Abstracts

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E1360. Musculoskeletal MythBusters: Normal Variable MR Appearance of and Pitfalls Associated With Ligaments, Fibrocartilage, Tendons, and Bones
Authors
  1. Barry Hansford; Oregon Health & Science University
Background
Numerous pitfalls are frequently encountered at multimodality musculoskeletal imaging which may mimic various tendinous, osseous, capsuloligamentous, muscular, and neurovascular pathologic conditions. These pitfalls may be secondary to variant anatomy, artifactual due to MRI or sonographic technique, or represent varying ranges of structure-specific normal including a spectrum of findings associated with aging in asymptomatic subjects. When an imaging finding of questionable significance is encountered, it is critical that the interpreting radiologist make every attempt to review any relevant clinical information in an effort to determine whether the imaging findings in question may account for the patient’s presenting symptomology. In order to accurately diagnose true musculoskeletal pathology, it is imperative that the radiologist be familiar with a multitude of pitfalls that may mimic disease. This familiarity will allow the radiologist to provide a more useful report for referring providers focusing on true pathology while eliminating potentially confusing or misleading findings which are inconsistent with the patient’s clinical presentation.

Educational Goals / Teaching Points
After viewing this exhibit, the learner will be able to: 1. Appreciate the importance of interpreting imaging findings in concert with clinical symptoms 2. Describe the normal variable MRI appearances of tendinous, osseous, fibrocartilage, and capsuloligamentous structures which are commonly mistaken for pathology 3. Better distinguish true musculoskeletal pathology from potentially incidental/confounding MRI findings 4. Understand expected aging-related changes of specific anatomic structures

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
TABLE OF CONTENTS/OUTLINE: Introduction/background -Joint-based review of common normal variant anatomy on MR imaging -Shoulder -Elbow/forearm -Wrist/hand -Pelvis/hips -Knee -Foot/ankle -Review of commonly encountered imaging findings which are often asymptomatic -Denervation teres minor, FAI morphology, ischiofemoral edema, etc -Asymptomatic imaging pitfalls at arthrography -Ulnar sided extravasation wrist, extravasation caudal to inferior glenohumeral ligament complex -Variable appearance of tendons, fibrocartilage, and capsuloligamentous structures with aging -Vessels mimicking pathology -Keys to distinguishing normal variants from pathology Summary

Conclusion
When a musculoskeletal imaging finding of questionable significance is encountered, it is critical that the interpreting radiologist make every attempt to review any relevant clinical information in an effort to determine whether the imaging findings in question may account for the patient’s presenting symptomology. In order to accurately diagnose true pathology, it is imperative that the radiologist be familiar with commonly encountered imaging pitfalls. This familiarity will allow the radiologist to provide a more useful report for referring providers ultimately resulting in better patient care.