no132014415骨骼正常與基本病變

1、骨骼和肌肉系統(tǒng)Musculoskeletal System1The 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. 2 Various imaging examinations are available for the evaluation of bone

2、s, 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, excell

3、ent contrast resolution, and ability to measure specific attenuation values.3Examination TechniquesX-ray Plain film, fluoroscopy, angiographyCT： plain scan, enhancementMRI： plain scan, enhancement4X-rayPlain film (basic examination)Routine radiographic evaluation of the bones should consist of anter

4、oposterior (or posteroanterior) and lateral views, which should include one joint and soft tissue Oblique and tangent views may be necessary in specific situations.5Knee of anteroposterior and lateral views6Lumbar spine7血管造影(angiography )For vascular diseases and bone tumor 關(guān)節(jié)造影(arthrography)For joi

5、nt diseases, very few used now 8angiography9Computed Tomographyplain scanInclude bone window and soft tissue windowenhancement - For differential diagnosisCT myelography10L4-5 CT soft tissue window and bone window11Knee: CT soft tissue window and bone window12Magnetic Resonance Imaging plain scan an

6、d 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.13Lumbar spine sagittal view (T1WI,T2WI)14Ultrasonography Ultrasonography is noninvasive and painless to the patient. Further

7、more, 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.15Normal Imaging AnatomyForm, s

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

9、er16Long bone Developing bonediaphysis：compact bone, medullary cavetymetaphysis：spongy boneEpiphysis: secondary ossification center epiphyseal plate：bone age： the age of creating secondary ossification in the epiphyses and the age of combining epiphysis with diaphysis171819Matured bone： diaphysis: c

10、ortex of bone, spongy bone, Medullary cavity of bone, vascular channel extremities: joint sesamoid bone20CT and MRIbone windowCortex, trabecula, medullary cavitysoft tissue windowMuscle, tendons, cartilage21股骨下段CT 骨窗、軟組織窗222324HeadlineSOMATOM Emotion 16 8.5 sec for 102 mm16 x 0.6 mmPitch 1.2Rotation

11、 0.6 sec130 kV77 effective mAsCourtesy of Jiangsu province people hospital / Nanjing, China25HeadlineSOMATOM 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, China2627282930313233MRI檢查 骨骼、關(guān)節(jié)、肌肉等軟組織有良好M

12、RI自然對比，能三維顯示上述各種正常、異常結(jié)構(gòu)，MRI增強掃描能提高診斷正確率。34Ultra-High Resolution 3TT1 VIBE 3D with Isotropic 0.4 mm3T1 3D VIBE water excitationTA 5:44, eff. SL 0.4 mm, matrix 512, partitions 112, FoV 100 mm35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36Ultra-High Resolution 1.5TT2

13、 DESS with isotropic 0.7 mmT2 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 DESSCourtesy Dr. Tallal C. Mamisch exclusive37Newsyngo MR B13Now you can evaluate smallest menisceal tears with a single sequencePD SPACE P

14、AT2 - isotropic resolution 0.84 mm MAGNETOM AvantoPD SPACE with FatSatPAT2 - isotropic resolution 0.84 mm MAGNETOM Avanto exclusive38 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)39Joint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

15、 cartilage)4041424344兒童踝關(guān)節(jié)45兒童膝關(guān)節(jié)464748兒童髖關(guān)節(jié)4950后交叉韌帶posterior cruciate ligament前交叉韌帶Anterior cruciate ligament51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 5253Spinecervical vertebrae, thoracic vertebrae, lumbar vertebrae, sacral vertebrae, coccygeal verteb

16、raephysiocurvature vertebra：vertebral body, vertebral arch, spinous process, transverse process, articular process, intervertebral discparavertebral soft tissue 545556575859CT6061MRI T1WI, T2WI626364多發(fā)性骨髓瘤65Soft tissueX-ray: limitedCT: betterMRI: best66前交叉韌帶完全撕裂267左膝內(nèi)上部軟組織血管瘤68Essential lesion of bo

17、neosteoprosisosteomalaciaBone destructionhyperostosisPeriosteal proliferationcalcificationosteonecrosismineral depositionBone deformationSoft tissue lesion69CTSimilar to X-ray film appearenceCT is better than X-ray film CT contrast enhancement for tumor differentiation70MRISoft tissue contrast is be

18、tter than CTCalcification and ossification is not sensitive in MRIMetastasis is more sensitive in MRI than CTMRI contrast enhancement is useful in diagnosis71OsteoporosisTotal body limited72骨密度分析區(qū)（五點修飾輪廓）模板的水樣部分模板的骨樣部分73Osteomalacia: mineral decrease74 Bone destruction75隱性骨轉(zhuǎn)移76脊柱結(jié)核7778Hyperostosis,

19、Osteosclerosis798081頸椎骨贅形成82椎間盤突出椎管狹窄83Periosteal proliferation8485Codeman triangle8687 Chondral calcification 8889軟骨肉瘤90 Osteonecrosis9192 mineral deposition93 bone malformation94surrounding soft tissue95上臂脂肪瘤96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。97滑膜肉瘤98關(guān)節(jié)基本病變關(guān)節(jié)腫脹(swelling of joint)關(guān)節(jié)破壞(destr

20、uction of joint)關(guān)節(jié)退行性變(degeneration of joint)關(guān)節(jié)強直(ankylosis of joint)關(guān)節(jié)脫位(dislocation of joint)99 Swelling of joint100101destruction of joint102degeneration of joint103ankylosis of joint104105dislocation of joint106級撕裂（b級）107108AB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

21、常的雙凹鏡形態(tài)，前后角萎縮或截斷并見信號改變，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109110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111損傷AT MRI正常AT MRI跟腱損傷的MRI表現(xiàn)*112MRIBetter soft tissue contrastInjuryMetastasis is sensitive in MRIRange of the lesion is more clear113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）114骨挫傷115116前交叉韌帶完全撕裂2117關(guān)節(jié)軟骨變薄關(guān)節(jié)