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ImagingofBonesandJoints
AConcise,MultimodalityApproach
KlausBohndorf,MD
ProfessorofRadiology
MRHighfieldCenter
DepartmentofBiomedicalImagingandImage-guidedTherapy
MedicalUniversityofVienna
Vienna,Austria
MarkW.Anderson,MD
ProfessorofRadiology
MSKImaging
DepartmentofRadiology
UniversityofVirginia
Charlottesville,Virginia,USA
MarkDavies,MRCP,FRCR
ProfessorofRadiology
DepartmentofRadiology
RoyalOrthopaedicHospital
Birmingham,UK
HerwigImhof,MD
ProfessorofRadiology
FormerlyDepartmentofBiomedicalImagingandImage-guidedTherapy

MedicalUniversityofVienna
Vienna,Austria
KlausWoertler,MD
ProfessorofRadiology
DepartmentofRadiology
TechnicalUniversityofMunich
Munich,Germany


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Translator: Grahame Larkin, Stuttgart, Germany Illustrator: Christiane and Dr. Michael von Solodkoff,
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Contents
1

AcuteTraumaandOveruseInjuries:Essentials

1.1

Normal Skeletal Development, Variations, and Transitions to Pathologic Conditions (W.
Michl)

1.1.1

NormalSkeletalDevelopment

1.1.2

VariationsandDisturbancesofSkeletalDevelopment

1.1.3

TransitionstoPathologicStates

1.2

Fractures:Definition,Types,andClassifications(K.Bohndorf)

1.2.1

DefinitionandClassification

1.2.2

FractureTypes

1.2.3

Classifications

1.3

FracturesinChildren(W.Michl)

1.3.1

SpecialFeaturesofFracturesinChildren

1.3.2

Battered-ChildSyndrome

1.4

FracturesoftheArticularSurfaces:Subchondral,Chondral,andOsteochondralFractures
(K.Bohndorf,S.Trattnig)

1.4.1

SubchondralFracture

1.4.2

ChondralFracture

1.4.3

OsteochondralFracture

1.5

StressandInsufficiencyFractures(K.Bohndorf)

1.5.1

Classification

1.5.2

InsufficiencyFracturesandDestructiveArthropathy

1.5.3

PathologicFractures

1.5.4

TransientOsteoporosisandTransientBoneMarrowEdema

1.6

FractureHealing

1.6.1

PrimaryFractureHealing(DirectCorticalReconstruction)(K.Bohndorf)

1.6.2

SecondaryFractureHealing(FractureHealingbyCallusFormation)(K.Bohndorf)

1.6.3

RadiologicalAssessmentafterFractureFixationofthePeripheralSkeleton(E.Knoepfle)

1.6.4

RadiologicalAssessmentafterImplantationofaJointProsthesisinthePeripheralSkeleton(E.
Knoepfle)

1.7

ComplicationsafterFractures

1.7.1

DelayedUnion,Nonunion,andPosttraumaticBoneCystFormation(K.Bohndorf)

1.7.2

PosttraumaticDisturbancesofGrowthinChildrenandAdolescents(W.Michl)

1.7.3

DisuseOsteoporosis(K.Bohndorf)


1.7.4

ComplexRegionalPainSyndrome(K.Bohndorf)

1.7.5

PosttraumaticOsteoarthritis(K.Bohndorf)

1.8

TraumaticandOveruseInjuriestoMuscles,Tendons,andTendonInsertions(K.Bohndorf,
A.Seifarth)

1.8.1

Muscles

1.8.2

Tendons

1.8.3

TendonInsertions(Enthesopathy)

1.9

PracticalAdviceonDiagnosticRadiographyinTraumatology(K.Bohndorf)

1.9.1

ReportofFindings

1.9.2

Follow-UpReviews

1.9.3

WhattoAvoid

2

AcuteTraumaandChronicOveruse(AccordingtoRegion)

2.1

CranialVault,FacialBones,andSkullBase(H.Imhof,N.Jorden)

2.1.1

FracturesoftheCranialVault

2.1.2

BasilarSkullFractures

2.1.3

FracturesofthePetrousBone

2.1.4

FacialBoneFractures

2.2

Spine

2.2.1

Anatomy,Variants,Technique,andIndications(T.Grieser)

2.2.2

MechanismsofInjuryandClassifications(T.Grieser)

2.2.3

SpecialTraumatologyoftheCervicalSpineandtheCraniocervicalJunction(T.Grieser)

2.2.4

InjuryPatternsofthe“Stiff”Spine(T.Grieser)

