骨與關(guān)節(jié)影像學課件

MUSCULOSKELETALSYSTEM

CHAPTER1

SKELETALSYSTEM一、IMAGINGMODALITIES1、ConventionalRadiography2、CT--ComputedTomography3、MRI--MagneticResonanceImaging4、UltrasonographyDistalfemora

radialiliumiliumClaviclefemorailiumCalcaneusiliumfemoraCONVENTIONALRADIOGRAPHY

Itistheprimarydiagnosticmethodsusedtoevaluatethemusculoskeletaldiseases,sincethehighcontrastthatexistbetweenboneandsofttissue.Thiswastobeexpectedasthecalciumsaltswithintheskeleton.(一)PlainfilmradiographyIncases,notonlytoshowthelocationandthesize,butalsotoarrivethediagnosis.femoratibiafemoraCONVENTIONALRADIOGRAPHYLimitation:1)Thepoorcontrastresolutionforsofttissue.2)Notallthediseasescanbediagnosedbyplainfilm,weneeduseCTorMRI.sacrumCT(Advantage)CTisabletodefinesofttissueandbonealterationsthatareundetectablewithconventionalradiographybecauseofitscross-sectionaldisplay,excellentcontrastresolutionandabilitytomeasurespecificattenuationvalues.MidtarsalWeuseCTscanswhenthediagnosisofplainfilmisnotreliable.ItisunwisetoperformCTintheabsenceofpreliminaryradiographsoftheareaofthebodytobeexamined.CTradialNONCONTRASTCTSECTION1)Bothsideofextremityshouldbescanforreasonofcompare.2)Sectionthicknessis5-10mm,ifthelesionissmall,wecanusethethinsectionof1-3mm.astragalCONTRASTCTSECTION1)Intravenouscontrastinjection.2)Normallyforthesoft-tissuemassesorsoft-tissuemassesofbonelesions.3)Bothfordirecttumorenhancement,necrosisandforlocalizationofmajorvesselsadjacenttoorsurroundedbythemass.hipCervicalvertebralbodyMRIAdvantage:Sinceitsintroduction,ithashadanenormousimpactonourunderstandingofthepathophysiologyofmusculoskeletaldiseasesTheimagesarecharacterizedbygreatinheritcontrast,excellentspatialresolutionandexquisiteanatomicdisplay.Itisparticularlysensitivetobonemarrowandishighlyeffectiveindetectingandcharacterizingawidevarietyofsofttissueconditions.MRIItsimportantindiagnosticdisordersofthemusculoskeletalsysteminclude:(theroleofMRI)1)greatsensitivitytophysicaldifferencesamongtissueandfluids.2)abilitytodisplaythesedifferencesastissuecontrast.3)capacitytoemphasizespecificphysicalpropertiesandmanipulatethemtoaccentuatetissuecontrast.MRI4)abilitytoimageinanotherplanetocomplementtheanatomicplaneorpathologicfeaturesofinterest.5)sensitivitytobloodflow,whichpermitsvisualizationofmajorbloodvesselswithouttheneedforintravascularcontrastagent.humerusNONCONTRASTMRIMAGING1)Inordertodevelopthesignal-noiseratio,chosethedifferentsurfacecoilaccordingtothelocation.2)ThegeneralsequenceisSEsequence:T1WI,T2WIandfatsuppression(FS).3)Useaxial,sagital,coronalandobliquesectionsaccordingthelocationoftumor.ProximaltibiaCONTRASTMRIMAGING1)Intravenouscontrastinjection.2)Normallyforthesoft-tissuemassesorsoft-tissuemassesofbonelesions.3)Bothfordirecttumorenhancement,necrosisandasanadditionalmethodtodifferentbenignlesionsfrommalignantlesions.ProximaltibiaULTRASONOGRAPHYThedevelopmentofhighfrequencylineararrayrealtimetransducershasdramticallyincreasedthecapabilitiesofultrasonogranphyintheevaluationofthemusculoskeletalsystem,particularlythesuperficialstructuresandintraoperativeuse.RotatecuffULTRASONOGRAPHYTheearliestandusefulapplicationisinthedifferentiationofcysticfromsolidmasslesions.Itisnoninvasiveandpainlesstothepatient.Itislessexpensive,saferandperformedmorerapidlythanmostalternativestudies.Itisausefultechniqueforguidingpercutaneousaspirationorbiopsy.OSTEOPOROSISOsteoporosisisaconditioninwhichthereisdecreasedbonemassperunitvolume,withthecompositionoftheboneremainingessentiallynormal.normalosteoporosisLumbarNormalOSTEOPOROSISRadiographicManifestations:1)decreaseddensityonroutineradiographs.2)Tubularbone:A.individualtrabeculaebecomethinned,andultimatelybecomefewerinnumber.B.thinningofthecortex.phalanxStressfractureofthefemoralneckOSTEOPOROSIS3)Spin:A.changesinthenormalconfigurationofthevertebralbodies.B.increasedprominenceoftheend-plates,increasedconcavityofend-plates(codfishvertebrae).C.compressivefracture.OSTEOPOROSISPathogenesis---Itisaheterogeneousdisorder.1)postmenopausal.2)nutritional3)hormonalandmetabolism4)physical5)tumor(malignant)OSTEOMALACIAOsteomalaciaisaconditioninwhichthereisdeficientmineralizationoforganicmatrixperunitvolume.OSTEOMALACIARadiographicManifestations:A:bonedensityisgenerallydecreased,especiallyinthespineandpelvis.B.trabeculaeandcortexhaveindistinctfuzzyedges.C.Weighe-bearingleadstobowingofthelongbones.D.pseudofracturesOSTEOMALACIAPathogenesisA.deficiencyofvitaminD.B.intestinalmalabsorptionC.liverandkidneydisease(renaltubulardisease).DESTRUCTIONOFBONEItisaconditioninwhichthenormalboneissubstitutedbypathologictissue.Boththetrabeculaeandthecortexcanbedestructed.-DESTRUCTIONOFBONERadiographicManifestations:bonedensityislocallydecreased.ProximaltibiathoraxvertebralbodyDESTRUCTIONOFBONEPathogenesisA.infection.B.inflammatorygranularC.tumorandtumor-likelesionsPyogenicFemoraFemoraHYPEROSTOSISOSTEOSCLEROSISHyperostosisosteosclerosisisaconditioninwhichthereisincreasedbonemassperunitvolumeChronicpyogenicofthefemoraHumerusHYPEROSTOSISOSTEOSCLEROSISRadiographicManifestations:bonedensityisincreasedwithorwithouttheenlargementoftheincludedbone.IliumHYPEROSTOSISOSTEOSCLEROSISPathogenesisA.chronicinfection.B.traumaC.tumorandtumor-likelesionsIliumulnaChronicpyogenicofthehumerusSequestraaredetachedordeadpiecesofboneseparatedfromsurroundinghealthytissuebyapathologicprocess.PERIOSTEALREACTIONWhentheperiosteumisstimulated,theosteoblastsinitsinnerlayerproliferateandproducethebone.CodmanTriangleComplexHaironendSingleLamellaMultipleLamellaeSunburstPERIOSTEALREACTIONRadiographicManifestations:periostealnewboneformationCALCIFICATIONINBONEANDCARTILAGEPrimarychondrogenictumormaypresentcalcificationintumor.FemoraNECROSISOFBONEItisthebonewhichitsmetabolismisstopped.FemoraCHANGESOFTHESURROUNDINGSOFTTISSUESPlainfilmcandemonstratethemuscle,planesandsubcutaneousfat.Intheconditionoftraumaandinfection,theradiologicfindingsaresurroundingsoft-tissueswelling,thedensitybecomehigher,thedisplacementofthedeepmuscleplane.CHANGESOFTHESURROUNDINGSOFTTISSUESIntheconditionoftumorandtumor-likelesions,theradiologicfindingsaresoft-tissuemass,displacementofofthedeepmuscleplane.CT Computedtomographyoftenisabletodefinesofttissueandbonealterationsthatareundetectablewithconventionalradiographybecauseofitscross-sectionaldisplay,excellentcontrastresolution,andabilitytomeasurespecificattenuationvalues.CTReformationoftransaxialimagesinthecoronalofsagitalplaneandthreedimensionalanalysisofimagedataaresignificantadditionaladvantagesofcomputedtomography.acetabulumMRIMagneticresonanceimagingisanimportantmethodforassessingdisordersofthemusculo-skeletaltissues.theimagesarecharacterizedbygreatinherentcontrast,excellentspatialresolution,andexquisiteanatomicdisplay.CompressionofthespinalcordMRIMRIisparticularlysensitivetobonemarrowalterationandishighlyeffectiveindetectingandcharacterizingawidevarietyofsofttissueconditions.ProximaltibiaMRIAdvancesinsurfacecoiltechnologyincreasetheusefulnessofmagneticresonanceimagingintheevaluationofjointdisease.TearofmeniscusTearofPCLDIAGNOSISOFDISEASESTraumaofmusculoskeletalsystemTheroleoftheimaging:A.toidentifythefractureortearsoftheligamentous.B.thesituationofdisplacementC.replacementundertheguideoffluoroscopy.D.toidentifythesituationofreplacementE.toexamtheprocessofhealingandcomplication.F.toidentifythepathologicfractureUlna(一)FractureMostinthetubularboneandthespin.Inallcasessuspectedoffracture,itisimperativetohavetwoviewofthebones.1)anteroposteriororpostero-anterior2)lateral3)ifnecessarily,otherviewsatrightanglestoeachotherviewscanbemade.ThefractureDefinition:Itisabreakinthecontinuityofboneorcartilage,orboth.Epiphysiolysisordetachmentoftheepiphysisisspecificfractureoccurinchild.ClinicandPathology:A.historyoftraumaB.pain,swellinganddisableThetubularbonefractureRadiographicManifestations:1)lineofradiolucentdensity,sharp,slightlyroughened,oftenjaggedorirregular.2)separationofbonefragment.3)areaofincreaseddensityfromoverridingoffragmentorimpaction4)deformityofbonecontourClavicleHumerusUlnaandradialThetubularbonefractureRadiographicManifestations:5)disturbanceofnormalanatomicalrelations6)irregularityofsurfaceofbone,thegreenstickfracture7)distortionofbonetrabeculaeColles’greenstickfractureTHETYPEOFTHEFRACTUREThefeaturesofafractureordislocationthatneedtobedescribedincludelocation,alignment,displacement,typeoffracture,andextentofsoft-tissueandarticularinvovment.THETYPEOFTHEFRACTUREAccordingtothedegree:completefractureincompletefractureTHETYPEOFTHEFRACTUREAccordingtheshapanddirectionofthefractureline:

