No.14 【1】.4.22 骨骼正常与基本病变7

1、邹月芬邹月芬 the diseases of musculoskeletal system are very common and complex. they are included trauma, infection, tumor, degeneration disease, metabolic and endocrine disease, congenital anomalies and so on. various imaging examinations are available for the evaluation of bones, joints, and soft tissu

2、es. some are general examinations used for the patients with many types of disorders. others have more limited indications. plain film radiography is routine technique in clinical practice. ct and mri are used more and more now, because of its cross-sectional display, excellent contrast resolution,

3、and ability to measure specific attenuation values.examination techniquesexamination techniques x-rayx-ray plain filmplain film, fluoroscopy, angiographyctct： plain scan, enhancementenhancementmrimri： plain scan, enhancementenhancementx-rayplain film (basic examination)plain film (basic examination)

4、 routine radiographic evaluation of the bones should consist of anteroposterior (or posteroanterior) and lateral views, which should include one joint and soft tissue oblique and tangent views may be necessary in specific situations. knee of anteroposterior and lateral views lumbar spine血管造影(angiogr

5、aphy ) for vascular diseases and bone tumor 关节造影(arthrography) for joint diseases, very few used now angiographycomputed tomographycomputed tomography plain scaninclude bone window and soft tissue window enhancement - for differential diagnosis ct ct myelographyl4-5 ct soft tissue window and bone wi

6、ndow knee: ct soft tissue window and bone windowknee: ct soft tissue window and bone windowmagnetic resonance imagingmagnetic resonance imaging plain scan and enhancement se,tse or gre are basic sequences. fat suppression sequences and use of intravascular contrast agents further increase the abilit

7、y to accentuate tissue contrast.lumbar spine sagittal view (t1wi,t2wi)ultrasonographyultrasonography ultrasonography is noninvasive and painless to the patient. furthermore, it is less expensive, safer, and performed more rapidly than most alternative studies. because it allows localization of lesio

8、ns in three dimensions, sonography is a useful technique for guiding percutaneous aspiration or biopsy and for mapping radiation portals.normal imaging anatomyform, structure and develop of bone formform：long bone, short bone, tabular bone, unregular bonestructurestructure: compact bone, spongy bone

9、, periosteum, medullary cavity of bonedevelopdevelop：intramembranous ossification (skull, facial bones)，endochondral ossification (trunk, limbs, base of skull, ethmoid)，ossification center long bonelong bone developing bonediaphysis：compact bone, medullary cavetymetaphysis：spongy boneepiphysis: seco

10、ndary ossification center epiphyseal plate：bone age： the age of creating secondary ossification in the epiphyses and the age of combining epiphysis with diaphysis matured bonematured bone： diaphysis: cortex of bone, spongy bone, medullary cavity of bone, vascular channel extremities: joint sesamoid

11、bonect and mrict and mri bone windowcortex, trabecula, medullary cavity soft tissue windowmuscle, tendons, cartilage 股骨下段ct 骨窗、软组织窗headlinesomatom emotion 16 8.5 sec for 102 mm16 x 0.6 mmpitch 1.2rotation 0.6 sec130 kv77 effective mascourtesy of jiangsu province people hospital / nanjing, chinaheadl

12、inesomatom emotion 16 53.8 sec for 318 mm16 x 0.6 mmrotation 1.0 sec130 kv123 effective masbone removalcourtesy of jiangsu province people hospital / nanjing, chinamri检查 骨骼、关节、肌肉等软组织有良好mri自然对比，能三维显示上述各种正常、异常结构，mri增强扫描能提高诊断正确率。ultra-high resolution 3tt1 vibe 3d with isotropic 0.4 mm3t1 3d vibe water

13、excitationta 5:44, eff. sl 0.4 mm, matrix 512, partitions 112, fov 100 mm方法 常用t1wi、t2wi及t2wi抑脂像，矢、轴、冠状位扫描。pdwi、dwi、t2map等 正常：躯干、四肢骨关节软组织结合正常解剖所见，病理发现异常病变ultra-high resolution 1.5tt2 dess with isotropic 0.7 mmt2 3d dess coronal isotropic necrosis, pat 2 with grappaeff. sl 0.7 mm, partitions 104, matr

