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Introduction   skeletal radiology(11月20.)
 

Introduction skeletal radiology(11月20.)

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Introduction   skeletal radiology(11月20.) Introduction skeletal radiology(11月20.) Presentation Transcript

  • MUSCULOSKELETAL RADIOLOGY Sun Yat-sen Memorial Hospital SYSU Dr. BILING LIANG
  • Musculoskeletal Radiology
    • INTRODUCTION
      • IMAGING TECHNOLOGY
      • NORMAL APPEARANCE
      • BASIC X-RAY SIGN
      • RADIOLOGY DIAGNOSIS OF COMMON DISEASES
  • Imaging technology
    • X-ray : plain film
      • Very good X-ray density resolution in bone & joint , the resolution of soft tissue not enough
    • CT : as X-ray, but good for positioning
    • MR :
      • advantage : very good soft tissue resolution
      • disadvantage : not sensitivity to display calcification
    • US :
      • Non-invasive image method, easy to perform
      • Can evaluate the soft tissue abnormalities
    • Skeletal CT
      • Soft tissue window :
        • Bone
        • muscle
      • Bone window:
        • Cortical :
        • Trabecula : network
        • Bone marrow cavity :
        • low density
  • X-ray plain film & arthrogram
  • Normal X-ray appearances
    • Bone – structure & development
    • Joint
    • Spine
    • Soft tissue
  • Normal X-ray appearances
    • Bone structure & development
      • Structure :
        • Cortical bone (compact )
        • Cancellous bone (Trabecula )
      • Development :
        • intramembranous ossification
        • Endochondral ossification
    Same histologic structure Different arrangement Cartilage -> bone formation -> remodel -> trabecular bone
  • Normal X-ray appearances cortex trabecula
  • Normal pediatric X-ray appearances 4 years , distal femur metaphysis epiphysis Epiphyseal plate
  • Normal pediatric X-ray appearances 9 m , distal femur 增殖带 成熟带 肥大带 退变带 成骨带 静止细胞带 {
  • Normal pediatric skeletal development 6M 1Y 2Y 3Y 4Y
  • Normal adult X-ray appearances Diaphysis shaft
  • Normal pediatric X-ray appearances
    • The ossification centers & the secondary ossification display & fusion, will occur at certain time of the life, refer to as bone age
    Bone age yrs ±1 New born
  • Normal X-ray appearances
    • The types of skeleton:
      • Long bone
        • Pediatric : diaphysis 、 metaphysis 、 epiphysis 、 epiphyseal plate
        • Adult : diaphysis (shaft) 、
      • Short bone
      • Flat bone – hematopoiesis
      • Irregular bone
    • Joint
    • Short bone
    Normal appearances pediatric adult
    • Flat bone
    Normal appearances
    • Spine
    Normal appearances
  • Normal X-ray appearances
    • Bone
    • Joint -- structure
    • Spine
    • Soft tissue
  • Normal X-ray appearances
    • Joint
      • Synovial joint -- knee
      • Fibrous joint --
      • Cartilaginous joint -- SI
      • Synostosis joint – skull
    • Joint is an organ
      • Articular capsule
      • synovium
      • cartilage
      • Cortical bone
      • Ligament & tenden
      • Fluid
    • Joint space
      • cartilage
    Articular cartilage Epiphyseal cartilage Fibrocartilage dics X-ray
  •  
  • Normal hip
      • bony articular surface
      • joint space
  • Normal joint structure
    • Elbow -- Synovial joint
    • SI joint -- Cartilaginous joint
    • wrist
    Normal joint structure
  • Basic X-ray signs
    • Osteoporosis
    • Osteomalacia
    • Bone destruction
    • Osteosclerosis
    • Periosteal reaction
      • Calcification
      • Bone necrosis
      • Mineral sedimentation
      • Bone deformity
      • Soft tissue abnormalities
    Musculoskeletal system Bone Joint
    • Joint swellen
    • Joint dislocation
      • Joint destruction
      • Joint bony/fibrous ankylosis
  • Osteoporosis
    • Definition :
      • The bone matrix or osteoid specific deficiency
      • Both of the organic material & calcium are decreased, but the ratio of them still normal
    • X-ray appearance :
      • Bone density decreased, local / general
      • The cortex become thinner , the trabeculae become thin and decreased number
      • Pathological fracture
    • Etiology :
      • Common : elderly , immobilization
      • Path : hormonal / vitamine deficiency
    Basic X-ray signs
    • Spine oteoporosis
      • Vertibral body deformity as “ fish vertibral ”
      • Bone density decreased
      • Trabecula thinner
    Osteoporosis Basic X-ray signs normal c
    • Thallassaemia
      • Chronic haemolytic anaemias cause widening of the spongiosa / cortex thinning in the proximal ends of long bone
    Osteoporosis Basic X-ray signs
  • Osteomalacia
    • Definition :
      • Insufficient mineralization of the osteiod
      • Lack of calcium for bone formation
    • X-ray appearance :
      • Bone density decreased generally, bone become softened and bend or even break, vertebral bodies biconcave (fish vertebrae)
      • The cortex become thinner, “ ground glass ” change, deficient bone formation
      • Pseudo-fracture, Pathological fracture
    • Etiology :
      • Deficient Vitamine D, Calcium (inadequate intake)
      • Excessive loss of calcium in renal disease
    Basic X-ray signs
    • Rickets
      • Bone density decreased
      • Bone softening & bend
      • Metaphysis
      • splaying & the epiphyseal plate widening
    Osteomalasia Basic X-ray signs
    • Rickets
      • Bone density decreased
      • Bone softening & bowed
    Osteomalasia Basic X-ray signs
  • Bone destruction Basic X-ray signs
    • Definition :
      • The pathologic tissue replaced the normal bone structure (cortex or spongiosa)
    • X-ray appearance :
      • Bone density decreased, rarefaction of bone
      • The cortex erosion
    • Etiology :
      • Inflammation or granuloma
      • Tumor or tumor-like lesion
    • Simple bone cyst :
      • Massive bone destruction / radiolucency area in proximal femur with well-defined margin, the cortex become thinning
    Bone destruction Basic X-ray signs
    • Giant cell tumor
      • Eccentric expanding (cystic) translucency area in the proximal fibilar bone , with multi-locular appearance
    Bone destruction Basic X-ray signs
    • Giant cell tumor
      • Eccentric expanding (cystic) translucency area in the distal radial bone
    Bone destruction Basic X-ray signs
    • Tuberculosis of right hip
      • Moth-eaten pattern bone destruction in cortex & trabeculae
      • Joint space narrowing
    Bone destruction Basic X-ray signs
  • Osteosclerosis /hyperostosis Basic X-ray signs
    • Definition :
      • Increase of amount of bone matrix in given volume of bone
    • X-ray appearance :
      • Bone density increased
        • Cortex thicken – periosteal growing
        • Bone marrow cavity narrowing – endostosis growing and trabecular thickening
    • Etiology :
      • Inflammation or granuloma (chronic)
      • Trauma & fracture
      • Tumor or tumor-like lesion
    • Chronic osteomyelitis :
      • Med-low part of the tibia
      • Cortex thickening
      • Bone marrow cavity narrowing and obliteraed
    Osteosclerosis Basic X-ray signs
    • Chronic osteomyelitis
      • Osteosclerosis of the bone between the areas of destruction
      • Bone marrow cavity narrowing & obliteration
    Osteosclerosis Basic X-ray signs
    • Osteosarcoma
      • Osteosclerosis inside the lesion
    Osteosclerosis Basic X-ray signs
    • Osteosarcorma
      • Osteosclerosis inside the lesion
      • Periosteal reaction
    Osteosclerosis Basic X-ray signs
    • Spinal metestasis
      • T11 verteble body bone density increased
    Osteosclerosis Basic X-ray signs
    • 骨质斑驳症
    Osteosclerosis Basic X-ray signs
    • Osteopetrosis
  • Periosteal reaction / periostosis Basic X-ray signs
    • Definition :
      • Periosteal new bone formation cause by various condition stimulated
    • X-ray appearance :
      • The newly developed periosteal bone in different form:
      • lamellae (onion peel) , spicules (sunrays) , lacelike , spurs , et al.
