Heterotopic Ossifications in patients with spine injury: an appropriate multidisciplinary diagnostic approach and the radiographer's role for the optimization of technical procedures.

Congress:

ECR 2020

Poster Number:

C-05704

Type:

Educational Exhibit

Keywords:

Performed at one institution, Observational, Retrospective, Education and training, Connective tissue disorders, Diagnostic procedure, CT, Conventional radiography, Musculoskeletal system, Musculoskeletal soft tissue, Musculoskeletal joint, Professional Issues

Authors:

M. BERTOLI¹, B. Musso²; ¹Torino/IT, ²Turin/IT

DOI:

10.26044/ecr2020/C-05704

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-05704

Fig. 17

Fig. 18: frog legs

Fig. 19: knee's lateral projection with patient supine and femur at 90° on the hip joint

Fig. 20: ax mpr ct

Fig. 21

Fig. 22: three-phase scintigraphy examples

Conclusion

Specific, appropriate and optimized diagnostic procedures shared with radiologists and specialists for traditional radiology, CT, MR, and Nuclear Medicine will be briefly displayed.

Conventional Radiology

Shoulder.

It is very important to acquire an image of the glenoid and humeral head on the glenoid plane, highlighting the joint relationships.

In this projection, the central beam is oblique in the mediolateral direction by at least 25 ° and centered on the coracoid process. (fig. 17)

Hip

In addition to the AP projection, which must be performed with particular attention to rotations, it is useful to perform a Frog legs projection: this projection is preferably acquired for both hips at the same time (fig. 18).

Use of dedicated foam cushions is essential to facilitate the positioning of the lower limbs and prevent patient slipping

Knee.

In addition to the AP projection, it is useful to acquire the lateral projection with the patient supine and knee flexed at 90°, so as to measure over time the hip degrees of flexion on the pelvis. (Fig.19)

For the radiological study of the other body segments, x-ray procedures need to be adapted to the patient's needs and physical condition.

During execution fo examinations, the radiographer will implement all his communication skills in order to maximize the compliance of the patient: time dedicated to information communication and reporting it's time to heal.

CT is the "gold standard" exam and the use of low dose protocols based on volumetric CTDI is recommended.

The CT study also requires the use of MPR reconstructions and, in particular, 3D ones, to allow the radiologist to study the relationship between the HO and the surrounding structures and the orthopedist to plan the surgical intervention. (fig. 20)

Magnetic resonance imaging, unlike other methods more suitable for studying bone, provides information especially regarding soft tissues and allows you to view any masses and evaluate their vascularization.

However, it has low specificity and its role in the diagnosis of HO is rather marginal(fig.21)

Nuclear Medicine procedure, performed in a serial way, is used to estimate the maturity of the calcifications and determine the most appropriate moment for surgical excision (fig. 22)