14、ix 576, fov 340 mm, sagittal mpr of t2 3d desscourtesy dr. tallal c. mamisch exclusivenewsyngo mr b13now you can evaluate smallest menisceal tears with a single sequencepd space pat2 - isotropic resolution 0.84 mm magnetom avantopd space with fatsatpat2 - isotropic resolution 0.84 mm magnetom avanto

15、 exclusive joint 关节分类不动关节(immovable joint)微动关节(amphiarthrodial joint)能动关节(movable joint)joint 关节间隙（joint space) 关节面(articular surface) 关节囊(joint capsule) 韧带(ligament) 关节软骨(articular cartilage) 儿童踝关节儿童膝关节儿童髋关节后交叉韧带posterior cruciate ligament前交叉韧带a n t e r i o r c r u c i a t e ligament股四头肌腱quadriceps

16、 femoris tendon髌韧带patellar ligament半月板meniscus髌股关节patellofemoral joint spinespinecervicalcervical vertebrae, thoracicthoracic vertebrae, lumbarlumbar vertebrae, sacralsacral vertebrae, coccygeal vertebraephysiocurvature vertebra：vertebral body, vertebral arch, spinous process, transverse process, ar

17、ticular process, intervertebral discparavertebral soft tissue ctmri t1wi, t2wi多发性骨髓多发性骨髓瘤瘤soft tissue x-ray: limited ct: better mri: best前交叉韧带完全撕裂2左膝内上部软组织血管瘤左膝内上部软组织血管瘤essential lesion of boneessential lesion of bone osteoprosis osteomalacia bone destruction hyperostosis p e r i o s t e a l prolife

18、ration calcification osteonecrosis mineral deposition bone deformation soft tissue lesionctct similar to x-ray film appearence ct is better than x-ray film ct contrast enhancement for tumor differentiationmrimri soft tissue contrast is better than ct calcification and ossification is not sensitive i

19、n mri metastasis is more sensitive in mri than ct mri contrast enhancement is useful in diagnosis osteoporosisosteoporosis total body limited骨密度分析区骨密度分析区（五点修饰轮廓）（五点修饰轮廓）模板的水样部分模板的水样部分模板的骨样部分模板的骨样部分 osteomalacia: mineral decreaseosteomalacia: mineral decrease bone destruction bone destruction隐性骨转移脊柱结

20、核hyperostosis, osteosclerosishyperostosis, osteosclerosis 颈椎骨赘形成椎间盘突出椎管狭窄 periosteal proliferation codeman triangle chondral calcificationchondral calcification 软骨肉瘤 osteonecrosisosteonecrosis mineral deposition bone malformationsurrounding soft tissue上臂脂肪瘤右小腿平滑肌肉瘤 男性77岁右小腿肿块1年，近一月来进行性增大肿块质硬，压痛不明显。滑

21、膜肉瘤关节基本病变 关节肿胀(swelling of joint) 关节破坏(destruction of joint) 关节退行性变(degeneration of joint) 关节强直(ankylosis of joint) 关节脱位(dislocation of joint) swelling of jointdestruction of jointdegeneration of jointankylosis of jointdislocation of joint级撕裂（b级）ab桶柄样撕裂内侧较外侧多见。半月板首先是纵向撕裂，主要是垂直型，若撕裂线内侧的半月板碎片向内移位，形成类似

22、桶柄形态。矢状面像上半月板体部失去正常的双凹镜形态，前后角萎缩或截断并见信号改变，在近髁间嵴层面见低信号的半月板碎片。冠状面像上半月板分为两个部分，原位部分（桶）明显萎缩，向内移位半月板碎片（柄）位于髁间棘旁m柄桶内侧副韧带损伤 内侧副韧带撕裂后，内侧支持带松弛跟腱损伤的跟腱损伤的mri表现表现*mrimribetter soft tissue contrastinjurymetastasis is sensitive in mrirange of the lesion is more clear异常mri征 骨骼：骨水肿、骨增生、骨破坏、骨膜增生，骨髓异常，骨梗死 关节：关节肿胀、软骨破坏、骨性关节破坏、半月板损伤、韧带损伤、关节退变、关节脱位 软组织：（另述）骨挫伤前交叉韧