医学精品课件：02.Musculoskeletal Radiology-本科英文教学2017已修改.pptx

1、Bone and joint system RadiologyYongMeiYongMei Li Li Department of RadiologyDepartment of RadiologyThe First Affiliated Hospital of CQMUThe First Affiliated Hospital of CQMU影像专家介绍李咏梅教授影像专家介绍李咏梅教授教授，主任医师，重庆医科大学附属第一医院放射科教授，主任医师，重庆医科大学附属第一医院放射科副主任，神经病学博士，硕士生导师，纽约大学医学副主任，神经病学博士，硕士生导师，纽约大学医学院影像研究中心访问学者。国家

2、自然科学基金一审评院影像研究中心访问学者。国家自然科学基金一审评委评议成员，中华放射学会第十四届神经专业学组青委评议成员，中华放射学会第十四届神经专业学组青年委员，中华放射年委员，中华放射学会传染病专业组委员学会传染病专业组委员发表论文发表论文8080余篇、第一作者或通讯作者发表余篇、第一作者或通讯作者发表SCISCI论文论文1313篇篇。获重庆市卫生局医学成果一等奖和科委三等奖、。获重庆市卫生局医学成果一等奖和科委三等奖、重庆医科大学优秀博士论文、国家自然科学基金重庆医科大学优秀博士论文、国家自然科学基金2 2项、项、重庆市自然科学医学基金重庆市自然科学医学基金2 2项、重庆市卫生局医学科项

3、、重庆市卫生局医学科研基金研基金4 4项、重庆医科大学优秀博士论文资助项、重庆医科大学优秀博士论文资助1 1项。多项。多次国外及在全国放射年会、全国磁共振年会、头颈放次国外及在全国放射年会、全国磁共振年会、头颈放射学年会、川渝放射年会以及重庆地区放射学分会发射学年会、川渝放射年会以及重庆地区放射学分会发言，言，实用医学杂志实用医学杂志中国中国CTCT和和MRIMRI杂志杂志磁共磁共振成像振成像等审稿人等审稿人研究方向：研究方向中枢神经脱髓鞘疾病、腹部和盆研究方向：研究方向中枢神经脱髓鞘疾病、腹部和盆腔各种疾病的影像诊断腔各种疾病的影像诊断Outline Normal bone and join

4、t anatomic imaging Basic pathologic changes imaging Bone and articular TraumaClassification of Bones Long bones longer than wide a shaft plus ends Short bones roughly cube-shaped Flat bones thin and flattened,usually curved Irregular bones various shapes,do not fit into other categoriesCommon imagin

5、g methods 1.X-ray plain film:CR,DR FLuoroscopy(透视透视)should play no part in the examination of bones or joints,apart from the localization of the metallic foreign bodies,reduction and fixation of the fractures Radiography,which is superior to fluoroscopy 5pX-ray plain is the first-selected methods；Be

6、cause of its calcium content,which is high density and differs from surrounding soft tissue，difference between the cortex bone and the sponge bone,is full of contrast p The skeletal system is one of the most common X-ray examinations in a radiological department in a hospital 6p May provide clues to

7、 the presence of various pathologic categories,such as congenital,inflammatory,metabolic,traumatic p Advantages:excellent natural contrast;fast imaging;cheap pricep Disadvantages:overlap image;poor soft tissue contrast and resolution;poor sensitivity of early stage of lesion7 Filming positions neces

8、sary position both Anterior-Posterior（A-P）position and lateral position（侧位）（侧位）,oblique position 8A-P positionLateral positionOblique position For study of a long bone,a near-by joint should be included in one film so as to make lacalization The surrounding soft tissue should be included in one film

9、 as much as possible.The bone or joint on the other side should be examined,for comparison.These are very useful,particularly in children and the forepart（早期）（早期）of the disease.9Common imaging methods2.CT:plain scan(平扫平扫),CE(Contrast Enhancement（增强（增强)p Intravenous injection of the iodinated contras