2.2.5

StableorUnstableFracture?(T.Grieser)

2.2.6

FreshorOldFracture?(T.Grieser)

2.2.7

DifferentialDiagnosis“OsteoporoticVersusPathologicFracture”(T.Grieser)

2.2.8

Stress Phenomena in the Spine: Stress Reaction and Stress Fracture (Spondylolysis) of the
NeuralArches(T.Grieser)

2.2.9

ValueofMRIinAcuteTrauma(T.Grieser)

2.2.10

RadiologicalAssessmentafterSurgeryoftheSpine(R.Fessl)

2.3

Pelvis

2.3.1

FracturesofthePelvicRing(E.J.Mayr)

2.3.2

AcetabularFractures(E.J.Mayr)

2.3.3

FatigueFracturesofthePelvis(E.J.Mayr)

2.3.4

HipDislocation/FractureDislocationsoftheHip(E.J.Mayr)

2.3.5

Pubalgia(OsteitisPubis)(K.Bohndorf)

2.4

ShoulderJoint(K.Woertler)


2.4.1
2.4.2

Anatomy,Variants,andTechnique
Impingement

2.4.3

RotatorCuffPathologyandBicepsTendinopathy

2.4.4

PathologyoftheRotatorInterval

2.4.5

ShoulderInstability

2.4.6

OtherLabralPathology

2.4.7

PostoperativeComplications

2.5

ShoulderGirdleandThoracicWall(N.Jorden)

2.5.1

SternoclavicularDislocation

2.5.2

ClavicularFracture

2.5.3

AcromioclavicularDislocation

2.5.4

ScapularFracture

2.5.5

SternalandRibFractures

2.5.6

StressPhenomenaoftheAcromioclavicularJoint

2.5.7

PosttraumaticConditionsSecondarytoInjuriesoftheShoulderGirdle

2.6

UpperArm

2.6.1

ProximalHumeralFractures(N.Jorden)

2.6.2

HumeralShaftFractures(N.Jorden)

2.6.3

DistalHumeralFractures(N.Jorden)

2.6.4

RadiologicalAssessmentafterSurgeryoftheUpperArm(E.Knoepfle)

2.7

ElbowJoint(E.McNally,O.Ertl,K.Bohndorf)

2.7.1

MedialCompartment

2.7.2

LateralCompartment

2.7.3

AnteriorCompartment

2.7.4

PosteriorCompartment

2.7.5

OsteochondralLesions:TraumaticLesions,Panner'sDisease,andOsteochondritisDissecans

2.7.6

Neuropathies

2.8

Forearm(A.Altenburger)

2.8.1

ProximalFracturesoftheForearm

2.8.2

RadialHeadandNeckFractures

2.8.3

ShaftFracturesoftheForearm

2.8.4

DistalForearmFractures

2.8.5

InstabilityoftheDistalRadioulnarJoint

2.8.6

UlnarImpingementSyndrome

2.8.7

RadiologicalAssessmentafterSurgeryoftheForearm(E.Knoepfle)

2.9

TheWrist(J.Zentner)

2.9.1

Anatomy,Variants,Technique,andIndications

2.9.2

FracturesandDislocationsandTheirComplications


2.9.3

CarpalInstabilitiesandMalalignments

2.9.4

TriangularFibrocartilageComplex

2.9.5

UlnocarpalImpactionSyndrome

2.9.6

TendonsoftheWrist

2.10

MetacarpalsandFingers(J.Zentner)

2.10.1

Anatomy,Technique,andIndications

2.10.2

Fractures

2.10.3

TendonandLigamentLesions

2.11

HipJoint

2.11.1

Anatomy,Variants,andTechniques(C.W.A.Pfirrmann,R.Sutter)

2.11.2

Fractures(C.W.A.Pfirrmann,R.Sutter)

2.11.3

FemoroacetabularImpingement(C.W.A.Pfirrmann,R.Sutter)

2.11.4

LabralLesions(C.W.A.Pfirrmann,R.Sutter)

2.11.5

ChondromalaciaandSynovitis(C.W.A.Pfirrmann,R.Sutter)

2.11.6

MuscleandTendonInjuries(C.W.A.Pfirrmann,R.Sutter)

2.11.7

SlippedCapitalFemoralEpiphysis(C.W.A.Pfirrmann,R.Sutter)

2.11.8

RadiologicalAssessmentafterFractureFixationandJointReplacementoftheHip(W.Michl)

