Lower Limbs

7.1. HIP (COXAL OR INNOMINATE) BONE

7.2. HIP JOINT

7.3. HIP JOINT X-RAY

7.4. IMAGING STUDIES OF THE HIP JOINT

7.5. FEMUR

7.6. MUSCLES OF THE THIGH: ANTERIOR VIEW

7.7. MUSCLES OF THE THIGH: POSTERIOR VIEW

7.8. THIGH SERIAL CROSS SECTIONS

7.9. UPPER RIGHT THIGH T1 MRI

7.10. MIDDLE RIGHT THIGH T1 MRI

7.11. LOWER RIGHT THIGH T1 MRI

7.12. KNEE AND KNEE JOINT OVERVIEW

7.13. KNEE JOINT INTERIOR

7.14. KNEE JOINT LIGAMENTS

7.15. KNEE JOINT X-RAY

7.16. SAGITTAL SECTION OF THE KNEE JOINT AND T2 MRI

7.17. CORONAL AND AXIAL T2 MRI STUDIES OF THE KNEE

7.18. ARTERIES OF THE THIGH AND KNEE

7.19. MAGNETIC RESONANCE ANGIOGRAPHY OF THE THIGH

7.20. TIBIA AND FIBULA

7.21. MUSCLES OF THE LEG: ANTERIOR VIEW

7.22. MUSCLES OF THE LEG: POSTERIOR VIEW

7.23. MUSCLES OF THE LEG: LATERAL VIEW

7.24. LEG CROSS SECTION AND FASCIAL COMPARTMENTS

7.25. AXIAL T1 MRI THROUGH THE LEG

7.26. VASCULAR STUDIES OF THE LOWER EXTREMITY: CTA/MRA OF THE LEG AND LOWER EXTREMITIES

7.27. DIGITAL SUBTRACTION ANGIOGRAPHY OF THE RIGHT LOWER EXTREMITY

7.28. BONES OF THE FOOT: SUPERIOR AND INFERIOR VIEWS

7.29. BONES OF THE FOOT: MEDIAL AND LATERAL VIEWS

7.30. ANKLE X-RAYS

7.31. CORONAL T1 AND T2 MRI OF THE ANKLE

7.32. SAGITTAL T1 AND T2 MRI OF THE ANKLE

7.33. X-RAYS OF THE FOOT

7.1 Hip (Coxal or Innominate) Bone

The hip bone is an innominate bone consisting of fused ilium, ischium, and pubic bones. Each has its own ossification center. Cartilage is replaced by bone by age 10, and complete fusion in the acetabulum occurs around puberty. Left and right innominate bones articulate with the sacrum at the auricular (“ear-shaped”) surfaces to comprise the pelvis.

7.2 Hip Joint

The head of the femur articulates with the lunate surface of the acetabulum of the innominate bone. The fibrous joint capsule has thickenings that form the iliofemoral, ischiofemoral, and pubofemoral ligaments. The iliofemoral ligament, called the Y ligament because it is shaped like an inverted Y, has an anterior location that restricts extension at the hip joint. The ligament of the head of the femur inside the hip joint cavity provides a route for a small artery to the head of the femur. It has no supportive role in maintaining the integrity of the joint.

7.3 Hip Joint X-Ray

A conventional x-ray should be the initial form of imaging when evaluating joint complaints. Causes of acute hip pain include inflammatory arthritis, septic arthritis, trauma, and tumors. The most common cause of chronic hip pain is degenerative arthritis, which may present as groin pain, thigh pain, or a loss of mobility. Radiographic signs of osteoarthritis are similar, regardless of the joint in which they occur, and include joint-space narrowing, subchondral cyst formation, and outgrowths of bone at the bone ends known as osteophytes. Subchondral cysts appear as well-defined lytic lesions at the articular surface.

