Radiograph of Skeletal System.pptmmmmmmmm

Musculoskeletal Imaging
My name
contact information
or project description

Background
• In humans, the major calcium storage organ is bone.
• Calcium is stored as calcium orthophosphate (CaPO4).
• Generally, calcium salts are soluble in aqueous solutions such
as plasma.
• Calcium metabolism is inseparable from phosphate metabolism.
• The major factors regulating calcium and phosphate
metabolism are parathyroid hormone (PHT), calcitonin
and calcitriol.

Components of Bone
• Compact tissue. The harder,
outer tissue of bones.
• Cancellous tissue. The
sponge-like tissue inside
bones.
• Subchondral tissue. The
smooth tissue at the ends of
bones, which is covered with
another type of tissue called
cartilage.

The Osteon
• The Osteon or the haversian system is
the functional unit of compact bone.
• Osteons are arranged parallel to long
axis in long bones, forming the
microstructure of bone.
• They contain a lumen, called the,
Haversian canal, which surrounds
blood vessels and nerve cells within
bone.

Hydroxyapatite Crystals
• 65% of bone tissue is inorganic mineral, which provides the
hardness of bone.
• The major minerals found in bone are calcium and
phosphorus in the form of an insoluble salt called
hydroxyapatite crystals that lie adjacent and bound to the
organic protein matrix.
• Hydroxyapatite crystal (a calcium phosphate ceramic)
is the basic natural inorganic component of the
skeletal system.

Hydroxyapatite Crystals
• Hydroxyapatite consists of
predominantly calcium and
phosphate in a hexagonal
crystal system and has the
formula Ca10(PO4)6(OH)2.
• The hydroxyl ion can be
replaced by fluoride, chloride
or carbonate.

Bone Development
• During the growth phase, the size of different bones
increases, from birth to about 20 years old,
• During the modelling phase, the bone change shape and
thickness and continue forming mass when stressed during
the modelling phase.
• The remodeling phase (bone metabolism) is a lifelong
process where the mature tissue removed and new bone
tissue is formed. It predominates during adulthood and
continues throughout life.
• Beginning around age 34, the rate of bone resorption
exceeds that of bone formation, leading to an inevitable loss
of bone mass with age.
•

Skeletal System Radiography
Musculoskeletal Radiology deals with the imaging of the body’s
bones along with cartilage, connective tissue, joints, ligaments,
muscles and tendons. This includes the following techniques:
• Conventional, computed and digital radiography.
• Fluoroscopy (continuous x-ray that shows movement of the
body part as in arthrography).
• Computed tomography (CT).
• Magnetic resonance imaging (MRI).
•

Indications of Bone Imaging
1. Inflammatory bone lesions as osteomyelitis.
2. Metabolic bone diseases as osteoporosis, osteomalacia,
Paget's disease and hyperparathyroidism.
3. Degenerative diseases as osteoarthritis and rheumatoid
arthritis.
4. Bone fractures.
5. Benign bone lesions.
6. Malignant bone lesions.

Normal Bone Radiography
• Mature bones consist of a dense cortex of compact bone and a
central medulla of cancellous bone.
• Cortex is seen radiographically as a white periphery of a bone.
• Central medulla is less dense. Cancellous bone that makes up
the medulla consists of a sponge-like network of thin bony
plates known as trabeculae.
• Trabeculae support BM and are seen radiographically
as a network of fine white lines in the medullary cavity.
•

Metabolic Bone Diseases
• Metabolic bone diseases are a diverse group of diseases
that result in abnormalities of bone turnover.
• Metabolic bone diseases encompass a diverse group of
diseases that diffusely affect the mass or structure of bones.
• These diseases have many causes, from genetic disorders,
to nutritional deficiencies, to acquired conditions.
• Imaging manifestations are also varied, and the same
disease process can have a wide range of skeletal findings.

