Bone Imaging
J.Lisý
Anatomy – long bones
• Diaphysis
• Metaphysis
• Zone of provisional
calcification
• Epiphyseal growth
plate
• Epiphysis
Anatomy – long bones
epiphysis
metaphysis
diaphysis
growth
(epiphyseal)
plate
zone of provisional
calcification
Epiphysis x Apophysis
Epiphysis
•articulates with adjacent bone
Apophysis
•doesn´t articulate with
adjacent bone
Epiphyseal or apophyseal plate should not be mistaken as fracture lines
Osteolysis
• focal decalcination
decreased attenuation
lucency (dark bone)
• marginal osteolysis
usuration, erosion
Osteosclerosis
• focally increased
attenuation
(white bone)
chron. OM
osteopetrosis
Osteoporosis
• less dense bone
• loss of organic and
anorganic bone
• darker, lucent bone
• compact, cortical bone
thinner
• white rim around bone
Osteomalacia
• reduced anorganic portion
• darker bone
• loss of cortical compact
bone
• Ill defined, hazy contours
rachitis
Periostal reaction
periosteum is not
normally seen
1) Spiculoid
2) Lamellar
3) Codman´s
triangle
Developmental dysplasia of the hip
• orthopaedic examination
and ultrasound
• pathological finding is
indication for X-ray
investigation
1) osification of femoral head
2) course of the acetabulum
3) position of the hip joint
Developmental dysplasia of the hip US
Ultrasound
alpha angle
• the slope of the superior
aspect of the bony acetabulum
(normal greater than 60º)
beta angle
• depicts the cartilaginous
component of the acetabulum
(normal if less than 55º)
evidence is insufficient to recommend routine screening for dev.
dyspl. of the hip in infants as a means to prevent adverse outcome
(U.S. Preventive Services Task Force, 2006)
Developmental dysplasia of the hip X-rays
X-rays
1) osification of femoral head
2) course of the acetabulum
3) position of the hip joint
Craniosynostosis
• premature closure of the
cranial sutures
• involved suture is narrow
or is not visible
• lacunar skull (expressive
impresiones of brain gyri
on the inner table of skull)
Scaphocephalia
brachicephalia
Turicephalia
Osteogenesis imperfecta
• congenital fragilitas
ossium
• deficient formation of
bone matrix and collagen
• repeated fractures of
different age
• bizare deformities
• bowed bones, extremities
shorter, cortex thin
Osteopetrosis (Albers-Schonberg)
• failure of normal resorption
of calcified chondral tissue
• osteosclerosis
• bottle-shaped metaphyses
• sandwich vertebra
• pathological fractures
Mucopolysacharidosis
Gargoylismus (Hurler´s type )
palm-leaf-shaped ribs
maldevelopment of upper half of
vertebral body (upside down parrot
beak shaped )
coxa valga
M. Perthes
•
•
•
•
•
most frequent aseptic necrosis
etiology unknown
head and neck of the femur
5th-10th year of age
X ray signs delayed 6 weeks after
clinical symptoms
• bones shorter, unhomogeneous
with foci osteosclerosis and
osteoporosis
• later fragmentation and deformity
Other aseptic necrosis
• Osgood-Schlatter
(tuberositas of tibia)
• Blount
(med. condyle
-tibia vara)
• Koehler I
(naviculare pedis)
• Koehler II
(head of MTT II)
• Haglund
(calcaneus)
• Kienbock
(lunatum)
Scheuermann´s disease
(juvenile vertebral epiphysitis )
etiology unknown
around puberty
Th spine
• expressive kyphosis
• wedge- shaped
vertebral body
• irregular margin of
the vertebral body
• Schmorl´s nodules
Osteomyelitis acute
• acute x chronic
• specific x unspecific
• X-ray changes delayed
10 to 20 days
• soft tissue swelling
• bone destruction
• erosion
Osteomyelitis chronic
• periosteal reaction
• irregular sclerotisation
