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RADIOLOGY
Dr.Sri Asriyani,SpRad
Dr. Muh. Ilyas, Sp.Rad
DEPARTEMENT OF RADIOLOGY
MEDICAL FACULTY OF HASASUDDIN UNIVERSITY
Introduction
Roentgenographic of bone give information about :
1.
2.
3.
4.
Guiding biopsy
5.
Follow Up
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Composition of bone :
25% of water
30% organic
45% nonorganic (radioopaque density) :
Ca phosphat 85%
Ca carbonat 15%
Blood suplay of bone :
1. A.Nutricia (fossa a.nutricia bone x-ray)
2. A.metaphyseal & a. epiphyseal (direct suplay for
meta/epiphyse)
3. A. Periosteal (branch from nutricia artery which through
the Harvers & Volkman system)
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RADIOLOGIC ANATOMY
Book of Meschan I :
1.
Articular cartilage
2.
Subarticular of epiphyse
3.
Epiphysis
4.
Epiphyseal line
5.
Metaphysis
6.
Diaphysis
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4.
3.
2.
1.
5.
6.
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Development anomaly/Congenital
2.
Infection
3.
4.
5.
Bone Dysplasia
6.
Bone tumors
7.
8.
1. Development Anomaly/Congenital
1.
2.
Upper extremities :
a. Bone absent : hemipelya distal
Phacomelya proximal
3.
Pelvis :
4. Lower extremities :
5. Columna vertebralis :
- Coronal clefts vertebra spina bifida
- Hemivertebra
- Sacralisation
- Lumbalisation
- Scoliosis
2.INFECTION OSTEOMYELITIS
a. Pyogenic / suppurative
* Stafilokokus * Pneumokokus
* Streptokokus
* Salmonella
Mechanisme of contamination
- Hematogenous from focus infection(throat & skin)
- External contamination
(open fracture/bone operation)
b. Spesifik/ non suppurative
- TBC, virus, dan fungi
- slowly than pyogenic
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OSTEOMYELITIS
a. Acute:
- commonly in children
- metaphyseal (distal femur, proximal tibia ,
proximal dan distal humerus ,radius, ulna and
collumna vertebrae )
Radiology :
- Lytic lesion
- Periosteal reaction
- Soft tissue swelling
b. Chronic :
inadequacy therapy
Radiology :
Generally Osteosclerosis
Acute osteomyelitis
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TUBERCULOUS SPONDYLITIS
Common site in column vertebrae :
A.
Marginal type
- Superior/inferior adjacent vertebral disc
- Destruction with lytic lesion in anterior
column, disc damage very fast
narrowing disc
- involvement multiple contiguous column.vertb
- wedge gibbus
- Spider leg app
- chronic Calsification in abses
- Osteosclerotic (-)
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B. Central Type
- Abcess /cold abcess in the central of
collumn vertb.
- destruction of disc slowly
- if extend to the periphery the process is
same with marginal
C. Anterior type
- process under periosteum
- extend below the Lig.Longitudinale anterior
- Disc destruction slowly
X-Ray evaluation :
1.
2.
Post reposition
3.
4.
5.
6.
Fracture Complication
1.
Osteomyelitis
2.
3.
Bone artrophy
4.
5.
Fracture type :
Transversal fr
Oblique/spiral/screw fr.
Comminuted fr more than 2 fragment
Avultion fr.
Green stick fr. (children)
Compression fr. vertebrae
Impression fr. skull
Linier fr.
Fr.transversal
Fr.oblik
Fr. kominutif
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Compression fracture.
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Fr.Colles
Fr. Galeazzi
Fr. Monteggia
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Fr. Galeazzi
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Fr. Monteggia
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Patologic Fracture
1.
Other
- T,V,Y shape fr.
- Impacted fr.
- Longitudinal fr.
Roentgenographic feature :
1. chondrocostal junction enlargement
(rachitis rosary)
2. Cupping metaphisis (muscle &ligamentum traction)
3. Bowing long bone
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Rickets
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B. Scurvy (hypovitaminosis C)
1.
2.
3.
Rontgen :
1. General Osteoporosis
2. Ground Glass Appearance
3. Cortex thin
4. Metafiseal wide (cupping)
5. Pelkens sign marginal spur formation
6. Wimbergers sign marginal ring
calcification of central ossification in epifiseal
7. Subperiosteal hematoma calcification
subperiosteal bone
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Scurvy
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5.BONE DYSPLASIA
Bone forming disturb or intrinsic bone modelling
A.Fibrous dysplasia
divided into 2 : monostatic (femur, tibia, costae,&
facial bone) dan Polystatic (many bone
unilateral)
Rontgen :
1.
