1. Bone Prepared by Dr.Salah Mohammad Fateh MBChB,DMRD,FIBMS(radiology) Lecture no. 1

7. Vertebral column

10. Lecture no. 1 Radiological approach to Bone diseases Prepared by Dr.Salah Mhamad Fateh MBChB,DMRD,FIBMS(radiology)

11. Imaging techniques; • X-ray • Isotope • US • CT • MRI

12. 1-Plain bone radiograph

13. Initially, a musculoskeletal lesion should be simply imaged with a plain film. It should be remembered that plain films remain the most reliable imaging method for assessment of both biological activity and probable histological diagnosis of an osseous lesion.

14. Signs of bone diseases in plain X-ray are;

15. 1-Decreased bone density 2-Increased bone density (sclerosis). 3- Periosteal reaction 4- Cortical thickening 5- Alteration in the trabecular pattern 6- Alteration in the shape of a bone 7-Altreration in bone age

16. 1-Decreased bone density • Localize (lytic area or area of ‘ bone distruction’) • Generalize

17. Localized decreased bone density

18. Generalize decreased bone density

19. 2-increased bone density (sclerosis). • Focal • Generalized

20. Generalize increase in bone density

21. Localize sclerotic lesion

22. 3- periostial reaction; • It refers to excessive bone produced by the periosteum, which occur in response to infection , trauma & tumors

23. Patterns of periosteal reaction;

24. 1- Linear

25. 2-sunray(Speculated)

26. 3-Onion skin

27. 4-Codman’s triangle

28. 4- Cortical thickening • Also involve laying down of new bone by the periosteum,but the process is very slow & it has the same homogeneous density as does the normal cortex& there is no separate lines or specules of calcification as seen in a periosteal reaction

29. Cortical thickening

30. causes 1- chronic osteomyelitis. 2-healed trauma 3- response to chronic stress or benign tumor

31. 5- alteration in the trabecular pattern Usually involving a reduction in the no. of trabeculae with an alteration in the remaining trabeculae. e.g in osteoporosis, there is reduction in the no. of the trabeculae & remaining trabiculae are more prominent than usual associated with thinning of the cortex. in paget‘s disease , there is thickening of the trabeculae & associated with thickening of the cortex & bone expansion

32. Normal

33. Normal Local osteoporosis ( femur)

34. Paget disease

35. 6- alteration in the shape of a bone • Congenital • Acquired , e.g Acromegaly, expanding bone tumors

36. Osteogenesisemperfecta

37. 7-Altreration in bone age

38. 2-US in musculoskeletal disease US can not demonstrate bone pathology but does have a complementary imaging role; • Detecting tenosynovitis, tendon tear & rupture. • In diagnosis of arthritis & osteomyelitis

39. 3-Radionuclide bone scaning Technetium-99m lablled phosphate complexes

40. Indication of radionuclide scan are • Detection of metastasis. • Detection of osteomyelitis . • Determination of whether a lesion in solitary or multiple. • Investigation of clinically suspected lesion when the Plain radiograph is –ve. • Investigation of radiographically equivocal cases whether is significant or not. • Investigation of pain full prosthesis .

41. Osteoidosteoma

42. 4-CT in bone disease • Is only needed in selected cases. • Indications for bone CT are • Demonstrating abnormalities in the areas where interpretation of plain films are frequently difficult for exam. Spine , hip &pelvis • As a guide for bone biopsy. • Demonstration of the extent &characterization of the bone tumor in selected cases to complement MRI

43. Osteoidosteoma

46. 4-MRI(magnetic resonance imaging) • Play a vital important role in musculoskeletal disorders. • In can demonstrate bone marrow directly but calcified tissues & cortical bones produces no signal. • MRI particularly good for showing soft tissue abnormalities

47. Indications of MRI • Disc herniation & spinal cord or nerve roots compression. • Dx of bone metastasis. • Extend of primary bone tumor. • To image soft tissue masses • To Dx osteomyelitis & shows any soft tissue abscess. • To Dx avascular necrosis & other joint pathologies

48. Localize alteration in trabicular pattern