    • Etiology :
      • Inflammation or granuloma (chronic)
      • Trauma & fracture
      • Tumor or tumor-like lesion
    Codman ’ s triangle: The new periosteal bone become eroded centrally leaving triangle areas of New bone at the edges
    • Subacute osteomyelitis
      • Smoth lamellae Periosteal reaction
    Periosteal reaction / periostosis Basic X-ray signs normal
    • Lacelike & spicules periosteal reaction
    Periosteal reaction / periostosis Basic X-ray signs
    • Fracture unhealing
      • Massive periosteal reaction surrounding the ulnar fracture area
    Periosteal reaction / periostosis Basic X-ray signs
    • Osteosarcoma
      • lamellae & spicules periosteal reaction, formed Codman ’ s triangle
    Periosteal reaction / periostosis Basic X-ray signs
    • periosteal reaction destructed by tumor
    • Formed Cordmen ’ s triangle
    Periosteal reaction / periostosis Basic X-ray signs
  • Calcification within bone/cartilage Basic X-ray signs
    • X-ray appearance :
      • The high X-ray density spot inside bone /soft tissue /mass
    • Etiology :
      • Inflammation or granuloma or degeneration , or bone necrosis (chronic)
        • Irregular shape
      • Cartilage tumor
        • Ring shape / half-ring shape
    • chondrosarcoma
      • The cartilage calcification (ring-shape) inside the tumor
    Calcification with bone/cartilage Basic X-ray signs
  • chondrosarcoma
    • Calcification after hematoma
      • Left shoulder surrounded by massive irregular high density shadow
    Calcification with bone/cartilage Basic X-ray signs
  • Bone necrosis Basic X-ray signs
    • Definition :
      • The death of bone tissue caused by gradual vascular impairment
      • ceasation of metabolism of local bone tissue
    • X-ray appearance :
      • Sequestrum – fragment of dense/necrotic bone be separated , the X-ray density “ high ” (sequestrum is normal density , cause by the surrounding bone osteoporosis)
    • Etiology :
      • Inflammation or granuloma (chronic)
      • Trauma & fracture
    • Femoral capital epiphysis
      • Slightly increased density of the epiphysis
      • The epiphysis becomed fragment and flattened
      • Osteoporosis of the neighbouring part of the femur
    Bone necrosis Basic X-ray signs
    • Chronic osteomyelitis
      • Osteosclerosis of the bone between the areas of destruction
      • The separated “ high ” density fragments against the surrounding osteo-translucency zone
      • Sequestra – lost blood supply and then the calcium content remain intact
    Bone necrosis Basic X-ray signs
  • Mineral sedimentation Basic X-ray signs
    • X-ray appearance :
      • Mineral material , (lead , phosphorus , et al.) excessive sedimentation in bone
        • Dense bands at metaphyseal end
      • High concentrations of fluorine compounds
        • Stimulates endosteal & periosteal osteoblastic activity and bone formation
    • Skeletal fluorosis
      • The lumbar spine and pelvis increased bone density
    Mineral sedimentation Basic X-ray signs
  • Deformity of bone Basic X-ray signs
    • May be localized or generalized
    • Multiple exostoses
    Deformity of bone Basic X-ray signs
    • Enlongated finger
  • Soft tissue abnormalities Basic X-ray signs
    • May cause by trauma / tumor
    • / infection ……
  •  
  • Basic X-ray signs
    • Osteoporosis
    • Osteomalacia
    • Bone destruction
    • Osteosclerosis
    • Periosteal reaction
      • Calcification
      • Bone necrosis
      • Mineral sedimentation
      • Bone deformity
      • Soft tissue abnormalities
    Musculoskeletal system Bone Joint
    • Joint swellen
    • Joint dislocation
    • Joint degeneration
      • Joint destruction
      • Joint bony/fibrous ankylosis
  • Joint destruction
    • Cartilage destruction – joint space narrowing
    • Cortex destruction – bone destruction & impairment, may cause subluxation / deformity
  • Joint ankylosis
    • Joint bony / fibrous ankylosis
  • Joint dislocation The displacement of the any body part from its normal position
  •  
  • MUSCULOSKELETAL RADIOLOGY TRAUMA Sun Yat-sen Memorial Hospital SYSU Dr. BILING LIANG