2.12

FemurandSoftTissuesoftheThigh

2.12.1

AnatomyandTechnique(O.Ertl)

2.12.2

Fractures(O.Ertl)

2.12.3

MuscleInjuriesoftheThigh(O.Ertl)

2.12.4

RadiologicalAssessmentafterSurgeryoftheThigh(E.Knoepfle)

2.13

KneeJoint

2.13.1

IndicationsandTechnique(S.Trattnig,K.M.Friedrich,K.Bohndorf)

2.13.2

CruciateLigaments(S.Trattnig,K.M.Friedrich,K.Bohndorf)

2.13.3

MedialSupportingStructures(S.Trattnig,K.M.Friedrich,K.Bohndorf)

2.13.4

LateralSupportingStructures(S.Trattnig,K.M.Friedrich,K.Bohndorf)

2.13.5

Patella,QuadricepsMuscle,andAnteriorLigaments(S.Trattnig,K.M.Friedrich,K.Bohndorf)

2.13.6

Menisci(S.Trattnig,K.M.Friedrich,K.Bohndorf)

2.13.7

Cartilage(S.Trattnig,K.M.Friedrich,K.Bohndorf)

2.13.8

BursaeandPlicae(S.Trattnig,K.M.Friedrich,K.Bohndorf)

2.13.9

FindingsafterCartilageReplacementTherapy(S.Trattnig,K.M.Friedrich,K.Bohndorf)

2.13.10 RadiologicalAssessmentofKneeReplacementSurgery(E.Knoepfle)
2.14

LowerLeg

2.14.1

Fractures(E.-M.Wagner)

2.14.2

RadiologicalAssessmentofSurgeryoftheLowerLeg(E.Knoepfle)

2.14.3

SoftTissueInjuriesandStressReactionsoftheLowerLeg(K.Bohndorf)


2.15

AnkleJointandFoot

2.15.1

Anatomy,Variants,andTechnique(E.-M.Wagner,W.Fischer,F.Sauerwald,N.Jorden)

2.15.2

Fracturesofthe(True)AnkleJoint(E.-M.Wagner)

2.15.3

OsteochondralLesionsoftheTalus(K.Bohndorf)

2.15.4

FracturesoftheTalusandCalcaneus(E.-M.Wagner,F.Sauerwald)

2.15.5

FracturesandDislocationsoftheTarsalBones(F.Sauerwald)

2.15.6

FracturesandDislocationsoftheForefoot(F.Sauerwald)

2.15.7

RadiologicalAssessmentafterSurgeryoftheAnkleandFoot(N.Jorden)

2.15.8

AcquiredMalalignments(N.Jorden)

2.15.9

Ligaments(W.Fischer)

2.15.10 Tendons(W.Fischer,S.Seifarth)
2.15.11 ImpingementSyndromes(W.Fischer)
2.15.12 TarsalTunnelSyndrome(W.Fischer)
2.15.13 SinusTarsi(W.Fischer)
2.15.14 PlantarFascia(W.Fischer)
2.15.15 PlantarPlateandTurfToe(W.Fischer)
2.15.16 Morton'sNeuroma(W.Fischer)

3

InfectionsoftheBones,Joints,andSofttissues

3.1

OsteomyelitisandOsteitis

3.1.1

Terminology,Classification,andInfectionRoutes(K.Bohndorf,A.P.Erler,R.Braunschweig)

3.1.2

HematogenousOsteomyelitis(K.Bohndorf,A.P.Erler,R.Braunschweig)

3.1.3

ChronicExogenousOsteomyelitis(K.Bohndorf,A.P.Erler,R.Braunschweig)

3.1.4

FormsofOsteomyelitis(SpecificPathogens)(K.Bohndorf)

3.1.5

InfectionsoftheSpine(K.Bohndorf)

3.2

SoftTissueInfections(T.Grieser)

3.2.1

NecrotizingFasciitis

3.3

SepticArthritis(K.Bohndorf)

3.3.1

NonspecificPathogens

3.3.2

TuberculousArthritis

3.4

MusculoskeletalInflammationsassociatedwithHIVInfections(K.Bohndorf)

4

TumorsandTumorlikeLesionsofBone,Joints,andtheSoftTissues

4.1

GeneralAspectsofDiagnosticImagingofSkeletalTumors(B.Jobke,K.Bohndorf)

