醫(yī)學(xué)影像學(xué)：骨骼和肌肉系統(tǒng)

1、骨骼和肌肉系統(tǒng)Musculoskeletal System,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,

2、 joints, and soft tissues. 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, excellen

3、t contrast resolution, and ability to measure specific attenuation values.,Examination Techniques,X-ray Plain film, fluoroscopy, angiography CT： plain scan, enhancement MRI： plain scan, enhancement,X-ray,Plain film (basic examination) Routine radiographic evaluation of the bones should consist of an

4、teroposterior (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(angiography ) For vascular diseases and bone tumor 關(guān)節(jié)造影(arthrography) Fo

5、r joint diseases, very few used now,angiography,Computed Tomography,plain scan Include bone window and soft tissue window enhancement - For differential diagnosis CT myelography,L4-5 CT soft tissue window and bone window,Knee: CT soft tissue window and bone window,Magnetic Resonance Imaging,plain sc

6、an and enhancement SE,TSE or GRE are basic sequences. Fat suppression sequences and use of intravascular contrast agents further increase the ability to accentuate tissue contrast.,Lumbar spine sagittal view (T1WI,T2WI),Ultrasonography,Ultrasonography is noninvasive and painless to the patient. Furt

7、hermore, it is less expensive, safer, and performed more rapidly than most alternative studies. Because it allows localization of lesions in three dimensions, sonography is a useful technique for guiding percutaneous aspiration or biopsy and for mapping radiation portals.,Normal Imaging Anatomy,Form

8、, structure and develop of bone form：long bone, short bone, tabular bone, unregular bone Structure: compact bone, spongy bone, periosteum, medullary cavity of bone develop：intramembranous ossification (skull, facial bones)，endochondral ossification (trunk, limbs, base of skull, ethmoid)，ossification

9、 center,Long bone Developing bone diaphysis：compact bone, medullary cavety metaphysis：spongy bone Epiphysis: secondary ossification center epiphyseal plate： bone age： the age of creating secondary ossification in the epiphyses and the age of combining epiphysis with diaphysis,Matured bone： diaphysis

10、: cortex of bone, spongy bone, Medullary cavity of bone, vascular channel extremities: joint sesamoid bone,CT and MRI,bone window Cortex, trabecula, medullary cavity soft tissue window Muscle, tendons, cartilage,股骨下段CT 骨窗、軟組織窗,Headline,SOMATOM Emotion 16 8.5 sec for 102 mm 16 x 0.6 mm Pitch 1.2 Rota

11、tion 0.6 sec 130 kV 77 effective mAs,Courtesy of Jiangsu province people hospital / Nanjing, China,Headline,SOMATOM Emotion 16 53.8 sec for 318 mm 16 x 0.6 mm Rotation 1.0 sec 130 kV 123 effective mAs,Bone removal,Courtesy of Jiangsu province people hospital / Nanjing, China,MRI檢查,骨骼、關(guān)節(jié)、肌肉等軟組織有良好MRI

12、自然對比，能三維顯示上述各種正常、異常結(jié)構(gòu)，MRI增強(qiáng)掃描能提高診斷正確率。,Ultra-High Resolution 3TT1 VIBE 3D with Isotropic 0.4 mm3,T1 3D VIBE water excitation TA 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、軸、冠狀位掃描。PDWI、DWI、T2MAP等 正常： 軀干、四肢骨 關(guān)節(jié) 軟組織 結(jié)合正常解剖所見，病理發(fā)現(xiàn)異常病變,Ultra-High Resolution 1.5T

13、T2 DESS with isotropic 0.7 mm,T2 3D DESS coronal isotropic necrosis, PAT 2 with GRAPPAeff. SL 0.7 mm, partitions 104, matrix 576, FoV 340 mm,Sagittal MPR of T2 3D DESS,Courtesy Dr. Tallal C. Mamisch,New syngo MR B13,Now you can evaluate smallest menisceal tears with a single sequence,PD SPACE PAT2 -

14、 isotropic resolution 0.84 mm MAGNETOM Avanto,PD SPACE with FatSat PAT2 - isotropic resolution 0.84 mm MAGNETOM Avanto,Joint,關(guān)節(jié)分類 不動關(guān)節(jié)(immovable joint) 微動關(guān)節(jié)(amphiarthrodial joint) 能動關(guān)節(jié)(movable joint),Joint,關(guān)節(jié)間隙（joint space) 關(guān)節(jié)面(articular surface) 關(guān)節(jié)囊(joint capsule) 韌帶(ligament) 關(guān)節(jié)軟骨(articular cartil

