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Semin Musculoskelet Radiol 2005; 9(2): 135-149
DOI: 10.1055/s-2005-872339
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.

Musculoskeletal Ultrasound and MRI: Which Do I Choose?

Jon A. Jacobson1
  • 1Department of Radiology, University of Michigan, Ann Arbor, Michigan
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Publication History

Publication Date:
26 July 2005 (online)

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ABSTRACT

In the diagnosis of musculoskeletal disorders, there are several applications where both ultrasound and magnetic resonance imaging (MRI) may be considered viable alternatives. Because there are advantages and disadvantages to each imaging method, often it is unclear which should be considered for a specific indication. This article reviews this topic in the following manner. First, musculoskeletal applications where there are significant advantages for the use of ultrasound are discussed, which includes evaluation of soft tissue foreign bodies, peripheral nerves, pathologies that require dynamic imaging for diagnosis, and soft tissues adjacent to metal hardware. This is followed by a discussion of indications where both ultrasound and MRI may be considered, such as evaluation of a focal tendon abnormality, focal ligament abnormality, soft tissue fluid collection, and confirmation of a probable benign cyst, such as Baker’s cyst and wrist ganglion. Musculoskeletal ultrasound should be viewed as an imaging method that complements MRI rather than one that competes with MRI in the evaluation of musculoskeletal abnormalities, as it can offer important information.