4.1.1

TheRoleoftheRadiologistinAssessingaSuspectedBoneTumor

4.1.2

GeneralApproachtoaSuspectedBoneTumor

4.1.3

DescriptionofaFocalBoneLesion


4.1.4

AssessmentoftheAggressivenessofaBoneLesion:GrowthRate

4.1.5

StagingofBoneTumors

4.1.6

Imaging Modalities for Tissue Diagnosis, Assessment of Biological Activity and Staging of
BoneTumors

4.2

PrimaryBoneTumors(B.Jobke,K.Bohndorf)

4.2.1

OsteogenicTumors

4.2.2

ChondrogenicTumors

4.2.3

ConnectiveTissueandFibrohistiocyticTumors

4.2.4

Ewing'sSarcomaandPrimitiveNeuroectodermalTumor

4.2.5

GiantCellTumor

4.2.6

VascularTumors

4.2.7

LipogenicTumors

4.2.8

MiscellaneousTumors

4.3

TumorlikeLesions

4.3.1

Osteoma,BoneIslands,andOsteopoikilosis(K.Bohndorf,H.Rosenthal)

4.3.2

FibrousCorticalDefectandNonossifyingFibroma(K.Bohndorf,H.Rosenthal)

4.3.3

Simple(Juvenile)BoneCyst(K.Bohndorf,H.Rosenthal)

4.3.4

AneurysmalBoneCyst(K.Bohndorf,H.Rosenthal)

4.3.5

LangerhansCellHistiocytosis(K.Bohndorf,H.Rosenthal)

4.3.6

FibrousDysplasia(K.Bohndorf,H.Rosenthal)

4.3.7

VascularMalformationsoftheBone(so-calledHemangioma)(W.A.Wohlgemuth,K.Bohndorf)

4.3.8

LessCommonTumorlikeLesions(K.Bohndorf,H.Rosenthal)

4.4

Metastases(K.Bohndorf)

4.4.1

Monitoring

4.5

SofttissueTumors

4.5.1

Introduction(B.Jobke,K.Bohndorf)

4.5.2

Clinically Important Soft Tissue Tumors, also Partially Amenable to Classification Using
ImagingProcedures(B.Jobke,K.Bohndorf)

4.5.3

Follow-up Reviews and Diagnostics for Recurrences of Soft Tissue Tumors (B. Jobke, K.
Bohndorf)

4.5.4

VascularMalformations(W.A.Wohlgemuth)

4.6

Intra-articularTumorsandTumorlikeLesions

4.6.1

LooseJointBodies(K.Bohndorf)

4.6.2

SynovialChondromatosis(K.Bohndorf)

4.6.3

GanglionandSynovialCyst(M.Gebhard)

4.6.4

LipomaArborescens(K.Bohndorf)

4.6.5

PigmentedVillonodularSynovitis/GiantCellTumoroftheTendonSheath(K.Bohndorf)


5

BoneMarrow

5.1

NormalBoneMarrow(I.M.Noebauer-Huhmann)

5.1.1

DistributionandAge-dependentPhysiologicalConversionofRedtoYellowMarrow

5.1.2

ReconversionofYellowtoRedMarrow/BoneMarrowHyperplasia

5.2

AnemiasandHemoglobinopathies(I.M.Noebauer-Huhmann)

5.2.1

Anemias

5.2.2

Hemoglobinopathies(Thalassemia,SickleCellAnemia)

5.3

MetabolicBoneMarrowAlterations(I.M.Noebauer-Huhmann)

5.3.1

HemosiderosisandHemochromatosis

5.3.2

LipidosesandLysosomalStorageDiseases

5.3.3

SerousAtrophy

5.3.4

FatAccumulationSecondarytoOsteoporosis

5.4

ChronicMyeloproliferativeDiseases(I.M.Noebauer-Huhmann)

5.4.1

MyelodysplasticSyndrome(AlsoKnownasPreleukemia)

5.4.2

PolycythemiaVera

5.4.3

Myelofibrosis/Osteomyelofibrosis

5.4.4

EssentialThrombocythemia

5.4.5

SystemicMastocytosis

5.5

MalignantDisordersoftheBoneMarrow(I.M.Noebauer-Huhmann)

5.5.1

MultipleMyeloma/SolitaryPlasmacytoma

5.5.2

Lymphoma

5.5.3

Leukemia

5.6

Therapy-relatedBoneMarrowAlterations(I.M.Noebauer-Huhmann)

6

OsteonecrosesoftheSkeletalSystem

6.1

Anatomy,Etiology,andPathogenesis(K.Bohndorf,R.Whitehouse)

6.2

BoneInfarction(R.Whitehouse,K.Bohndorf)

6.3

Osteonecrosis(R.Whitehouse,K.Bohndorf)

6.3.1

OsteonecrosisoftheFemoralHead

6.3.2

OsteonecrosisoftheLunate

6.3.3

OsteonecrosisoftheScaphoid

6.3.4

OsteonecrosisoftheVertebrae

6.4

SequelaeofRadiotherapy(B.Jobke)

6.5

Pseudo-osteonecroses(K.Bohndorf,R.Whitehouse)


7

Osteochondroses

7.1
7.1.1

Anatomy,Etiology,andPathogenesis(K.Bohndorf)
WhatDotheDifferentFormsofOsteochondrosisHaveinCommon?

