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The role of imaging diagnostics in the treatment of musculoskeletal disorders.

The role of imaging diagnostics in the treatment of musculoskeletal disorders.

Diagnostic imaging and other types of diagnostics play an important role in the proper treatment of musculoskeletal disorders in adults, children and adolescents.

The most important studies include:

  1. Magnetic Resonance Imaging (MRI)
  2. Ultrasound of the musculoskeletal system (MSK – ultrasonography)
  3. X-ray examination

Other useful studies are:

  1. CT – computed tomography (CT) – used less frequently, mainly in the case of extensive fractures
  2. PET-CET – positron emission tomography (PET-CET) – used almost exclusively in the diagnosis of cancers of bones and surrounding structures
  3. DEXA densitometry – for the diagnosis of bone mineralization disorders (osteopenia, osteoporosis, hypostosis, rickets, excessive bone mineralization)
  4. EMG – neurophysiological examination of peripheral nerve conduction and nerve plexuses (Electromyography)
  5. Laboratory tests – rheumatological profiles, markers of bone turnover in osteoporosis, identification of autoimmune diseases
  6. Low-emission scanner examination – applies to advanced posture defects in three-dimensional (3D) image.

By far the most frequently performed examination in orthopedic diagnostics is magnetic resonance imaging. The development of MRI studies proceeded and proceeds as follows:

  1. The improvement of the resolution and, consequently, the quality of the test was carried out by constructing devices with increasing magnetic field strength: 1.5 T (Tesla), 3.0 T to 7.0 T
  2. Replacing the reconstruction of the 2D study with three-dimensional 3D images
  3. Providing higher head spin speed up to 640 rows (this shortens the test time and improves the image quality of the ISS)

Currently, the best magnetic resonance imaging in the world is considered to be the Toshiba Cannon Vantage Titan 3.0 T 3D. Japanese and American manufacturers are leading in these technologies.

The first 7.0 T magnetic resonance imaging in Europe was commissioned at the Medical University of Vienna about 12 years ago. This city is also the seat of the European Society of Radiology (ESR) – it is currently the largest radiological medical society in the world. It has 58,000 members, sets standards and is the most opinion-forming. The European Society of Musculoskeletal Radiology (ESSR) is also based in Vienna.

Switzerland (Swiss Society of Musculoskeletal Radiology – SSSR), Austria (where the first ultrasound scanner was created) and Japan (the first ultrasound scanner with color Doppler) are the countries that are leaders in the development of imaging diagnostics of the musculoskeletal system.

Currently, due to the widespread access to MRI examinations and the decrease in their prices, this examination is mainly used in adult and paediatric orthopedics and in sports medicine.

The most important link in professional diagnostics is a good radiologist (MSK Radiologist), who describes the image according to ESR standards.

The second tool enabling examination and (in many cases) making an accurate diagnosis is ultrasound of the musculoskeletal system. It allows you to examine superficially located organs (external joints, single tendons, muscles, ligaments, peripheral nerves, small organs). One of the main applications of ultrasound is the diagnosis of ultrasound of hip joints in newborns and infants between 2 and 6 weeks of age. Subsequent examinations should take place every 6-8 weeks until physiological maturity of both joints is reached.

It should be remembered that these tests are aimed at avoiding DDH – developmental hip dysplasia, which, unlike congenital hip dislocation, is an acquired, developmental disease. In the world, we study mainly using the method of Professor Reinhard Graf (Vienna, Graz, Stolzalpe), in some US states the lesser-known method of Professor Theodore Harcke from the University of Delaware is used. Ultrasound is also useful for the examination of damaged or overloaded muscles, tendons, superficial ligaments, external surfaces of open joints, cysts and peripheral nerves. The examiner’s ability to use HD Color Doppler applications is also useful. Unfortunately, ultrasound examinations have their limitations – they do not allow to assess the internal surfaces of the joints, articular cartilage, deeper elements. However, they are useful for the assessment of microcirculation disorders in enthesopathies and injuries, the assessment of cysts, liquid contents.

The ultrasound scanner is the only diagnostic device that has the possibility of unlimited examination in real time (“live”), which allows you to perform dynamic tests (image in motion). X-ray examinations are used in the diagnosis of fresh bone injuries (here we enter trauma surgery, not orthopedics), assessment of bone union and in paediatric orthopaedics – for the diagnosis of postural defects in children and for the diagnosis of aseptic osteonecrosis in children.

Another examination worth mentioning is EMG, very useful for diagnosing peripheral nerve damage and peripheral nerve compression in interfascial tightness syndromes. The DEXA densitometry test is the basic diagnostic test, next to the examination of markers of bone turnover, in the treatment of osteoporosis. To sum up: imaging diagnostics is an obvious introduction to treatment. Its proper performance allows the diagnosis of the disease, as well as the return to full fitness and many activities.


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