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E1386. Magnetic Resonance Imaging of Musculoskeletal Emergencies: What the Radiologist Needs to Know
Authors
  1. Ningcheng Li; Oregon Health and Science University
  2. Barry Hansford; Oregon Health and Science University
Background
Magnetic resonance imaging (MRI) has seen increase in availability and utilization in the emergent setting for both traumatic and non-traumatic musculoskeletal (MSK) etiologies. MRI provides unparalleled soft tissue, bone marrow, and fine anatomic details. Emergent MSK MRI may have a complementary role to computed tomography (CT) or may be the preferred cross-sectional imaging modality depending on the clinical question/indication. The interpretation of emergent MSK MRI may be daunting for some radiologists who are more comfortable interpreting STAT musculoskeletal CT examinations. However, given the increasing availability and use of rapid MRI protocols in the acute setting, it is imperative that radiologists are familiar with the key MRI findings of common emergent MSK pathology.

Educational Goals / Teaching Points
• Discuss the various types of musculoskeletal (MSK) emergencies • Describe the MRI appearances of MSK emergencies with focus on high-yield imaging and clinical pearls • Describe the role of MRI in assessment and treatment for MSK emergencies • Describe the emerging rapid MSK MRI techniques and protocols

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
1. Overview of MSK Emergency a. Trauma b. Infection c. Others 2. When does MRI add value, in combination with CT or standalone without CT? 3. MRI sequence/protocol review a. Trauma protocol b. Infection protocol c. Emerging rapid MRI MSK protocols 4. Case presentation. Highlight entity-specific imaging and clinical pearls as well as appropriate MRI indications which may change management a. Trauma i. Stress fracture ii. Radiographically or CT occult fractures iii. Ligamentous injury iv. Tendon/muscle rupture v. Hematoma vi. Pathologic fracture b. Infection i. Cellulitis ii. Myositis iii. Abscess iv. Necrotizing fasciitis v. Osteomyelitis vi. Septic arthritis vii. Septic bursitis viii. Septic thrombophlebitis brachial plexus c. Rhabdomyolysis d. Myonecrosis e. Transient osteoporosis f. Osteonecrosis g. Aneurysm erosion mimicking infection/abscess 5. Summary

Conclusion
With technological advancement and protocol fine-tuning, MRI availability and use in the emergent setting is increasing given the ability to definitively answer clinical questions for which CT may be equivocal. Familiarity with rapid MRI techniques and entity specific key imaging findings reinforces the radiologist’s role as a value provider to referring clinicians which ultimately results in better patient care/outcomes.