7.1.2

ToWhichDisordersistheTerm“Osteochondrosis”NotApplicable?

7.2

ArticularOsteochondroses

7.2.1

Perthes’Disease(W.Michl,K.Bohndorf)

7.2.2

Freiberg'sDisease(OsteochondrosisoftheMetatarsalHeads)(K.Bohndorf)

7.2.3

Köhler'sDiseaseTypeI(K.Bohndorf)

7.2.4

Panner'sDiseaseandHegemann'sDisease(K.Bohndorf)

7.2.5

OsteochondritisDissecans(K.Bohndorf)

7.3

Nonarticular(Apophyseal)Osteochondroses(K.Bohndorf)

7.3.1

WhatdoApophysealOsteochondrosesHaveinCommon?

7.3.2

Osgood–SchlatterDisease

7.3.3

Sinding–Larsen–JohanssonDisease

7.3.4

Sever'sDisease

7.3.5

“LittleLeaguer'sElbow”

7.4

PhysealOsteochondroses(W.Michl)

7.4.1

Scheuermann'sDisease

7.4.2

Blount'sDisease

8

Metabolic,Hormonal,andToxicBoneDisorders

8.1

Osteoporosis(T.Grieser)

8.1.1

ClassificationandClinicalPresentationofOsteoporosis

8.1.2

BoneDensityTesting

8.1.3

RadiographicFindingsinOsteoporosis

8.2

RicketsandOsteomalacia(B.Jobke)

8.3

HyperparathyroidismandHypoparathyroidism(B.Jobke)

8.3.1

Hyperparathyroidism

8.3.2

Hypoparathyroidism

8.4

RenalOsteodystrophy(B.Jobke)

8.5

Drug-inducedChangestotheBone(B.Jobke)

8.5.1

Corticosteroids

8.5.2

OtherDrugs

8.6

Amyloidosis(B.Jobke)

8.7

OtherOsteopathicDiseases(K.Bohndorf)

8.7.1

HemophilicArthropathy

8.7.2

Acromegaly

9

CongenitalDisordersofBoneandJointDevelopment

9.1

BoneAgeAssessmentinGrowthDisorders(W.Michl)

9.2

CongenitalDysplasiaoftheHip(W.Michl)

9.3

CongenitalDeformitiesoftheFoot(W.Michl)

9.4

PatellofemoralDysplasia(J.Zentner)

9.5

ScoliosisandKyphosis(W.Michl)

9.5.1

Kyphosis

9.5.2

Scoliosis

9.6

CongenitalDisordersofSkeletalDevelopment(W.Michl)

9.6.1

DiagnosticPathwayforClassificationofSkeletalDysplasia

9.6.2

TheMostCommonNeonatalSkeletalDysplasias

10

RheumaticDisorders

10.1

Introduction

10.1.1

CommonPathogenicFeatures(F.Roemer)

10.1.2

Radiographic Features of the Peripheral Joints and their Role in Differential Diagnosis (K.
Bohndorf,G.M.Lingg,N.Jorden)

10.1.3

Radiographic Features of the Spine and Sacroiliac Joints and Their Differential Diagnosis (K.
Bohndorf,G.M.Lingg,N.Jorden)

10.2

OsteoarthritisofthePeripheralJoints(F.Roemer)

10.2.1

BasicPrinciplesofImagingTechniques

10.2.2

IndividualJoints

10.2.3

TreatmentofOsteoarthritis

10.3

DegenerationoftheSpine(R.Fessl)

10.3.1

Anatomy,Variants,andInformationonImagingandTechnique

10.3.2

ClinicalPresentationoftheDegenerativeSpine

10.3.3

DegenerativeDiskDisease

10.3.4

JuxtadiscalBonyAlterations

10.3.5

FacetJointandUncovertebralOsteoarthritisandDegeneration-basedSpondylolisthesis

10.3.6

LigamentousandSoftTissueChanges

10.3.7

SpinalCanalStenosis

10.3.8

Instability,SegmentalHypermobility,andFunctionalStudies

10.4

DiffuseIdiopathicSkeletalHyperostosis(F.Roemer)