Osteoporosis
• Osteoporosis, is the most common metabolic bone disease,
results in generalized loss of bone mass and deterioration in
the bone microarchitecture.
• Osteoporosis is the most common metabolic bone disease,
affecting 13%-18% of women older than 50 years and 1%-4%
of men older than 50 years.
• Osteoporosis may results in substantial morbidity and
mortality, primarily through causing pathologic fractures.

Causes of Osteoporosis
• Primary: no cause is identifiable
 postmenopausal (type 1): occurs in 50-65-year-olds females.
 Senile (type 2): occurs in the elderly.
• Secondary (type 3): occurs due to a range of causes including:
 Endocrine (e.g. hyperthyroidism, hyperparathyroidism, DM).
 Medications (e.g. steroids).
 Chronic illness (chronic liver disease, MS, malnutrition.
 Inflammation.

Radiographic Features of Osteoporosis
• Generalized decreased bone density can be appreciated by
decreased cortical thickness and loss of bony trabeculae in the
early stages in radiography.
• Plain radiograph is not a sensitive modality, as 30-50% bone loss
is required to appreciate decreased bone density.
• Vertebrae, long bones (proximal femur), calcaneum and tubular
bones are usually affected.
• Dual Energy X-ray Absorptiometry (DEXA) is the gold standard
of diagnosing osteoporosis for measuring bone mineral density.

Pattern of Bone Loss in Osteoporosis
(a) Radiograph and diagram show normal
mineralization of vertebrae of 17-year-old girl.
Note fine meshwork pattern of trabecular bone.
(b) Radiograph and diagram show osteoporosis of
the vertebra of a 57-year-old man. There is a loss
of the horizontal trabecular bone, with increased
prominence of the vertical trabeculae.
(c) Radiograph and diagram show osteoporosis of
vertebrae of an 82-year-old woman. Note marked
loss of vertical and horizontal trabecular bone,
resulting in big gaps between the vertical trabecula.

Pattern of Bone Loss in Osteoporosis
X-ray of both knees
showing osteoporosis

Osteomalacia and Rickets
• Osteomalacia is a disease of “soft bone” due to decreased
bone mineralization (deposition of calcium phosphate in
bone matrix) that weakens bones and can cause them to
break more easily.
• Osteomalacia develops most commonly due to a vitamin D
deficiency or less frequently due to a digestive or
kidney disorder.
• In children, inadequate concentrations of vitamin D
cause rickets.

Pattern of Radiograph in Rickets
A 3-year-old girl:
(a) Radiograph of skull shows a partially patent frontal
suture (arrow).
(b) Radiograph of the chest shows wide and rounded anterior
rib ends (circles). This finding is often called a “rachitic
rosary” because the chain of rounded rib ends resembles
rosary beads at physical examination.
(c) Radiograph of both hands shows diffuse osteopenia,
fractures of several metacarpals (solid arrows), cupped
fragmented metaphysis of distal radii and ulnae (ovals).
(d) Radiograph of both knees shows fracture of patient’s
right distal femur (black arrow), as well as fractures of her
right tibia and both fibulae (dashed arrows). metaphysis
are fragmented, and fractured (solid arrows).
(e) Radiograph of both lower extremities obtained 2 years
later than a–d shows diffuse osteopenia, bowing of the
tibiae and fibulae, and widening of the growth plates with
sclerosis and irregularity on the metaphyseal side.
Transverse sclerotic metaphyseal bands (arrows) parallel
to the growth plate reflect periods of intermittent adequate
mineralization followed by poor mineralization.

Paget disease
• Paget disease of the bone is a common, chronic metabolic
bone disorder characterized by excessive abnormal bone
remodeling leading to increase bone resorption.
• The pelvis, spine, skull, and proximal long bones are most
frequently affected.
• The etiology is not known, viral infection (paramyxovirus) in
association with genetic susceptibility has been postulated.
• The classically described radiological appearances are
expanded bone with a coarsened trabecular pattern..

