B o n e

i Department of Radiologym a g i n g Imaging Modalities

Plain film Computed Tomography Magnetic Resonance Imaging 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, Tumor : Congenital : normal variation, syndrome, metabolic 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 /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 ) or sclerosis New bone production Periosteal reaction Matrix production by bone tissue Osteolytic lesion

Geographic uniform, sharply defined border Benign 80% : giant cell tumor, , 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 Spreading of infection from arterial supply (metaphysis, epiphysis, diaphysis) to adjacent area From direct contact Devitalization of bone, (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) , 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