Basics of MSUS musculoskeletal ultrasound Dr Marwa Abo Elmaaty Besar Mansoura University .pdf

Basics of MSUS musculoskeletal ultrasound Dr Marwa Abo Elmaaty Besar Mansoura University
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1. Basic of Musculoskeletal
Ultrasound (MSUS)
Marwa Abo Elmaaty Besar
Lecturer Of Internal Medicine
(Rheumatology Immunology Unit)
(Pediatric Rheumatology)
Mansoura University

2. Every step toward your goal:

4. What is Ultrasound?
•Mechanical sound energy.
•Sound travel through body
tissue (bone, muscle,
tendon, fat, skin), with
different pressure; (high,
low).
•Transducer is an electrical
signal, converted into sound
pulse, hit tissues converted
into electrical signal again.
EularOn-line Course on Ultrasound –module n°1
LeneTerslev, Marcin Szukdlarek, NannoSwen

5. steps of US imaging:
EularOn-line Course on Ultrasound –module n°1
LeneTerslev, Marcin Szukdlarek, NannoSwen

6. Probe
•Superficial probe.
•linear probe.
•Frequencies: 12-18MHZ.
•Hockey stick for small
joint of hand.
EularOn-line Course on Ultrasound –module n°1
LeneTerslev, Marcin Szukdlarek, NannoSwen

7. “piezo-electric effect” of crystals

8. The image produced with a 14 MHz transducer, depth 3.0 cm. penetration from 3 to 5.5 cm
High frequencies (> 12 MHz) can give high axial resolution but on the expense of tissue penetration,
while low frequencies (<10 MHz) result in better penetration into deeper tissues at the cost of axial
resolution.

9. Musculoskeletal
Ultrasound Probe
•Specific mark of probe;
✓proximal = left side; longitudinal.
✓Left = left; transverse.
•Left side of screen is medial part of screen.
EularOn-line Course on Ultrasound –module n°1
LeneTerslev, Marcin Szukdlarek, NannoSwen

10. MSUS Probe with enough gel
EularOn-line Course on Ultrasound –module n°1
LeneTerslev, Marcin Szukdlarek, NannoSwen

11. MSUS Probe, Proper handling:-
EularOn-line Course on Ultrasound –module n°1
LeneTerslev, Marcin Szukdlarek, NannoSwen

12. Echogenicity:
The percentage of beam reflected and can be divided into:

14. Bone
a very bright structure and appears ‘hyperechoic’
EularOn-line Course on Ultrasound –module n°1

15. Tendon
show tightly packed hyperechoic lines
representing the fibrils of the tendon
EularOn-line Course on Ultrasound –module n°1

16. Ligament
show tightly packed hyperechoic lines representing the fibrils of the tendon
EularOn-line Course on Ultrasound –module n°1

17. Cartilage:
Anechoic non compressible structure
EularOn-line Course on Ultrasound –module n°1

18. Nerve
•‘honeycomb’ or ‘pepper pot’ like structures
•composed of hypoechoic spots embedded in a
hyperechoic background
EularOn-line Course on Ultrasound –module n°1

19. fluid
an anechoic appearance it should respond to pressure
EularOn-line Course on Ultrasound –module n°1

20. Blood vessel
an anechoic appearance, doppler activity
EularOn-line Course on Ultrasound –module n°1

21. Bursa
an anechoic appearance
EularOn-line Course on Ultrasound –module n°1

22. Muscle:
hypoechoic, with some internal signals as a result of collagen fibres.
EularOn-line Course on Ultrasound –module n°1

23. Synovium
EularOn-line Course on Ultrasound –module n°1

24. fat
hypoechoic, with irregular hyperechoic lines inside
EularOn-line Course on Ultrasound –module n°1

26. Anisotropy

27. Theheal-toe manoeuvre

28. Toggling

29. Posterior reverberation

30. Posterior shadow

31. Normal strcture

32. Normal strcture

33. Identify

34. Identify

35. Identify

36. Identify

37. Identify

38. Identify

39. Assess:

41. Reference:-
1. Ultrasound acoustics: (www.explorescience.com)
2. Schmidt WA, Schmidt H, SchickeB, Gromnica-IhleE. Standard reference values
for musculoskeletal ultrasonography. Ann Rheum Dis. 2004;63(8):988-94.
3. FornageBD, Rifkin MD. Ultrasound examination of tendons. RadiolClin North Am
1988;26:87-107
4. Bianchi S, MartinoliC. Ultrasound of the Musculoskeletal system 2007. ISBN 978-
3-540-42267-9, Springer. Page: 1-137.
5.Diagnostic ultrasound. Principles and instruments. FW Kremkau–W.B. Saunders
Company 2002.
6. Torp-Pedersen S, Szkudlarek, EllegaardK, D’Agostino MA , IagnoccoA, NaredoA,
Balint P, Wakefield RJ, Torp-Pedersen A, Christensen R, TerslevL. Colour or Power
Doppler -Which is more sensitive and do machine settings matter? EULAR congress
2012. Abstract SAT0389