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Bone Imaging

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Bone Imaging B o n e i Department of Radiologym a g i n g Imaging Modalities Plain film Computed Tomography Magnetic Resonance Imaging Bone scan Ultrasonography Arthrography Normal anatomy Bone : long bone, axial bone,flat bone sesamoid bone Epiphysis, metaphysis,diaphysis Cortex, medulla Joint : fibrous joint , cartilageneous joint, synovial joint Joint space,joint surface,articular cartilage, Subchondral bone,joint effusion,joint capsule Plain film Trauma: fracture , dislocation Infection: swelling, periosteal reaction Tumor : Congenital : normal variation, syndrome, metabolic bone disease Bone survey: Systemic disease Plain film Spine: AP, lateral, oblique, flexion,extension, swimming,open mouth Shoulder: AP, oblique Yview,lateral ,axillary view Wrist: AP,lateral, deviation view Hand: PA, oblique Pelvis: AP,frogleg,oblique,judet, lateral sacral Knee: AP, lateral, patella view Ankle: AP, lateral, mortise view, Foot : PA, oblique Complication of fractrue Loss of line, height Delay bone union, non union,pseudoarthrosis Joint ankylosis Osteomyelits around fracture Aseptic necrosis Formation of bone in muscle,soft tissue Bone atrophy Sudeck’s atrophy Fat embolism Systemic bone lesion Metastasis ->bone scan Metabolic bone (ricket , scurvey)- >bone survey Paget disease Multiple myeloma->bone survey Fluorosis Osteopoikilosis Leukemia Heavy metal poisoning Normal variation CT MUSCULOSKELETAL FRACTURE/DISLOCATION INDETERMINATE BONE LESION MRI MUSCULOSKELETAL MARROW INVOLVEMENT SOFT TISSUE TUMOR/MASS LIGAMENTOUS/CARTILAGE TEAR AVASCULAR NECROSIS OSTEOMYELITIS/SEPTIC ARTHRITIS Matching (more than one) 1. Plain film ………a. fracture 2. Bone scan ………b. ligament/ 3. CT cartilage tear 4. MRI ………c. bone metastasis 5. Arthrography ………d. Avascular necrosis ………e. bone/soft tissue tumor ลักษณะที่ส ำคัญทำงรังสี Bone destruction ( osteolytic ) Hyperostosis or sclerosis New bone production Periosteal reaction Matrix production by bone tissue Osteolytic lesion Geographic uniform, sharply defined border Benign 80% : giant cell tumor, bone cyst, enchondroma, Brodie’s abscess Malignant 20% : multiple myeloma, metatasis, Osteolytic lesion Motheaten ragged border Benign 20% : Acute Osteomyelitis Malignant 80% : osteosarcoma, metastasis ,multiple myeloma Osteolytic lesion Permeative : ill definded area spreading through marrow space Aggressive,malig nant process Such as ewing ‘s sarcoma,osteosar coma, lymphoma, ลักษณะที่ส ำคัญทำงรังสี Bone destruction ( osteolytic ) Hyperostosis or sclerosis New bone production Periosteal reaction Matrix production by bone tissue Hyperostosis or Sclerosis Benign : osteomyelitis, Paget’s disease, Fibrous dysplasia, osteoid osteoma Malignant : osteosarcoma, osteoblastic metastasis from CA prostate and CA breast Mixed lytic and sclerotic lesion : metastasis, osteosarcoma ลักษณะที่ส ำคัญทำงรังสี Bone destruction ( osteolytic ) Hyperostosis or sclerosis New bone production Periosteal reaction Matrix production by bone tissue Periosteal reaction Solid type Thin solid - usually benign : fracture, osteomyelitis, osteoid osteoma Thick solid : osteoid osteoma, osteosarcoma, Codman’s triangle : Malignant : osteosarcoma : Benign : subperiosteal hemorrhage, infection, Periosteal reaction Interrupted type Lamellated (onion skin) Ewing’s sarcoma, osteomyelitis Perpendicular (sunburst, sunray) : osteosarcoma, metastatic tumor Amorphous : osteosarcoma, Ewing’s sarcoma ลักษณะที่ส ำคัญทำงรังสี Bone destruction ( osteolytic ) Hyperostosis or sclerosis New bone production Periosteal reaction Matrix production by bone tissue Tumor new bone , matrix production by bone tissue Osteogenic(tumor bone) - dense homogeneous ivory-like : osteosarcoma Chrondrogenic (tumor cartilage) : chondrosarcoma, enchondroma Stippling calcifications Punctate calcifications Flocculent calcifications Popcorn calcifications Bone tumors Benign bone tumor Osteoma ,osteoid osteoma, osteoblastoma Chondroma,chondroblastoma, enchondroma Osteochondroma,chondromyxoid fibroma Giant cell tumor Neurofibroma, neurofibromatosis Malignant bone tumor Sarcoma: osteosarcoma, chondrosarcoma,ewing sarcoma,periosteal sarcoma,fibrosarcoma,angiosarcoma,reticulum cell sarcoma Multiple myeloma, plasma cell myeloma Lymphoma, Hodgkin disease, leukemia Metastasis Neuroblastoma Paget sarcoma Benign bone lesions Well defined , smooth sclerotic border Geographic bone destruction Medullary cavity or cortex Expansion of cortex Focal homogeneous calcification or ossification Solid periosteal reacion No soft tissue mass Deformity of bone Primary bone Malignancy Permeative or motheaten bone destruction Wide zone of transition Interruted periosteal reaction Spiculation or sunburst Extraosseous soft tissue mass Metaphysis Secondary bone malignancy Moth-eaten bone destruction (Geographic, moth eaten ) Medulla and cortex Diaphysis No periosteal reaction Pathological fracture Bone infection Soft tissue swelling Small area of osteoporosis Spreading of infection from arterial supply (metaphysis, epiphysis, diaphysis) to adjacent area From direct contact Devitalization of bone, sequestrum(spicule of dead bone) Reactive new bone formation, involucrum Infectious arthritis Destruction of joint space Joint effusion Soft tissue swelling osteoporosis Neuropathic Arthropathy (Charcot joint) Severe joint destruction Fragmentations Joint instabitity Joint effusion Lack of osteoporosis Rheumatoid Arthritis Osteoporosis Joint space narrowing Marginal erosion Subluxation with joint deformity Fusiform soft tissue swelling Osteoarthritis Localized joint space narrowing Subchondral sclerosis Osteophytes or spurs Subchondral cyst Gouty Arthritis Man > 40 years 1st metatarso-phalangeal jt. Punched out lesion Preservation joint space Asymmetrical soft tissue swelling with or without calcification (tophus) The request form What (plain film,CT,MRI,U/S) Where (part of body) When, how long of the symptom Why (infection, trauma, tumor, congenital, mass) Who request, phone number How : name of 2 views of examination The request form Who : ward , phone number Name of doctor, phone number Full name, less abbreviation Importance Lab: blood creatinine level Fracture Fracture line : invole joint space?, fracture other site Pathological fracture (underlying tumor, infection) Stress fracture, insuffiency fracture Film x-rary at least 2views Follow up film Not seen early fracture-> sclerosis healing Pathological fracture->non mal union ,soft tissue reaction .
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