• sequestration, involucrum
Brodie´s abscess
• metaphysis of the long
bones (most frequent
femur)
• circumscribed osteolytic
area with sclerotic margin
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Osteomyelitis sclerotisans Garré
• unpyogenic
• osteosclerosis
• spindle-like diaphyseal
enlargement
Tuberculous spondylodiscitis
• specific
• early destruction of disc
(lower intervertebral space)
• later infection crosses
vertebral endplates
(higher intervertebral space)
• complications
paravertebral/epidural
abscess
Congenital syphylis ( lues )
• diaphysitis
• metaphysitis (Wegener´s
zone )
• periostitis
Wimberger´s sign:
erosions at the medial
portion of the proximal
metaphysis
Rachitis (rickets) avitaminosis D
Osteomalacia ( bone
substituted by osteoid)
• unsharp margins
• tumbler-like deformity of
metaphyses
• rachitic rosary on the ribs
Healing:
• periostosis
• doubled zone of the
provisional calcification
Scorbut (scurvy) avitaminosis C
• Subperiosteal hematomas
• Multiple epifyzeolysis
Pelkan´s sign :
sharp metaphyseal margins
Winberger´s sign :
sclerotic rim around porotic
epiphysis
Degeneration 1st grade
• most common bone involvement
• sharper margins of articular surface
Degeneration 2nd grade
• osteophytes
Degeneration 3rd grade
•
•
•
•
subchondral sclerosis
subchondral pseudocysts
narrow articular space
periarticular calcifications
Degeneration 4th grade
• bone necrosis
• (sub)luxation
Bekhterev´s disease (spondylitis ankylosans)
1.Sacroiliac joints
• subchondral osteoporosis
• subchondral erosions (rosary
sign)
• ankylosis
Bekhterev´s disease (spondylitis ankylosans)
2. spine thoracic
• rigid
• marked kyphosis
• bamboo stick
Paget´s disease (osteitis deformans)
• enlargement of the bone
• deformity (bone is bowed)
• pathological fractures
• osteosclerosis and osteoporosis
• malignant degeneration is a
serious, but infrequent
complication
Bone cyst
• lucent focus within bone with
an expansion effect
• cortex can be thin
Non-osifying fibroma
• in metaphyses
• eccentrical subcortical
• occasionally multilocular
Osteochondroma (cortical exostosis)
• bone exostosis
• always from
metaphysis toward
diaphysis
• cartilaginous cup
not visible
Osteoma
• bone only
• round shaped shadow
• sharp margins
• paranasal sinuses
Enchondroma
• from chondral tissue (cartilage X ray lucent, invisible
• defect in bone, often expansion effect, thin and perforated
cortical contour
• m. Ollier multiple chondromatosis of the bones
Osteoid osteoma
• diaphysis lower limbs
• osteoplastic changes
• nidus ( detectable CT ) round
osteolytic lesion with small
calcification
Histiocytosis from Langerhans cells
• Eosinophilic granuloma
sharp demarcated osteolytic
defect
• Hand-SchullerChristian - map skull
Osteosarcoma
• osteolytic/ osteoplastic
• periostal reaction
laminated, onion-skin
spicular (Sharpey ligg.)
Codman´s triangle
Osteosarcoma MRI
• soft tissue part of the tumor - regression after
chemo/radio therapy
Ewing sarcoma
Metastases
• The next four tumors
comprise 80% of all
metastases to bone
– Breast (70% of bone
mets in women)
– Prostate (60% of all
bone mets in men)
– Kidney
– Lung
• osteolytic (kidney, lung)
• osteoplastic (prostate)
• mixed (breast)
• most common malignant bone
tumors
• most involve axial skeleton
(skull, spine and pelvis)
where red bone marrow is found
• 90% of skeletal mets are
multiple
• Spinal mets destroy posterior
vertebral body including pedicle
pedicle-sign
Metastases neuroblastoma
Skull
diploe