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SKELETAL RADIOLOGY dr. H.Undang Ruhimat,SpRad

SKELETAL RADIOLOGY dr. H.Undang Ruhimat,SpRad. Principles of Radiologic Interpretation. Technical Consideration Skeletal Anatomy and Physiology The Categorical approach to bone disease Radiologic predictor variables Medicolegal implication. Technical consideration. Plain Film Radiography

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SKELETAL RADIOLOGY dr. H.Undang Ruhimat,SpRad

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  1. SKELETAL RADIOLOGYdr. H.Undang Ruhimat,SpRad

  2. Principles of Radiologic Interpretation • Technical Consideration • Skeletal Anatomy and Physiology • The Categorical approach to bone disease • Radiologic predictor variables • Medicolegal implication

  3. Technical consideration Plain Film Radiography Tomography Contrast Examination Radionuclide Imaging Computed Tomography Magnetic Resonance Imaging

  4. Skeletal Anatomy and Physiology Skeletal Development Intramembranous Ossification Enchondral Ossification Bone Structure Epiphyse – Physis – ZPC – Metaphysis Diaphysis Cortex – Medulla – Periosteum Endosteum Bone Metabolism Bone mineral - Hormones

  5. Anatomy

  6. Anatomy

  7. Anatomy

  8. The Categorical approach to bone disease Congenital Arthritis Trauma Blood Infection Tumor Endocrine,Nutritional,Metabolic Soft Tissue

  9. Radiologic Predictor Variables Preliminary Analysis Clinical data Number of lesions Symetri of lesions Determination of Systems Involved

  10. Radiologic Predictor Variables Analysis of The Lesions Skeletal Location Position Within Bone Site of Origin Shape Size Margination Cortical Integrity

  11. Radiologic Predictor Variables Behavior of Lesions Osteolytic Lesions Osteoblastic Lesions Mixed Lesions Matrix Periosteal Response Solid Respons Laminated Respons Spiculated Respons Codmans’ Triangle

  12. Radiologic Predictor Variables Soft Tissue Changes Supplementary Analysis Other imaging Procedures Laboratory Examination Biopsy

  13. TRAUMA Fracture and Dislocation The radiographs should be made Include at least one joint Preferably two joints Two position AP – LAT

  14. TRAUMA Time intervals between Radiographic Study Initial Diagnostic study Post reduction and post immobilization One or Two weeks later, if position has changed After approximately six eight weeks for Primary callus After each plaster cast or traction change Before final discharge of patient

  15. TRAUMA Types of Fracture Closed fracture Does not break the skin or communicate with the outside environment Simple fracture Open fractur Penetrates the skin over fracture site Compound fracture

  16. TRAUMA Comminuted fracture Two or more bony fragments have separated Non Comminuted fracture Penetrates completely through the bone Avulsion fracture Tearing away of a portion of the bone Impaction fracture Bone is driven into its adjacent segmen

  17. TRAUMA Incomplete Fracture Broken only one side of the bone Greenstick (Hickory Stick) fracture Torus (Buckling) fracture Fracture Orientation Oblique fractur Commonly occurs in the shaft of long tubular bone 45° to the long axis of the bone

  18. Fractur

  19. Fracture

  20. TRAUMA Spiral fractur Torsion, coupled with axial compression and angulation Transverse fractur Run at a right angle to the lonh axis Uncommon through healthy bone Pathologic fractur

  21. Fracture

  22. TRAUMA Spatial Relationships of Fracture Aligment Position of the distal fragment in relation to the proximal fragment Apposition Closeness of the bony contact at the fracture site If the ends are pulled referred to as Distraction

  23. Fracture

  24. TRAUMA Rotation Twisting forces on a fractured bone along its longitudinal axis Traumatic Articular Lesions Subluxation Dislocation Diastasis Epiphyseal Fractures Salter-Harris Classification

  25. Salter - Harris

  26. Dislocation

  27. TRAUMA Fracture Healing Main steps in fracture healing Formation of hematoma Organization of hematoma Formation of fibrous callus Replacement of fibrous callus by primary bany callus Absorption primary bany callus Transformation to secondary bony callus Remodeling

