骨关节放射课件

BoneandJointimagingLeiming

Xu,MDDept.ofRadiology,The2ndHospitalZhejiangUnivSchlofMedicineObjectivesIdentifynormalboneandjointimagingappearancesUnderstandthebasicimagingfeaturesofmusculoskeletallesionstolearntoobserveandanalyzebonefracture,osteomyelitisandbonetumorOptionofimagingmethodsX-rayfilmfirstselectionoften2positionsshouldbetaken,APviewandlateralview.SometimetangentialprojectionavailableatleastincludingonejointcomparisonwithcontralateralnormalaspectCTscanavoidinganatomicoverlapofplainfilmdetailingfinecalcificationandbonedestructionMRIhighresolutionofthenormaltissueandpathologicconditionsDifficulttodetectcalcificationandobservebonedestructionScaphoidfracturelymphomaSoftTissueExtensionLongBoneStructure

CompactBoneOuterLayerHaversianSystemSpongyBoneEndsoflongbonesCartilageNormalanatomy

ChildepiphysisCRITOL(Capitellum-Radius-Internalormedialepicondyle-Trochlea-Olecranon-Externalorlateralepicondyle)Serialtime：1-3-5-7-9-11yearNormalanatomyNormalShoulderelbowNormalWristNormalKneeNormalAnkleBasicimagingfeaturesOsteoprosis

adiseaseinwhichbonesbecomefragileandmorelikelytofracture.Usuallythebonelosesdensity,whichmeasurestheamountofcalciumandmineralsintheboneOsteoprosis

adiseaseinwhichbonesbecomefragileandmorelikelytofracture.Usuallythebonelosesdensity,whichmeasurestheamountofcalciumandmineralsinthebone

ricketsOsteomalacia

softeningofthebonesduetoalackofvitaminDoraproblemwiththebody'sabilitytobreakdownandusethisvitaminOsteomalaciasofteningofthebonesduetoalackofvitaminDoraproblemwiththebody'sabilitytobreakdownandusethisvitaminNormalbonetissuewasreplacedbypathologictissueX-rayshowsosteolyticencroachment,Geographicmoth-eatenpermeativeBonedestructionPatternsofBoneDestructionGeographicDestructivelesionwithsharplydefinedborderImpliesaless-aggressive,moreslow-growing,benignprocessNarrowtransitionzoneMoth-eatenPermeativeNon-ossifyingfibromaPatternsofBoneDestructionGeographicMoth-eatenAreasofdestructionwithraggedbordersImpliesmorerapidgrowthProbablyamalignancy

PermeativeMultipleMyelomaPatternsofBoneDestructionGeographicMoth-eatenPermeativeIll-definedlesionwithmultiple“worm-holes”SpreadsthroughmarrowspaceWidetransitionzoneImpliesanaggressivemalignancyRound-celllesionsLeukemia

PatternsofBoneDestructionGeographicMoth-eatenPermeativeLessmalignantMore

malignantPeriostealReactionsBenignNoneSolidMoreaggressiveormalignantLamellatedoronionpeelSunburstCodman’strianglePeriostealReactionsBenignNoneSolidAggressive/malignantonion-peelSunburstCodman’striangleNon-ossifyingfibromaPeriostealReactionsBenignNoneSolidAggressive/malignantonion-peelSunburstCodman’striangleChronicosteomyelitisContinuingsolidperiosteal

reationPeriostealReactionsBenignNoneSolidAggressive/malignantonion-peelSunburstCodman’striangleEwingsarcomaPeriostealReactionsBenignNoneSolidAggressive/malignantonion-peelSunburstCodman’striangleOsteo-sarcomaPeriostealReactionsBenignNoneSolidAggressive/malignantonion-peelSunburstCodman’striangleOsteo-sarcomaEwingSarcomaTriangularandsunburstperiostealreactionPeriostealReactionsSolidonion-peelSunburstCodman’striangleLessmalignantMoremalignantTumorMatrixandsoft-tissuemasseOsteoblasticFluffy,cotton-likeorcloud-likedensitiesOsteosarcomaCartilaginousComma-shaped,punctate,annular,popcorn-likeEnchondroma,chondrosarcoma,chondromyxoid

