Liposuction is a cosmetic procedure to reduce the volume of adipose tissue in the neck, arms, legs and/or abdomen. Areolar fat, a deeper layer of adipose tissue, is the main target and shows a good response to vacuum-assisted liposuction.
There are three types of this procedure 1,2:
Subperiosteal abscesses refer to the subperiosteal spread of infection characterized by purulent encapsulated fluid collections within the subperiosteal space.
Subperiosteal abscesses are more often seen in children than in adults 1,2.
Subperiosteal abscesses have b...
An ulcer refers to the break in the skin, epithelium, or mucous membrane resulting in the discontinuity in the surface tissue, necrosis, and often pus formation 1.
immunocompromised (e.g. diabetics) 1
immobile patients 1,2
advanced age 2
poor nutrition 2
increased moisture 2
Sinus tracts are an abnormal connection between a fluid collection with a mucous mucosal surface and/or skin 1,2. It can result from acute or chronic processes and occasionally extend into the joints and bones 1.
The term sinus tract is non-specific; however, when used in soft tiss...
The talocrural angle can be used to assess for fibular shortening after a fracture.
The talocrural angle is measured on the mortise view as the angle between a line along the distal tibial plafond articular surface and another line joining the tips of both malleoli 3,4.
The first metatarsal declination angle can be used to assess for metatarsus primus elevatus in hallux rigidus.
The first metatarsal declination angle is formed between the longitudinal axis of the first metatarsal and the supporting surface 1-4.
normal: 20-21° 1-...
The patellofemoral angle is a measure of patellar tilt and is useful in the diagnosis of patellofemoral instability and excessive lateral pressure syndrome.
The patellofemoral angle is formed between a line drawn along the bony lateral patellar facet and another line drawn along t...
The fourth-fifth intermetatarsal angle is used to assess for a bunionette deformity. It should not be confused with the first intermetatarsal angle, used to assess for hallux valgus deformity.
The fourth-fifth intermetatarsal angle is formed between the long axis of the fourth and...
The Friedman or scapular line can be used to determine glenoid version and glenoid bone loss 4. Glenoid version angle measured by the Friedman method has better inter-reader reliability than the scapular body method 2.
The Friedman line is drawn along the long axis of the scapula ...
AP Meary's angle or AP talus-first metatarsal angle is used to assess for midfoot abduction/adduction in pes planus and pes cavus to assist with pre-operative planning 1.
On a weight-bearing AP foot radiograph, a line is drawn down the longitudinal axis of the first metatarsal to ...
The posterior tibial line is drawn along the posterior aspect of the distal tibial shaft on a lateral ankle x-ray and can be used to assess the sagittal alignment of the talus when comparing side-to-side and/or calculate the posterior tibial line-talar ratio 1,2.
Medial cuneiform to second metatarsal distance is the measurement of the distance between the lateral aspect of the medial cuneiform and the medial aspect of the base of the second metatarsal bone 1,2.
Medial cuneiform to second metatarsal distance is an important measurement used in ass...
Lateral tibiotalar distance is a measurement on an ankle anterior drawer lateral view to assess for ankle instability.
On an ankle anterior drawer lateral view (typically performed using a Telos device 2-4), the distance between the posterior tip of the distal tibial articular sur...
Medial cuneiform-fifth metatarsal height is the distance between the most inferior part of the medial cuneiform and the most inferior part of the base of the 5th metatarsal and is used to evaluate the height and integrity of the medial vertical arch 1.
Medial cuneiform-fifth metatarsal h...
Quadratus femoris injections under image guidance ensure precise delivery of an injectate and ensure the sciatic nerve is avoided during the procedure. CT and ultrasound can be used, with ultrasound becoming more challenging in those with larger body habitus.
therapeutic for ischi...
The CT ankle protocol serves as an examination for the bony assessment of the ankle and rearfoot and is almost always performed as a non-contrast study. It can be also combined with a CT arthrogram for the evaluation of chondral and osteochondral injuries or can encompass the whole foot in certa...
The gamma nail or trochanteric nail is an osteosynthetic implant designed to treat proximal femoral fractures in the trochanter area with a closed intramedullary fixation method.
The gamma nail consists of a funnel-shaped intramedullary nail with slight bending to reflect proximal femoral diaph...
Pudendal nerve blocks are performed on those with suspected or proven pudendal neuralgia. Using CT will ensure accurate needle placement, which aims for a perineural pudendal nerve injection in the pudendal canal, also known as Alcock's canal.