2.
3.
4.
5.
6.
Fibrous dysplasia:
Ireguler circumscribed destruction of
bone with thick sclerotic margin
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B. Osteogenesis Imperfecta :
consisted of 2 type congenital (since born) &
tarda (the symptoms seen in childhood)
Rontgen :
1.
Osteoporotic (ground glass appearance)
2.
Multiple fracture
3.
Bowing of inferior extremity
4.
Vertebra biconcave
5.
Bone deossification + diameter of bone become
wider
6.
skull: - thin tabula + warmian bone
7.
Protrusio acetabuli
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C. Achondroplasia
All long bone (extremity) short
But Corpus Vertebra still normal Roentgen :
1.
2.
3.
Achondroplasia
6. BONE TUMOR
May benign or malignant and may primer or
secondary (metastasis) :
To differentiated the tumor is malignant or not
1.
Age
2.
How long the pain & the swelling and the growth
of the tumor (slowly or fast)
3.
0 - 5 years
: neuroblastoma
2. 5 - 20 years
: ewing tumor
3. 10 - 25 years
: osteosarcoma
4. 20 - 40 years
: giant cell tumor
5. 20 - 70 years
: lipoma
6. 30 - 45 years
: fibrosarkoma
7. 30 - 50 years
: periosteal sarcoma
8. 30 - 60 years
: chondrosarcoma
9. 30 - 70 years
: hemangioma
10. 40 - 80 years
: metastase, Multipel Mieloma
There are 3 principal point in bone lesion assessment :
* infection or neoplasma
* benign or malignant
*primer or secondary
1.
2. Cartilage :
a. Benign
:Chondroma,Chondroblastoma,
Chondromixoid Fybroma
b. Malignant ( Chondrosarcoma )
3. Fibrous :
a. Benign : Fibrosa, Brown Tumor
b. malignant : Fibrosarkoma
4. Giant Cell ( Giant Cell Tumor )
a. Benign : GCT,ABC {Aneurysma Bone Cyste}
b. Malignant
6. BONE TUMOR
B. From other tissue in the bone:
1. Vessels : Hemangioma, Glomus
Tumor, Hemagiosarcoma
2. Nerve : Neurofibroma, Neuroblastoma,
Neurofibrosarcoma
3. Fat : Lipoma, Liposarcoma
4. Natokord : Chordoma
5. Epitel : Dermoid, Adamantinoma
6. Limfoid/Hemopoetik ; Limfoma, Leukimia,
Plasmositoma,Multipel Mieloma
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Benign Tumor :
1. Bone Island ( Enostosis )
Ro : - Soliter/ Multiple
- always in Medulla
- density Homogen
- margin may Irreguler .
Spiculated into meduller
2. Osteoma :
Ro : - Sites : Skull, Sinus Paranasalis
- size 2.5 Cm
- high density ,good defined margin
& homogen
3. Osteoid Osteoma
Man : Woman = 3 : 1
Decade 2 / 3
Predilection :
Diafise of long bone (50% proximal Femur )
Tibia
Skull rarely
Ro : - Radiolucent area, Oval/rounded sclerotic
margin
- High density
- Diameter 2.5 Cm
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4. Osteochondroma
- outgrowth of bone , from cortex diafise long
bone
- point away from nearest joint
Ro :
- Pedunculated type (outgrowth of bone from
cortex trabecula penetrate into medulla
trough the defect of the cortex )
- Calcification
- size 8-10 cm point away from joint
- Pelvic & scapula irregular & high density
Cauliflower app.
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Osteolitic margin
Ro :
reabsorbsion bone area with bone expansion
Size varying 2-20 cm
Cortex thin & expansion
Tepi endosteal margin is good defined with cortex
Soap Bubble Appearance
Trantition zone between lesion & medulla,
sometime with sclerotic. Similar with
osteoclastoma. Sometime scalloped atau irreguler,
sclerotic margin
Angiography similar with Osteoclastoma
DD : Osteoclastoma /Giant Cell Tumor
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Malignant Tumor
Osteosarcoma
according to position (central,peripheral)
according to lesion (osteolytic,osteosclerotic,
mixed)
Man > woman
Ro :
Sites : distal femur, rarely in tibia, sternum, costae,
skull
Position of lesion : metafise / dyafise
50% sclerotic, may osteolytic, mixed (irregular
margin )
Periosteal reaction sunburst/Sun Ray app.
