Introduction And Bone Disease

Imaging of Bone Joint Soft tissues diseases

Guan sheng , MD Radio.depart. 1st hospital ZZU

Imaging techniques Plain bone radiographs (X-ray) ✦ Radionuclide bone scanning (ECT) ✦ Computed tomography (CT) ✦ Magnetic resonance imaging (MR) ✦ Digital substraction angiography(DSA) ✦ Ultrasound Imaging (US) ✦

nuclide

Radiograph

MR CT

Advantages and disadvantages in Musculoskeletal 、 Soft tissues

Plain X-ray film Rich experiences ✦ Best resolution in bone ✦ Economic ✦

Two dimension ✦ Overlap ✦ Limitation in soft tissues ✦

CT Good axis view ✦ Irregular bone ✦ Good density resolution ✦ Good 3-D reconstruction imaging ✦

Radiation ✦ Limitation in joint ✦

MR High sensitivity ✦ Multi-plane ✦ Good resolution (soft tissues 、 joint) ✦ Functional imaging (diffusion) ✦

Calcification ✦ Osteoperiosteal reaction ✦

ECT Skeleton ✦ Function (metabolic 、 physiological) ✦

✦

Poor spatial resolution

Summary A Conventional plain film ： spatial R 、 periosteal reaction 、 experiences ✦ CT ： bone ✦ MR ： Promising marrow 、 soft tissue 、 joint 、 spine extent ✦

sacrum Chondroma AP lateral

CT

MR

Summary B Experiences ： Plain>CT>ECT>MR ✦ Sensitivity ： MR>ECT>CT>Plain ✦ Skeleton ： MR=ECT>CT and plain ✦ Fracture ： plain—CT—MR ✦ Shortness ： MR
IMAGING OF BONE

Imaging of bone Anatomic terms (normal sign) ✦ Bone Maturation ✦ Signs of bone diseases ✦

Anatomic terms (normal sign) End of bone Joint space Growth plate

diaphysis

Anatomic terms (normal sign)

Metaphysis Epiphysis

Cartilagenous Epiphyseal plate

Cartilagenous Epiphyseal plate

Epiphysis Diaphysis

6ys

Metaphysis

Growth plate

Joint space diaphysis

18ys

End of bone

3m

3ys 6ys

10ys

Bone maturation 13ys

18ys

Imaging of bone Anatomic terms (normal sign) ✦ Bone Maturation ✦ Signs of bone diseases ✦

Signs of bone diseases Decrease in bone density or signal ✦ Increase in bone density or signal ✦ Periosteal reaction ✦ Alteration in structure or shape ✦ Alteration in bone age ✦

Decrease in bone density or signal

Decrease in bone density or signal

Decrease in bone density or signal

Decrease in bone density or signal

Decrease in bone density Basic pathological changes ✦ All kinds of lesions in bone ✦ Lytic lesion / osteoporosis / osteomalacia ✦ Localized / Diffused / Generalized ✦

Signs of bone diseases Decrease in bone density or signal ✦ Increase in bone density or signal ✦ Periosteal reaction ✦ Alteration in structure or shape ✦ Alteration in bone age ✦

Increase in bone density or signal

Normal bone

lesion

Increase in bone density Basic pathological changes ✦ All kinds of lesions in bone ✦ Sclerotic lesion / new bone ✦ Localized / Diffused / Generalized ✦

Change of density or signal represent bone destruction

Signs of bone diseases Decrease in bone density or signal ✦ Increase in bone density or signal ✦ Periosteal reaction ✦ Alteration in structure or shape ✦ Alteration in bone age ✦

Periosteal reaction Periosteum -- invisible ✦ Reaction to pathology ✦ Several patterns ✦ Not specific ✦

Periosteal reaction Periosteum -- invisible ✦ Reaction to pathology ✦ Several patterns ✦ Not specific ✦

Excess bone

Periosteal reaction

Lamellar

Periosteal reaction

Codman’s triangle

Signs of bone diseases Decrease in bone density or signal ✦ Increase in bone density or signal ✦ Periosteal reaction ✦ Alteration in structure or shape ✦ Alteration in bone age ✦

Alteration in structure or shape

congenital

Alteration in structure or shape

exostoses

Alteration in structure or shape

Alteration in structure or shape

Signs of bone diseases Decrease in bone density or signal ✦ Increase in bone density or signal ✦ Periosteal reaction ✦ Alteration in structure or shape ✦ Alteration in bone age ✦

