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Musculosceletal Imaging For Medical Student: Herman Pieter L. W
Musculosceletal Imaging For Medical Student: Herman Pieter L. W
Musculosceletal Imaging For Medical Student: Herman Pieter L. W
Herman Pieter L. W
Radiologist
ULTRASOUND
MRI Scintigraphy
CT Scan
Plain Film
Primary imaging modality of
bone and joint imaging,
particularly in trauma
Advantages
fast
inexpensive
readily available
good for assessing bones and
joints
Plain Film
Primary imaging modality of
bone and joint imaging,
particularly in trauma
Disadvantages
uses ionising radiation (x rays)
limited information regarding
soft tissues
How to Interpret MSK images?
What is this???? What??????
ABC-s
Evaluasi sistematik
a.Alignment
b.Bone
c.Cartilage
d.Soft tissue
ABC-s
Evaluasi sistematik
a.Alignment
b.Bone
c.Cartilage
d.Soft tissue
Plain x-ray Orthogonal Views (AP-Lat) for
fractures
Mal - alignment ; joint dislocation
Spondylolisthesis
AC joint dislocation
Sacro-coccygeal angulation- post trauma
Scoliosis: Neutral + lateral bendings
ABC-s
Evaluasi sistematik
a.Alignment
b.Bone
c.Cartilage
d.Soft tissue
BONE
Bentuk
Cortex
Medula
Trauma/
FRAKTUR
Fraktur
Tipe Fraktur
Arah garis fraktur
Fraktur inkomplet dan
epiphysiolysis
Patah Tulang pada lempeng tulang yang
masih tumbuh: Epiphysiolysis
Klasifikasi menurut Salter & Harris
S A L T R
slipped above lower through ruined
Trauma
lempeng
pertumbuhan
Pathologic Fracture
Plain films post ORIF (open reduction
internal fixation)
After 2 months
Pins and wires Dislocated pins
OSTEOMYELITIS
Soft tissue mass above the right knee Osteomyelitis
TUMOR
Despite all of the imaging advances: CT,
MRI, Scintigraphy .
Osteosarcoma
Parosteal sarcoma
Osteochondroma
Typical Locations of Bone Lesions
Informations needed to formulate diagosis
or differential diagnosis of bone tumor
Age
Growth Rate/ Activity
Periosteal reaction
Location
Matrix calcification
Soft tissue Component
Size of the lesion
The form of calcification determine the
tissue origin of the Tumor
Punctate
chondoid/ Flocculent
chondroblastic Comma shaped
Ring like
Fluffy
osteoid/ Amorphous
osteoblastic Cloudlike
Calcification Matrix
ChondroblasticEnchondroma
Informations needed to formulate diagosis
or differential diagnosis of bone tumor
Age
Growth Rate/ Activity
Periosteal reaction
Location
Matrix calcification
Soft tissue Component
Size of the lesion
CT Large soft tissue mass malignant transformation
from (benign) Osteochondroma to Chrondrosarcoma
Informations needed to formulate diagosis
or differential diagnosis of bone tumor
Age
Growth Rate/ Activity
Periosteal reaction
Location
Matrix calcification
Soft tissue Component
Size of the lesion
Size and Diagnosis
a.Alignment
b.Bone
c.Cartilage
d.Soft tissue
Catrilage: Joint narrowing
Catrilage: Joint narrowing + osteophyte / lipping
Example of applying ABCs
(A)Spndylolisthesis
(B)Spondylolysis
(C)Severe DDD-
degenerative disc
disease
ABC-s
Evaluasi sistematik
a.Alignment
b.Bone
c.Cartilage
d.Soft tissue
Swelling after DPT injection
Ultrasound
Relatively inexpensive
Sound waves reflecting from soft tissue interfaces
No ionizing radiation
MSK applications
tendon injuries especially rotator cuff
soft tissue masses
US guided biopsy
ROTATOR CUFF TEAR
The majority of cuff
tears: in supraspinatus
tendon.
Supraspinatus
(longitudinal)
GT
Normal Achilles
Calcaneus
Computed Tomography (CT)
x ray tube rotated around the patient
metal artefact
Aneurysmal clip.
Pace maker.
Stress Fx.
MRI for Stress Fx.
Nuclear Medicine
entire skeleton at once
bone scan is an indicator of bone turn over
very sensitive, not specific
fracture
tumour
arthritis
infection
metabolic bone disease
Normal plain film
between
referring
physicians and
Radiologist is
most important