Stages of Paget Disease
• In the early phase, the osteolytic or hot phase, active bone
resorption that destroys both the cortex and cancellous bones.
• In the intermediate or mixed phase, bone destruction is
accompanied by new bone formation. Bone remodeling
appears radiographically as thickening of the cortex and coarse
trabeculation of cancellous bone.
• In the cool or sclerotic phase, a diffuse increase of bone
density occurs together with enlargement and widening of the
bone and marked cortical thickening.

Osteolytic (Hot) Phase
(A) Lateral radiograph of the skull of a 60-year-
old man shows an osteolytic lesion in the parieto-
occipital area. This sharply demarcated defect,
known as Osteoporosis Circumscripta,
represents a hot phase of the disease.
(B) Radionuclide bone scan shows a
characteristic localized increased uptake of the
radiopharmaceutical tracer.
(C) Lateral radiograph of the skull of a 65-year-
old woman reveals osteoporosis circumscripta in
the fronto-parietal area.

Osteolytic (Hot) Phase of Paget disease
(A) Anteroposterior radiograph of the
lower leg of a 68-year-old woman
shows an wedge of osteolytic
destruction in the midportion of
the tibia (arrow).
(B) Magnification study of the
midfemur in another patient
shows the purely osteolytic phase
of Paget disease.

Intermediate (Mixed) Phase
(A) In the intermediate phase, seen affecting the
tibia in a 62-year-old woman, thickening of
the cortex and a coarse trabecular pattern in
medullary portion of the bone are
characteristic features with anterior bowing.
(B) In another patient, an 81-year-old woman,
intermediate phase is seen in the pubic and
ischial bones.
(C) Mixed phase affecting the proximal phalanx
of the middle finger (arrows) is seen in a 67-
year-old woman with Paget disease.

Intermediate (Mixed) Phase
Focal patchy densities in the skull,
having a “cotton ball” appearance, are
typical of the intermediate phase of
Paget disease as seen in this
radiograph of a 68-year-old woman.

Sclerotic (Cool) Phase
• Anteroposterior radiograph of the
forearm of a 57-year-old man with
polyostotic Paget disease shows
enlargement of the left radius with a
marked bowing deformity.
• Other signs of the cool phase of the
disease are seen in the diffuse
sclerotic changes and the indistinct
demarcation between the cortex and the
spongiosa.

There is considerable thickening of the cortex and bone
deformity.
(A) The pelvic cavity, seen here in an 80-year-old
woman, may assume a triangular appearance.
(B) Involvement of a long bone, in this case the distal
humerus of a 60-year-old woman, exhibits marked
cortical thickening, narrowing of the medullary cavity,
and a coarse trabecular pattern.
(C) Similar changes are present in the tibia in a 72-year-
old man.
(D) Anteroposterior radiograph of the skull of an 82-
year-old woman reveals typical changes of the cool
phase of Paget disease.
.

(A) Lateral radiograph of the skull of an 80-year-
old woman demonstrates numerous
coalescent densities associated with
thickening and sclerosis of the cranial vault
and base of the skull.
(B) CT sections clearly demonstrate predominant
involvement of the inner table with marked
diminution of the diploic space.
(C) Thickening of the cranial vault.
(D,E) Scintigraphy demonstrates markedly
increased uptake of radiopharmaceutical.

Osteomyelitis
• Occurs commonly in diaphyseal ends of long bones.
• Osteomyelitis is usually caused by microorganisms,
predominantly bacteria usually staphylococci that enter bone.
• Bl. Culture is positive in about 50% of patients.
• X-ray may not positive until 14-21 days after clinical onset.
• Bone scan usually is positive as early as 24 hr. after onset.
• the gold standard for diagnosis is based on positive culture
from a bone biopsy

Osteomyelitis Radiography
• Conventional radiographic evaluation of acute osteomyelitis is
insufficient because bone changes are not evident for 14-21
days after the onset of infection because BM oedema, is the
earliest pathological feature, is not visible on plain films.
• The diagnosis of osteomyelitis is often based on radiologic
results which demonstrate a lytic center with a ring of sclerosis,
though bone cultures are normally required to identify the
specific pathogen, in addition to clinical picture.
• Other findings include soft tissue and deep muscle edema.