Extra-articular injections occur when the needle tip is not within the targeted joint during joint injections.
Defined by the presence of contrast outside of a joint in fluoroscopic or CT guided procedures, or the lack of direct visualization and resisted flow of intra-articular in...
Knee joint injections under image guidance ensure precise delivery of an injectate into the knee joint. Either fluoroscopy, ultrasound or CT can be used to guide and administer injectates, which may be diagnostic (e.g. anesthetic), "therapeutic" (e.g. anesthetic/steroids, PRP), or for CT or MR a...
Tibial torsion refers to the rotation or twist along the longitudinal axis of the lower leg or more specifically the tibial bone.
Internal tibial torsion is a cause of in-toeing gait a common rotational variant in toddlers, usually resolving spontaneously by the age of 5 years 1. Externa...
Groin pain is a symptom manifesting in a wide spectrum of clinical disorders and diseases in athletes and non-athletes.
The Doha agreement in 2014 identified and classified groin pain in athletes and defined the following clinical entities 1,2:
adductor-related, pubic-related, inguinal-related...
MRI of the wrist is a fairly frequent examination in musculoskeletal radiology practice and not quite as common in general radiological practice. This approach is an example of how to create a radiological report of an MRI of the wrist knee with coverage of the most common anatomical sites of po...
MRI of the ankle is one of the more frequent examinations faced in daily radiological practice. This approach is an example of how to create a radiological report of an MRI of the ankle with coverage of the most common anatomical sites of possible pathology, within the ankle without claim for co...
MRI of the elbow is a fairly frequent examination in musculoskeletal radiology practice and not quite as common in general radiological practice. This approach is an example of how to create a radiological report of an elbow MRI with coverage of the most common anatomical sites of possible patho...
MRI of the shoulder is one of the more frequent examinations faced in daily radiological practice. This approach is an example of how to create a radiological report of an MRI shoulder with coverage of the most common anatomical sites of possible pathology, within the shoulder.
Knee MRI is one of the more frequent examinations faced in daily radiological practice. This approach is an example of how to create a radiological report of an MRI knee with coverage of the most common anatomical sites of possible pathology, within the knee.
A systematic rev...
The elbow radiograph checklist is just one of the many pathology checklists that can be used when reporting to ensure that you always actively exclude pathology that is commonly missed; this is particularly helpful in the examination setting, e.g. the FRCR 2B rapid-reporting.
The Tanner-Whitehouse (TW) method is a way of assessing the bone age of children. There are several variations of this method, but all use a DP radiograph of the left hand and wrist to assess the relative maturity of the bones of the patient.
The TW2 (Tanner-Whitehouse 2) methods 1:
Medial condyle trochlear offset (MCTO) is a measurement to assess the height of the medial trochlear facet with respect to the trochlear groove 1.
Medial condyle trochlear offset has been described for the assessment of trochlear dysplasia in skeletally immature patients 1. It measures a...
Ventral trochlear prominence (VTP) describes and measures the bony surplus in the anterior femoral surface at the most superior or proximal aspect of the trochlea.
Ventral trochlear prominence is used for the assessment of trochlear dysplasia, a risk factor for patellofemoral instability...
Trochlear facet asymmetry (FA) refers to the condition of the medial facet being abnormally small if compared to the lateral facet in trochlear dysplasia 1.
Facet asymmetry is also used as a measurement in magnet resonance imaging for trochlear dysplasia to make it more objective 1-3, th...
Trochlear depth (TD) measures the depth of the trochlear groove in relation to the femoral condyles.
Trochlear depth is used for the assessment of trochlear dysplasia, a dysplastic deformity of the femoral head, which is a known risk factor for patellofemoral instability 1-6.
A review o...
Lateral trochlear inclination (LTI) is the inclination angle between the femoral trochlea and a posterior condylar tangential line 1.
The lateral trochlear inclination angle is used in the assessment of trochlear dysplasia, a dysplastic deformity of the distal femur, which is a known ris...
The wrist radiograph checklist is just one of the many pathology checklists that can be used when reporting to ensure that you always actively exclude pathology that is commonly missed; this is particularly helpful in the examination setting, e.g. the FRCR 2B rapid-reporting.
The hand radiograph checklist is just one of the many pathology checklists that can be used when reporting to ensure that you always actively exclude pathology that is commonly missed; this is particularly helpful in the examination setting, e.g. the FRCR 2B rapid-reporting.
