医学影像学课件：骨骼二eng

1、Musculoskeletal system II Colles Fracture 2 Smith Fracture 3 Distant radius Fracture Extension type: Colles fxs Flexion type: Smith fxs 4 Colles Fracture Older individuls within 2.5cm from the artiular end of the radius Does not extend into joint space Dorsal angulation with radial and dorsal displa

2、cement of distal fragment Frequently associated with fracture of ulnar styloid Non-traumatic Spinal fracture Cause: osteoporosis Chronic compressed fracture: clear margin, hyperostosis is common Acute compressed fracture：incontinous margin，collapse；MRI Fatsupression T2 6 Fatique Fracture a type of s

3、tress fracture, and is due to abnormal stresses on normal bone. It should not be confused with an insufficiency fracture, which occurs due to normal stresses on abnormal bone. 2nd、3rd metatarsal, tibia /fibia，without dislocation。 Focal bone density decreased or osteosclerosis，Callus formation， fract

4、ure line may not be clear MRI: low signal fracture line，marrow edema，soft tissue swelling. 7 Occult Fracuture Intra-bone trabecular fracture，marrow hemorrhage along fracture line MRI demonstrate marrow edema，long T1 long T2 line signal 9 Epiphyseal fracture classification a fracture involving the ep

5、iphyseal plate of a long bone, which causes separation or fragmentation of the plate. Also called Salter fracture. 10 T2WIT1WI 11 Methods CharacteristicAdvantagedisadvantage FluoroscopySeldom used Plain film first choice Spatial resolution Bone substance-surrounding soft tissue is full of contrast a

6、nd detail. joint capsule, ligament, articular cartilage invisible DSAused uncommontumors and vascular abnormalities. Invasive Arthrograph y Injection contrast media, replaced by CT and MRI gradually. Invasive CTExcellent Contrast resolution; 3D reconstruction; cross-sectional display; measurement of

7、 specific attenuation values; Window technique quick, accurate, un-invasive. complex anatomy region Small and occult lesions Enhanced CT :elevate density difference between the lesion and normal tissue+characteristics of enhancement MRIMultiplanar imaging; Soft tissue contrast ; multi-parameter imag

8、ing; enhanced MR imaging normal structure (capitulum, bony articular surface, articular-cartilage, joint capsule, tendon, ligament, and fat tissue, soft tissue)+pathologic tissues(masses, edema, joint effusion, hemorrhage, and traumatic and degenerative tissues) the early changes and characteristics

9、 of blood supply of the lesions. 12 Normal imaging manifestation Articular capitulum and articular cartilage The joint capsule and the ligament The joint space 13 The Joint space Low density space between the opposite capitulum on the plain film and CT imaging. The veritable anatomical cavity, The a

10、rticular-cartilage A little synovia. 14 adultchild Bony articular surface Joint space 15 Knee 16 Ankle 17 Quiz? Destruction of joint Definition: the articular-cartilage and the sub-chondral bone have been invaded or replaced by pathologic tissue. 19 Destruction of joint b. b. Bony articular ony arti

11、cular surfacesurface c.Sub-Bony articular surface c.Sub-Bony articular surface bonebone Sub-chondral bone(b+c)Sub-chondral bone(b+c) a.Joint space narrowing c.High signal bone marrow replaced by low and mixed signal a.a. b.Low signal cortex replaced by high or mixed signal of pathological tissue Def

12、ect and dstruction of b+c, low density,lose bone structure Imaging findingsImaging findings X-ray and CTX-ray and CTMRIMRI 20 QUIZ？ Changes of joint space Width increase: large intra-articular effusion Narrow: destruction of articular cartilage Slight changecompare with the normal side DiseaseLocati

13、on,Time Acute pyogenic arthritisWeight-bearing Tuberculosis arthritisLater Rheumatoid arthritisEarly, uniform Degenerative Joint DiseaseWeight-bearing 22 QUIZ？ QUIZ? Swelling of the joint Causes: articular inflammation, trauma, and hemorrhage, and so on. Pathologic foundation: The hyperaemia of syno

14、vial membrane The swelling of the periarticular soft tissues and joint capsule The intra-articular effusion and hemorrhage 25 Swelling of the joint Pathological changeX-ray CTMRI(signal) T1 T2 +C Swelling of the joint1.enlargement of the contour 2.Density of surrounding soft tissue 3.the loss of def

15、inition or displacement of the fat line in the soft tissue lowhighno Intra-articular effusion hydro-density imaginglowhighno intra- articular Hemorrhage acute density CT values ( 6080HU) lowlow Fluid-fluid level subacutehighhigh chroniclowhigh puslow-density area with rim enhancement lowhighrim enha