Alteration in bone age. Bone age epiphyseal centers fusion indication of maturation. ✦ Measurement hand / wrist ✦

Alteration in bone age

Carpal bones

Commonly Encountered Bone Diseases Tumor ✦ Infection -- Osteomyelitis ✦ Metabolic ✦

Bone tumor Benign ✦ Malignant ✦

Solitary ✦ Multiple ✦

Benign bone tumor ✦ ✦ ✦ ✦ ✦ ✦

✦ ✦ ✦

Fibrous dysplasia Osteoid osteoma En/Chondroma Osteochondroma Cyst Giant cell tumor Expansion (rarely breach the cortex) Well demarcated (intact edge) Sclerotic rim

Enchondroma/Chondroma Lytic expanding lesion ✦ Metarcaple / proximal or middle phalanges ✦ Flecks of calcium ✦

Giant cell tumor 20~40 ys (epiphyses fused) ✦ Subarticular (knee, wrist, shoulder) ✦ Expanding destruction ✦ Well defined margin ✦ Thin cortex but intact ✦ Rarely metastasize ✦ Both malignant/benign ✦

Giant cell tumor Expanding destruction ✦ Well defined margin ✦ Subarticular (knee, wrist, shoulder) ✦ Thin cortex but intact ✦ Rarely metastasize ✦ Both malignant/benign ✦

MR Giant cell tumor

Bone Cyst Children and young adults ✦ Humerus and femur ✦ Pathological fracture ✦

Malignant bone tumor Sarcoma (Osteo/ Chondro/Fibro) ✦ Ewing’s sarcoma ✦ Metastasis ✦ Myeloma multiple ✦ Lymphoma ✦ leukaemia ✦

Malignant bone tumor Poorly defined margins ✦ Cortex destroy ✦ Periosteal reaction ✦ Soft tissue mass ✦

Sarcoma (Osteo / Chondro / Fibro) 5~20 ys, elderly ✦ Metaphysis , around knee ✦ Bone destruction ✦ Ill-defined ✦ Periosteal reaction (spiculated) ✦ Tumor bone ✦

Osteosarcoma

Osteosarcoma

F 9Y

Chondrosarcoma Ilium ✦ Multilobular mass ✦ Chondroid calcification ✦ Septations enhanced ✦

Ewing’s sarcoma Highly malignant ✦ Children ✦ Shaft of long bone ✦ Onion skin periosteal reaction ✦

Metastasis Commonest in bone ✦ Multiple focal ✦ Lytic / sclerotic / mixture ✦ Spine>skull>ribs>pelvis >humeri>femora ✦

Metastasis

Sclerotic metastasis

Metastasis

Nasopharyngeal Cancer

Myeloma Solitary (plasmacytoma) ✦ Lytic bone destruction (metastasis) ✦ Diffuse (osteoporosis) ✦ Better defined deposit ✦ Increased activity on radionuclide ✦

Plasma cell myeloma In Ischial tuberosity

Infection disease Osteomyelitis Tuberculosis

Osteomyelitis Staphylococcus aureus ✦ Infants and children ✦ Radionuclide, MR at early stage ✦ Acute and chronic ✦ Bone destruction ✦ Sequestrum ✦ Hyperplasia and sclerosis ✦

Tuberculosis Asia and Africa ✦ Seldom in bone ✦ Spine , large joint ✦ Asymptomatic in the early stage ✦ Simulate benign tumor ✦

Metabolic / Endocrinic diseases

Metabolic/Endocrinic diseases Rickets and osteomalacia ✦ Hyperparathyroidism ✦ Renal osteodystrophy ✦ Acromegaly ✦

Rickets and osteomalacia Metaphyses widened/cupped ✦ Plate widen ✦ Deformities ✦ Greenstick fracture ✦ looser zone ✦

Rickets and osteomalacia ✦

Poor mineralization of osteoid

Acromegaly Overgrowth of articular cartilage ✦ Adolescence – Gigantism ✦ Adult –acromegaly ✦

Hands/feet (prominent tufts) ✦ Enlarged pituitary fossa ✦ Skull vault thickened ✦ Face (prognathous jaw) ✦

Acromegaly

Fibrous dysplasia Developmental abnormality ✦ Unknown cause ✦ Osteoblasts fail to differentiate and mature ✦ Sigle/few/many ✦ Unilateral/bilateral ✦ Intramedullary / diaphyseal in long bone ✦ Radiolucent / hazy / ground glass ✦

Fibrous dysplasia

Fibrous dysplasia