15、age),兒童踝關(guān)節(jié),兒童膝關(guān)節(jié),兒童髖關(guān)節(jié),后交叉韌帶posterior cruciate ligament,前交叉韌帶 Anterior cruciate ligament,股四頭肌腱 quadriceps femoris tendon 髕韌帶 patellar ligament,半月板meniscus,髕股關(guān)節(jié) Patellofemoral joint,Spine,cervical vertebrae, thoracic vertebrae, lumbar vertebrae, sacral vertebrae, coccygeal vertebrae physiocurvature v

16、ertebra：vertebral body, vertebral arch, spinous process, transverse process, articular process, intervertebral disc paravertebral soft tissue,CT,MRI T1WI, T2WI,多發(fā)性骨髓瘤,Soft tissue,X-ray: limited CT: better MRI: best,前交叉韌帶完全撕裂2,左膝內(nèi)上部軟組織血管瘤,Essential lesion of bone,osteoprosis osteomalacia Bone destruc

17、tion hyperostosis Periosteal proliferation,calcification osteonecrosis mineral deposition Bone deformation Soft tissue lesion,CT,Similar to X-ray film appearence CT is better than X-ray film CT contrast enhancement for tumor differentiation,MRI,Soft tissue contrast is better than CT Calcification an

18、d ossification is not sensitive in MRI Metastasis is more sensitive in MRI than CT MRI contrast enhancement is useful in diagnosis,Osteoporosis Total body limited,骨密度分析區(qū) （五點(diǎn)修飾輪廓） 模板的水樣部分 模板的骨樣部分,Osteomalacia: mineral decrease,Bone destruction,隱性骨轉(zhuǎn)移,脊柱結(jié)核,Hyperostosis, Osteosclerosis,頸椎骨贅形成,椎間盤突出椎管狹窄,

19、Periosteal proliferation,Codeman triangle,Chondral calcification,軟骨肉瘤,Osteonecrosis,mineral deposition,bone malformation,surrounding soft tissue,上臂脂肪瘤,右小腿平滑肌肉瘤,男性77歲右小腿腫塊1年，近一月來進(jìn)行性增大腫塊質(zhì)硬，壓痛不明顯。,滑膜肉瘤,關(guān)節(jié)基本病變,關(guān)節(jié)腫脹(swelling of joint) 關(guān)節(jié)破壞(destruction of joint) 關(guān)節(jié)退行性變(degeneration of joint) 關(guān)節(jié)強(qiáng)直(ankylosi

20、s of joint) 關(guān)節(jié)脫位(dislocation of joint),Swelling of joint,destruction of joint,degeneration of joint,ankylosis of joint,dislocation of joint,級撕裂（b級）,A,B,桶柄樣撕裂內(nèi)側(cè)較外側(cè)多見。半月板首先是縱向撕裂，主要是垂直型，若撕裂線內(nèi)側(cè)的半月板碎片向內(nèi)移位，形成類似桶柄形態(tài)。矢狀面像上半月板體部失去正常的雙凹鏡形態(tài)，前后角萎縮或截?cái)嗖⒁娦盘柛淖?，在近髁間嵴層面見低信號的半月板碎片。冠狀面像上半月板分為兩個(gè)部分，原位部分（桶）明顯萎縮，向內(nèi)移位半月板碎片（柄）位于髁間棘旁,M,柄,桶,內(nèi)側(cè)副韌帶損傷,內(nèi)側(cè)副韌帶撕裂后，內(nèi)側(cè)支持帶松弛,*,*,MRI,Better soft tissue contrast Injury Metastasis is sensitive in MRI Range of the lesion is more clear,異常MRI征,骨骼：骨水腫、骨增生、骨破壞、骨膜增生，骨髓異常，骨梗死 關(guān)節(jié)：關(guān)節(jié)腫脹、軟骨破壞、骨性關(guān)節(jié)破壞、半月板損傷、韌帶損傷、關(guān)節(jié)退變、關(guān)節(jié)脫位 軟組織：（另述）,骨挫傷,前交叉韌帶完全撕裂2,關(guān)節(jié)軟骨變薄,