10.5

RheumatoidArthritisandJuvenileIdiopathicArthritis(F.M.Kainberger)


10.5.1
10.5.2

RheumatoidArthritis
JuvenileIdiopathicArthritis

10.6

Spondylarthritis(F.M.Kainberger)

10.6.1

AnkylosingSpondylitis

10.6.2

ReactiveArthritis

10.6.3

PsoriaticArthritis

10.6.4

EnteropathicArthritis

10.6.5

UndifferentiatedSpondylarthritis

10.7

ChronicRecurrentMultifocalOsteomyelitisandSAPHOSyndrome(K.Bohndorf)

10.7.1

ChronicRecurrentMultifocalOsteomyelitis

10.7.2

SAPHO

10.8

ArticularChangesinInflammatorySystemicConnectiveTissueDiseases(Collagenoses)(G.
M.Lingg)

10.8.1

SystemicLupusErythematosus

10.8.2

ProgressiveSystemicSclerosis

10.8.3

PolymyositisandDermatomyositis

10.8.4

MixedCollagenoses

10.8.5

Vasculitis

10.9

Crystal-induced Arthropathies, Osteopathies, and Periarthropathies (G. M. Lingg, K.
Bohndorf)

10.9.1

Gout

10.9.2

CalciumPyrophosphateDepositionDisease(CPPD)

10.9.3

HydroxyapatiteCrystalDepositionDisease

11

MiscellaneousBone,Joint,andSoftTissueDisorders

11.1

Paget’sDisease(H.Douis,M.Davies)

11.2

Sarcoidosis(H.Douis,M.Davies)

11.3

HypertrophicOsteoarthropathy(H.Douis,M.Davies)

11.4

Melorheostosis(H.Douis,M.Davies)

11.5

CalcificationsandOssificationsoftheSoftTissues(K.Bohndorf,T.Grieser)

11.5.1

SoftTissueCalcifications

11.5.2

SoftTissueOssifications

11.6

CompartmentSyndrome(T.Grieser)

11.7

Rhabdomyolysis(T.Grieser)

11.8

PeripheralNerveEntrapmentandNerveCompressionSyndromes(T.Grieser)


11.9
11.9.1

NeuropathicOsteoarthropathyandDiabeticFoot(K.Bohndorf)
NeuropathicOsteoarthropathy

11.9.2

DiabeticFoot

11.10

AdhesiveCapsulitis(K.Bohndorf)

12

InterventionsInvolvingtheBone,SoftTissues,andJoints

12.1

Arthrography(N.Jorden)

12.1.1

Indications

12.1.2

Contraindications

12.1.3

Technique

12.1.4

Complications

12.2

Biopsy(K.Bohndorf,A.Seifarth)

12.2.1

Indications

12.2.2

Contraindications

12.2.3

Technique

12.2.4

Complications

12.2.5

Results

12.3

Drains(K.Bohndorf,A.Seifarth)

12.3.1

Indications

12.3.2

Contraindications

12.3.3

Technique

12.3.4

Complications

12.3.5

Results

12.4

NerveRootBlock(K.Bohndorf,A.Seifarth)

12.4.1

Indications

12.4.2

Contraindications

12.4.3

Procedure

12.4.4

Complications

12.4.5

TrialNerveRootBlock

12.5

FacetBlock(K.Bohndorf,A.Seifarth)

12.6

Vertebroplasty,Kyphoplasty,andSacroplasty(K.Bohndorf,A.Seifarth)

12.6.1

Indications

12.6.2

ImagingProceduresbeforeDiagnosis

12.6.3

Contraindications

12.6.4

Complications

12.6.5

Technique


12.6.6

Results

12.7

LaserTherapyandRadiofrequencyAblation(K.Bohndorf,A.Seifarth)