linearfracturestarfracturetransversefractureobliquefracturespiralfractureTHETYPEOFTHEFRACTUREAccordingthefracturefragment:Avulsionfracture--occurswhenanosseousfragmentifpulledfromtheparentbonebyatendonorligament.Impactionfracture--resultswhenonefragmentofboneisdrivenintoanapposingfragment.Comminutedfracture--itisonewithmorethantwofracturefragments.THEFRACTUREPOSITION

ANDALIGNMENTItisneedtoconfirmthedisplacementofthedistalfracturefragment.Thefracturepositiondescribestherelationshipofthefracturefragments,exclusiveofangulation,comparedwiththenormalanatomicsituation.ElbowTHECONTRAPOSITION

ANDALIGNMENT

Thealignmentofafracturereferstothelongitudinalrelationshipofonefragmenttoanother.Ifthereisnosignificantangulation,thefractureissaidtobeinanatomicornearanatomicalignment.Byconvention,angulationofthedistalfragmentisdescribedinrelationshiptotheproximalone.VARUSVALGUSTHECHARACTERISTICSOFCHILD’SFRACTURES1)Epiphysiolysisordetachmentoftheepiphysis2)Incompletefracture-occurintheresilientelasticbonesofchildrenandyoungadults.theymaybeclassifiedfurtherintovarioustypes,includingbowing,greenstickandtorusfracture.FRACTUREHEALINGRadiographicManifestations:1)decalcificationoffragmentends2)formationofcalcifiedperiostealcallus.3)endostealcallus4)reformationoftrabecularbone5)disappearanceoffracturelineFRACTUREHEALINGManyfactorscanmodifythehealingprocess:1)theageofthepatient(healingismorerapidintheimmatureskeleton)2)thetypeofboneinvolvedandlocation3)nutrition4)methodsoftreatmentCOMPLICATIONOFFRACTURE1)delayedunionornonunion2)malalignmentfollowingfractureunion3)osteoporosisfollowingfracture4)infection5)avascularnecrosis7)degenerationFRACTUREINTHECOMMONLYLOCATION1)Colles’fractureisatransversefractureofradiuswithdorsaldisplacement,maybewithorwithoutulnarfracture.2)supracondularfractureofthehumeral--commonlyencounteredinchildren.3)fractureoftheneckofthefemur--commonlyencounteredinelderlypersonswithosteoporosis.thelocationcanbesubcapital,transcervical,basicervical,intertrochantericandsubtrochanteric.THEROLEOFCTINTHEFRACTURE1)notastheroutingexaminationofthetrauma.2)CTisbestappliedtotraumaticabnormalitiesinregionsofcomplicatedanatomy,suchasthespine,thebonesinfaceandpelvis,theglenohumeralandsternocalvicuraljointsandthefoot.3)3Dreformationisusefulforthetreatment.THEROLEOFMRIINTHEFRACTURE1)itisnotasgoodasX-rayorCTtoshowthefractureline.2)itissensitivelytoshowthebonemarrowedemaandbonebruise--lowersignalinT1WIandhighsignalinT2WI.(ItisnormalinplainfilmandCT)3)thefracturelineitselfisfaintontheMRI.THESPINALFRACTURE1)CommonlyoccurinC5,C6,T11,T12,L1,L2.2)Commonlyonlyonevertebralbody.THESPINALFRACTUREPlainfilm1)cuniformvertebrabody,compressionfractureofanterioredge.2)dorsalangulation3)vertebraldisplacement,dislocation4)fracturesofthetransverseprocessescuniformvertebraTHESPINALFRACTURECTCTimagescanbeofgreatbenefitintheassessmentofspinalinjuries:vertebralfracture,typeoffractures,displacementdegreeofthesegments,deformationofthecannel,straitnessofthecanal,andthehematomainthecanal.THESPINALFRACTUREAccordingthesignofCT,thefractureofthespincanbeclassifiedintotwotypes:1)burstfracture-2)isolatedcompressionfracturethemostimportantthingofCTscanistodetecttheinfluencetothecordandnerveroots.

THESPINALFRACTUREMRIMRimagingissuperiortoallotherimagingmethodsintheassessmentofthespinalcordandisparticularlyusefulinpatientswithneurologicdeficitsoutofproportiontotheirbonyinjury.THESPINALFRACTURE1)burstfracture-2)isolatedcompressionfracture3)fracture-dislocation4)injuryoftheintervertebralspace5)ruptureoftheligament6)injuryofthespinalcordPROTRUSIONOFINTERVERTEBRALDISCClinicandpathology

1)predominantinmiddleage,maleismorethanfemale,usuallyhasthehistoryoftrauma.2)frequentlyinthelowerlumbar3)hastheintimaterelationshipbetweentheintervertebraldiscandimportantneurologicstructures.PROTRUSIONOFINTERVERTEBRALDISCRadiographicManifestations:Plainfilm1)narrowingoftheintervertebralspace2)osteophyteofthevertebraledge.