    • Fracture : complete or inconplete break in the continuity of bone or cartilage , this requires a loading force applied to bone
      • Traumatic fracture
      • Stress fracture
      • Pathologic fracture
    • May acompany severe soft tissue torn / bleeding / important organ torn
    Fracture & dislocation Trauma
    • Purpose of Radiology
      • Evaluated fracture / dislocation
        • position
        • Apposition
          • Anatomical apposition
          • Displacement
          • Lack of apposition
        • Alignmemt
        • Rotation
      • The result of reduction
      • Healing of fracture & callus formation
        • Un-union & delayed union
        • Infection
        • Ossificatory myositis
    • Imagine technique
      • X-ray
      • CT
      • MRI
      • US
      • SCINTIGRAPHY
    fracture & dislocation Trauma The state of contact of the fracture fracgment ends The relationship of the long axes of the fracture fragments
    • X-ray :
      • Fracture line : the break of bone shows a irregular translucent line (separated – translucent
      • overlap - dense)
        • Transverse fracture / oblique fracture / spiral fracture
        • Compression / crush fracture
        • Comminution fracture ( > 2) / segmental fracture
      • Incomplete fracture :
      • Fracture in children
        • Greenstick fracture :
        • Epiphyseal separation
    fracture & dislocation Trauma
    • The fracture types
    Fracture & dislocation Trauma spiral fracture Transverse fracture Compressive fracture Comminution fracture oblique fracture
    • The distal third of the tibia & fibula Comminution fracture
    Fracture & dislocation Trauma
    • X-ray :
      • Fracture line : the break of bone shows a irregular translucent line
        • Transverse fracture / oblique fracture / spiral fracture
        • Comprese fracture
        • Comminution fracture ( > 2) / segmental fracture
      • Incomplete fracture :
      • Fracture in children
        • Greenstick fracture :
        • Epiphyseal separation
    fracture & dislocation Trauma angling or buckling of the cortex without the lucent fracture line Epiphysis & cartilage plate separated from the metaphysis
    • Linear fracture of the skull
    Fracture & dislocation Trauma
  • Healing of fracture & callus formation Acute phase 2W 2M
    • Lower humerus fracture – deformity of union
    Fracture & dislocation Trauma
    • Middle tibia & fibela fracture – deformity of union
    Fracture & dislocation Trauma Apposition Alignmemt
        • Un-union & delayed union
    Fracture & dislocation Trauma
    • Hip dislocation
    Fracture & dislocation Trauma
    • Elbow dislocation
    • Colles ’ fracture
      • A transverse fracture through the distal radius
      • With dorsal displacement & angulation of the distal radial fragment
      • Malalignment as “ silver fork ” deformity
      • The ulnar styloid is often detached
    Fracture & dislocation Trauma
    • Epicondylar fracture of humerus
      • A transverse fracture above the condyles of the humerus
    Fracture & dislocation Trauma
    • Epicondylar fracture of humerus
      • A transverse fracture above the condyles of the humerus
    Fracture & dislocation Trauma
    • Compression / wedge fracture
    Fracture & dislocation Trauma
    • Compression / wedge fracture
    Fracture & dislocation Trauma
  •  
    • Normal intervertebral disc
    Protrusion of the intervertebral disc (discal herniation) Annulus fibrosis Nucleus pulposus
  • Protrusion of the intervertebral disc (discal herniation)
    • Normal intervertebral disc
    Annulus fibrosis Nucleus pulposus Vertebral end plate Stablilize the spine
    • CT : normal intervertebral disc
    Protrusion of the intervertebral disc (discal herniation)
  • Protrusion of the intervertebral disc (discal herniation) bulge protrusion
    • disc herniation
    Protrusion of the intervertebral disc (discal herniation) Space occupying lesion
  • Disc herniation MRI normal
    • Schmorl ’ s nodule
    Protrusion of the intervertebral disc (discal herniation) Annulus fibrosis Nucleus pulposus protruded into the end plate – form the Schmorl ’ s nodule
  • Thank you