10、t medium（碘对（碘对比剂）比剂）with CT,which can define the scope of the lesionsp CT value,HU,Water=0HU,Air=-1000HU，Bone=1000HUp CT is an important technique for the study of diseases of bones and joints,especially of the skull,spine and pelvis.10p CT has been popularized and has advantages:high density resolu

11、tion;avoiding overlap image;post-processp The ability to allows for multiplanar or 3-D reconstruction.pDisadvange:soft tissue resolution sensitvity less than MRI 11Common imaging methods3.MRI:plain scan（T1WI,T2WI,fat suppresion）;C EpHigh soft tissue resolutionpPrefer to joint,muscle,tendon肌腱肌腱,carti

12、lage（软骨）（软骨）pHigh sensitivity for edema,hemorrhage（出血）（出血）,necrosis（坏死）（坏死）12pSome X-ray findings may lag behind the clinical symptoms and signs,as in case of infection and tumors;it requires a period of time before radiology changes are apparent.pCT and MRI can show the around the bones and joints,

13、so the disease can be demonstrated easier and earlier.osteonecrosisoffemoralhead股骨头缺血坏死股骨头缺血坏死pyogenicosteomyelitis化脓性骨髓炎化脓性骨髓炎13 Normal bone and joint anatomy imagingX-rayCTMRIOuter 外板外板 Inter内板内板 Dipole板障板障 compact bone骨密骨密质质spongy bone（松质骨）（松质骨）cortical bonePeriosteum（骨膜）（骨膜）medullarymedullary ca

14、vitiytrabeculae骨小梁骨小梁 long bone anatomy vs radiographyosteoepiphysis(二次骨化中心二次骨化中心)epiphyseal plate（骺板）（骺板）metaphysis(干骺端干骺端)diaphysis（骨干）（骨干）Childrens long bone radiographyp Bones lengthen entirely by growth of the epiphyseal platesp epiphyseal plate：cartilage bone p Pushes the epiphysis away from t

15、he diaphysis16 Bone age Epiphysis development Secondary ossification center epiphyseal plate epiphyseal linesecondaryossificationcenterdiaphysisMetaphysis干骺段干骺段Epiphysis骨骺骨骺Epiphyseal plate骺板骺板Epiphyseal Cartilage骺软骨骺软骨 Childrens long bone radiography vs MRILong bone CTCT has better cability for dis

16、playing cortial and trabeculae（骨小梁）（骨小梁）Long bone MRI20Cortical boneuhigh,low,medium,mixsignalumild,medium,markedenhancementCortical bonCortical boneCortical boneMSK MRI Signal characteristicsT1WIT2WIcortical bone lowlowbone marrowhighhighcartilagemediumhighmusclemediummediumfat tissuehighhighligame

17、ntlowlow脊柱正常X线表现Spine radiographyA-P positionLateral position椎弓根Whole spine CT and MRIWhole spine CT and MRILumbar spine CT/MRIsaggital imageAF纤维环纤维环NP髓核髓核Spinal nervesFacets小关节小关节Dural硬膜囊硬膜囊discLumbar spine CT/MRIaxial image IVD:endplate终板终板,annulus fibrosus纤维环纤维环,nucleus polposus髓核髓核MRI can accura

18、tely evaluate disc structure,find the early degenerative changes.IntervertebralIntervertebral Disc MRIDisc MRIJoint imaging Radiography：joint space,bony articular surfaceKnee CTKnee MRIMRI can be used to evaluate all articular structures include cartilage,ligament,tendon,muscle.Basic pathologic chan

19、ges imagingImportant partBone changesJoint changesBone Matrix 35%organic components有机质有机质 Composed of cells,fibers,and organic substances Collagen（胶原）胶原）65%inorganic mineral salts无机质无机质 Primarily calcium phosphate（钙磷）（钙磷）Resists compressionBone basic pathologic changes1 1.changes of decreased bone d