Acute Osteomyelitis Radiography
• There is accumulation of pus within the medullary cavity
leading to raised intramedullary pressure and vascular
congestion, which can disrupt the intraosseous blood supply.
• Reactive bone and hyper vascular granulation tissue may form
around intramedullary pus, giving rise to a well-circumscribed
intraosseous abscess, known as a Brodie’s abscess.
• Rise in intramedullary pressure may lead to rupture of the bony
cortex, producing a cortical defect known as a cloaca.

• Intramedullary pus can spread outward through the cloaca and
form a subperiosteal abscess.
• Continual accumulation of pus in the subperiosteal space leads
to rupture of the periosteum and spread of infection to soft
tissues through a channel between the bone and skin surface
known as a sinus tract.
• In up to 1% of patients who have persistent draining sinus
tracts, squamous cell carcinoma may develop in the
epithelial lining of the tract.

The anteroposterior radiograph
shows a well-defined lucent lesion
with surrounding sclerosis
observed centrally within the
posterior aspect of the tibia, which
is an intraosseous abscess
(Brodie’s abscess) in the
proximal third of the diaphysis.

(A) The anteroposterior radiograph shows a
well-circumscribed lucent lesion with sclerotic
margins in the right distal femur, suspicious for
an intraosseous abscess.
(B) coronal TI image of the right femur shows
that the lesion is within the medullary cavity and
has high signal (black arrow).
The BM of the distal diaphysis has diffuse high
signal (white arrow) compared to the mid-
diaphysis, representing bone marrow oedema;

Osteomyelitis in the right foot of a 63-year-old male.
(A) The dorso-plantar radiograph shows a
periosteal reaction around the 1st metatarsal
diaphysis (white arrowheads);
(B) T1 MRI short axis coronal image of the same
patient demonstrating marked soft tissue oedema
surrounding the 1st metatarsal. The periosteum
(white arrowheads) is separated from the cortex
(white arrow) by high signal material representing
pus. There is a defect in the cortex (black arrow),
known as a cloaca, that allows pus to drain from the
medullary cavity into the subperiosteal space.

Chronic Osteomyelitis Radiography
• The pathological features of chronic osteomyelitis are a result
of osteonecrosis, caused by disruption of the intraosseous and
periosteal blood supply during the acute stage of disease.
• A fragment of dead infected bone becomes separated from
viable bone and is known as a sequestrum.
• Bacteria within the sequestrum are protected from antibiotics
and endogenous immune response, thus forming a nidus for
chronic infection which may persist for many years.

• In an attempt to resolve the sequestrum, an inflammatory
reaction characterized by osteoclastic resorption and periosteal
new bone formation occurs.
• The sequestrum becomes surrounded by pus, granulation
tissue and a reactive shell of new bone known as an
involucrum.
• The involucrum may have a cloaca through which the pus or
sequestrum can be discharged

Characteristic imaging features of chronic
osteomyelitis include:
1. Sequestrum: Dead bone fragment
separated from surrounding bone due to
necrotic changes with bone resorption.
2. Involucrum: Thick sheath of periosteal
new bone formation
3. Cloaca: An opening in the involucrum
which drains purulent and necrotic
material out of the dead bone.

Characteristic imaging features of chronic
osteomyelitis include:
1. Sequestrum: Dead bone fragment
separated from surrounding bone due
to necrotic changes with bone
resorption.
2. Involucrum: Thick sheath of
periosteal new bone formation
3. Cloaca: An opening in the involucrum
which drains purulent and necrotic
material out of the dead bone.