7.4 Imaging Studies of the Hip Joint

If an initial hip x-ray is normal or inconclusive, magnetic resonance imaging (MRI) is usually the next modality of choice. MRI is advantageous over other imaging modalities in its soft tissue contrast and high resolution. It can often detect pathophysiological changes before they are seen on conventional radiography. It is the most sensitive imaging modality for stress fractures, which appear as a low-signal line on both T1-weighted and T2-weighted images, with a surrounding high-signal area on T2-weighted images representing edema. Fractures of the hip most often occur in the femoral neck or the intertrochanteric region. A potential complication of femoral neck fractures is avascular necrosis (AVN), which can lead to total joint destruction requiring a hip replacement if not caught early. In these two coronal images, there is an area of depression in the otherwise spherical femoral head. This is the fovea capitis, which is the attachment site of the ligamentum teres. It is the only part of the femoral head not covered by articular cartilage.

7.5 Femur

The femur articulates with the acetabulum of the hip bone in a multiaxial ball-and-socket joint and with the tibia in a modified hinge joint at the knee (where flexion/extension is the primary movement; a little rotation is possible when the knee is flexed). The greater trochanter is the attachment of the abductor muscles of the hip joint and lateral rotators. The iliopsoas muscle, a powerful flexor, inserts on the lesser trochanter. The adductor muscle group inserts on the linea aspera on the back of the femur. The adductor magnus muscle also inserts on the adductor tubercle at the top of the medial condyle.

7.6 Muscles of the Thigh: Anterior View

This right lower limb is rotated laterally a bit to show the adductor compartment to better advantage. The extensor compartment of the thigh (quadriceps, sartorius), innervated by the femoral nerve, is anterior; the adductors are medial. The obturator nerve (an anterior division nerve) and artery supply the latter. The femoral nerve (a posterior division nerve) supplies the extensor compartment, and the femoral artery supplies the entire lower extremity with the exception of the adductors.

7.7 Muscles of the Thigh: Posterior View

The gluteal muscles are posterior and lateral to the hip joint. Posterior on the thigh are the hamstring muscles that extend the hip and flex the knee. The sciatic nerve, with tibial and common fibular nerve components, supplies the flexor compartment of the thigh and all of the muscles of the leg and foot. It is not accompanied by an artery and vein. The hamstring muscles receive their blood supply from the profunda femoris branch of the femoral artery. After supplying the anterior muscles of the thigh, the femoral vessels course medially to the back of the knee, where they become the popliteal vessels after passing through the hiatus of the adductor magnus tendon.

7.8 Thigh Serial Cross Sections

The anterior extensor compartment (red) is supplied by the femoral nerve and (superficial) femoral artery. The posterior flexor compartment (gray) is supplied by the tibial component of the sciatic nerve and profunda femoris branch of the (common) femoral artery. The medial adductor compartment (purple) is supplied by the obturator nerve and artery.

7.9 Upper Right Thigh T1 MRI

On T1 images fat produces a high signal, as seen here in the bone marrow, the subcutaneous tissue, and between muscle fibers and muscle groups. The cortex of the femur is a low-signal area (black). Compare the muscles of the anterior, posterior, and medial compartments with Fig. 7.8. Surrounded by fatty tissue between the anterior and medial compartments are the (superficial) femoral and deep femoral artery and vein. Within the posterior compartment in this image are the semitendinosus muscle, the semimembranosus tendon (low-signal area), the biceps femoris muscle, and the sciatic nerve. Also visualized is the inferior part of the gluteus maximus muscle and the iliotibial tract (area of low signal located lateral to the vastus lateralis). The inferiormost insertion of the gluteus maximus muscle is onto the gluteal tuberosity and the upper extent of the linea aspera.

7.10 Middle Right Thigh T1 MRI

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Tags: Netters Introduction to Imaging

Jan 10, 2016 | Posted by admin in RADIOGRAPHIC ANATOMY | Comments Off

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Lower Limbs

Lower Limbs

7.1 Hip (Coxal or Innominate) Bone

7.2 Hip Joint

7.3 Hip Joint X-Ray

7.4 Imaging Studies of the Hip Joint

7.5 Femur

7.6 Muscles of the Thigh: Anterior View

7.7 Muscles of the Thigh: Posterior View

7.8 Thigh Serial Cross Sections

7.9 Upper Right Thigh T1 MRI

7.10 Middle Right Thigh T1 MRI

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