  28. TRAUMA Complication of Fractures Immediate complication Arterial injury Compartement syndrome Gas gangrene Fat embolism syndrome Thromboembolism

  29. TRAUMA • Intermediate complication • Osteomyelitis • Myositis ossificans • Synostosis • Delayed union • Delayed complication • Osteonecrosis • Osteoporosis • Non union – Mal union

  30. Myositis Ossificans

  31. INFECTION Suppurative Osteomyelitis General Consideration Systemic or Local infections Immunosuppresed patients, alcoholics, newborns, and drug addicts are predisposed Antibiotics have significatly reduced the sepsis-related mortality

  32. INFECTION Etiology Staphylococcus aureus causes 90% Pathway for the spread Hematogenous Contigunous Direct Implantation Postoperative

  33. INFECTION Radiologic Features Bone scan are the earliest means of diagnosis Radiographic latent period for plain film 10 days for extremities 21 days for spine Soft tissue alteration : elevated fat planes, obliterated fat planes, increased density.

  34. INFECTION Bone changes : Moth-eaten bone destruction Usually metaphyseal in origin Periosteal new bone formation Solid – Laminated – Codman’s Triangle Sequestrum Involucrum Joint space destruction (ankylosis)

  35. 0steomyelitis

  36. Osteomyelitis

  37. INFECTION Septic Arthritis General consideration Single joint involvment in the rule Most common rute is hematogenous or direct traumatic implantation Etiology Most frequently is Staphylococcus Aureus

  38. INFECTION Radiologic Features The knee and hip are the most common sites Joint effusion leads to distrorsion of the fat folds Positive Waldenstorm’s sign Rapid loss of joint space Bony ankylosis

  39. INFECTION Nonsuppurative osteomyelitis (tuberculosis) General Consideration Found in patients such as prepubertal children, debilitated geriatric, silicosis, AIDS sufferers, Lymphoma patients, Alcoholics, corticosteroid and drug abusers

  40. INFECTION Etiology Mycobacterium tuberculosis Two mode of spread Inhalation Ingestion

  41. INFECTION Radiologic Features Spinal tuberculosis is most common at L-I Early sign for spine are : Lytic endplate destruction loss of disc height Anterior “ gouge defect “ Paraspinal swelling

  42. INFECTION Advanced sign for spinal involvement are: Vertebral body collaps Gibbus formation and obliteration of the disc Tubercular arthritis is common in the hip and knee Uniform joint space narowing, early destruction of the subchondral cortex, “moth-eaten” bone destruction and juxtaarticular osteoporosis are the cardinal sign of tubercular arthritis

  43. Tuberculosis

  44. Tuberculosis

  45. TUMORS AND TUMORLIKEPROCESSES METASTATIC BONE TUMORS PRIMARY MALIGNANT BONE TUMORS Multiple myeloma Osteosarcoma Ewing’s Sarcoma PRIMARY QUASIMALIGNANT BONE TUMOR Giant Cell Tumor

  46. TUMORS PRIMARY BENIGN BONE TUMORS Osteochondroma Osteoma Bone island Osteoid osteoma Simple bone cyst Aneurysmal bone cyst

  47. TUMORS Metastatic Bone Tumors General Consideration The most common malignant tumors CNS tumors and basal cell Ca rarely Life threatening complication Insidence 70% are metastatic, 30% are primary In females 70% from breast Ca In males 60% from prostate Ca

  48. TUMORS Radiologic Features Technetium bone scan 80% of all metastase are located in the central or axial skeleton - Spine and Pelvis being a most common Alteration in bone density and architecture 75% osteolytic, moth eaten or permeative 15% osteoblastic Periosteal respose is rare

  49. Metastatic

  50. TUMORS Primary Malignant Bone Tumors Multiple Myeloma Bone scan are cold Gross Osteoporosis may be the only early sign Punched out lesions Vertebra plana or wrinkled vertebra Preservation of pedicles

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