• After 6 weeks of the onset of
hematogenous osteomyelitis.
• The peripheral new bone
(involucrum) has developed (white
arrow) and the central dead bone has
separated (sequestrum, black arrow).
• The involucrum is well vascularized
and will eventually reform a new
humeral diaphysis (white arrow).

Bone Tumors
• Primary bone tumors are rare, <1% of all malignancies.
• Clinical history may be extremely helpful:
 Age of the patient.
 History, symptoms, clinical examination.
• On radiography, Location of tumor, for example:
 Diaphysis: Ewing sarcoma.
 Metaphysis: osteogenic sarcoma.
 Epiphysis: chondroblastoma and giant cell tumor.

Radiological Assessment of Bone Tumors
• Matrix of lesion, i.e. appearance of material within the tumor:
 Lytic, i.e. lucent or dark.
 Sclerotic, i.e. dense or white.
• Effect on surrounding bone:
 Expansion and thinning of cortex: more likely benign.
 Penetration of cortex: more likely malignant.
 Periosteal reaction and new bone formation: osteogenic
sarcoma, Ewing sarcoma.

Radiological Assessment of Bone Tumors
• Other imaging modalities add further, often complementary
information on staging and complications.
• MRI is used to assess tumor extent within the marrow cavity of
the bone and associated soft tissue mass.
• CT is more sensitive than MRI in the detection of calcification;
it may be used in specific instances where accurate
characterization of the tumor matrix may be diagnostic,
such as suspected cartilage tumor.
• MRI and/or PET/CT may be used to assess therapy response.

Osteosarcoma
• Common sites of involvement of osteosarcoma are the
metaphyseal areas (91%) of long bones of the extremities with
its occurrence in (descending order) lower end of femur, upper
end of tibia, upper end of humerus and upper end of femur.
• It can uncommonly occur in the diaphysis (9%).
• Most osteosarcomas occur in children, teens, and
young adults between the age of 1 and 30.
• About 10% of osteosarcomas occur in people older than 60.

Radiological Assessment of Osteosarcoma
• The characteristic radiological features are sun-burst
appearance, periosteal lifting with formation of Codman's
triangle and new bone formation in the soft tissues.
• Codman's triangle is a radiological sign of a periosteal
reaction, that occurs when bone lesions grow so aggressively
that they lift the periosteum off the bone.
• Other features of osteosarcoma are sclerosis, cortical
destruction and new bone formation in the soft tissues.

Radiological appearance of Osteosarcoma
X-ray of humerus:
anteroposterior view of
osteosarcoma in the
proximal humerus showing
typical sun burst or sun ray
appearance with new bone
formation in soft tissues, and
Codman's triangles (arrows).

(a) X-ray anteroposterior and lateral views
of proximal tibia and knee joint showing
diaphyseal osteosarcoma of tibia with
sclerosis (arrow), cortical destruction on
posteromedial side (arrow heads) and
new bone formation in the soft tissues
(b) x-ray distal end of femur (anteroposterior
and lateral views) showing
sclerosis/radio-opacity in sclerosing
osteosarcoma.

• (Left) X-ray shows an osteosarcoma in
the femur (thighbone).
• Note the formation of new bone in a
typical "sunburst" pattern.
• (Right) When viewed from the side, a
Codman triangle can also be seen rising
from the bone.

• There is an aggressive lytic lesion in the
distal metaphysis of femur.
• Soft tissue swelling is noted.
• There are sparse areas of ossification in
the tumor matrix.

CT Scan in Osteosarcoma
• CT scan delineates the bony anatomy/architecture like cortical
integrity more clearly and picks up pathological fracture and is
helpful in assessing ossification and calcification (chondroid
component) more accurately.
• However, soft tissue component and medullary extent is best
defined by an MRI.
• The CT is predominantly utilized in assisting biopsy
and staging by assessing distant metastases to other
organs as lung and liver.