The lumbar spine checklist is just one of the many pathology checklists that can be used when reporting to ensure that you always actively exclude pathology that is commonly missed; this is particularly helpful in the examination setting, e.g. the FRCR 2B rapid-reporting.
The thoracic spine checklist is just one of the many pathology checklists that can be used when reporting to ensure that you always actively exclude pathology that is commonly missed; this is particularly helpful in the examination setting, e.g. the FRCR 2B rapid-reporting.
The cervical spine checklist is just one of the many pathology checklists that can be used when reporting to ensure that you always actively exclude pathology that is commonly missed; this is particularly helpful in the examination setting, e.g. the FRCR 2B rapid-reporting.
The medial clear space is a radiographic measurement that may be useful in the diagnosis of ankle instability, syndesmotic injuries and ankle fractures 5.
The medial clear space is used in the prediction of deltoid ligament injury 1 and in conjunction with the tibiofibular clear space th...
The tibiofibular overlap (TFO) is the overlapping area between the anterior distal tibial prominence and the medial edge of the distal fibula 1-3.
Together with the tibiofibular clear space (TFCS) and the medial clear space, the tibiofibular overlap space has been used in the diagnosis a...
The tibiofibular clear space is a radiographic measure and defined as the space between the groove of the distal tibial prominence and the medial margin of the distal fibula 1-3.
Together with the tibiofibular overlap and the medial clear space, the tibiofibular clear space has been used...
The shoulder radiograph checklist is just one of the many pathology checklists that can be used when reporting to ensure that you always actively exclude pathology that is commonly missed; this is particularly helpful in the examination setting, e.g. the FRCR 2B rapid-reporting.
The first metatarsophalangeal angle, also known as hallux valgus angle (HVA) or hallux abductus angle, is a measurement used to assess the presence and severity of the alignment of the first metatarsophalangeal joint on a weight-bearing dorsoplantar radiograph of the foot.
The foot radiograph checklist is just one of the many pathology checklists that can be used when reporting to ensure that you always actively exclude pathology that is commonly missed; this is particularly helpful in the examination setting, e.g. the FRCR 2B rapid-reporting.
The pelvic radiograph checklist is just one of the many pathology checklists that can be used when reporting to ensure that you always actively exclude pathology that is commonly missed; this is particularly helpful in the examination setting, e.g. the FRCR 2B rapid-reporting.
The knee radiograph checklist is just one of the many pathology checklists that can be used when reporting to ensure that you always actively exclude pathology that is commonly missed; this is particularly helpful in the examination setting, e.g. the FRCR 2B rapid-reporting.
The sulcus angle is useful in the assessment of patellofemoral instability and trochlear dysplasia.
The angle is formed by the trochlear opening of the knee, measuring the angle between the medial and lateral facets. Classically described in axial x-rays of the knee performed at 3...
Sternoclavicular joint (SCJ) injections under image guidance ensure precise delivery of an injectate into the joint and importantly that needle depth is under direct visualization.
arthropathy, e.g. osteoarthritis
Elbow injection usually refers to an elbow joint injection, but especially to patients, it can be a term used referring to other procedures which include:
common extensor origin microtenotomy
common flexor origin microtenotomy
distal biceps tendon sheath injection
elbow joint injection
Foot injection is a non-specific term, often used by patients, in reference to tarsal or metatarsal joint injections, and to other injections which include:
calcaneocuboid joint injection
metatarsophalangeal joint (MTPJ) injection
naviculocuneiform joint injection
plantar fascia microtenoto...
Knee injection is a general term and can be made in reference, especially by patients, to multiple procedures which include:
common peroneal (fibular) nerve injection
knee joint injection
patella tendon microtenotomy
Long head of biceps brachii (LHB) tendon sheath injections under ultrasound guidance ensure accurate delivery of injectate, which is important as these injections are often performed for diagnostic purposes.
alternative access to the glenohumeral join...
There are a number of pain rating scales used by clinicians and researchers to gauge the severity of patients' pain. Commonly used methods:
pain numeric rating scale (NRS/NPRS)
visual analog scale (VAS)
verbal rating scale (VRS)
faces pain scale-revised (FPS-R)
Pain numeric rating scale
Bipolar shoulder lesions of anterior glenohumeral dislocations (i.e. combined bony Bankart lesions and Hill-Sachs defects) put patients at increased risk of Hill-Sachs engagement or recurrent instability. Determining if the Hill-Sachs defects are on-track or off-track can help guide management, ...
