Imaging of

Bone
Joint
Soft tissues

diseases Guan sheng , MD

Radio.depart. 1st hospital

ZZU
 Imaging techniques
 Plain bone radiographs (X-ray)
 Radionuclide bone scanning (ECT)
 Computed tomography (CT)
 Magnetic resonance imaging (MR)
 Digital substraction angiography(DSA)
 Ultrasound Imaging (US)
 nuclide

Radiograph

MR
CT
Advantages and disadvantages

in
Musculoskeletal 、 Soft tissues
 Plain X-ray film
 Rich experiences
 Best resolution in bone
 Economic

 Two dimension
 Overlap
 Limitation in soft tissues
 CT
 Good axis view
 Irregular bone
 Good density resolution
 Good 3-D reconstruction imaging

 Radiation
 Limitation in joint
 MR
 High sensitivity
 Multi-plane
 Good resolution (soft tissues 、 joint
)
 Functional imaging (diffusion)

 Calcification
 Osteoperiosteal reaction
 ECT
 Skeleton
 Function (metabolic 、 physiological)

 Poor spatial resolution

 Summary A
 Conventional plain film ：
spatial R 、 periosteal reaction 、 experiences
 CT ： bone
 MR ： Promising
marrow 、 soft tissue 、 joint 、 spine
extent
 sacrum
Chondroma

AP

lateral

CT MR
 Summary B
 Experiences ： Plain>CT>ECT>MR
 Sensitivity ： MR>ECT>CT>Plain
 Skeleton ： MR=ECT>CT and plain
 Fracture ： plain—CT—MR
 Shortness ： MR<CT 、 ECT<plain
IMAGING
OF
BONE
 Imaging of bone

 Anatomic terms (normal sign)

 Bone Maturation
 Signs of bone diseases
 Anatomic terms (normal sign)
End of bone
Joint space

Growth plate

diaphysis
Anatomic terms (normal sign)

Metaphysis

Cartilagenous
Epiphysis Epiphyseal plate
 Cartilagenous
Epiphyseal plate

Epiphysis

Diaphysis

6ys Metaphysis
 Growth plate

Joint space
diaphysis

End of bone
18ys
3m
3ys
6ys
10ys

Bone
maturation
13ys
18ys
 Imaging of bone

 Anatomic terms (normal sign)

 Bone Maturation
 Signs of bone diseases
 Signs of bone diseases
 Decrease in bone density or signal
 Increase in bone density or signal
 Periosteal reaction
 Alteration in structure or shape
 Alteration in bone age
Decrease in bone density or signal
Decrease in bone density or signal
Decrease in bone density or signal
Decrease in bone density or signal
Decrease in bone density
 Basic pathological changes
 All kinds of lesions in bone
 Lytic lesion / osteoporosis / osteomalacia
 Localized / Diffused / Generalized
 Signs of bone diseases
 Decrease in bone density or signal
 Increase in bone density or signal
 Periosteal reaction
 Alteration in structure or shape
 Alteration in bone age
Increase in bone density or signal
 Normal bone

lesion
 Increase in bone density
 Basic pathological changes
 All kinds of lesions in bone
 Sclerotic lesion / new bone
 Localized / Diffused / Generalized
Change of density or signal
represent
bone destruction
 Signs of bone diseases
 Decrease in bone density or signal
 Increase in bone density or signal
 Periosteal reaction
 Alteration in structure or shape
 Alteration in bone age
 Periosteal reaction
 Periosteum -- invisible
 Reaction to pathology
 Several patterns
 Not specific
 Periosteal reaction
 Periosteum -- invisible
 Reaction to pathology
 Several patterns
 Not specific

Excess bone
 Periosteal reaction

Lamellar
 Periosteal reaction

Codman’s triangle
 Signs of bone diseases
 Decrease in bone density or signal
 Increase in bone density or signal
 Periosteal reaction
 Alteration in structure or shape
 Alteration in bone age
Alteration in structure or shape

congenital
Alteration in structure or shape

exostoses
Alteration in structure or shape
Alteration in structure or shape
 Signs of bone diseases
 Decrease in bone density or signal
 Increase in bone density or signal
 Periosteal reaction
 Alteration in structure or shape
 Alteration in bone age
 Alteration in bone age.
 Bone age
epiphyseal centers
fusion
indication of maturation.
 Measurement
hand / wrist
 Alteration in bone age

