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Sep 25th
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MRI - Hamstring

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Both MRI and ultrasound are highly accurate in demonstrating injuries of the hamstring muscles [1,2.]

The hamstrings are composed of several muscles, with the most frequently injured muscle being the long head of biceps femoris [3.]

In professional athletes, MRI and ultrasound may be used to assist in estimating the time out of competition, and allowing athletes to return to competition safely [4.]

Hamstring tears usually heal well with time, strengthening and a rehabilitation programme, however in certain settings, such as a non healing tear, degeneration of the tendon or overlying bursitis, non specific pain, such as sciatica like symptoms, as well as buttock pain, may occur.  In this setting, further ultrasound guided treatment may be of benefit [5.] This often results in non specific pain, such as sciatica like symptoms as well as buttock pain, exacerbated when sitting down.

Treatment options include autologous blood/platelet rich plasma injections as well as cortisone injections into the ischial bursa, which overlies the hamstring tendons. Inflammation and scar tissue surrounding the hamstring muscles may entrap the adjacent sciatic nerve and may result in poor hamstring stretch and sciatica. In these patients, ultrasound guided sciatic nerve release/neurolysis is often therapeutic.

References
  1. Connell DA, Schneider-Kolsky ME, Hoving JL, Malara F, Buchbinder R, Koulouris G, Burke F, Bass C. Longitudinal study comparing sonographic and MRI assessments of acute and healing hamstring injuries. AJR Am J Roentgenol 183(4):975-84, 2004
  2. Koulouris G, Connell D. Hamstring muscle complex: an imaging review. Radiographics 25(3):571-86, 2005
  3. Koulouris G, Connell D. Evaluation of the hamstring muscle complex following acute injury. Skeletal Radiol 32(10):582-9, 2003
  4. Koulouris G, Connell DA, Brukner P, Schneider-Kolsky M. Magnetic resonance imaging parameters for assessing risk of recurrent hamstring injuries in elite athletes. Am J Sports Med 35(9):1500-6, 2007
  5. Koulouris G, Connell D. Imaging of hamstring injuries: therapeutic implications. Eur Radiol 16(7):1478-87, 2006

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MRI Groin Pain

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MRI examination of the left hip demonstrates high signal undermining the origin of the adductor longus (groin) muscle, a common finding seen in athletes presenting with groin pain. This is an injury often associated with osteitis pubis (OP).

Images through the groin demonstrates an area of increased signal in keeping with the diagnosis of a partial thickness tear at the origin of the adductor muscle (adductor longus) as it arises of the pubic bone.  This is a specific finding on MRI that well correlates with the clinical findings of pain on the same side [1].

Similar hyperintensity may also been seen in the adjacent muscle as well as bone in keeping with increased fluid (oedema).  The presence of oedema in the marrow of the pubic bone is the hallmark finding of the diagnosis of osteitis pubis, commonly referred to as “OP” [2].

Interestingly, patients with groin pain will often have changes of early arthritis of the hip, which is seen as loss of cartilage and small cysts in the bone marrow.  It is thought that the decreased range of motion in the hip, specifically internal and external rotation [3], results in additional stress on the pubic bone and therefore predispose such patients to developing osteitis pubis.

 

 

References:

  1. Brennan D, O'Connell MJ, Ryan M, Cunningham P, Taylor D, Cronin C, O'Neill P, Eustace S.  Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology 235(1):162-7, 2005
  2. Verrall GM, Henry L, Fazzalari NL, Slavotinek JP, Oakeshott RD.  Bone biopsy of the parasymphyseal pubic bone region in athletes with chronic groin injury demonstrates new woven bone formation consistent with a diagnosis of pubic bone stress injury. Am J Sports Med 36(12):2425-31, 2008
  3. Verrall GM, Hamilton IA, Slavotinek JP, Oakeshott RD, Spriggins AJ, Barnes PG, Fon GT.  Hip joint range of motion reduction in sports-related chronic groin injury diagnosed as pubic bone stress injury. J Sci Med Sport. 2005 Mar;8(1):77-84.
  4. Verrall GM, Slavotinek JP, Barnes PG, Esterman A, Oakeshott RD, Spriggins AJ.  Hip joint range of motion restriction precedes athletic chronic groin injury. J Sci Med Sport 10(6):463-6, 2007
  5. Koulouris G.   Imaging review of groin pain in elite athletes: an anatomic approach to imaging findings. AJR Am J Roentgenol 191(4):962-72, 2008
  6. Zoga AC, Kavanagh EC, Omar IM, Morrison WB, Koulouris G, Lopez H, Chaabra A, Domesek J, Meyers WC. Athletic pubalgia and the "sports hernia": MR imaging findings. Radiology 247(3):797-807, 2008
  7. Omar IM, Zoga AC, Kavanagh EC, Koulouris G, Bergin D, Gopez AG, Morrison WB, Meyers WC.  Athletic pubalgia and "sports hernia": optimal MR imaging technique and findings. Radiographics 28(5):1415-38, 2008

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Last Updated ( Thursday, 03 July 2014 22:25 )
 
 

MRI Brain

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Since its introduction, MRI has become the imaging modality of choice for most body parts and the exquisite quality of images is best seen in the brain.

Note that scans of the brain may be performed in any plane, so “slices” can be made from any angle.  Arteries and veins are well visualised, as is the grey and white matter.  Even the very fine cranial nerves can be seen.  MRI is crucial in diagnosing conditions such as stroke, bleed (haemorrhage) and tumours.

A specific benign tumour, known as an acoustic (vestibular) neuroma often presents with hearing loss and can be confidently diagnosed with a quick dedicated scan of the relevant region.

 

Since 1 November 2013, GPs are able to request four new Magnetic Resonance Imaging (MRI) Medicare services for patients 16 years of age and over.

This includes 

  • Scan of head for unexplained seizures and unexplained chronic headache with suspected intracranial pathology.

This enables GPs to refer adult patients (16 years and over) for an MRI examination of the head to Melbourne Radiology Clinic based on the clinical indication shown above.

 

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Last Updated ( Wednesday, 26 February 2014 13:00 )
 
 
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