The Dynamic Magnetic Resonance Imaging

Fig. 8.1
Dynamic MRI scan acquired at the level of the arm during flexion/extension

The dynamic investigation arises as very useful during ongoing muscle injuries with large hematomas, which at times are not well definable in their extension and therefore can be placed in the differential diagnosis together with any growths of benign or malignant nature.

That is the case of Fig. 8.2, in which various sequences performed by dynamic ultrasound, elastosonography, and MRI are featured, demonstrating a large lesion partly colliquated and partly structured, referring to a possible space-occupying lesion.


Fig. 8.2
Dynamic MRI (a) clearly documents the actual extent of a muscle lesion, be it due to a tumor or, as in this case, to a large posttraumatic hematoma. The additional detail provided by US, using power Doppler (b) or elastography (c), can guide needle biopsy aspiration if required

In Fig. 8.3, it becomes fully highlighted, during the dynamic phases of contraction and flexed extension of the lower limb that the mentioned lesion is constituted by a large hematoma involving the medial twin head muscle, surely more perceivable during the dynamic phases.


Fig. 8.3
Dynamic MRI demonstrates the different morphology of the mass during muscle contraction as the leg is flexed/extended

Another extremely useful application of the mentioned method is provided through the fusion method (Fig. 8.4), which allows the overlap even in dynamic with the ultrasound investigation performed in real time.


Fig. 8.4
Fusion technology affords optimal follow-up of muscle lesions through the overlay of US and MRI scans

Thus it is possible to check in a more accurate manner the possible alterations not underlined by either method and, above all, to use this method during the follow-up, in order to examine and better assess the evolution of the clinical picture.

Certainly a suitable utilization is carried out at the level of the extensive muscle lesions, during which at times the ultrasound examination does not allow a panoramic picture, so to provide certain and well-defined details of the extension of the mentioned lesion.

During the active and passive contraction phases, the presence of a partial lesion of the quadriceps muscle of the femur at the distal insertion is featured in Fig. 8.5, with evident greater retraction during the active contraction phase.


Fig. 8.5
Dynamic MRI scan obtained at several degrees of quadriceps flexion/extension and contraction, clearly demonstrating the partial retraction of the injured muscle

The employment of the dynamic method proves to be equally useful in ongoing plotted detachments of the osteotendon junction, such as the case of the anterior inferior iliac spine investigated through computed tomography plus 3D reconstruction (Fig. 8.6a) and better defined by the means of the dynamic MRI method, which during the phase of contraction shows in a more accurate manner the diastasis of the bone fragment retracted through the contraction of the adjacent muscle components (Fig. 8.6b).


Fig. 8.6
(a) 3D CT reconstruction demonstrating complete traumatic avulsion of the anterior inferior iliac spine. (b) Dynamic MRI image acquired during muscle contraction

The employment of the dynamic method in ongoing lesions caused by compression proves to be of fundamental importance, which can be difficult to approach by the means of the ultrasound investigation, especially in relation to the formation of a wide groove which does not allow a suitable probe support.

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Sep 6, 2017 | Posted by in ORTHOPEDIC | Comments Off on The Dynamic Magnetic Resonance Imaging

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