Carpal bones
Commonly Encountered
Bone Diseases

 Tumor
 Infection -- Osteomyelitis
 Metabolic
 Bone tumor

 Benign
 Malignant

 Solitary
 Multiple
 Benign bone tumor
 Fibrous dysplasia
 Osteoid osteoma
 En/Chondroma
 Osteochondroma
 Cyst
 Giant cell tumor

 Expansion (rarely breach the cortex)

 Well demarcated (intact edge)
 Sclerotic rim
 Enchondroma/Chondroma
 Lytic expanding lesion
 Metarcaple / proximal or middle phalanges
 Flecks of calcium
 Giant cell tumor
 20~40 ys (epiphyses fused)
 Subarticular (knee, wrist, shoulder)
 Expanding destruction
 Well defined margin
 Thin cortex but intact
 Rarely metastasize
 Both malignant/benign
 Giant cell tumor
 Expanding destruction
 Well defined margin
 Subarticular (knee, wrist, shoulder)
 Thin cortex but intact
 Rarely metastasize
 Both malignant/benign
 MR
Giant cell tumor
 Bone Cyst
 Children and young adults
 Humerus and femur
 Pathological fracture
Malignant bone tumor
 Sarcoma (Osteo/ Chondro/Fibro)
 Ewing’s sarcoma
 Metastasis
 Myeloma
multiple
 Lymphoma
 leukaemia
 Malignant bone tumor
 Poorly defined margins
 Cortex destroy
 Periosteal reaction
 Soft tissue mass
 Sarcoma (Osteo / Chondro / Fibro)
 5~20 ys, elderly
 Metaphysis , around knee
 Bone destruction
 Ill-defined
Osteosarcoma
 Periosteal reaction (spiculated)
 Tumor bone
Osteosarcoma
F 9Y
 Chondrosarcoma
 Ilium
 Multilobular mass
 Chondroid calcification
 Septations enhanced
 Ewing’s sarcoma
 Highly malignant
 Children
 Shaft of long bone
 Onion skin periosteal reaction
 Metastasis
 Commonest in bone
 Multiple focal
 Lytic / sclerotic / mixture
 Spine>skull>ribs>pelvis
>humeri>femora
 Metastasis

Sclerotic
metastasis
 Metastasis

Nasopharyngeal Cancer
 Myeloma
 Solitary (plasmacytoma)
 Lytic bone destruction (metastasis)
 Diffuse (osteoporosis)
 Better defined deposit
 Increased activity on radionuclide

Plasma cell myeloma

In Ischial tuberosity
Infection disease
Osteomyelitis
Tuberculosis
 Osteomyelitis
 Staphylococcus aureus
 Infants and children
 Radionuclide, MR at early stage
 Acute and chronic
 Bone destruction
 Sequestrum
 Hyperplasia and sclerosis
 Tuberculosis
 Asia and Africa
 Seldom in bone
 Spine , large joint
 Asymptomatic in the early stage
 Simulate benign tumor
Metabolic / Endocrinic
diseases
Metabolic/Endocrinic diseases

 Rickets and osteomalacia

 Hyperparathyroidism
 Renal osteodystrophy
 Acromegaly
 Rickets and osteomalacia

 Metaphyses widened/cupped
 Plate widen
 Deformities
 Greenstick fracture
 looser zone
 Rickets and osteomalacia
 Poor mineralization of osteoid
 Acromegaly
 Overgrowth of articular cartilage
 Adolescence – Gigantism
 Adult –acromegaly

 Hands/feet (prominent tufts)

 Enlarged pituitary fossa
 Skull vault thickened
 Face (prognathous jaw)
Acromegaly
 Fibrous dysplasia
 Developmental abnormality
 Unknown cause
 Osteoblasts fail to differentiate and mature
 Sigle/few/many
 Unilateral/bilateral
 Intramedullary / diaphyseal in long bone
 Radiolucent / hazy / ground glass
Fibrous dysplasia
Fibrous dysplasia