196_eposter - Stanley Radiology

Report
A PICTORIAL REVIEW
EDUCATIONAL EXHIBIT
ABSTRACT ID: IRIA – 1177
Authors: Dr Subarekha T B*, Dr Mohan Kumar Y*, Dr Murugesan A*, Dr Anbarasu
A**, Dr Sivasubramanian B**,
Institution: * Jansons MRI diagnostics Pvt Ltd, Erode.
** SRL diagnostics-Hi tech scans, RS puram, Coimbatore.
MENISCAL TEARS
 A tear is a well defined high signal area reaching up to
the articular surface in at least 2 imaging planes or an
area of distortion in the absence of prior surgery.
 Horizontal, Longitudinal, Radial, Root, Complex,
Displaced
NOT
TEAR
HORIZONTAL TEAR- PARALLEL TO THE TIBIAL PLATEAU
Coronal (a) and Sagittal (b) PDFS images demonstrating high signal area
(arrow) in the anterior horn of lateral meniscus reaching the inferior
meniscal surface parallel to the tibial plateau consistent with horizontal tear
HORIZONTAL TEAR
Coronal PDFS (c) and T1(d) images demonstrating horizontal tear (arrow) of the
body of medial meniscus
LONGITUDINAL TEAR - parallel to long axis of the
menisci
Coronal PDFS (a) and T1(b) images demonstrating high signal area (arrow)
in the posterior horn of medial meniscus reaching the articulating surface
perpendicular to the tibial plateau consistent with longitudinal tear
LONGITUDINAL TEAR
Coronal (c) and sagittal PDFS(d) images demonstrating high signal area
(arrow) in the posterior horn of medial meniscus reaching the articulating
surface perpendicular to the tibial plateau consistent with longitudinal tear
LONGITUDINAL TEAR
Coronal PDFS (c) and PD (d) images demonstrating high signal area
(arrow) in the posterior horn of medial meniscus reaching the articulating
surface perpendicular to the tibial plateau consistent with longitudinal tear
RADIAL TEAR perpendicular to the long axis of both tibial plateau and the meniscus.
Extends from free edge towards periphery
Sequential Coronal PD FSE (d and e )demonstrating cleft and marching cleft
signs of radial tear (arrow). Truncated triangle sign is also seen in (e). A radial
tear is seen along the free edge of the anterior horn of medial meniscus.
ROOT TEAR
Sagittal (a) and coronal (b) PDFS images demonstrating high signal area
(arrow) in the posterior root of medial meniscus consistent with root tear.
COMPLEX TEAR Combination of two or more components
complex
Coronal PDFS (a) and(b) images demonstrating complex tear with
horizontal (straight arrow) and longitudinal (curved arrow)components of
the body and posterior horn of medial meniscus. A paramniscal cyst (arrow)
is seen adjacent the posterior horn in sagittal PDFS (c)image.
COMPLEX TEAR
Coronal PD (a) and(b) images demonstrating complex tear with horizontal
(straight arrow) and longitudinal (curved arrow)components of the body
and posterior horn of medial meniscus. A paramniscal cyst (arrow) is seen
adjacent the posterior horn in sagittal PD (c)image.
DISPLACED TEARS
 Displaced longitudinal tear – bucket handle tear
 Displaced horizontal tear – flap tear
 Displaced radial tear – parrot beak tear.
BUCKET HANDLE TEAR Longitudinal tear with central
migration of the inner fragment (handle).
Coronal PDFS and PD images demonstrating displaced central fragment of the
medial meniscus consistent with bucket handle tear. The displace fragment is in
the intercondylar fossa forming ‘fragment in the notch’ sign.
BUCKET HANDLE TEAR
Sagittal PDFS (c) and PD (d) images demonstrating displaced central fragment
(straight arrow) paralleling posterior cruciate ligament (curved arrow) forming
double PCL sign.
BUCKET HANDLE TEAR
Axial PDFS image (e) demonstrating displaced central fragment
(arrow) in the intercondylar notch diagnostic of bucket handle tear.
Sagittal PDFS (f) image demonstrating absent bow tie sign.
FLAP TEAR- Displaced horizontal tear.
Sagittal (a) and coronal (b)PDFS images demonstrating displaced horizontal flap
tear of the medial meniscus (arrow in a). There is horizontal flap tear of the
posterior horn of medial meniscus with flipped meniscus in the intercondylar
notch (arrow in b)
FLAP TEAR
Axial (c) and sagittal (d)PDFS images demonstrating displaced horizontal flap
tear of the lateral meniscus. There is horizontal flap tear of the posterior horn of
lateral with flipped meniscus anterior to anterior horn.
FLAP TEAR
Coronal (e) and sagittal (f)PDFS images demonstrating displaced horizontal flap
tear of the medial meniscus. There is horizontal flap tear of the body of meniscus
(arrow) with displaced fragment superior to posterior horn.
References:
 Jie C. Nguyen, MS Arthur A. De Smet, Ben K. Graf, Humberto G. Rosas. MR
Imaging–based Diagnosis and Classification of Meniscal Tears. RadioGraphics
2014; 34:981–999.
 Arthur A. De Smet. How I Diagnose Meniscal Tears on Knee MRI. AJR 2012;
199:481–499.
 Shetty D S, Lakhkar B N, Krishna G K. Magnetic resonance imaging in
pathologic conditions of knee. Indian J Radiol Imaging 2002;12:375-81.
 Prasad A, Brar R, Rana S. MRI imaging of displaced meniscal tears: Report of a
case highlighting new potential pitfalls of the MRI signs. Indian J Radiol
Imaging 2014;24:291-6.

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