PROTRUSIONOFINTERVERTEBRALDISCPlainfilm:

3)changeofthealignment4)Schrmorl’snode5)thepresenceofcalcificationPROTRUSIONOFINTERVERTEBRALDISCCT(definition)

1)Discalprotrusion--thedisplacednucleusisstillconfinedbytheoutermostannularfiber.---isassociatedwithgeneralizedextensionofthediscalcontourbeyondthemarginsofthevertebralbodyinasymmetricanduniformfashion.PROTRUSIONOFINTERVERTEBRALDISCCT

2)Discalextrusion--thedisplacednucleushasviolatedtheouterfibersoftheannularfibrousbutstillisconfinedbytheepiduralspace.----isassociatedwithfocalextensionofthediscalcontour,maybecompanywithcalcificationanddisplacementoftheextraduralfat.PROTRUSIONOFINTERVERTEBRALDISCMRI

Itisthebestmethodtoshowtheprotrusionofintervertebraldisc.NORMALDISC:lowersignaldensityinT1WIhighsignaldensityinT2WIPROTRUSIONOFINTERVERTEBRALDISCMRI1)Discalprotrusion--thedisplacednucleusisstillconfinedbytheoutermostannularfiber.---isassociatedwithgeneralizedextensionofthediscalcontourbeyondthemarginsofthevertebralbodyinasymmetricanduniformfashion.

PROTRUSIONOFINTERVERTEBRALDISCMRI

2)Discalextrusion--thedisplacednucleushasviolatedtheouterfibersoftheanulusfibrousbutstillisconfinedbytheepiduralspace.----isassociatedwithfocalextensionofthediscalcontour,maybecompanywithcalcificationanddisplacementoftheextraduralfat.RUPTUREOFTHETENDONS

ANDLIGMETSNormalyoccurinaccuteinjurycalcifiedintotwotypes:completeincompleteRUPTUREOFTHETENDONSANDLIGMETSPlainfilmcan’tshowthetears

RUPTUREOFTHETENDONSANDLIGMETSCT

candirectlyshowthetendonsandligamentNormal:band-likeorovalsoft-tissuedensitystructure.Rupture:illegibilityofthetendonsandligament,edema,configurationdisappearevenbecomefragments.

RUPTUREOFTHETENDONSANDLIGMETSMRI

thebestmethodtodirectlyshowthetendonsandligamentNormal:lowersignaldensitystructure.Rupture:incompletetear--completetear--

MENISCALTEARSPlainfilmcan’ttoarrivethediagnosisofmeniscaltears.Arthrographycan,butitiscomplex,interventionalandoftenwithartificial.MENISCALTEARSCThasenoughsensitivityandaccuracytoshowthemeniscustears.半月板

Tears--lowerdensity

MENISCALTEARSMRInon-interventionalmethodthebestmethodtoshowthemeniscustearsmeniscusMENISCALTEARSMRI

GradeI--containoneorseveralcircularfociofintermediatesignalintensityGradeII--alinearregionofintermediatesignalintensitythatdoesnotextenttoanarticularsurfaceGradeIII--linearorirregularregionsofintermediatesignalintensitythatextendtothearticularsurfaceINFECTIONOFTHEMUSCULOSKELETALSYSTEM一.Pyogenicosteomyelitistheincidenceofclassicacuteosteomyelitishasdecreased,butsubacutepresentationhavebecomemorecommon.theuseofimmunosuppressiveagentsandantibioticshasaffectedtheorganismsinvolvedandledtoantibiotic-resistantstrains.PYOGENICOSTEOMYELITISCanbeclassifiedintothreetypes:1)infectionsecondarytohematogenousspread2)directextensionfromsoft-tissueinfection3)infectionfollowingopenfractureorpenetratingwounds.hematogenousspreadisthemostcommonone.PYOGENICOSTEOMYELITIS1)commonlyinchildren,male>female2）usuallysituatedintibia,femur,humerusandradial.PYOGENICOSTEOMYELITISAccordingtotheclinicalpresentation,osteomyelitismaybesubdividedintotwotypes:acutechronicACUTEPYOGENICOSTEOMYELITISClinicandpathology:Classically,acuteosteomyelitisisfoundmostlyinthepediatricagegroup.Patientspresentwithrapidonsetofpain,tenderness,andassociatedsignsofsystemictoxicity,includinghighfeverandleukocytosis.ACUTEPYOGENICOSTEOMYELITISRadiologicappearance:inthefirst2weeksfollowingtheonsetofsymptomstheradiologicfindingarelimitedtolocal,deepsoft-tissueswellinginthemetaphysealregioncontinuouswiththeunderlyingbone.ACUTEPYOGENICOSTEOMYELITISRadiologicappearance:thefindingarefrequentlyverysubtle,withdisplacementmuscleplanesbestappreciatedwhenacomparisonviewisavailable.Swellingofthedeepmuscle,followingwiththesuperficialmuscleandsubcutaneousedema.Withoutsignificantbonechange.ACUTEPYOGENICOSTEOMYELITISRadiologicappearance:aftertwoweeks,wecanseethebonechange:1)bonedestruction:aragged,moth-eatenappearancewithfociofdestructionintermingledwithareasofapparentlynormalbone.