Mulder sign is a clinical test used to examine causes of metatarsalgia associated with Morton neuroma. It has high specificity (100%) but relatively low sensitivity (62%) 2. See the ultrasound correlate described separately: sonographic Mulder sign.
With one hand, clasp the metatarsa...
The sonographic Mulder sign is the ultrasound correlate of the clinical Mulder sign during examination of the forefoot to investigate causes of metatarsalgia associated with Morton neuroma 1. The intermetatarsal space is predominantly composed of fat inferiorly and also contains the neurovascula...
There a number of features that can help distinguish between lipoma and well-differentiated liposarcoma. This article relates to superficial well-differentiated liposarcomas that typically occur in the extremities, also known as atypical lipomatous tumors, and not retroperitoneal liposarcoma.
The alpha angle is a radiological measurement proposed for the detection of cam morphology, which is sometimes associated with femoroacetabular impingement (FAI).
The term alpha angle is also used in a separate and unrelated context in the evaluation of developmental dysplasia of ...
The McMurray test is used to assess the presence of meniscal tears within the knee.
Clinical tests used for the detection of meniscal tears provide varying levels of diagnostic parameters including sensitivity and specificity. MRI is considered the most accurate diagnostic tool for ...
Coarse trabecular bones can result from a number of causes. They include:
Paget disease (bone)
hemaglobinopathies, e.g. thalassemia
Coarse trabecular pattern in bone (mnemonic)
The coracohumeral interval is usually measured on axial or oblique sagittal CT or MRI and normally measures between 7-11 mm. A measurement <6 mm is always considered abnormal 1.
Lower back pain (also known as lumbago) is very common and is often referred for imaging. However, the vast majority of cases are due to benign self-limiting causes which do not require imaging and resolve with conservative measures. Numerous authors have described various methods for supporting...
The differential diagnosis of a mass in the inguinal region includes:
hydrocele of the canal of Nuck
spermatic cord hydrocele
lymphadenopathy or necrotic lymph node
aneurysm or pseudoaneurysm of the femoral artery
The extrusion index is a radiographic measurement of femoral head bony coverage by the acetabulum. It is useful in assessing for developmental dysplasia of the hip as well as femoroacetabular impingement.
It is calculated by dividing the horizontal distance of the lateral femoral h...
There are several ankle impingement syndromes. They are characterized by a limited range of motion and pain on attempting specific movements about the joint and often in a load-bearing position. They have variable etiology and pathogenesis. They are best classified according to location.
Geographic appearance is a term used in imaging, and other clinical fields (e.g. histopathology) to describe lesions with a well-circumscribed margins with adjacent tissues. The term derives from the somewhat similar appearance of the outline of countries on a map or the clear demarcation forme...
Describing a bone lesion is an essential skill for the radiologist, used to form an accurate differential diagnosis for neoplastic entities, and occasionally non-neoplastic. In addition to patient demographics, the radiographic features of a bone lesion are often the primary determinant of non-h...
Densitometric vertebral fracture assessment (VFA) is an image of the lumbar and thoracic spine acquired on dual energy x-ray absorptiometry (DXA) scanners, for the purpose of diagnosing osteoporotic vertebral fractures.
The technique is available on DXA scanners under a variety of...
Magnetic resonance neurography (MRN) is a relatively new non-invasive imaging technique for dedicated assessment of peripheral nerves.
It is used to assess peripheral nerve entrapments and impingements as well as localization and grading of nerve injuries and lesions.
Canadian C-spine rules are a set of guidelines that help a clinician decide if cervical spine imaging is not appropriate for a trauma patient in the emergency department. The patient must be alert and stable.
There are three rules:
is there any high-risk factor present that requires cervical s...
NEXUS (National Emergency X-Radiography Utilization Study) is a set of validated criteria used to decide which trauma patients do not require cervical spine imaging.
Trauma patients who do not require cervical spine imaging require all of the following:
alert and stable
no focal neurologic de...
Coronal balance is one of the features that needs to be assessed on long spine radiographs obtained for spinal deformity, particularly scoliosis. It measures whether or not the upper spine is located over the midline (normal) or off to one side.
To assess coronal balance, a vertic...
Sagittal balance forms part of the plain radiographic assessment of spinal deformity including kyphotic or lordotic deformities and scoliosis.
There are numerous ways of assessing this, using various bony landmarks and angles to evaluate whether or not a normal distribution of weight and...
The central sacral vertical line (CSVL) is used in the assessment of spinal scoliosis.
