Download Diagnostic Imaging of Bones and Joints

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Diagnostic Imaging of
Bones and Joints
Dr. Ahmed ZAYED
MCs. Degree & Egyptian Board of Orthopedic surgery
Senior Lecturer Insaniah University
MSK Imaging – Imaging Modalities
1) Plain Radiographs
2) Computed Tomography
3) Ultrasound
4) Magnetic Resonance Imaging
5) Bone scan.
6) Arthrography
1- Plain Radiographs
The first order diagnostic imaging modality
Widely available
Reproducible
Patient friendly
‘Inexpensive
Rules
Don’t accept bad quality or mal-positioned view x-ray.
Minimum 2 views. “One view
is No view”
Joint above & joint below.
The side of the film must be assigned.
Protect yourself and the patient.
R
or
L
Plain Radiographs – 2 views
Plain Radiographs – 2 views
Posterior
Dislocation
Protect the patient.
Yourself
Radiation apron
ROUTINE RADIOLOGIC
EVALUATION
Consists of the angles of projection that best
demonstrate the anatomy while utilizing the least
amount of exposures.
Common Views:
Anteroposterior (AP)
Lateral (R and L)
Oblique (R and L)
Patient positioning for each projection is
standardized throughout the USA
10 y male normal
AP and mortise view
ABC’S OF VIEWING FILMS
 A: ALIGNMENT displacement and deformity
 B: BONE DENSITY generalized or localised
lesion (Excessive sclerosis or Osteolytic)
 C: CARTILAGE SPACES decreased or increased
 S : SOFT TISSUES odema or swelling
deformity
displacement
B. BONE DENSITY
1. Assess general bone density
*contrast between soft tissues and bone
*contrast between cortical margin and the
cancellous bone and medullary cavity
*loss of contrast means loss of bone density
ie: osteoporosis
*labeled as osteopenia, demineralization or
rarefaction
diffuse weakening of the bone
senile osteoporosis
C. CARTILAGE SPACES
1. Assess joint space width
2. Assess subchondral bone
3. Assess the epiphysis and growth
plates
S : SOFT TISSUES
Assess the gross size of the musculature
Assess outline of joint capsules
May be calcified or increased joint volume
from infection hemorrhage or inflammation
Assess the periosteum: normally indistinct.
Computed Tomography (CT)
Computed Tomography (CT)
 Widely available
 Reproducible, although variety of techniques
 Excellent bone assessment
 Occasionally useful for soft tissue assessment
 Patient friendly
 Moderate expense
 Interventional options. (CT guided biopsy)
Computed Tomography
 Usually supine axial exam, with some alternative
positioning options
 Can develop reformatted images after exam for
alternative views
 Imaging time in seconds, rarely minutes
 Usually without IV or oral contrast
CT - Fractures
Spine fracture
MRI
Magnetic Resonance Imaging
 Excellent for soft tissue pathology
 Good-excellent for bone pathology
 NOT patient friendly
 Large expense.
 Take long time.
 No radiation.
 Suitable for pregnents.
MRI – Absolute Contraindications
 Cardiac Pacemakers
 Electronic stimulators
 Metallic foreign bodies in the orbit
MRI - Relative Contraindications
 Penile prostheses
 IUD’s
 Cardiac valves
 Berry aneurysm clips
 Retained bullet fragments
 Claustrophobia: fear of Narrow closed places
MRI
 Indicated if diagnosis not reached by more
simplified method.
 Multiplanar imaging obtained without changing
position.
 One exam = one body part
 Average exam time 45 minutes.
 Strict guidelines for sedation.
 Optional contrast .
MRI
Osteochondritis dissecans
MRI – Internal Derangement
Sagittal, Meniscus NL
Posterior Horn Tear
ACL
Intact ACL
Torn ACL
Open
Closed
Ultrasound
Ultrasound
 Not available at all institutions
 Reproducible in trained hands
 Excellent for superficial soft tissue elements including
tendons and muscle
 Patient friendly, non-invasive.
 Small to moderate expense
Ultrasound
 Rotator cuff lesion.
 DDH.
 Rupture tendoachilis.
 Torn meniscus.(still under trial).
 Swellings.
Ultrasound
Bone Scan
 Very sensitive for skeletal pathology
 Mildly sensitive for soft tissue pathology
 Usually nonspecific as an isolated test
 Mostly patient friendly; no significant environmental
exposure.
 Small-moderate expense.
Bone scan
 Excellent for specific pathologies
 Osteomyelitis
 Metastases – Not Multiple myeloma
 Occult fracture
 Reasonably reassuring
 Normal is usually normal
Bone Scan
 IV injection radioisotope (Tc-99m) bound to
phosphate +/- dynamic imaging
 Approx 3 hour delay
 Delayed static imaging with a superficial detector
Prostate Metstasis
Arthrography
 Arthrography is introduction of contrast
agent positive contrast iodine iodide
solution negative contrast, air or
combination of both into the joint space.
 Advantages:
 Simple
 Effective
Arthrography
Arthrography
 Any joint
 Shoulder
 Ankle
 Elbow
 Knee
Arthrography
Intra-articular injection of dye to visualize the joint
 Soft tissue injuries
 CDH
Sinography
Tracking the sinus in COM
Myelography
Rarely used now alone, usually with CT
Bone mass density test
Bone mass density test
L. Spine
Hip
Lower radius
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