CT Scan in Osteosarcoma
• Axial and sagittal CT images (a, b) of
the distal right femur of a 62-year-old
male show a heavily mineralized
mass along the posterior aspect of
the distal femoral metadiaphysis.
• The mass is intimately associated
with the surface of the bone and
shows no evidence of medullary
involvement.

MRI in Osteosarcoma
• MRI should include the whole of the involved bone with one
joint above and below so that skip lesions are not missed in
the same bone and across the joint.
• MRI accurately and precisely delineates (1) extent of the
tumor into the soft tissues and the medullary canal, (2)
involvement of joint, (3) crossing of the lesion through and/or
around the growth plate, (4) any skip lesion in the same bone
and across the joint in other bone, (5) proximity and/or
encasement of the neurovascular bundle by the tumor.

MRI in Osteosarcoma
• The response of chemotherapy is being judged by MRI as the
neo-angiogenesis decreases with chemotherapy, necrosis
occurs, and the tumor shrinks with better capsulation.
• MRI is also being coupled with Positron Emission
Tomography (PET/MRI) for detection of systemic involvement
by the tumor, local recurrence, and metastasis after treatment.
• In view of the nonspecific findings of an MRI, it should always
be correlated with the patient's x-ray.

MRI in Osteosarcoma
A 33 year-old female exhibited low-grade parosteal OGS at
the left distal femur.
(1A) The lateral view of the radiography revealed classical
ossified mass on the periosteum (arrowheads) with a
presence of string sign, a radiolucent line separating
the ossified mass and underlying cortex (arrows).
(1B) MRI of the sagittal section of the mass revealed a
heterogeneous signal, with the solid component
predominately hypointense on T1-WI (arrow).
(1C) hyperintense on T2-WI (arrow).
(1D) and well enhancement on T1-WI with fat saturation
after gadolinium contrast enhancement (arrow).

MRI in Osteosarcoma
Osteosarcoma in the distal end of femur:
(a) X-ray thigh with knee anteroposterior
view showing big soft tissue component
on the medial side;
(b) MRI-coronal section showing the
medullary extent (arrow);
(c) MRI-axial section showing the proximity
of the popliteal vessels.

MRI in Osteosarcoma
• (A) X-ray showing a large soft tissue mass with
numerous small calcifications.
• (B) CT shows a large deep-seated mass in adductor
magnus muscle, which is fairly circumscribed and
has both a solid and cystic component.
• (C) Dynamic MRI shows low signal intensity in the
cystic component of the cyst and a high signal
intensity of the solid component.
• (D) T2-weighted images with fat suppression
(coronal view), there is a high signal intensity in the
cystic component and a low-to-isointense signal in
the solid component.

MRI in Osteosarcoma
• Osteosarcoma in the distal end of
femur:
• MRI scan shows an osteosarcoma
in the lower left femur (thighbone)
of a 10-year-old patient

Telangiectatic Osteosarcoma
• Telangiectatic osteosarcomas is an aggressive type of high-
grade osteosarcomas.
• They typically occur in adolescents with a median age of 15-
20 years. There is a recognized male preference.
• The characteristic features are: Osteolysis with osteoid matrix,
neoplastic bone formation, bone expansion, cystic spaces with
fluid-fluid levels, enhancing septae and cortical destruction.
• location in a metaphyseal-diaphyseal region with epiphyseal
extension.

• Telangiectatic type of osteosarcoma
of the proximal tibia:
• (a) X-ray anteroposterior and lateral
views showing dominant osteolysis
and bon expansion
• (b) MRI showing cystic spaces with
fluid-fluid levels, enhancing septa and
cortical bone destruction.

Sagittal (left) and Coronal (right) MRI:
• There is a multiloculated lytic lesion in
the distal metaphysis of the femur.
Multiple fluid-fluid levels are seen in the
lesion.
• Massive edema is seen in the muscular
compartments.
• Bone marrow edema involves the
epiphysis.