Index

GuidetoImportantClassifications


Preface
Brevityisthesoulofwit
WilliamShakespeare,Hamlet
This book is a concise, practically oriented textbook that concentrates on the
essentialsofmusculoskeletalimaging.Itisintendedtoprovideanoverviewof
the subject and also to serve as an aid for getting started, as a reference book,
andasafaithfulcompanionrightuptoboardexaminationsandbeyond.Thatis
why the book is organized around clinical disorders, describing the imaging

findingsofallmodalitiesrelevanttoeachdisorder.Itisnotintendedtoreplace
moredetailedsubspecialtytextbooks.
Thirty-five authors have contributed to the text and images. It should not,
however, read as a multi-authored book because it follows the principle of
“many authors but only one style.” The editors have carefully revised,
harmonized, supplemented, or sometimes trimmed the text and images to
produce a book that is “cast from a single mold”—that is its claim. In this it
honors the ethos and form of its “progenitor,” the third edition of Thieme's
RadiologischeDiagnostikderKnochenundGelenke,throughthecarefulreview
and adaption by the editors Mark Anderson (USA) and Mark Davies (Great
Britain),oftheEnglishrenditionbyGrahameLarkin.
Comprehensive books, whether printed or electronically rendered, in our view
continue to be the ideal tool for gaining an overview, learning the basic
principles, and acquiring knowledge of the field of musculoskeletal radiology.
Researchhasshownthattextandimagesmustrelatetoandsupporteachotherto
maximize comprehension and memorization. As a result, the format we have
chosenistopresentthematerialinunitsoftwofacingpageswhereverpossible,
withtheleft-handpagefortextandtherighthandpageforimages.Manyimages
havebeenannotatedtoavoidtheneedforlong,exhaustivecaptions.
The book has been designed and composed with this principle in mind.
Nevertheless, considerable additional information has been placed on the
ThiemeMediaCenter,accessibleviatheinternet(see“HowtoUseThisBook”).
Thisisintendednotsimplyasatributetothetechnologicalspiritofthetimes,


but also as a practical way to expand the book's contents. In this way the
problemofsquaringthecircle—ofproducinganaffordable,compactbookwhile
atthesametimemakingavailableevenmoreimagesandinformation—hasbeen
elegantly solved.The web-basedsupplementarymaterialis clearlyindicatedin
the book by the use of the MediaCenter icon so that the reader can decide

whetherornotitwillbeusefultotakeadvantageofit.
ThesupportoftheThiemepublishinghouseforthisbookhasbeenexemplaryin
every way. This publisher has a history of producing esthetically beautiful yet
challengingbooks,withoutexcludingthemselvesfrommodern-daymedia.That
isastrokeofluckforeditorsandauthorslikeuswhohopetoseemanyofour
ideas and intentions put into practice. We would like to express our thanks to
Stephan Konnry for supporting this endeavor. We are also grateful to the
editorialteam,inparticularGabrieleKuhn-GiovanniniandJoStead,andtoLen
Cegielka,thecopyeditor,fortheirskills,patience,empathy,andtenacityduring
therealizationofourjointproject.
KlausBohndorf,MD
MarkW.Anderson,MD
MarkDavies,MRCP,FRCR
HerwigImhof,MD
KlausWoertler,MD


Acknowledgments
Armin Seifarth, MD, Augsburg, for editing and reviewing all chapters on
ultrasound.Wheredeemednecessary,hehasaddedmaterialtothechaptersand
suppliedmoreimages.
Walter Braun, MD, Professor of Surgery, Augsburg, for his competent and
promptadviceonChapters1and2fromthetraumatologist'sstandpoint.
ThomasNaumann,MD,formerheadoftheDepartmentofOrthopedicSurgeryI,
HessingKlinik,Augsburg,forimprovementstoChapter9.3.
Martin Seidler, MD, Augsburg, and Mr. Ulf Wolkenstein, Augsburg, for
providingandgivingadviceonthenecessaryITrequirements.
Many colleagues have kindly and generously supplied image material. In
particular the sterling work by Thomas Grieser, MD (Augsburg), Herbert
Rosenthal, MD (Hanover), and Dr. Bjoern Jobke (Heidelberg) deserves

particularacknowledgment.Thenamesofthecontributorsarenotedbelowthe
images; this information has been omitted for images that originate from the
archivesoftheeditors.
TheEditors


Contributors
EditorsandAuthors
KlausBohndorf,MD
ProfessorofRadiologyMRHighfieldCenter
Department of Biomedical Imaging and Image-guided Therapy Medical
UniversityofViennaVienna,Austria
MarkW.Anderson,MD
ProfessorofRadiologyMSKImaging
DepartmentofRadiologyUniversityofVirginiaCharlottesville,VA,USAMark
Davies,MRCP,FRCR
Professor of Radiology Department of Radiology Royal Orthopedic Hospital
Birmingham,UK
HerwigImhof,MD
Professor of Radiology Formerly Department of Biomedical Imaging and
Image-guidedTherapyMedicalUniversityofViennaVienna,Austria
KlausWoertler,MD
Professor of Radiology Department of Radiology Technical University of
MunichMunich,Germany