Other Typically : cortex destruction & invasion to
soft tissue
Soft tissue swelling
Codman Triangle
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2. Fibrosarcoma
5 % skeletal tumor
Low grade pain 1 year
Often in medulla
Metafise
80% knee
Ro :
Typically osteolytic
Expansion of cortex
3. Chondrosarcoma
Age : 30 70 thn
Sites : Pelvis, costae, proximal femur
Ro :
Local cortex destruction, ill defined
transition between normal tissue & lesion
cannot be differentiated
Central tumor irregular calcification
Endosteal erosion, scalloping
pop-corn appearance
Periosteal reaction Lamellar
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Chondrosarkoma
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4. Ewing Tumor
from medula
age 5 20 years
Sites : long bone
Ro :
Lamelar Periosteal reaction(Onion Skin app.)
Codman Triangle
Sometime Sclerotic (longitudinal band)
Bone destruction
Soft tissue swelling
Ewings tumor
5. Sinovioma
70% inferior extremity knee
Age < 30 years
Very malignat immediately metastasis to lymphe
Ro :
Soft tissue mass around the joint
Many calcification
Irregular bone destruction near the joint
Thickening of sinovial & erosion of
juxtacapsular
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6. MM (Multiple Mieloma)
Primary Malignant tumor of bone marrow
Ro :
Osteoporosis cortical thinning menipis
Osteolytic
Punch out lesion multiple, rounded,good
defined, intact, varying
Inner cortex scalloping
Sometime expansive with soap bubble app.
DD : metastasis
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7. Metastasis
May osteolytic, osteoblastic
ill defined
Irregular margin & sometime with sklerotic margin
sites of metastasis :
vertebrae
costae & sternum
skull & pelvic
other bone
Late stage :
a.
in
same
time
the
trabecula
a.
infarct
c.
SITES OF OSTEOCHONDRITIS
1. Corpus verteba Calve Disease
2. Vertebral epiphyse Scheuermann disease
3. Capitulum Humerus Panners Disease
4. Lunatum Kienboeck disease
5. Proxphlanges (jari) thiemmanns disease
6. Caput metacarpal dietrich disease
7. Caput femoris calve leg perthes
Osteoporoses
Defenition
Systemic skeletal diseases decrease of
bone mass & microstructure caused bone
more weak & more easier to have fracture
Radiologic of osteoporosis
1. Conventional Radiology
- Vertebrae x-ray 4 grading
- Femur x-ray used index Singh
- Metacarpal
2. Fotodensitometri/Radiografi Densitometri
3. Single Photon Absorptiometry (SPA)
4. Quantitative Computed Tomography (QCT)
5. Pheripheral Quantitative Computed Tomography (POCT)
6. Dual Energy X-Ray Absorptiometry (DXA)
7. Sonodensitometri
8. Neutron Activation Analisys
9. Compton Scattering
10. Radioisotop
11. Magnetic Resonance Imaging (MRI)
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B. OSTEOARTHRITIS (OA)
- Osteoarthrosis degeneratif joint disease
- Predilection from the knee
- Woman > man
Rontgen (finger) most find at interphalangeal joint
Ro (Knee) :
C. PSORIATIC ARTHRITIS
Predominant destruction distal interphalangeal joint (as
Osteoartritis)
Ankylosing at interphalangeal joint
DD.
Rheumatoid at interphalangeal joint
Joint space more wide surface is clearly
Destruction artriris at interphalangeal joint of feet thumb
Mild osteoporosis
Foot more shown psoriatic arthritis
Bone mineralisation is normal
PSORIATIC ARTHRITIS
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D. ANKYLOSING SPONDYLITIS
Marie strumpells/von bechterews/rhematoid
spondylitis woman = man commolly youth
Rontgen :
Sacro-iIiac Joint (SI joint) blur wider narrowing
sklerosing/ankylosing (bilateral)
Always start at SI Joint
Squaring anterior corpus vertebrae
Generalize osteoporosis
E. RHEUMATOID ARTHRITIS
- Woman > man
- Multiple & Symetris
- Mostly : proksimal interphalangeal
joint, metacarpophalangeal joint,wrist joint
(radiocarpal), not all joint can affect
Rontgen :
Periarticular
destruction
Osteoporosis
cartilage
F. GOUT
Man > woman
> 40 years
Rontgen :
Radiologic change after multiple attack
Commonly only one joint metacarphalangeal
joint ( but other joint in hand & leg can be
attacked)
Deposite of Na. urat not radiopact (not seen
,just periarticular & joint swelling)
Decrease of Osteoporosis
SKULL- X RAY
Information /abnormality :
Fracture
Infection
Tumor : - primery
- secondaryr
Sinus paranasalis
Kongenital
Sign of Intracranial pressure increasing :
Suture more wide
Impressiones digitatae
Destruction of sella
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