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    Disc Table of Contents Disc Table of Contents Document Transcript

    • The Osler Institute Excellence in Continuing Medical Education Sir William Osler (1849-1919) Radiology Review Course Notes Disc 1 Disc 2 Disc 3 Disc 4 Disc 5 Copyright 2008, The Osler Institute. All Rights Reserved.
    • The Osler Institute Excellence in Continuing Medical Education Sir William Osler (1849-1919) Radiology Disc 1 Notes Metabolic and Endocrine Disease Articular Disorders Bone Trauma Bone and Soft Tissue Tumors Questions and Answers Overview of Cardiac Cardiac Applications Interventional Radiology Copyright 2008, The Osler Institute. All Rights Reserved.
    • Metabolic and Endocrine Disorders Sandor A. Joffe, M.D. Attending Radiologist Beth Israel Medical Center, NY
    • Metabolic and Endocrine Diseases Affecting Bone x Osteoporosis x Vitamin D Disorders – Rickets – Osteomalacia x Parathyroid Disorders – Hyperparathyroidism – Renal Osteodystrophy – Hypoparathyroidism – Pseudohypoparathyroidism – Pseudopseudohypoparathyroidism
    • Metabolic and Endocrine Diseases Affecting Bone x Pituitary Disorders – Acromegaly, gigantism, hypopituitarism x Thyroid Disorders – Hyperthryoidism, thyroid acropachy, hypothyroidism x Other Disorders – Cushing syndrome, diabetes mellitus, complications of pregnancy, Paget disease
    • Terminology x Osteopenia – “Poverty of bone” – Best radiographic term x Osteoporosis – Qualitatively normal bone – Quantitatively deficient bone x Osteomalacia – Inadequately mineralized bone matrix (osteoid)
    • Osteoporosis x Most common metabolic bone disease x Distribution – Generalized – Regional – Localized
    • Age Related Osteoporosis (senescent or postmenopausal) x Gradual loss of bone mass – Men » Begins in 5th-6th decade » 0.4%/year – Women » Begins in 4th decade » 0.75-1.0%/year » 2-3%/year after menopause – Related to estrogen deficiency
    • Differential Diagnosis of Generalized Osteoporosis x Osteomalacia – Rickets in children with metaphyseal changes – In adults, indistinct trabeculae and looser zones x Hyperparathyroidism – Subperiosteal resorption
    • Regional Osteoporosis x Immobilization or disuse x Reflex sympathetic dystrophy (RSD) x Transient regional osteoporosis – Transientosteoporosis of the hip – Regional migratory osteoporosis
    • Osteoporosis of Immobilization and Disuse x Begins 2-3 months after immobilization x Usually subsides within 1-2 years (sooner with mobilization) x High bone turnover – ↑↑ resorption – ↑ or ↓ formation x Loss of calcium x Mainly in appendicular skeleton
    • Osteoporosis of Immobilization and Disuse x X-ray findings (may mimic malignancy) – Uniform osteoporosis (most common) – Speckled or spotty osteoporosis (especially periarticular) – Band-like osteoporosis (subchondral, metaphyseal) – Cortical lamellation or scalloping
    • Reflex Sympathetic Dystrophy x Sudeck’s atrophy, shoulder-hand syndrome x Due to a variety of conditions, classically minor trauma x Pathogenesis is unknown but may be related to spinal reflexes x Most common in shoulder and hand x Stiffness, pain, tenderness, weakness, swelling x Variable duration, may be irreversible
    • Reflex Sympathetic Dystrophy x X-ray findings – Softtissue swelling – Regional osteoporosis, especially periarticular – No erosions or joint space narrowing x Bone scan – Increased periarticular activity
    • Spinal Changes of Osteoporosis x Osteopenia (increased radiolucency of bone) x Thinning or loss of trabeculae – Particularlyhorizontal trabeculae – Relative prominence of vertical trabeculae may mimic hemangioma
    • Spinal Changes of Osteoporosis x Changes in vertebral body shape – Cartilaginous (Schmorl’s) nodes » Disc herniation into the vertebral body » Due to weakness of cartilaginous endplate or subchondral bone » Surrounding sclerosis
    • Spinal Changes of Osteoporosis x Changes in vertebral body shape – Wedge-shaped – Biconcave (“fish vertebrae”) » Seen in other metabolic disorders (osteomalacia, HPT) – Compression
    • Osteoporosis in Cortex of Tubular Bones x Endosteal resorption – Scalloped inner margin – Cortical thinning x Intracortical resorption (seen with moderate to rapid bone turnover) – Longitudinal linear radiolucent striations x Subperiosteal resorption (seen with rapid bone turnover) – Irregularity of outer margin
    • Osteoporosis in Spongiosa of Tubular Bones x Subchondral bone (common in RSD, immobilization) – Linear, band-like, or spotty radiolucencies x Metaphysis – Band-like radiolucencies x Diffuse (common in senile osteoporosis) – Homogeneous or spotty radiolucencies
    • Other Findings in Osteoporosis x Fractures – Vertebral bodies, proximal femur, distal radius, proximal humerus x Insufficiency fractures – Pelvis, sacrum, femoral neck, tibia, sternum
    • Rickets and Osteomalacia x Rickets – Interruptionin development and mineralization of growth plate x Osteomalacia – Inadequate or delayed mineralization of osteoid in mature cortical bone
    • X-Ray Findings of Rickets x Most prominent in areas of high growth – Costochondral junction, distal femur, proximal humerus, proximal and distal tibia, and distal ulna and radius x Widening of growth plate (deficient mineralization)
    • X-Ray Findings of Rickets x Widening and cupping of metaphysis (disorganized zone of maturation) x Loss of sharp epiphyseal margin x Periarticular swelling x Rachitic rosary x Bowing of long bones (displacement of epiphyses due to weak growth plate)
    • X-Ray Findings of Osteomalacia x Osteopenia (loss of trabeculae) x Unsharp trabecular margins (inadequately mineralized osteoid) x Cortical lucencies
    • X-Ray Findings of Osteomalacia x Pseudofractures (Looser zones) – Lucencies with sclerotic margins perpendicular to cortex (inadequately mineralized osteoid) – Do not extend across entire bone – Scapula, ribs, pubic rami, medial proximal femora, posterior proximal ulnae – Bilaterally symmetric – May fracture