Contributors
AmadeusAltenburger,MD
StaffRadiologist
DepartmentofRadiologyandNeuroradiologyKlinikumAugsburg
Augsburg,Germany

RainerBraunschweig,MD
ChairmanandRadiologistDepartmentofDiagnosticImagingandInterventional
RadiologyBGKlinikBergmannstrostHalle,Germany
HassanDouis,MRCP,FRCR
ConsultantMusculoskeletalRadiologistDepartmentofRadiologyUniversityof


BirminghamBirmingham,UK
AndreasPeterErler,MD
StaffRadiologist
Department of Diagnostic Imaging and Interventional Radiology BG Hospital
BergmannstrostHalle,Germany
OliverErtl,MD
Radiologist
DiagnosticCenterVinzentinumAugsburg,Germany
RobertFessl,MD
Staff Neuroradiologist Department of RadiologyandNeuroradiologyKlinikum
Augsburg
Augsburg,Germany
WolfgangFischer,MD
Radiologist
MRICenter
HessingparkKlinik
Augsburg,Germany
KlausM.Friedrich,MD
Associate Professor of Radiology Neuroradiology and MSK Radiology
Department of Biomedical Imaging and Image-guided Therapy Medical
UniversityofViennaVienna,Austria
MichaelGebhard,MD
StaffRadiologist

DepartmentofRadiologyandNeuroradiologyKlinikumAugsburg
Augsburg,Germany
ThomasGrieser,MD
StaffRadiologist
DepartmentofRadiologyandNeuroradiologyKlinikumAugsburg
Augsburg,Germany
BjoernJobke,MD
StaffRadiologist
DepartmentofRadiologyGermanCancerCenter


Heidelberg,Germany
NicolasJorden,MD
DepartmentofRadiologyandNeuroradiologyKlinikumAugsburg
Augsburg,Germany
FranzM.Kainberger,MD
Professor of Radiology Neuroradiology and MSK Radiology Department of
BiomedicalImagingandImage-guidedTherapyMedicalUniversityofVienna
Vienna,Austria
EgbertKnoepfle,MD
StaffRadiologist
DepartmentofRadiologyandNeuroradiologyKlinikumAugsburg
Augsburg,Germany
GerwinM.Lingg,MD
Radiologist
FormerlyAcura-SanHaRheumatologyCentreBadKreuznach,GermanyEdgar
JohannMayr,MD
Professor of Orthopaedic Surgery Department of Trauma, Hand and
ReconstructiveSurgeryKlinikumAugsburg
Augsburg,Germany

EugeneMcNally,FRCR
ConsultantMusculoskeletalRadiologistTheOxfordClinic
Oxford,UK
WolfgangMichl,MD
PedriatricRadiologistFormerlyDepartmentofRadiologyandNeuroradiology
KlinikumAugsburg
Augsburg,Germany
IrisMelanieNoebauer-Huhmann,MD
Associate Professor of Radiology Neuroradiology and MSK Radiology
Department of Biomedical Imaging and Image-guided Therapy Medical
UniversityofViennaVienna,Austria
ChristianW.A.Pfirrmann,MD
ProfessorofRadiologyChairman


BalgristHospital
UniversityofZurich
Zurich,Switzerland
FrankRoemer,MD
AssociateProfessorofRadiologyInstituteofRadiologyUniversityofErlangen
Erlangen,Germany
HerbertRosenthal,MD
ProfessorofRadiologyChairman
DepartmentofDiagnosticandInterventionalRadiologyKRHKlinikum
Hannover,Germany
FabianSauerwald,MD
Staff Orthopaedic Surgeon Department of Trauma, Hand and Reconstructive
SurgeryKlinikumAugsburg
Augsburg,Germany
ArminSeifarth,MD

Radiologist
RadiologieimZentrum
Munich,Germany
RetoSutter,MD
StaffRadiologist
BalgristHospital
UniversityofZurich
Radiology
Zurich,Switzerland
SiegfriedTrattnig,MD
ProfessorofRadiologyChairman
MRHighfieldCenter
Department of Biomedical Imaging and Image-guided Therapy Medical
UniversityofViennaVienna,Austria
Eva-MariaWagner,MD
StaffRadiologist
DepartmentofRadiologyandNeuroradiologyKlinikumAugsburg
Augsburg,Germany