KEYWORDS

Ultrasound (US) - magnetic resonance (MR) - soft tissues

REFERENCES

  • 1 Mayer V. Ultrasonography of the rotator cuff.  J Ultrasound Med. 1985;  4 607
    PubMedGoogle Scholar
  • 2 Jacobson J A, van Holsbeeck M T. Musculoskeletal ultrasonography.  Orthop Clin North Am. 1998;  29 135-167
    CrossrefPubMedGoogle Scholar
  • 3 Lin J, Fessell D P, Jacobson J A, Weadock W J, Hayes C W. An illustrated tutorial of musculoskeletal sonography: part I, introduction and general principles.  AJR Am J Roentgenol. 2000;  175 637-645
    PubMedGoogle Scholar
  • 4 Lin J, Fessell D P, Jacobson J A, Weadock W J, Hayes C W. An illustrated tutorial of musculoskeletal sonography: part 3, lower extremity.  AJR Am J Roentgenol. 2000;  175 1313-1321
    PubMedGoogle Scholar
  • 5 Lin J, Jacobson J A, Fessell D P, Weadock W J, Hayes C W. An illustrated tutorial of musculoskeletal sonography: part 2, upper extremity.  AJR Am J Roentgenol. 2000;  175 1071-1079
    PubMedGoogle Scholar
  • 6 Lin J, Jacobson J A, Fessell D P, Weadock W J, Hayes C W. An illustrated tutorial of musculoskeletal sonography: part 4, musculoskeletal masses, sonographically guided interventions, and miscellaneous topics.  AJR Am J Roentgenol. 2000;  175 1711-1719
    PubMedGoogle Scholar
  • 7 Silvestri E, Martinoli C, Derchi L E, Bertolotto M, Chiaramondia M, Rosenberg I. Echotexture of peripheral nerves: correlation between US and histologic findings and criteria to differentiate tendons.  Radiology. 1995;  197 291-296
    CrossrefPubMedGoogle Scholar
  • 8 Bude R O, Rubin J M. Power Doppler sonography.  Radiology. 1996;  200 21-23
    PubMedGoogle Scholar
  • 9 Rosenthal S J, Jones P H, Wetzel L H. Phase inversion tissue harmonic sonographic imaging: a clinical utility study.  AJR Am J Roentgenol. 2001;  176 1393-1398
    PubMedGoogle Scholar
  • 10 Lin D C, Nazarian L N, O'Kane P L, McShane J M, Parker L, Merritt C R. Advantages of real-time spatial compound sonography of the musculoskeletal system versus conventional sonography.  AJR Am J Roentgenol. 2002;  179 1629-1631
    CrossrefPubMedGoogle Scholar
  • 11 Lin E C, Middleton W D, Teefey S A. Extended field of view sonography in musculoskeletal imaging.  J Ultrasound Med. 1999;  18 147-152
    PubMedGoogle Scholar
  • 12 Erickson S J. High-resolution imaging of the musculoskeletal system.  Radiology. 1997;  205 593-618
    PubMedGoogle Scholar
  • 13 Craig J G, Jacobson J A, Moed B R. Ultrasound of fracture and bone healing.  Radiol Clin North Am. 1999;  37 737-751 , ix
    CrossrefPubMedGoogle Scholar
  • 14 Patel S, Fessell D P, Jacobson J A, Hayes C W, van Holsbeeck M T. Artifacts, anatomic variants, and pitfalls in sonography of the foot and ankle.  AJR J Roentgenol. 2002;  178 1247-1254
    PubMedGoogle Scholar
  • 15 Martinoli C, Derchi L E, Pastorino C, Bertolotto M, Silvestri E. Analysis of echotexture of tendons with US.  Radiology. 1993;  186 839-843
    PubMedGoogle Scholar
  • 16 Crass J R, van de Vegte G L, Harkavy L A. Tendon echogenicity: ex vivo study.  Radiology. 1988;  167 499-501
    PubMedGoogle Scholar
  • 17 Jacobson J A. Musculoskeletal sonography and MR imaging. A role for both imaging methods.  Radiol Clin North Am. 1999;  37 713-735
    CrossrefPubMedGoogle Scholar
  • 18 Dinnes J, Loveman E, McIntyre L, Waugh N. The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review.  Health Technol Assess. 2003;  7 iii,1-166
    PubMedGoogle Scholar
  • 19 Middleton W D, Payne W T, Teefey S A, Hildebolt C F, Rubin D A, Yamaguchi K. Sonography and MRI of the shoulder: comparison of patient satisfaction.  AJR Am J Roentgenol. 2004;  183 1449-1452
    CrossrefPubMedGoogle Scholar
  • 20 Failla J M, van Holsbeeck M, Vanderschueren G. Detection of a 0.5-mm-thick thorn using ultrasound: a case report.  J Hand Surg [Am]. 1995;  20 456-457
    PubMedGoogle Scholar
  • 21 Horton L K, Jacobson J A, Powell A, Fessell D P, Hayes C W. Sonography and radiography of soft-tissue foreign bodies.  AJR Am J Roentgenol. 2001;  176 1155-1159
    CrossrefPubMedGoogle Scholar
  • 22 Boyse T D, Fessell D P, Jacobson J A, Lin J, van Holsbeeck M T, Hayes C W. US of soft-tissue foreign bodies and associated complications with surgical correlation.  Radiographics. 2001;  21 1251-1256
