Download Lower Extremity Anatomy

Anatomy of the Lower Extremity
in Computed Tomography
Michael C. Ficorelli, RT
Lesson Description
To explain the various exams pertaining to the
lower extremity using computed tomography,
incorporating cross sectional anatomy from
images
Lesson Description
• To be able to identify anatomy of the lower
extremity. Understand the clinical indications for
exams of the abdomen. To understand the methods
of patient scanning, positioning, and protocols. To
understand indications for contrast.
CT of the Lower Extremity
(Hip, Knee, Ankle, Foot)
Ankle and Foot Bony Anatomy
• 7 Tarsal Bones
– Talus – responsible with the calcaneus for bearing weight; wedge
shaped body with upper surface (trochlea) which articulates with
Tibia and Fibula
– Calcaneus – Largest tarsal, prominence of the heel, tuberosity
which is insertion for ligaments and tendons (Achilles)
• Sustentaculum Tali – medial surface which supports the talus
• Sinus Tarsi – canal from articulation between talus and calcaneous
– Navicular, Cuboid, Lateral Cuneiform, Intermediate Cuneiform,
Medial Cuneiform
•
•
•
•
5 Metatarsals
14 phalanges – 3 for each toe except hallux (2)
Distal Tibia – Medial malleoli
Distal Fibula – Lateral malleoli
Ankle and Foot Anatomy
• Arches:
– Longitudinal arch: Two parts – lateral and medial
– Provides firm base for support
– Transverse arch: Distal row of tarsals (Cuboid, 3
cuneiforms) and bases of metatarsals creating
dome – major weight bearing arch
• Important:
– Retinacula – sheaths of tendons around the ankle
– Fascia – thickened area on plantar surface
Foot
Anatomy
Foot Anatomy
Ankle Joint
Knee Bony Anatomy
• Made up of:
– Distal Femur – lateral and medial condyle and epicondyle
• Smooth anterior surface for articulation with the patella
• Posterior - intercondylar fossa
• Adductor tubercle – above medial epicondyle attachment for adductor
magnus
– Tibia – widened proximal end with medial and lateral condyles
• Tibial Plateau – widened medial and lateral surfaces for articulation with
femur
• Intercondylar eminence (Tibial Spine) – between the plateaus with two
peaks (tubercles)
• Tibial Tuberosity – site of attachment of patellar ligament anteriorly
– Fibula – long thin bone
• Head – apex, sharp and superior with surface that articulates with the
lateral condyle of the tibia
Knee Anatomy
• Patella
– Largest sesamoid in the body
– Flat triangular bone with base proximal and apex distal
• Joint – 2 separate articulations – Femorotibia and
Patellofemoral
– Capsule – strong, fibrous membrane reinforced by
extracapsular ligaments
• Anteriorly blends with quadriceps tendon
– Synovial membrane is largest synovial cavity of the body
– Menisci – (2) found between femoral condyles, connective
tissue
• Medial – attached to MCL, less mobile
• Lateral – closed ring
– Ligaments – External and Internal
• External – MCL, Lateral Collateral, Patellar
