Transcript BONE IMAGING

BONE IMAGING
Presented by
Dr Dalia Al –Falaki
Department of Radiology
Colleage of medicine
NORMAL X-RAY OF PELVIS
FRONTAL VIEW
NORMAL PELVIC LINES
FEMALE PELVIS
MALE PELVIS
Congenital bone disease
DEVELOPMENTAL DYSPLASIA OF
HIP(CDH)
This is very important condition because
success in its treatment depend on early
diagnosis.
It is usually unilateral (L:R =11:1 ), but may be
bilateral ( unilateral : bilateral =11:4).
Female more commonly affected ( F:M=5:1).
Family or twin history is also common.
DEVELOPMENTAL DYSPLASIA OF
HIP(CDH)
IMAGING
ULTRASOUND
Accepted as primary method of investigation
Image is obtained with child lie on his side , linear
ultrasound probe is positioned parallel to ilium.
Presence of shallow bony acetabular roof, lateral
displacement of acetabular cartilagenous labrum ,
with Perkins line demonstrate the cartilagenous
femoral head is displaced laterally.
CORONAL PLANE
ALPHA ANGLE MORE THAN 60 DEGREE
INDICATE NORMAL BONY ACETABULUM
NORMAL HIP JOINT
CARTLAGENOUS FEMORAL HEAD
DISPLACED LATERALY
DEVELOPMENTAL DYSPLASIA OF
HIP(CDH)
PLAIN FILM RADIOLOGY 
1- Notch above acetabulum may be present.
2-Retarded ossification of femoral ossific nucleus.
3- poor development of acetabulum, shallow acetabulum. 
4- From the age of 6 month s onward, the radiological 
diagnosis is usually easy, the femoral head is displaced
upward & outward, with delayed ossification of its
epiphysis, the acetabulum will be shallower than that of
normal hip , its roof will not be set horizontally but will
slope upward & outward ( increased acetabular angle > 35
).
PLAIN FILM RADIOLOGY
5- Disturbed Shenton,s line ( line which is
drawn along the inner surface of obturator
foramen to the medial surface of femoral
neck, normaly it should be convex ).
6- Perkin,s line : this vertical line is drawn
through the outermost point of bony
acetabulum dowenward , this line is lateral
to normal epiphysis ,, while it will be medial
to epiphysis in DDH.
PLAIN FILM RADIOLOGY
7- In old neglected DDH , there will be false
articulation of femoral head with the ilium bone
lead to psudoarthrosis.
8-Osteochondrosis may complicate DDH .
9- If hip reduction is failed, arthrography is advised,
because of possibility of soft tissue abnormality
prevent successful reduction like presence of
inverted acetabular labrum, this soft tissue
abnormality also can be demonstrated on MRI.
HELGENREINER LINE
ACETABULAR ANGLES
PERKINS
LINE
DEGREE OF SSIFICATION OF THE LEFT
EPIPHYSIS IS REDUCED COMPARED TO
THE NORMAL RIGHT HIP
RIGHT HIP DDH
OSTEOGENESIS IMPERFECTA
This is rare disorder manifested by increased fragility
of bone & osteoporosis , dental abnormality, lax
joint , thin skin , it is due to abnormality of type one
collagen .
RADIOLOGICAL FEATURES:
1- General reduction in bone density .
2- Cortical thinning with bowed, thin, gracile long
bones.
3- In 10 % fractures are seen at birth.
4- Wormian bones are seen in the skull.

