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Musculoskeletal Imaging

E3219. Focused Ultrasound in the Evaluation of Musculoskeletal Disorders: Applications and Techniques

Gholamrezanezhad A,  Kosaraju V,  Paspulati R. University Hospitals Cleveland Medical Center, Case Reserve University, Cleveland, OH

Address correspondence to A. Gholamrezanezhad (a.gholamrezanezhad@yahoo.com)

Background Information: Musculoskeletal ultrasound is widely gaining acceptance by orthopedic surgeons and rheumatologists as an effective diagnostic modality and is rapidly growing in the medical community of the United States. Musculoskeletal radiologists have also shown extensive interest in clinical application of ultrasound in the diagnosis of musculoskeletal disorders. A thorough understanding of the technique, pitfalls, clinical applications, and limitations of this imaging modality is essential for appropriate use of musculoskeletal ultrasound by radiologists.

Educational Goals/Teaching Points: The aims of this educational exhibit are to highlight the role of ultrasound in the imaging of ligaments, tendons, soft tissues, joints, and osseous structures and review the technical details of ultrasound imaging in musculoskeletal system. Participants will be able to describe the key ultrasound findings in musculoskeletal disorders and apply this knowledge to diagnostic and therapeutic management of patients. We will also illustrate the diagnostic performance of ultrasound compared to CT and MRI in the diagnosis of musculoskeletal disorders and discuss its added or complementary value.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: In this educational exhibit, we will cover ultrasound technique (transducers; frequency range, 3.5 MHz and 7.5–18 MHz) and linear array including stand-off pads, extended FOV, split screens (comparison of color and power Doppler), and specifications for shoulder, elbow, hand and wrist, hip, knee, and ankle. We will also cover the clinical applications for muscular disorders (muscle injury, inflammatory disease, and mass lesions), articular disorders (intraarticular bodies and joint effusion), tendon or ligament disorders (tendinitis and traumatic tendon and ligament injuries), nerve disorders (entrapments, neuropathy, and mass lesions), and pediatric pathologies (hip dislocations, painful joint, torticollis, and soft tissue masses). Lastly, we will review planning and guiding an invasive procedure and evaluation after surgery as well as pitfalls and advances and future directions.

Conclusion: Focused ultrasound is a useful imaging tool to evaluate musculoskeletal disorders, such as tendon and muscular injuries, inflammatory disease (such as synovitis, tenosynovitis, and bursitis), and articular changes (including bone erosions and cartilage damage). Moreover, musculoskeletal ultrasound is a valuable tool to monitor the response to different therapies and guide local diagnostic and therapeutic procedures. Musculoskeletal radiologists should continue to increase their familiarity with this imaging technique and its advantages and limitations to improve and increase its clinical applications in daily practice of skeletal radiology.