    CrossrefPubMedGoogle Scholar
  • 23 Shiels II W E, Babcock D S, Wilson J L, Burch R A. Localization and guided removal of soft-tissue foreign bodies with sonography.  AJR Am J Roentgenol. 1990;  155 1277-1281
    PubMedGoogle Scholar
  • 24 Duncan I, Sullivan P, Lomas F. Sonography in the diagnosis of carpal tunnel syndrome.  AJR Am J Roentgenol. 1999;  173 681-684
    CrossrefPubMedGoogle Scholar
  • 25 Chiou H J, Chou Y H, Cheng S P et al.. Cubital tunnel syndrome: diagnosis by high-resolution ultrasonography.  J Ultrasound Med. 1998;  17 643-648
    PubMedGoogle Scholar
  • 26 Quinn T J, Jacobson J A, Craig J G, van Holsbeeck M T. Sonography of Morton's neuromas.  AJR Am J Roentgenol. 2000;  174 1723-1728
    PubMedGoogle Scholar
  • 27 Buchberger W, Judmaier W, Birbamer G, Lener M, Schmidauer C. Carpal tunnel syndrome: diagnosis with high-resolution sonography.  AJR Am J Roentgenol. 1992;  159 793-798
    CrossrefPubMedGoogle Scholar
  • 28 Redd R A, Peters V J, Emery S F, Branch H M, Rifkin M D. Morton neuroma: sonographic evaluation.  Radiology. 1989;  171 415-417
    PubMedGoogle Scholar
  • 29 Provost N, Bonaldi V M, Sarazin L, Cho K H, Chhem R K. Amputation stump neuroma: ultrasound features.  J Clin Ultrasound. 1997;  25 85-89
    CrossrefPubMedGoogle Scholar
  • 30 Thomas A J, Bull M J, Howard A C, Saleh M. Peri operative ultrasound guided needle localisation of amputation stump neuroma.  Injury. 1999;  30 689-691
    CrossrefPubMedGoogle Scholar
  • 31 Beggs I. Sonographic appearances of nerve tumors.  J Clin Ultrasound. 1999;  27 363-368
    CrossrefPubMedGoogle Scholar
  • 32 Reynolds Jr D L, Jacobson J A, Inampudi P, Jamadar D A, Ebrahim F S, Hayes C W. Sonographic characteristics of peripheral nerve sheath tumors.  AJR Am J Roentgenol. 2004;  182 741-744
    CrossrefPubMedGoogle Scholar
  • 33 Lin J, Jacobson J A, Hayes C W. Sonographic target sign in neurofibromas.  J Ultrasound Med. 1999;  18 513-517
    CrossrefPubMedGoogle Scholar
  • 34 Farin P U, Jaroma H, Harju A, Soimakallio S. Medial displacement of the biceps brachii tendon: evaluation with dynamic sonography during maximal external shoulder rotation.  Radiology. 1995;  195 845-848
    PubMedGoogle Scholar
  • 35 Jacobson J A, Jebson P J, Jeffers A W, Fessell D P, Hayes C W. Ulnar nerve dislocation and snapping triceps syndrome: diagnosis with dynamic sonography-report of three cases.  Radiology. 2001;  220 601-605
    CrossrefPubMedGoogle Scholar
  • 36 Choi Y S, Lee S M, Song B Y, Paik S H, Yoon Y K. Dynamic sonography of external snapping hip syndrome.  J Ultrasound Med. 2002;  21 753-758
    PubMedGoogle Scholar
  • 37 Pelsser V, Cardinal E, Hobden R, Aubin B, Lafortune M. Extraarticular snapping hip: sonographic findings.  AJR Am J Roentgenol. 2001;  176 67-73
    CrossrefPubMedGoogle Scholar
  • 38 Neustadter J, Raikin S M, Nazarian L N. Dynamic sonographic evaluation of peroneal tendon subluxation.  AJR Am J Roentgenol. 2004;  183 985-988
    CrossrefPubMedGoogle Scholar
  • 39 Okamoto M, Abe M, Shirai H, Ueda N. Morphology and dynamics of the ulnar nerve in the cubital tunnel. Observation by ultrasonography.  J Hand Surg [Br]. 2000;  25 85-89
    CrossrefPubMedGoogle Scholar
  • 40 Abdel-Salam A, Eyres K S, Cleary J. Drivers' elbow: a cause of ulnar neuropathy.  J Hand Surg [Br]. 1991;  16 436-437
    CrossrefPubMedGoogle Scholar
  • 41 Beggs I. Sonography of muscle hernias.  AJR Am J Roentgenol. 2003;  180 395-399
    CrossrefPubMedGoogle Scholar
  • 42 De Smet A A, Winter T C, Best T M, Bernhardt D T. Dynamic sonography with valgus stress to assess elbow ulnar collateral ligament injury in baseball pitchers.  Skeletal Radiol. 2002;  31 671-676
    CrossrefPubMedGoogle Scholar
  • 43 Nazarian L N, McShane J M, Ciccotti M G, O'Kane P L, Harwood M I. Dynamic US of the anterior band of the ulnar collateral ligament of the elbow in asymptomatic major league baseball pitchers.  Radiology. 2003;  227 149-154
    PubMedGoogle Scholar
  • 44 Jacobson J A, Lax M J. Musculoskeletal sonography of the postoperative orthopedic patient.  Semin Musculoskelet Radiol. 2002;  6 67-77
