospital for Special Surgery

Chief

New York Presbyterian Hospital

MRI Division

New York, New York

Department of Radiology and Imaging

Ali Moshirfar, MD

Hospital for Special Surgery

New York, New York

Assistant Professor

Professor

Department of Orthopaedic Surgery

Radiology

The Johns Hopkins University School of Medicine

Weill Medical College

Baltimore, Maryland

Cornell University

 

Director

New York, New York

Center for Advanced Orthopaedics and Pain Management

Priya D. Prabhakar, MD, MPH

Ashburn, Virginia

Luis E. Moya, MD

Clinical Assistant Professor

Department of Radiology

Clinica Alemana de Santiago

Je erson Medical College

Santiago, Chile

Thomas Je erson University

Rick W. Obray, MD

Philadelphia, Pennsylvania

Sta Radiologist

Fellow

Interventional Pain Medicine

Albert Einstein Medical Center

Mayo Clinic

Philadelphia, Pennsylvania

Rochester, Minnesota

 

 

xviii Contributors

Douglas E. Ramsey, MD

Instructor

Diagnostic Radiology

Russell H. Morgan Department of Radiology

and Radiological Science

The Johns Hopkins University School of Medicine

Baltimore, Maryland

Fellow

Musculoskeletal Radiology

Russell H. Morgan Department of Radiology

and Radiological Science

The Johns Hopkins Hospital

Baltimore, Maryland

John D. Reeder, MD, FACR

Director of Imaging

Proscan Imaging Columbia

Columbia, Maryland

Daniel M. Sciubba, MD

Assistant Professor

Department of Neurosurgery

The Johns Hopkins University School of Medicine

Baltimore, Maryland

Director

Minimally Invasive Spine Surgery

Department of Neurosurgery

The Johns Hopkins Hospital

Baltimore, Maryland

Director

Spine Research

Department of Neurosurgery

The Johns Hopkins Hospital

Baltimore, Maryland

Meena W. Shatby, MD

The Woodlands Sports Medicine

The Woodlands, Texas

Michael K. Shindle, MD

Orthopaedic Fellow

Hospital for Special Surgery

New York, New York

Paul D. Sponseller, MD, MBA

Professor and Executive Vice Chair

Pediatrics Division Chief

Department of Orthopaedic Surgery

The Johns Hopkins University School of Medicine

The Johns Hopkins Hospital

Baltimore, Maryland

Uma Srikumaran, MD

Chief Resident

Department of Orthopaedic Surgery

The Johns Hopkins University School of Medicine

The Johns Hopkins Hospital

Baltimore, Maryland

Bruce A. Wasserman, MD

Associate Professor

Russell H. Morgan Department of Radiology

and Radiological Science

The Johns Hopkins University School of Medicine

Baltimore, Maryland

Director of Diagnostic Neurovascular Imaging

The Johns Hopkins Hospital

Baltimore, Maryland

Monica D. Watkins, MD

Fellow

Neuroradiology

The Johns Hopkins Hospital

Baltimore, Maryland

Radiologist

American Radiology

Baltimore, Maryland

Lukas P. Zebala, MD

Chief Resident

Department of Orthopaedic Surgery

Washington University in St. Louis School of Medicine

Barnes-Jewish Hospital at Washington University Medical

Center

St. Louis, Missouri

Abbreviations

Abbreviation

Definition

Abbreviation

Definition

2D

two-dimensional

MCP

metacarpophalangeal

3D

three-dimensional

MFH

malignant fibrous histiocytoma

AC

acromioclavicular

MGHL

middle glenohumeral ligament

ACL

anterior cruciate ligament

MR

magnetic resonance

AIDS

acquired immune deficiency

MRI

magnetic resonance imaging

 

syndrome

MTP

metatarsophalangeal

AP

anteroposterior

OCD

osteochondritis dissecans

CSF

cerebrospinal fluid

 

OR osteochondral defect

CT

computed tomography

PCL

posterior cruciate ligament

CVJ

craniovertebral junction

PVNS

pigmented villonodular synovitis

ECU

extensor carpi ulnaris

RA

rheumatoid arthritis

FDA

Food and Drug Administration

RCL

radial collateral ligament

FHL

flexor hallucis longus

RF

radiofrequency

FSE

fast spin echo

SE

spin echo

HAGHL

humeral avulsion of the

SLAP

superior labrum anterior and

 

glenohumeral ligament

 

posterior (lesions)

HIV

human immunodeficiency virus

SPONK

spontaneous osteonecrosis of

IGHL

inferior glenohumeral ligament

 

the knee

IP

interphalangeal

STIR

short tau inversion recovery

ITB

iliotibial band

TE

echo time

LCL

lateral collateral ligament

TFCC

triangular fibrocartilage complex

LUCL

lateral ulnar collateral ligament

TR

repetition time

MCL

medial collateral ligament

UCL

ulnar collateral ligament

xix