20、ensity：osteoporosis 骨质疏松骨质疏松 Osteomalacia 骨质软化骨质软化 bone destruction 骨质破坏骨质破坏2 changes of increased bone density：osteosclerosis and hyperostosis 骨质疏松硬化骨质疏松硬化 periosteal reaction 骨膜反应骨膜反应 chondral calcification 软骨钙化软骨钙化 osteonecrosis 骨骨坏死坏死3.mixed bone changes：ReferenceReference：bone and bone and soft

21、 tissuesoft tissueOsteoporosis（OP,骨质疏松）骨质疏松）D:a decrease in normal mineralized bone tissue per unit volume,which mineral and organic matters decrease in proportion,quantitatively deficient bone tissue leads to decreased mechanical strength and increases the risk of bone fracture Histology:Cortical t

22、hinness and the number and size of trabeculae decreaseOsteoporosis Etiology primary：postmenopausal（绝经后）（绝经后）women and older men；decreased Ca intake,low vitamin D levels,and hyperparathyroidism.Secondary：Immobilization，Rheumatoid arthritis，Cancer，COPD，Chronic kidney/liver disease2 month laterosteopor

23、osis X-ray findings:Decreased bone density,increased radio-lucencythin and decreased cortical bone and trabeculae，wide inter-trabecular space Spine:vertebral height loss and compress changes flatten,double concave shape双凹状双凹状normalnormalOPOPBone density:decreaseCortical bone:thinTrabeculae:thin and

24、decreaseOsteoporosis：Osteoporosis CT CT：similar with X-rayDecreased bone densityThin cortical boneThin and sparse trabeculaenormalOPOsteoporosis MRIMRI：No directly observe bone structureIndirect sign：inter-trabeculae space broaden yellow bone marrow T1W high signal(Ivory white,象牙白象牙白)normalOPOsteoma

25、lacia(骨质软化骨质软化)D:the softening of the bones caused by defective bone mineralization secondary to inadequate amounts of available calcium and phosphate.Etiology:vitamin D deficiency inadequate calcium intake renal diseasechanges of decreased bone densityOsteomalacia X-ray findings:Bone density decrea

26、se,radio-lucency increaseCortical bone and trabeculae thin and decrease，ill-defined edgeWeight-bearing bone deformity Osteomalacia specific X-ray findings:Pseudo-fracture line(假骨折线假骨折线,Loosers zones):a lucent line about 1 2 mm wide vertical to the cortex Metaphysis and epiphysis:widened epiphyseal p

27、late,brush shape毛刷状毛刷状 change of metaphysisBone destruction(骨质破坏骨质破坏)D:localized absence of normal bone tissue and replaced by pathological tissues when a disease process affects the bone.Etiology:Inflammation,granuloma,tumors or tumor-like lesions X-ray findings：A localized bone defect areas of dec

28、reased density and loss of bone structures.CT:better to show details and small or early stages of bone destruction,but less to show the whole information than X-ray film.MRI：absence of normal bone tissue signal and replace by pathological tissue signal advantage to evaluate the involved scope both b

29、one,joint and soft tissueHyperostosis and Hyperostosis and osteosclerosisosteosclerosis(骨质增生硬化骨质增生硬化 )D:an increase in normal bone tissue per unit volume Histology:osteogenisis cortical bone thicken,trabecular increase and enlarge Etiolgoy:trauma,inflammation,degenerative changes,tumor,hypoparathyro

30、idism(甲旁减甲旁减)，poison(fluorosis氟氟中毒中毒).HyperostosisHyperostosisX-ray/CT findings:an increase bone density generally,with thickened cortex and trabeculaethe medullary space narrow even vanish the cortical bone and spongy bone cannot be distinguishedMRI：less sensitive than and CT,low signal both T1WI a

31、nd T2WI,help to find the surrounding edemaHyperostosisHyperostosisPeriostealPeriosteal Proliferation Proliferation（骨膜增生）（骨膜增生）Periosteal reaction(骨膜反应骨膜反应 )D:when the periosteum is irritated pathologically,osteoblasts in the inner layer will be activated and produce sub-periosteal new bone 成骨细胞成骨细胞