ACUTEPYOGENICOSTEOMYELITISRadiologicappearance:2)periosteumresponse:aslightamountofperiostealcalcificationlaiddownalongtheoutersideofthecortexandparallelingit.ACUTEPYOGENICOSTEOMYELITISRadiologicappearance:3)sequestrum:itisanareaofdeadboneisolatedfromlivingbonebysurroundingbedofgranulationtissue.theyusuallyappeardenserthanthesurroundingosteoporoticlivingbone.ACUTEPYOGENICOSTEOMYELITISCT

CTmayoccasionallybeofvalueintheearlydiagnosisofosteomyelitis,toshowtheswellingofsofttissue,pusofsubperiosteum,granulationtissue,sequestrum,especiallysmallsizeofdestructionandsequestrum.ACUTEPYOGENICOSTEOMYELITISMRI

itismoreusefultoidentifythechangesinsofttissueandmedullawithMRIthanx-rayandCT.Thechangesofsignaldensity:T1WI:T2WI:ACUTEPYOGENICOSTEOMYELITISDifferentialdiagnosis:1)non-classicalbonetuberculosis2)malignantbonetumorCHRONICPYOGENICOSTEOMYELITISClinicandpathology:Itisthecontinuationoftheacutestage.Multiplefactorsmayberesponsible,includinginadequatetherapyforacutestage,alteredimmunityorrepairprocesses,drainingsinuses,andlargesequestra.CHRONICPYOGENICOSTEOMYELITISRadiologicappearance:1)thebonedestructionbecomemorepronounced.2)multiplescleroticlesionswithsoft-tissueswellingandslightperiostealreaction.

CHRONICPYOGENICOSTEOMYELITISRadiologicappearance:3)thereisthickeningandincreaseddensityincorticalandcancellousbonewithoutsignificantareasofrarefaction.4)sequestrum:CHRONICPYOGENICOSTEOMYELITISCT:similarastheplainfilm

CHRONICPYOGENICOSTEOMYELITISMRIThechangesofsignaldensity:sclerosisgranulationdrainingsinusesT1WI:lowerlowerlowerT2WI:lowermiddlinghighCHRONICPYOGENICOSTEOMYELITISDifferentialdiagnosis:bonetumorSOFT-TISSUEINFECTIONInfectionofsofttissuestructurecommonlyresultsfromdirectcontaminationaftertraumaorfromadisease(e.g.,diabetesmellitus)thatdisruptstheskinsurface.Hematogenousspreadislessimportantasamechanisminsofttissuecontamination.SOFT-TISSUEINFECTIONRadiologicappearance:1)itislimitedtoshowthechangesofsoft-tissuewithplainfilm.2)swellingwithobliterationofadjacenttissueplanesischaracteristicofsoftinfection.thighSOFT-TISSUEINFECTIONCT1）swellingwithobliterationofadjacenttissueplanes2)abscess:SOFT-TISSUEINFECTIONMRI:Itismoresensitivethanothermodalitiestoshowthechanges.TUBERCULOSISOFTHEBONETuberculosisoftheisachronicdiseasewiththecharacteristicsofbonedestructionandosteoporosis.

TUBERCULOSISOFTHEBONEThefemur,thetibia,andthesmallbonesofthehandsandfeet

aremostcommonlyinvolved.Typically,themetaphysesareaffected.