Staging of Osteosarcoma
• (a) Plain X-ray chest of a patient of
osteosarcoma showing multiple
metastatic lung nodules
• (b) CT scan (axial section) demonstrating
multiple metastases in both lungs
• (c) Tc-99m bone scan of osteosarcoma
in the proximal humerus with hot spot at
this site and in spine, ribs and a focus in
the skull bone.

Response to Treatment
• X-ray anteroposterior and lateral
views showing that after
chemotherapy the tumor
becomes well defined with
better capsulation: (a) before
chemotherapy and (b) after
chemotherapy.

Osteoarthritis
• Osteoarthritis (OA), also known as degenerative joint disease
(DJD), is the most common form of arthritis.
• Osteoarthritis is common, affecting ~25% of adults. The
prevalence increases with age.
• In the age group below 50 years, men are more often affected,
while in older age disease is more common in women.
• Strong risk factors for osteoarthritis include obesity;
increasing age; female sex (particularly between the
age of 50 and 80) and family history.

Osteoarthritis
• Key radiographic features of osteoarthritis are joint space
narrowing, subchondral sclerosis, and visualization of
osteophytosis.
• If all three of these findings are not present, another
diagnosis should be considered.
• Recently, with the increasing use of MRI in the
assessment of osteoarthritis, other findings have been
studied, such as bone marrow lesions and synovitis.

Radiographic Features of Osteoarthritis
• Joint space narrowing:
 Characteristically asymmetric.
• Subchondral sclerosis:
 Sclerotic changes occur at joint margins.
• Osteophytosis:
 Osteophytes are cartilage-capped bony proliferations
(bony spurs) at join margins due to articular cartilage damage.
 Small osteophytes are known as spiking.

Other Features of Osteoarthritis
• Joint erosions:
 Several joints may exhibit degenerative erosions.
• Subchondral cysts (Geodes):
 Subchondral cysts or pseudocysts, are well-defined cystic
lesions at the periarticular surfaces.
• Bone marrow (BM) lesions:
 visible on MRI as BM edema, often adjacent to areas
of cartilage damage, denoting early osteoarthritis changes.

Plain Radiograph of Osteoarthritis
• Plain radiograph is the most commonly used modality in
assessment of osteoarthritis due to its availability and low cost.
• It can detect bony features of osteoarthritis, such as joint
space loss, subchondral cysts and sclerosis, and
osteophytes.
• It is, however, relatively insensitive to early disease
changes. Other limitations are a lack of assessment
of soft-tissue structures and low intrareader reliability

CT/MRI of Osteoarthritis
• CT has excellent accuracy in assessing bony osteoarthritis
changes. It is especially useful in the assessment of the facet
joints.
• MRI can very accurately assess both bones and soft-tissue
joint structures.
• MRI can detect bone marrow changes and cartilage
loss, both of which are early osteoarthritis changes
and are not visible on radiographs.

CT of Osteoarthritis
• Left, Coronal CT image of a 64 years
old shows features of osteoarthritis
such as joint space narrowing in lateral
compartment (arrowheads) and intra-
and perimeniscal calcification (arrow).
• Right, Corresponding fusion image
PET/CT shows marked perimeniscal
synovitis medially and laterally as well
as around the cruciate ligaments.

MRI of Osteoarthritis
Coronal MRI image of a 56 years old
shows features of osteoarthritis such as:
• joint space narrowing in lateral
compartment with cartilage damage
(yellow marker).
• Intra- and perimeniscal osteophytes
(Brown marker).
• Lateral perimeniscal synovitis (Blue
marker).
• Bone marrow oedema (Green marker).

Radiograph of Skeletal System.pptmmmmmmmm

Recommended

Recommended

More Related Content

Similar to Radiograph of Skeletal System.pptmmmmmmmm

Similar to Radiograph of Skeletal System.pptmmmmmmmm (20)

More from IbrahemIssacGaied

More from IbrahemIssacGaied (20)

Recently uploaded

Recently uploaded (20)

Radiograph of Skeletal System.pptmmmmmmmm