16、ncem ent 26 QUIZ? Ankylosis of joint Sequence of destruction of joint Bony ankylosisFibrous ankylosis definitionthe total obliteration of joint space, the articular capitulums were crossed by bony trabeculations the joint space crossed by fibrous tissue causePyogenic arthritisTuberculosis arthritis

17、X-rayCan be discoveredcannot 28 QUIZ? Dislocation of Shoulder Joint 30 Dislocation of HIP Anterior dislocationPosterior dislocationCentral dislocation 31 Shenton lineFracture of femoral head and dislocation of hip 32 Dislocation of Hip 33 Dislocation of Hip TRAUMA OF JOINT Fracture Swelling of joint

18、 dislocation Occult Fracture Osteocartilaginous bodies Intra-articular hemorrhage Marrow edema Intra-articular hemorrhage Articular cartilage injury Tear of ligament Vasular injury Disruption and occlusion of major vessels Arteriovenous fistulae Aneurysm Angiography MRI CT X-ray 34 TRAUMA OF JOINT C

19、hondral and osteochondral fractures Traumatic synovitis and hemarthrosis Tendon and ligament injuries Meniscus tear TRAUMA OF JOINT Chondral and osteochondral fractures 36 Trauma of jointPC Ligament injuries 37 Grading of Meniscal Tears: MRI I: globular changes II: linear changes not to margin III:

20、linear to sup/inf margin IV: complex linear changes Only grade III and IV visible on arthroscopy 38 Basic Radiologic Features of Joint Disease Destructuion of joint Changes of joint space Swelling of the joint Ankylosis of joint Dislocation 39 Bone Joint Soft tissue Inflammation Tumor Trauma Metabol

21、ic Avascular necrosis Inflammation Infectious Pyogenic Arthritis Tuberculosis Non-infectious Rheumatoid Arthritis Ankylosis Spon QUIZ? Pyogenic arthritis Pathologic apperance 1. Early stage: the surface of joint becoming blurred,the swelling of joint 2. Middle stage: the surface of joint destruction

22、 and accompany with the narrow of joint space(weight bearing or stress) 3. Later stage: articular bony ankylosis 43 Tuberculosis Destruction and hyperostosis coexist，osteoporosis appeared in early stage Periosteal reaction is rare Sand-like sequestrum epiphyseal plate and articular cartilage can be

23、invaded non weight-bearing part Long bone metaphysis Short tubular bone Hip Knee Spine Non-infectious inflammation Rheumatoid arthritis：young and middle age female， joint extremity ，chronic、multiple、symmetrical、 erosive、progressive Ankylosing spondylitis：young male，axial skeletal and spinal ankylosi

24、s，progressive Degenerative joint disease：middle and old age， degeneration of articular cartilage, weight-bearing joint QUIZ? Rheumatoid arthritis early phase：swelling of soft tissue surrouding joint、 osteoporosis middle phase：bone destruction of articular surface(marginal erosion）、narrowing of joint

25、 space Late phase：apparent osteoporosis，atrophy of soft tissue， subluxtion or dislocation of joint,deformity、ankylosis of joint QUIZ? QUIZ? QUIZ? Ankylosing spondylitis sacroiliac joint：bilateral rat-bite destruction, narrowing、ankylosis Squaring of vertebral bodies ：bony destruction of superior and

26、 inferior corner of vertebral anterior border Bamboo-spine：ossification of fibrous annal and ligament Large joint：bilateral symmetrical destruction, bony ankylosis QUIZ? DEGENERATIVE JOINT DISEASE Radiological appearance l Narrowing of joint space(weight-bearing) l Subchondral sclerosis l Marginal o

27、steophyte formation l Subchondral cysts l No osteoporosis usually 61 Differentiation：pyogenic/tuberculosis/degenerative/rheumatoid arthritis 化脓性化脓性 26yr male26yr male，swellingswelling ofof rightright wristwrist 3 3 months months PEPE：SwellingSwelling andand tendernesstenderness ofof rightright wrist

28、wrist. . BasicBasic signsign？ DiagnosisDiagnosis？ case1 2yr male2yr male，hidrosishidrosis、nightnight terrorterror 3 3 monthsmonths PEPE：occipitaloccipital bold,bold, lowlow extremityextremity appearedappeared O O shapeshape. . BasicBasic signsign？ DiagnosisDiagnosis？ case2 42yr42yr femalefemale，swellingswelling ofof jointjoint ofof handhand、morning stiffness for 8 morning stiffness for 8 months.months. PEPE：swellingswelling andand deformity ofdeformity of interphalangea