• Internal – ACL, PCL
GROSS KNEE ANATOMY
KNEE ANATOMY
KNEE ANATOMY
KNEE ANATOMY
KNEE ANATOMY
KNEE ANATOMY
Ankle / Foot Protocol
Parameters
Single Slice
4 SLICE
16 SLICE
FEET FIRST. SUPINE
SAME
SAME
• Lung nodules
DEPENDS ON WHAT
SAME
SAME
SCANNING
AREA
• CancerPART
100ML AT 1-2ML/SEC
SAME
SAME
CONTRAST
• Vascular disease 0.5MM
16X0.75
DETECTOR COLLI NA
14-18
SAME
SAME
DFOV
• Effusion
and infiltration
SAME
SAME
SLICE THICKNESS 16-20 MM
• TraumaNONE
SAME
SAME
ANGLE
3MM
VARIES
VARIES
TABLE
• FEED/ROT
Pulmonary
Parenchymal
diseases
1
VARIES
VARIES
PITCH
• Hilar Masses
1 -2 SEC
0.75 SEC
1.5SEC
ROT TIME
PATIENT
RECON
STANDARD/BONE
SAME
SAME
WINDOW
450W/30L—
2000W/200L
SAME
SAME
Coronal Foot
1 – Calcanous
2 – Talus
3 – Navicular
4 – Medial Cuneiform
5 – Base of 1st MT
6 – 2nd MT
7 – 2nd Prox Phalanx
8 – 2nd Middle Phalanx
9 – 2nd Distal Phalanx
10 – 5th MTP Joint
11- Navicular
Coronal Foot
1 – Base of 5th MT
2 – Cuboid
3 – Calcaneus
4 – Navicular
5 – Medial Cuneiform
6 – 1st MT
7 – 1st Prox Phalanyx
8 – 1st Distal Phalanyx
9 – 2nd Middle Phalanyx
10 – 4th MT Head
AXIAL ANKLE
2
1
1- Fibula
2- Tibia
AXIAL
1- Lateral malleolus
2
1
3
2- Tallus
3- Medical
malleolus
AXIAL
1- Talus
2- CALCANUS
1
3- NAVICULAR
3
2
AXIAL
1- CUNEIFORM BONES
2- CUBOID BONE
1
2
SAGITAL MPR
1- TALUS
1
2- SINUS TARUS
2
6
3
3- CALCANEUS
4- CUBOID
5
5- CUNEIFORM
6- NAVICULAR
4
CORONAL MPR
1- LATERAL
MALLEOLUS
2
3
2- TALAR JOINT
1
4
3- MEDICAL
MALLEOLUS
4- TALLUS
5- CALCANEOUS
5
CORONAL MPR
1- Calcaneous
1
BONE VS SOFT TISSUE
BONE
SOFT TISSUE
KNEE
1- FEMUR
1
KNEE
1- Medial condyle
2- Patella
2
3
1
3- Lateral condyle
4- intercondylar fossa
4
KNEE
1- Tibial Plataeu
1
KNEE
1-Tibia
1
2- Head of fibula
2
CORONAL KNEE
1- Intercondylar fossa
3
1
2
2- Tibial plateau
3- Condyle of femur
PROTOCOL FOR HIP AND BONY PELVIS
Parameters
Single Slice
4 SLICE
PATIENT
• Lung
FEET FIRST. SUPINE
SAME
nodules
CREST TO PUBIS
SAME
SCANNING AREA
ABOVE JOINT TO BELOW
• Cancer
LESSER TUBEROSITY
• Vascular disease
100ML AT 2ML/SEC @ 30
SAME
CONTRAST
SECOND DELAY
• Effusion
4 X 1MM
DETECTOR
COLLI andNAinfiltration
DEPENDS ON PATIENT FOR
SAME
DFOV
• Trauma
PELVIS/ 20 CM FOR HIP
5 MM
SAME
SLICE
THICKNESS
• Pulmonary
Parenchymal
diseases
NONE
SAME
ANGLE
• Hilar Masses
16 SLICE
SAME
SAME
SAME
16 X 0.75
SAME
SAME
SAME
TABLE FEED/ROT
3-5 MM
VARIES
VARIES
PITCH
1 OR 1.6
VARIES
VARIES
ROT TIME
1- 2SEC
0.75 SEC
1 SEC
RECON
STANDARD/BONE
SAME
SAME
WINDOW
450W/30L—1600W/600L
SAME
SAME
HIPS
1- Head of Femur
4
1
2- Acetabulum
3- Fovea Capitis
3
4- Pubic Bone
2
5
5- Ischium
HIPS
1
1- Pubic Ramus
2
2- Femoral Neck
3- Ischial Tuberosity
4- Greater
Trochanter
3
4
HIPS
1- Symphysis Pubis
2
1
2- Lesser
Trochanter
HIPS
1- Pubic Bone
1
HIP CORONAL MPR
1- SYMPHYSIS PUBIS
1
2- PUBIC BONE
2
HIP CORONAL MPR
1- Greater Trochanter
1
2
2- Acetabulum
3- Femoral Neck
3
4
4- Lesser Trochanter
BONY PELVIS
1- Sacrum
2- Ilium
1
3- S.I. Joint
3
2