Topics in magnetic resonance imaging: sports medicine.

Abstract

To grow and sustain referrals for musculoskeletal magnetic resonance imaging (MRI), successful group practices have recruited radiologists with specialized interest and training in musculoskeletal imaging. Musculoskeletal radiologists are valuable because they can talk-the-talk with orthopedists. Skillful communication is important. All orthopedists are trained to interpret radiographic studies during their residency. Sports orthopedists consider themselves self-sufficient when it comes to MRI interpretation. They have the advantage of knowing patients' symptoms and findings on physical examination; however, orthopedists are impressed by added value. Therefore, to get respect—as they say on the playing field—radiologists must see more in the images than their orthopedic colleagues. Successful musculoskeletal radiologists understand the anatomy of joints, the biomechanics of trauma, the sequela of injury, and the rationale behind surgical treatments. It also helps if they participate in conferences, observe arthroscopic or open surgical procedures, and learn about cutting-edge operative techniques. MRI, with its unique soft-tissue contrast resolution and multiplanar capabilities, has become one of the most widely applied diagnostic tools in the assessment of musculoskeletal disorders. The development of MRI has coincided with a boom in health consciousness and physical fitness. New echelons of weekend warriors advance onto football fields, ski slopes, and golf courses to challenge themselves and their aging joints and spines. They are breaking in new running shoes, mountain bikes, and snowboards, while sometimes breaking tendons, ligaments, and cartilage. Over the past 2 decades, the radiologic literature has exploded with publications describing the profound diagnostic capabilities of MRI in evaluating sports-related injuries. Using the latest imaging techniques, surface coils, and software, MRI has matched the capabilities of orthopedists to diagnose intra-articular disorders while maintaining the advantage in assessing myotendinous and occult osseous injuries. This two-part series of Topics in Magnetic Resonance Imaging is devoted to sports medicine. Authors will share current advanced information about MRI acquisition and interpretation (Part I appears in Topics in Magnetic Resonance Imaging, volume 14, number 1; Part II appears in Topics in Magnetic Resonance Imaging, volume 14, number 2). In the opening article of Part II, Chris Beaulieu and Garry Gold describe the elements of interactive MR imaging and interventional MR-guided procedures. Carl Winalski and Krishanu Gupta address the MRI of articular cartilage before and after surgical repair procedures. They describe the nuances of lesion detection, including the rationale supporting protocol design and pulse parameter selection. Jenny Bencardino, Ara Kassarjian and William Palmer review practical information about the hip, providing an overview of MR applications in sports-related osseous injury and myotendinous injury, as well as MR arthrographic applications in the evaluation of acetabular labral tear. In the knee article, William Palmer takes a biomechanical approach to explain the functional relationships between stabilizing structures. William Morrison highlights and illustrates the spectrum of osseous, tendon, and ligament abnormalities seen in athletes, and he comments on pertinent technical developments and anatomic subtleties. Diego Jaramillo and Rachel Oeppen focus on the young athlete and the specific injuries that predominate in the immature skeleton. This second issue concludes with the article by Leon Rybak and Martin Torriani, who explore the role of MRI in the assessment of trauma-related injuries to the myotendinous unit. We are indebted to all authors for their extraordinary contributions of time and expertise, to Scott Atlas for his invitation to compile this issue, and to Andrea Allison-Williams and Helen Powers for their invaluable editorial assistance.