    Article in Thieme ConnectPubMedGoogle Scholar
  • 45 Breidahl W H, Stafford Johnson D B, Newman J S, Adler R S. Power Doppler sonography in tenosynovitis: significance of the peritendinous hypoechoic rim.  J Ultrasound Med. 1998;  17 103-107
    PubMedGoogle Scholar
  • 46 Jacobson J A, Lancaster S, Prasad A, van Holsbeeck M T, Craig J G, Kolowich P. Full-thickness and partial-thickness supraspinatus tendon tears: value of US signs in diagnosis.  Radiology. 2004;  230 234-242
    CrossrefPubMedGoogle Scholar
  • 47 Waitches G M, Rockett M, Brage M, Sudakoff G. Ultrasonographic-surgical correlation of ankle tendon tears.  J Ultrasound Med. 1998;  17 249-256
    PubMedGoogle Scholar
  • 48 Rockett M S, Waitches G, Sudakoff G, Brage M. Use of ultrasonography versus magnetic resonance imaging for tendon abnormalities around the ankle.  Foot Ankle Int. 1998;  19 604-612
    PubMedGoogle Scholar
  • 49 Fessell D P, Vanderschueren G M, Jacobson J A et al.. US of the ankle: technique, anatomy, and diagnosis of pathologic conditions.  Radiographics. 1998;  18 325-340
    PubMedGoogle Scholar
  • 50 Ward S I, Teefey S A, Paletta Jr G A et al.. Sonography of the medial collateral ligament of the elbow: a study of cadavers and healthy adult male volunteers.  AJR Am J Roentgenol. 2003;  180 389-394
    PubMedGoogle Scholar
  • 51 Jacobson J A, Propeck T, Jamadar D A, Jebson P J, Hayes C W. US of the anterior bundle of the ulnar collateral ligament: findings in five cadaver elbows with MR arthrographic and anatomic comparison-initial observations.  Radiology. 2003;  227 561-566
    PubMedGoogle Scholar
  • 52 Jacobson J A, Oh E, Propeck T, Jebson P J, Jamadar D A, Hayes C W. Sonography of the scapholunate ligament in four cadaveric wrists: correlation with MR arthrography and anatomy.  AJR Am J Roentgenol. 2002;  179 523-527
    PubMedGoogle Scholar
  • 53 Lee J I, Song I S, Jung Y B et al.. Medial collateral ligament injuries of the knee: ultrasonographic findings.  J Ultrasound Med. 1996;  15 621-625
    PubMedGoogle Scholar
  • 54 Milz P, Milz S, Putz R, Reiser M. 13 MHz high-frequency sonography of the lateral ankle joint ligaments and the tibiofibular syndesmosis in anatomic specimens.  J Ultrasound Med. 1996;  15 277-284
    PubMedGoogle Scholar
  • 55 Fessell D P, van Holsbeeck M. Ultrasound of the foot and ankle.  Semin Musculoskelet Radiol. 1998;  2 271-282
    PubMedGoogle Scholar
  • 56 Fessell D P, Jacobson J A, Craig J et al.. Using sonography to reveal and aspirate joint effusions.  AJR Am J Roentgenol. 2000;  174 1353-1362
    CrossrefPubMedGoogle Scholar
  • 57 Riebel T W, Nasir R, Nazarenko O. The value of sonography in the detection of osteomyelitis.  Pediatr Radiol. 1996;  26 291-297
    CrossrefPubMedGoogle Scholar
  • 58 Loyer E M, Kaur H, David C L, DuBrow R, Eftekhari F M. Importance of dynamic assessment of the soft tissues in the sonographic diagnosis of echogenic superficial abscesses.  J Ultrasound Med. 1995;  14 669-671
    PubMedGoogle Scholar
  • 59 Loyer E M, DuBrow R A, David C L, Coan J D, Eftekhari F. Imaging of superficial soft-tissue infections: sonographic findings in cases of cellulitis and abscess.  AJR Am J Roentgenol. 1996;  166 149-152
    PubMedGoogle Scholar
  • 60 Ward E E, Jacobson J A, Fessell D P, Hayes C W, van Holsbeeck M. Sonographic detection of Baker's cysts: comparison with MR imaging.  AJR Am J Roentgenol. 2001;  176 373-380
    CrossrefPubMedGoogle Scholar
  • 61 Cardinal E, Buckwalter K A, Braunstein E M, Mih A D. Occult dorsal carpal ganglion: comparison of US and MR imaging.  Radiology. 1994;  193 259-262
    PubMedGoogle Scholar
  • 62 Bianchi S, Abdelwahab I F, Zwass A, Giacomello P. Ultrasonographic evaluation of wrist ganglia.  Skeletal Radiol. 1994;  23 201-203
    PubMedGoogle Scholar
  • 63 Breidahl W H, Adler R S. Ultrasound-guided injection of ganglia with corticosteroids.  Skeletal Radiol. 1996;  25 635-638
    CrossrefPubMedGoogle Scholar

Jon A JacobsonM.D. 

Associate Professor of Radiology, Director, Division of Musculoskeletal Radiology, Department of Radiology

University of Michigan Medical Center, 1500 East Medical Center Drive

TC-2910L, Ann Arbor, MI 48109-0326