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Case Study for MRI (1)

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3 views

Case Study for MRI (1)

Uploaded by

malakghazi06
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Jordan University of Science and Technology

Faculty of Applied Medical Science


Department of Applied Medical Science
Radiologic Technology Department
Supervisor: Dr.Mohammad Ayasrah
Done by: Ruba Al Harahsheh 159821

Magnetic resonance imagining for knee: A case study

Introduction
The knee is the body’s largest and most complex joint, notable for its mobility despite
lacking intrinsic stability. It functions as a gliding hinge joint with two main articulations:
the tibiofemoral and patellofemoral joints. The tibiofemoral joint supports weight-
bearing, while the patellofemoral joint enables knee extension. These joints can be further
divided; the medial and lateral tibiofemoral compartments each connect corresponding
femoral and tibial condyles. The knee, essential for walking, running, and jumping,
enables flexion, extension, and slight rotation, with movement in six degrees of freedom
through rolling, gliding, and rotating. This range of motion, supported by ligaments and
tendons, underscores the knee’s complexity. i

Magnetic resonance imaging (MRI) is essential for diagnosing and managing knee conditions,
offering high-resolution images of soft tissues and bones. The knee’s complex structure and
various injury mechanisms make MRI crucial for capturing detailed images of menisci, ligaments,
and tendons. Advances in MRI, including improved imaging for postoperative knees and metal
artifact reduction, further enhance assessment accuracy. In acute trauma, MRI helps
differentiate between cases needing surgery and those suited for conservative treatment. For
chronic knee issues, MRI is highly specific, reducing the need for additional imaging, while
ultrasound serves as an affordable option for assessing soft-tissue masses.ii

Case presentation

Patient Profile: A 49-year-old male presents with progressive left knee pain and limited
mobility. His medical history includes a previous trauma to the tibia, which required surgical
repair on the medial tibial plateau. Current concerns suggest possible degenerative joint
changes in the left knee.

Clinical Assessment: The patient reported worsening knee pain in the left knee,
particularly around the medial side, where a past trauma and surgical repair were
previously conducted. The pain had progressively limited his ability to walk comfortably
and engage in regular activities. Due to the chronic nature of his symptoms and a history
of trauma, further imaging and assessment were advised.

Modality imaging:

 X-ray (Initial Assessment): The X-ray confirmed degenerative changes within


the left knee joint, particularly in the medial tibiofemoral compartment. Evidence
of previous repair on the medial tibial plateau was also noted.

 Nuclear Medicine Scan (Technetium-99m MDP Isotope Bone Scan):


o Procedure: A 3-phase bone scan was performed to rule out any active
bone pathology in response to the patient’s knee pain.
o Early Images: Displayed normal flow and blood pool activity in both
knee regions.
o Delayed Images: Demonstrated a focal area of increased radiotracer
uptake within the proximal left tibia, suggestive of localized pathology.
o Other Findings: Irregular radiotracer uptake in multiple large joints (both
upper and lower limbs), indicative of degenerative changes, with no
evidence of suspicious lesions elsewhere in the skeleton.
o Conclusion: Active bone lesion detected in the proximal left tibia. This
was noted to be non-specific, requiring correlation with other imaging
modalities to exclude significant pathology.
 MRI Findings (Left Knee):

o Medial Tibial Plateau Repair: There is evidence of previous repair work


on the medial tibial plateau.
o Osteoarthritic Changes: Marked osteoarthritic changes observed in the
medial tibiofemoral compartment, contributing to joint degeneration.
o ACL (Anterior Cruciate Ligament): Displays a horizontal orientation
with signs indicative of a low-grade chronic partial tear.
o PCL (Posterior Cruciate Ligament): Remains intact, showing no
abnormalities.
o Medial Meniscus: Degenerative signal changes observed in the posterior
horn of the medial meniscus, with extrusion of the meniscal body.
o Lateral Meniscus and Collateral Ligaments: Both are intact, with no
signs of injury or degeneration.
o Joint Effusion: Small amount of joint effusion detected, likely secondary
to osteoarthritic changes.
Discussion

Diagnosis

Based on the clinical presentation and imaging findings, the patient was diagnosed with:

 Advanced Osteoarthritis of the Left Knee, predominantly affecting the medial


tibiofemoral compartment, likely exacerbated by prior tibial trauma and repair.
 Chronic Partial ACL Tear: Low-grade, chronic partial tear of the ACL due to
chronic strain and possibly contributing to knee instability.
 Degenerative Changes in the Meniscus: Likely secondary to osteoarthritis with
medial meniscus extrusion.
 Proximal Tibial Bone Lesion: Active lesion seen on nuclear medicine scan,
likely associated with post-traumatic degenerative changes rather than a
malignant process, though further imaging may be considered for monitoring.

Management Plan

1. Conservative Management:
o Pain Management: NSAIDs for pain control, with recommendations to
monitor for gastrointestinal side effects.
o Physiotherapy: To strengthen surrounding muscles and support joint
stability.
o Activity Modification: Advising the patient to reduce high-impact
activities that may worsen joint degeneration.
2. Further Monitoring and Imaging:
o Follow-up Nuclear Medicine Scan: To monitor the focal uptake area in
the proximal tibia for any changes suggestive of active bone pathology.
o Possible CT or Repeat MRI: If symptoms worsen or if there is concern
for progression of the tibial lesion.
3. Surgical Consideration:
o Given the extent of osteoarthritis and partial ACL tear, surgical options,
including total knee arthroplasty, could be considered if conservative
measures fail to control symptoms.

Conclusion

The patient is likely to experience continued symptoms due to the chronic degenerative
nature of the condition, with the potential need for surgical intervention in the future.
Ongoing monitoring of the active tibial lesion is essential, though it is suspected to be
benign given the lack of suspicious features on imaging. Conservative management,
combined with physiotherapy and pain control, aims to improve functional outcomes and
delay the need for surgical intervention.
i
Hirschmann and Müller, “Complex Function of the Knee Joint.”
ii
Nacey et al., “Magnetic Resonance Imaging of the Knee.”

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