It is a line constructed on frontal films of the spine and pelvis to measure coronal balance, drawn as follows:
a line connecting the top of the iliac crests is drawn
a second line is drawn perpendicular t...
This is a basic article for medical students and other non-radiologists
Shoulder radiographs are commonly performed for shoulder injury assessment and followup. Using a standard system to approach the x-ray means it is much more likely you will find the abnormality.
This is a basic article for medical students and other non-radiologists
Wrist radiographs are commonly used for the assessment of the wrist following trauma.
distal radius and ulna have smooth joint surface
carpal arcs are smooth
carpal bones do not overlap
The Amsterdam wrist rules are validated clinical decision rules for determining which patients require radiographic imaging (wrist radiography) for acute wrist pain following trauma. The initial study evaluated 882 patients and were published in 2015 1. The decision rules assessed different clin...
Subacromial bursal corticosteroid injections, also known as subacromial-subdeltoid bursal injections, are used in patients with limited or no response to initial treatment with impingement syndrome, subacromial bursitis and/or rotator cuff disorders. Non-steroidal anti-inflammatory drugs (NSAIDs...
Carpal height is used to diagnose and assess the severity of carpal collapse. It is defined as the distance between the base of third metacarpal and the subchondral bony cortex of the distal radius. But due to variations between individuals, it is more appropriate to calculate the carpal height ...
The OMERACT ultrasound group published a consensus in 2005 of widely accepted definitions of abnormal ultrasound findings in rheumatological diseases:
erosion: an intra-articular discontinuity of the bone surface that is visible in two orthogonal planes 4
joint effusion: abnormal hypoechoic or...
The iliofemoral line is traced on an AP pelvis projection. It is a curvilinear line, along the outer surface of the ilium, through the superior acetabular rim and the femoral neck.
It should be bilaterally symmetrical. Asymmetry may be the result of congenital dysplasia, slipped femoral capital...
The Ottawa ankle rules are a clinical decision-making strategy for determining which patients require radiographic imaging for ankle and midfoot injuries. Proper application has high (97.5%) sensitivity and reduces the need for radiographs by ~35% 1,2,4.
There are two components, assessing for...
This is a basic article for medical students and other non-radiologists
Polyarthritis (arthritis affecting several joints) is common, especially in older patients. Symptoms may range from mild pain and restriction to severe, debilitating disease with mutilated joints.
Wrist x-rays are commonly used for the assessment of the wrist following trauma. This is usually a fall onto an outstretched hand.
It is useful to have a systematic approach; I tend to start proximally and work distally looking at structures on both views together:
Fluid-fluid levels in bone tumors is a commonly encountered finding, both in benign as well as malignant bone tumors, and can be used to differentiate between the two.
On the sagittal T2W image:
measure the length of the largest fluid-fluid level (A)
measure the maximum length of...
Gissane angle, also known as the "critical angle of Gissane", is a measurement on lateral foot radiographs used to evaluate the severity of calcaneal fractures.
The Gissane angle is measured by drawing lines along the superior surfaces of the anterior process and the posterior face...
Coxa magna is the asymmetrical, circumferential enlargement and deformation of the femoral head and neck. Definitions in the literature vary but enlargement with asymmetry >10% in size is a reasonable cut-off for diagnosis 1.
Coxa profunda refers to a deep acetabular socket. On pelvis x-rays it is seen as the acetabular fossa being medial to the ilioischial line. It should be differentiated from protrusio acetabuli, where the femoral head is seen additionally medial to the ilioischial (Kohler's) line. Coxa profunda i...
The coracoclavicular (CC) distance is an indicator of the integrity of the coracoclavicular ligament.
The coracoclavicular distance is assessed on frontal radiography of the shoulder or clavicle or the coronal projection of a CT or MRI as the distance between the superior cortex of...
Describing a fracture is a basic requirement when making an assessment of a plain radiograph. There are many ways to approach the assessment of the radiograph; this is just one approach.
I: Describe the radiograph
What radiograph (or radiographs) are you looking at? Check the who, what, why, w...
Tumors that metastasize to bone may be remembered using the mnemonic "PBKTL", rendered as "lead kettle", as "Pb" is the standard abbreviation for the chemical element, lead.
For females, breast and lung are the most commo...
The intermetatarsal angle is a measurement used to assess hallux valgus and metatarsus primus varus deformities.
The term intermetatarsal angle alone typically refers to assessment of the first and second metatarsals. Occasionally the term first intermetatarsal angle is used to spe...