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  • Day - 6 RADIOLOGY OF MSK

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    Dewa ayu Narheswari
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    This document discusses radiology imaging modalities for musculoskeletal disorders. It covers plain radiography, ultrasound, CT, MRI, and nuclear scintigraphy. Plain radiography is described as the primary initial imaging modality. Characteristics of normal bone structures, joints, and soft tissues are outlined, as well as abnormalities like fractures, dislocations, bone density changes, and soft tissue swelling. The "Rule of two" concept for obtaining optimal radiographic views is also explained. Other imaging modalities are briefly discussed for evaluating bone and soft tissue abnormalities. Key fracture and bone lesion terms are defined.

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    This document discusses radiology imaging modalities for musculoskeletal disorders. It covers plain radiography, ultrasound, CT, MRI, and nuclear scintigraphy. Plain radiography is described as the primary initial imaging modality. Characteristics of normal bone structures, joints, and soft tissues are outlined, as well as abnormalities like fractures, dislocations, bone density changes, and soft tissue swelling. The "Rule of two" concept for obtaining optimal radiographic views is also explained. Other imaging modalities are briefly discussed for evaluating bone and soft tissue abnormalities. Key fracture and bone lesion terms are defined.

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    51 views54 pages

    Day - 6 RADIOLOGY OF MSK

    Uploaded by

    Dewa ayu Narheswari
    This document discusses radiology imaging modalities for musculoskeletal disorders. It covers plain radiography, ultrasound, CT, MRI, and nuclear scintigraphy. Plain radiography is described as the primary initial imaging modality. Characteristics of normal bone structures, joints, and soft tissues are outlined, as well as abnormalities like fractures, dislocations, bone density changes, and soft tissue swelling. The "Rule of two" concept for obtaining optimal radiographic views is also explained. Other imaging modalities are briefly discussed for evaluating bone and soft tissue abnormalities. Key fracture and bone lesion terms are defined.

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    of 54

    Radiology Imaging in

    Musculoskeletal (MSK) Disorders

    Elysanti Dwi Martadiani


    Department of Radiology
    Faculty of Medicine, Udayana University
    MSK Imaging – Imaging Modalities
    • Plain Radiographs
    • Ultrasound
    • Computed Tomography
    • Magnetic Resonance Imaging
    • Nuclear Scintigraphy
    PLAIN RADIOGRAPH
    Plain Radiographs
    • Widely available
    • ‘Inexpensive’
    • Primary imaging modality
    • Sometimes can reveal soft tissue abnormality
    Terms
    Radiosclerotic / osteoblastic Radioluscent / osteolytic
    Radiographic imaging of the MSK

    ADULT CHILD
    The important things have to be
    evaluated in Plain Radiograph

    • Alignment
    • Bones
    • Joints
    • Soft tissue
    • Rule of two
    Alignment
    Loss of alignment may be due to :
    Bone fracture
    Joint dislocation
    Normal
    alignment
    Loss of alignment
    Bone structure

    • Cortex : outer

    • Medulla : inner
    Bone density

    Increased density Normal density Decreased Osteopenia


    Joint

    CARTILAGE
    MENISCUS
    CARTILAGE
    SOFT TISSUE
    SOFT TISSUE SWELLING MASS
    Rules of two
    1 . Two views: one view is too few / no view
    2 . Two joints: image the joint above and below a long bone
    3 . Two sides: compare the other side (difficult cases only)
    4 . Two abnormalities: look for a second abnormality
    5 . Two occasions: compare current films with old films (especially for
    fracture )
    6 . Two visits: repeat the film after a procedure or after an interval
    7 . Two opinions: ask colleague for opinion for doubtful cases
    8 . Two records: write down clinical and radiographic findings
    9 . Two specialists: also get a formal radiological report
    10 . Two examinations: do not forget other tests such as US,CT, MRI, or
    isotope bone scanning for complex cases.
    Rule of two : two views, two joints

    AP LATERAL
    Ultrasound
    • Operator dependent
    • Superficial soft tissue elements including
    ligaments, tendons and muscle  excellent
    LIGAMENT US

    Calcaneus

    ATFL
    Computed Tomography (CT)
    • Bone assessment  excellent  can reveal
    fracture of the complex bones (e.g tarsal,
    manus, facial bones)
    • Sometimes can reveal soft tissue assessment
    • Interventional options  core biopsy for
    tumor
    CT SCAN : FACIAL BONE FRACTURE
    CT SCAN : SPINE
    FRACTURE
    CALCANEAL
    FRACTURE
    Magnetic Resonance Imaging
    • Soft tissue abnormality  excellent
    • Bone abnormality : Good – excellence for
    several cases
    SPINAL CORD CONTUSION
    KNEE MRI : MENISCAL INJURY
    Nuclear Medicine
    • Bone scan : can show whole skeleton at
    one time of examination
    • Very sensitive but not specific
    – fracture
    – infection
    – inflammation
    – tumour
    – metabolic
    Bone scan – multiple
    bony metastases
    TRAUMA
    Fracture and dislocation
    • Fracture : a break of the structural continuity
    of bone or periosteum  cortical
    discontinuity

    • A dislocation : when the joint surfaces become


    completely disengaged
    Fracture Terms
    • Complete or incomplete
    • Comminution fracture
    • Displaced fracture fragments
    • Angulation, rotation
    • Associated with joint subluxation or
    dislocation
    Complete Incomplete fracture
    : Greenstick fr.
    Comminuted fracture
    Non displaced Displaced
    fracture fracture
    Rotation Angulation
    Associated with joint subluxation or
    dislocation
    Joint dislocation
    Fracture Healing
    • Essential event : creation of bony bridge
    between fracture fragments
    • Bony callus begins 3-4 weeks after injury, and
    continues until firm union is formed 2-3
    month later

    • Malunion, delayed union, non union


    Callus dan Malunion
    Fracture of the growth plate: Epiphysiolysis

    Salter & Harris Classification

    S A L T R
    slipped above lower through ruined
    OSTEOMYELITIS
    Osteomyelitis
    • Osteon = bone
    Myelos = marrow
    Itis = inflammation
    Infection of bone CORTEX
    marrow
    MARROW
    • Acute
    Chronic osteomyelitis
    Acute Stage Osteomyelitis
    Cortex destruction
    / rarefaction Periosteal Reaction

    rarefaction

    Periost rx
    Chronic Stage Ostemyelitis

    Sequestrum
    ~ set apart
    Involucrum ~
    wrap

    Cloaca~ track,
    opening
    Chronic Stage
    Involucrum Sequestrum Cloaca : opening /track
    BONE TUMOR
    HOW TO EVALUATE BONE TUMOR?
    TYPE OF BONE DESTRUCTION
    Geographic Moth-eaten Permeative
    PERIOSTEAL REACTION

    ONION SKIN SUNBURST/ CODMAN


    SUNRAY TRIANGLE
    ONION SKIN SUNBURST CODMAN’S
    TRIANGLE

    EWING SARCOMA OSTEOSARCOMA


    Morfologi : SOFT TISSUE MASS
    Osteoarthritis
    • Degenerative joint
    disease
    • Osteophytes
    • Joint space
    narrowing
    • Sclerotic of
    subchondral bone
    • Soft tissue
    swelling due to
    joint effusion
    TAKE HOME MESSAGE
    • Do not forget to apply ‘ rule of two’ while
    evaluating MSK lesion.

    • Important in evaluating bone tumor: age &


    sex, pattern of destruction, periosteal
    reaction, matrix, soft tissue mass, location,
    single or multiple.
    THANK YOU

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