32、X-ray film:a high density shadow parallel to the cortex with various patterns as linear,luminar,lacelike(花边状花边状),and spiculate Help to differentiate malignant and benign and activity of diseaseOsteosarcoma骨肉瘤骨肉瘤Ewingsarcoma尤文肉瘤尤文肉瘤InfectionCodmans triangle:Codman triangle is due to direct erosion of

33、 the already formed periosteal new bone by fast growing tumor.Osteonecrosis（骨坏死）（骨坏死）D:the death of bone caused by local bone blood supply disruption,metabolic termination Sequestrum：the dead bone Etiology:infection,trauma,avascular necrosis,bone infarctionchanges of decreased bone densityX-ray film

34、 findings:-early stages negative-local isolated fragment of high bone density,surrounding lucent areaOsteonecrosis CT,MRI：better capability to observe sequestrum than X-ray film,as same as soft tissue Chondral calcification(软骨钙化软骨钙化)small areas of cartilage matrix calcification in the bone or cartil

35、age,on behalf of cartilage tissue in the lesion X-ray:granular颗粒状颗粒状,punctate点状点状,annular环状环状 high density nodulechanges of decreased bone densityJoint basic pathologic changes pSwelling of joint 关节肿胀关节肿胀pDestruction of joint 关节破坏关节破坏pAnkylosis 关节强直关节强直pDislocation of joint关节脱位关节脱位pDegeneration of j

36、oint 关节退行性变关节退行性变Swelling of joint 关节肿胀关节肿胀 the buildup of fluid in the soft tissue surrounding the joint，caused by joint effusion or other soft tissue inflammatory edema and hemorrhage X-ray findings:increased soft tissue density,enlarged joint spaceJoint basic pathologic changes CT and MRI:higher

37、resolution of soft tissue than X-ray MRI can differentiate capsule edema and thickening,joint effusion or hemorrhageDestruction of joint 关节破坏关节破坏 D:defect of joint cartilage and bone,replaced by pathological tissue Etiology:infection,TB,RA,tumorJoint basic pathologic changes X-ray film findings:Bone

38、 joint surface fuzzy/defect Joint space narrowSubchondral bone destruction Ankylosis关节强直关节强直 joint stiffness due to abnormal adhesion and rigidity of the bones of the joint Fibrous ankylosis Bony ankylosisJoint basic pathologic changes Joint dislocation 关节脱位关节脱位 luxation separation of two bones wher

39、e they meet at a joint Subluxation,complete luxation X-ray film:joint misalignment,joint space widening CT:display more details small avulsed fracture MRI:evaluate cartilage,ligament,tendon injury shoulderelbowhipankleDegeneration of joint 关节退行性变关节退行性变 Images：joint hyperostosis，marginal osteophytes,

40、joint space narrowing,subchondral sclerosis,and subchondral cysts Soft tissue basic pathologic changes Soft tissue swelling Soft tissue massSoft tissue massSoft tissue swelling Soft tissue calcification Soft tissue gasSoft tissue basic pathologic changesSummary Imaging techniques of bone X-ray film：

41、first-prefer CT for irregular bone MRI for cartilage and soft tissue Normal bone anatomic imaging children bone Spine Joint Summaryp Basic pathologic changes imaging changes of decreased bone density osteoporosis 骨质疏松骨质疏松 osteomalacia 骨质软化骨质软化 bone destruction 骨质破坏骨质破坏 changes of increased bone density osteosclerosis and hyperostosis 骨质疏松硬化骨质疏松硬化 periosteal reaction 骨膜反应骨膜反应 chondral calcification 软骨钙化软骨钙化 osteonecrosis 骨坏死骨坏死 Joint basic pathologic changes:p Fracture:X-ray findings,children fracture,spine fracture