The document summarizes diagnostic radiology findings of musculoskeletal infectious diseases and joint disorders. It describes imaging features of acute and chronic osteomyelitis caused by bacteria and tuberculosis including bone destruction, periosteal reaction, and abscess formation. It also compares findings of pyogenic and tuberculous arthritis, noting tuberculosis involves bone margins and causes osteoporosis while pyogenic arthritis affects weight-bearing areas and leads to more bone destruction and sclerosis. Common joint disorders like osteoarthritis, ankylosis, and dislocations are outlined.

1. Diagnostic Radiology of Musculoskeletal System Zhang Zhaohui Department of Radiology The First Affiliated Hospital of Sun Yat-sen University

2. Infectious diseases of bone

6. Soft tissue swelling without visibe bone destruction with increase in diameter Focal bone destruction 1 2

7. 第 5 次 3 Bone destruction and osteosclerosis Osteosclerosis, without soft tissue swelling 5 4

8. Acute osteomyelitis Bone destruction sequestrum ( ) periosteal new bone formation ( )

9. Acute osteomyelitis of tibia Extensive bone destruction involving whole tibia with different degree of sclerosis

10. Acute osteomyelitis of radius Radiograph shows bone destruction and laminated periosteal new bone formation.

11. Radiograph shows moth eaten bone destruction at distal metaphysis of tibia. Acute osteomyelitis of tibia

12. Acute osteomyelitis of tibia

13. Acute osteomyelitis of tibia T 1 WI T 2 WI T 1 WI +C

16. Radiographs show sclerosis, widening and deformation of tibia with narrowing of medullary cavity. Chronic osteomyelitis of tibia

17. Chronic osteomyelitis of humerus

18. Chronic osteomyelits of fibula with sequestrum

19. Chronic osteomyelits of radius with sequestrum

21. Brodie’s abscess Round bone destruction ( )with extensive sclerosis in the lower third of tibia.

22. Brodie’s abscess of tibia

23. Brodie’s abscess of femur

25. Tuberculosis of femur Well defined bone destruction at distal metaphysis of femur with a small sequestrum. There is no sclerosis and no periosteal new bone formation

27. Tuberculosis of fibula Well defined bone destruction at proximal metaphysis of right fibula with slight marginal sclerosis. There is no periosteal new bone formation

28. Tuberculosis of metaphysis and epiphysis of proximal tibia

29. Tuberculosis of epiphysis of distal fibula with invasion of joint

30. Comparison of pyogenic osteomyelitis and tuberculosis of long bone Uncommon, small Common, large Sequestrum Uncommon Common, various pattern Periosteal reaction Destruction and osteoprosis, sclerosis uncommon Destruction and sclerosis Osseous changes Common Uncommon Involvement of epiphysis Focal, may invade joint, seldom extend to diaphysis Extensive, may involve whole diaphysis Extent Slow Acute and rapid Progression Tuberculosis Pyogenic osteomyelitis

32. Expansile bone destruction of first metatarsal bone with thinning of cortex

33. Expansile bone destruction of first metacarpal bone with periosteal new bone formation

35. Tuberculosis of cervical spine Destruction and collapse of C6 vertebral body and narrowing of C6/7 intervertebral space

36. Destruction , collapse and fusion of C4, 5 vertebral body , disappearance of C4/5 intervertebral space and kyphosis.

37. Destruction , collapse and fusion of T8,9 vertebral body , disappearance of T8/9 intervertebral space and formation of paravertebral abscess ( ). Soft tissue abnormality

38. Tuberbulosis of L2, 3 L1

39. Destruction of vertebral body with paravertebral abscess and calcifications

40. Tuberculosis of spine with paravertebral abscess T1 before inject contrast T2 before inject C T1 after C inject

42. Imaging of Joint

47. Osteoporosis and swelling of knee joint

48. A: Normal knee joint B: Swelling of knee joint. Note the increased density and widened space between distal femur and patella. A B

49. Fat pad displacment Like chinese character 八 Supracondylar fracture

50. T 1 WI +C T 2 WI Effusion of knee joint with thickened synovium +C T 1 WI T1

52. Inferior dislocation of shoulder joint The humeral head is inferior to glenoid fossa.

53. Posterior and lateral displacement of the radius and ulna with respect to humerus

54. Congenital hip dislocation Radiograph of pelvis demonstrates an superiorly dislocated femoral head as well as the shallow acetabulum on the right side.

55. Subluxation of knee joint Radiograhs show destruction of osteo-articular surface and subluxation of knee joint with narrowed but visible joint space

57. Narrowing of joint space and destruction of osteo-articular surface Pyogenic arthritis of left hip joint

58. Narrowing of left hip joint space, destruction of bone and subluxation of joint

60. joint space narrowing, subchondral sclerosis, and osteophyte formation (an outgrowth or excrescence of a bone) Osteoarthritis of knee joint

61. Osteoarthritis of hip joint Radiograph of pelvis shows joint space narrowing, subchondral sclerosis, osteophyte and lucency of subchondral cyst ( )

63. Intra-articular body within knee joint

65. Intra-articular body within right hip joint

67. Bony ankylosis of elbow joint Radiographs show union of bones in elbow joint and disappearance of joint space.

68. Bony ankylosis of hip joint

70. Fibrous ankylosis of knee joint Radiograhs show destruction of osteo-articular surface and subluxation of knee joint with narrowed but visible joint space

71. Fibrous ankylosis of knee joint

76. Pyogenic arthritis of right hip joint Radiograph shows narrowing of joint space ， irregular and unsmooth osteo-articular surface ， enlargement of acetabulum, proximal and lateral subluxation of femoral head.

77. Pyogenic arthritis of hip joint Radiograph shows loss of joint space ， destruction of osteo-articular surface.

78. Pyogenic arthritis of hip joint Radiograph shows loss of joint space ， destruction of osteo-articular surface, and osteosclerosis . Normal

79. Chronic pyogenic arthritis of hip joint Radiograph shows loss of joint space ， destruction of osteo-articular surface, and prominent osteosclerosis.

80. Bony ankylosis of right hip joint after pyogenic arthritis

84. Tuberculosis of knee joint Well defined bone destruction at distal metaphysis of femur with swelling of knee joint

85. Tuberculosis of hip joint Destruction of femur head, neck and acetabulum with swelling of joint and osteoporosis of left part of pelvis and upper third of left femur

86. Tuberculosis of right hip joint Narrowing of joint space and osteoporosis

87. Tuberculosis of left knee joint Radiographs of left knee joint show swelling of joint. right left

88. Radiographs show joint destruction, narrowing of joint space, swelling of joint, osteoporosis and subluxation. Tuberculosis of knee joint

89. Radiographs show maringal erosion( ), narrowing of joint space, swelling of joint and osteoporosis Tuberculosis of knee joint

90. Tuberculosis of knee joint Plain CT scan Contrast enhanced CT scam Comparison of CT and radiograph

91. Comparison of tuberculous and pyogenic arthritis acute and rapid slow Progression bony fibrous Ankylosis early late Joint space loss weight-bearing area margin Bone destruction + ± Osteosclerosis ± + Osteoprosis Pyogenic arthritis Tuberculous arthritis

92. Thank you for your attention ！