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SummaryThis study includes 50 patients complaining from elbow joint lesions. Plain radiography, CT and MR imaging were done for all patients included in this study. Traumatic lesions were the most common pathological entity in our study; ten patients were suffering from simple osseous fractures. Both plain radiography and CT showed the fracture line, CT was superior in detection of intra-articular bony fragments in old non-union fractures. MRI detects bone marrow edema in six cases, intra-articular hematoma in one case and joint effusion in one case, which could not be seen in both plain radiography and CT.Six cases showed post traumatic soft tissue lesions. Plain radiography and CT detect soft tissue calcification in one case, obliteration of the fat pad sign in one case (appeared by plain radiography), and small soft tissue swelling in posterior region of the elbow in one case. MRI was superior to Plain radiography and CT in evaluation of the soft tissue. It showed LCL tear in two cases, MCL tear in one case, one case of ulnar nerve neuropathy, one case of olecranon bursitis and one case showed muscle strain with hemorrhagic effusion.Two cases showed complex osseous and soft tissue lesions. MRI was superior to plain radiography and CT in detection of LCL tear and presence of joint effusion.Six cases showed non traumatic soft tissue lesions. MRI showed tendon and ligaments injuries which could not be seen in both plain radiography and CT. plain radiography and CT only showed soft tissue calcification in three cases.In nine case of osteoarthritis MR imaging was superior to plain radiography in detection of articular cartilage loss in advanced (two) cases, intra-articular loose bodies in two cases, and joint effusion in three cases. CT also showed the intra-articular loose bodies.MRI showed the poorly enhanced pannus in four cases of rheumatoid arthritis, which could not be seen in plain radiography or CT study. Plain radiography was superior in detection of osteoporotic changes. While in one case of early rheumatoid arthritis MRI was the only imaging modality which detect early synovial thickening with mild effusion.In two cases of hemophilia, plain radiography showed radio-opaque joint swelling, MRI showed the hemophilic pseudo tumor while CT was superior in detecting the bony erosions.In nine cases of soft tissue tumors MR imaging gave characteristic appearance of certain tumors such as lipoma and schwannoma. While in other tumors, the appearance was suggestive and histopathological study was conclusive.In two cases of synovial lesions, both plain radiography and CT showed the chondromatosis, while MR imaging added information about synovial thickening. In the other case of PVNS, CT was helpful in detection of bone erosions and MR imaging showed the enhanced synovial mass.In one case of Ewing’s sarcoma MR imaging was superior in detection of the true extend of the tumor as well as cortical destruction.ConclusionMR imaging is a powerful imaging modality for solving diagnostic problems involving the elbow. The high soft tissue contrast and multiplanner capability are the most important advantages of MR imaging.-MR imaging can detect bone marrow edema, intra-articular fragments and joint effusion in traumatic osseous fractures.-MR imaging can detect soft tissue lesions such as ligaments and tendon injuries as well as muscle strain.-MR imaging can detect nerve entrapment and neuropathies around the elbow joint.-MR imaging is superior to plain radiography and CT in detecting articular cartilage loss in advanced osteoarthritis.-MR imaging can detect early synovial proliferation and pannus formation as well as asses active cases of rheumatoid arthritis.-In hemophilic arthropathy, MR imaging can detect bleeding in the joint space as well as state of the synovium.-MR imaging can detect benign and malignant soft tissue tumors involving elbow region. It can be useful for characterizing some soft tissue tumors such as lipomas.-In cases of synovial tumors CT is helpful in detection of bone erosions which may not be seen in MR imaging.-Also MR imaging can be used for follow a tumor after surgery, radiation therapy and chemotherapy to check for residual tumor, recurrence, or healing.-MR imaging can be used in detect extension of bony tumor as well as associated cortical destruction and soft tissue involvement.In imaging of elbow lesions, plain radiography and CT should be obtained prior to MR imaging in cases with history of recent or old trauma. When soft tissue injuries or neuropathies were suspected MR imaging is the modality of choice, however plain radiography may shows heterotopic calcification of the affected ligament.
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