TUBERCULOSISOFTHEBONERadiographicfindingsincludeosteopenia,osteolyticfociwith

poorlydefinededges,andvaryingamountsofsclerosis.TUBERCULOSISOFTHEBONERadiographicfindings:1)location:metaphysisandepiphysis2)bonedestructionnormalywihoutsurroundingsclerosisTUBERCULOSISOFTHEBONERadiographicfindings:3)littleornoperiostealreaction4)thefocusmaycrosstheepiphyseallineandinvolvesthejointTUBERCULOSISOFTHEBONE

CTandMRimagingdemonstratetheextentoftheactive

infectionanditscomplicationsTUBERCULOSISOFTHEBONETuberculousinvolvementoftheshort,tubularbonesofthehands

andfeetistermedtuberculousdactylitis.Thisformoftuberculosis

isespeciallyfrequentinchildren.TUBERCULOSISOFTHEBONETuberculousosteomyelitiscanbemimickedbypyogenicorfungal

infections.Ahelpfulfeatureindistinguishingtuberculous

frompyogenicinfectionisthattransphysealspreadoccursin

theformer;TUBERCULOUSSPONDYLITISThespineisthemostcommonsiteofosseousinvolvementbytuberculosis(50%).Themostcommonlocationislumbar,especiallyL1.Morethanonevertebralbodyistypicallyaffected.TUBERCULOUSSPONDYLITISThediseaseprocessmostoftenbeginsintheanteriorpartofthevertebralbodyadjacenttotheendplate.Thediskspacemaythenbecomeinvolvedviaanumberofrouts.Collapseofavertebralbody,particularlytheanteriorsegment,mayresultintuberculouskyphosis.

TUBERCULOUSSPONDYLITIS

Paraspinalinfectionmayinvolvethepsoas

muscle,resultinginpsoasabscesswhichcanextend

intothegroinandthigh.CalcificationwithintheabscessisvirtuallypathognomonicoftuberculosisTUBERCULOUSSPONDYLITISCTandMRimagingareofgreatvalueindemonstratingasmall

focusofboneinfectionandtheextentofthedisease.

TUMORSANDTUMOR-LIKEDISEASEINMUSCULOSKELETALSYSTEMBONETUMORSANDTUMOR-LIKELESIONSImagingexaminationhasanimportantpartinthediagnosisoftumorsandtumor-likelesionofthebone,theycanidentifythelocation,size,surroundingsituation,andeventoarrivecorrecteddiagnosis.BONETUMORSANDTUMOR-LIKELESIONSThepurposeofimagingofbonetumors:1)toidentifythelesionsaretumorsornot.2)toidentifythetumorsarebenignormalignant,primaryofsecondary.3)toidentifythehistologytypesofthelesions.4)toidentifytheextensionofthetumors.BONETUMORSANDTUMOR-LIKELESIONSInordertoarriveacorrectdiagnosis,oneshouldtoconsidermultiplefactors:location,numbers,typesofbonedestruction,periostealresponse,changesofthesurroundingsofttissue.BONETUMORSANDTUMOR-LIKELESIONSLocation:BONETUMORSANDTUMOR-LIKELESIONSNumbers:Primary:singlesecondaryandmultiplemyeloma:multiple.BONETUMORSANDTUMOR-LIKELESIONSThepatternofbonedestruction:Geographicbonedestruction--istheleastaggressivepatternofbonedestruction,anditgenerallyisindicativeofaslow-growinglesion.BONETUMORSANDTUMOR-LIKELESIONSMotheatenbonedestruction--isthemoreaggressivepatternofbonedestruction,characteristicofalesionthatisgrowingmorerapidlythanonethatdemonstratesgeographicbonedestruction.normalMotheatenBONETUMORSANDTUMOR-LIKELESIONSPeriostealresponse:benigntumors:nonorregularlymalignanttumors:irregularlyCodman’striangleBONETUMORSANDTUMOR-LIKELESIONSSofttissuemass:benigntumors:nonordisplacemalignanttumors:massandswellingBONETUMORSANDTUMOR-LIKELESIONSDifferentiationbetweenbenignandmalignantbenignmalignantgrowingslowly