Imaging

Pes Anserine Bursitis

Preliminary Diagnosis: Pes Anserine Bursitis

Pes Anserine Bursitis

I. What imaging technique is first-line for this diagnosis?

  • MRI

II. Describe the advantages and disadvantages of this technique for diagnosis of pes anserine bursitis.

Advantages

  • Able to detect other causes of pain or weakness in the joint such as tendonitis, tenosynovitis, or tears of the tendons of the pes anserinus (sartorius, gracilis and semimembranosus)

  • Exclude connection to medial meniscus and joint effusion with good certainty

  • Does not make use of any ionizing radiation

Disadvantages

  • Expensive

  • Time consuming.

  • Requires significant patient cooperation to minimize motion artifact

  • Intravenous contrast requires that the patient have good renal function with a GFR greater than 60. Administration of intravenous contrast is decided individually on a case by case basis with a GFR greater than 30 and less than 60

III. What are the contraindications for the first-line imaging technique?

  • Contraindicated in patients with non–MR-compatible metallic hardware or foreign bodies

IV. What alternative imaging techniques are available?

  • Ultrasound

  • CT with or without contrast

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of pes anserine bursitis.

Ultrasound

Advantages

  • Able to detect fluid collection and whether fluid is simple or complex.

  • Optimal modality for concomitant detection and aspiration of fluid if indicated

  • Relatively inexpensive

  • Portable imaging modality

  • Does not use ionizing radiation

Disadvantages

  • Requires a skilled technician trained in musculoskeletal imaging with a high index of suspicion for detection of pathology

  • Limited evaluation in obese patients

CT with or without contrast

Advantages

  • Able to see fluid-filled bursa in its typical location

  • Further detail of bone if fracture or osseous lesions suspected

  • Performed much more quickly than MR imaging

  • Requires less patient cooperation and is associated with less motion artifact than MR imaging

Disadvantages

  • Soft tissue structures and tendons better evaluated with MRI

  • Exposes the patient to a large amount of ionizing radiation

  • Imaging with intravenous contrast requires that the patient have good renal function with a creatinine of 0.6-1.2 mg/dL for an adult

VI. What are the contraindications for the alternative imaging techniques?

Ultrasound

  • No significant contraindications exist

CT with or without contrast

  • Contraindicated in a pregnant patient, especially within the first two trimesters

  • Relative contraindication in patients with a contrast allergy

  • Relative contraindication in patients with renal failure

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