fibromaTumorMatrixOsteoblasticFluffy,cotton-likeorcloud-likedensities asOsteosarcomaCartilaginousSofttissuemasseoftenmeansmalignantprocessOsteosarcomadistalfemoralosteosaromaFemoralosteosarcomaTumorMatrixOsteoblasticCartilaginousComma-shaped,punctate,annular,popcorn-like

asEnchondroma,chondrosarcoma,enchondromaOsteosclerosisabnormalhardeningandincreaseindensityofboneSequestralbone

afragmentofbonethathasbecomenecroticasaresultofdiseaseorinjuryandhasseparatedfromthenormalbonestructureJointSwellingJointdegenerationErosion,encroachmentofanarticularsurface,withsubarticularsurfaceedema,sclerosingandcystNarrowingthearticularspaceSubluxationOsteophyte(bonespur),enthesophyteandtendoncalcificationLeftkneeosteoarhritis

(OA)Leftkneeosteoarhritis(OA)Pigmentedvillnodullar

synovitis(PVNS)-hemosiderin-ladenmacrophagesSynovial

OsteochondromatosisUsualConditionsTraumafracturecontusion(bonebruiseortrabecular

microfracture)vertebraldischerniationInfectiousosteomyelitistuberculosisTumorandtumor-likediseasebenign：bonegiantcelltumor(GCT)，osteochondromamalignant：osteosarcoma，metastasisFracture(fx)Abreakinthecontinuityofbone,cartilage,orbothTranschondral,chondralandosteochondral

fx.Closedandopenfx;CompleteandincompleteSimplelinear，comminuted(butterfly,segmentalandcrush),avulsion,impaction,depressionandcompressionfractureChildfracture：greenstickfractureFracturesoftheBoneKnowfracturesbasedondiagramsorbyx-rayrecognitionAlignmentandpositionAlignment,longitudinalrelationshipofonefragmenttoanother.Varus

vs.ValgusPositionrelationshipofthefracturefragment,exclusiveofangulation,tothenormalanatomicsituationDisplacementdeviationfromanatomicpositionRotatorydisplacementAppositiondegreeofbonecontactatthefracturesiteSurgicalneckfxofthehumerusColles’fxFemoralneckimpactionfxandintertrochanteric

fxTibialplateaudepressionfxCompressionfxofL1GreenstickfxFxhealingBleedingandhematoma—reparativegranulation—callusenvelop—bonehealing—remodelingDelayedunionnonunionVertebraldischerniationPlainfilm,narrowingoftheintervertebtalspace,osteophyteCTrevealsherniateddiscdirectlyMRIshowsprotrudeddiscandthecalsac,medulla,andnerverootinvolvedDiscprotrusionandSchmorlnodulesepticosteomyelitisHematogenousinfectiousprocessStaphylococcusaureus,groupBstreptococcous,andEscherichiacoliaremorefrenquentlyidentifiedVascularanatomyCommonatadolecentandyoungadultMale23

yearold.FeverandleftkneepainoneweekAcuteosteomyelitisAcuteosteomyelitisMale23

yearold.FeverandleftkneepainoneweekAcuteosteomyelitisChronicosteomyelitisTuberculous

spondylitisUsuallyaffectedinthoracicandlumbarVertebralbodyerosionDiscovertebrallesion,intervertebtalspacenarrowingParaspinalabscess,psoasabscessThoracictuberculosis（T9～T10）tumorandtumor-like

diseaseofboneosteochondromaCommonbenigntumorOsseousprotuberancearisingfromepiphysealsurfaceofalongtubularbone,cartilaginouscapcanbeinvisibleifnocalcificationPedunculatedorsessilePointawayfromthenearbyjointandtowardthediaphysisMedullarycavityandcortexiscontinuouswiththoseoftheparentboneGiantcelltumorUsusllydiscoveredinthethirdandfourthdecadesofl