WORMIAN BONE
LATERAL VIEW OF SKULL X-RAY
OSTEOGENESIS IMPERFECTA
GENERAL DIFFUSE REDUCTION IN THE BONE DENSITY
OSTEOPETROSIS
( MARBLE BONE ):
Type of bone dysplasia, result from failure of resorption of
primary fetal primitive spongiosa by the vascular
mesenchyme
RADIOLOGICAL FEATURE:
1-Increased density & thickening of long bones.
2- Erlenmeyer flask deformity of long bone .
3- Fractures are usually transverce & heal with normal callus.
4-sclerosis & thickening of skull base,neural foramina are
encroached upon & blindness results in severe cases.
5-spine show rugger jersey spine., spondylolisthesis can
occur.
OSTEOPETROSIS SPINE
ROGER GERCY SPINE SANDWEAGE SHAPE
OSTEOPETROSIS
GENERAL INCREASE IN BONE DENSITY
ACHONDROPLASIA
This is the most common type of disproportionate dwarfism:
1-Trident hands with short wide stubby fingers.
2- Depressed nasal bridge with a prominent forehead & a
disproportionately large skull.
3- Exacerbation of lumbosacral angle.
4- Tubular bone are short and wide ( humeri & femora are affected more
than distal bones).
5-V- shaped defects are seen at the metaphyses
6- The pelvis is small , pelvic inlet resembles champagne glass.
7-Short AP diameter of vertebral bodies, posterior scalloping may occur,
bullet-nosed vertebral bodies may occur at thoracolumbar junction.,
reduced sagital diamerter of spinal canal, interpedicular distance is
reduced from L1 to L5.
Achondroplasia skull frontal view
Enlarged vault small skull base stenosis of foramen
magnum
Achondroplasia lateral view
Prominent forehead
depressed nasal bridge
Skull base on ct scan shaded surface
display
Achondroplasia skull base on ct scan
bone window
Bullate shaped vertebral body at
thoracolumbar junction
Upper limb achondroplasia
Achondroplasia lower limb
Achondroplasia pelvis
Vertical iliac wings resemble the shape of tombstones
CONGENITAL SPINE VETEBRAL
LESIONS
1- Hemivertebra : half of vertebra is developed, can
be single , multiple , lead to spinal deformity
mainly scoliosis .
2-Butterfly vertebra: central body indentationon both
superior & inferior surface.
3-Block vertebra :congenital fusion of adjacent two
or more vertebrae.
4- Spina bifida : defect in posterior neural arch.
5- Transitional vertebra : sacralization of L5 vertebra
or lumeralization of S1 vertebra.
SKULL SHAPE CONGENITAL
LESIONS :
1- Scaphocephaly : long narrow skull.
2-Brachycephaly: short wide skull. 
3- Microcephaly :due to premature fusion of 
skull sutures , skull vault is abnormally
small, the subject is mentally handicapped.
Congenital cranial meningocele &
encephalocele
1-they are commonest in the frontal & 
occipital regions.
2- but can occur any where over skull vault
or base of skull.
3- seen in form of bone defect beneath 
scalp swelling , hypertelorism, nasal
obstruction due to nasopharyngeal mass
as in case of basal encephalocele.

Frontal encephalocele on sagital section of
MRI of the brain
OSTEOCHONDROSIS
It is disease of epiphysis of bones , 
beginning as necrosis & followed by healing
,ocurre because of avascular necrosis which
could be due to trauma , endocrine cause .
Osteochondritis of femoral capital
epiphysis ( perthes ):
1- most common between 4-9.
2-M:F =4:1.
3- lateral displacement of femoral head.
4- subcortical fissure in femoral ossific nucleus.
5- reduction in the size of femoral ossific nucleus of the epiphysis.
6- fissuring , fragmentation, condensation of fragmented femoral capital
epiphysis.
7- metaphyseal broadening & irregularity.
8- healing stage the femoral capital heal, epiphysis heal but it shape is like
mushroom : deacrease in hight , increased in width.
9- can be complicated by 2ndry degenerative joint disease.
OSTEOCHONDRITIS OF VERTEBRAL
EPIPHYSEAL PLATES ( adolescent kyphosis ,
Sheuermann,s disease )
1- affect both sexes.
2-begin at puberty.
3-irregularity affecting the superior and inferior parts
of vertebral bodies.
3- wedging of vertebral bodies and kyphosis appear.
4- shmoral nodules due to central disc nucleus
herniation are seen more than four in no. & disc
spaces become narrowed..
5- sometimes paraspinal bulge are seen at level of
the lesion.
OSTEOCHONDRITIS OF VERTEBRAL
BODY( vertebra plana , Calves disease) :
The vertebral body is collapsed & increased in
density, adjacent disc spaces are normal or
increased in height , recovery to normal
shape follows , but it may be incomplete.
Osteochondritis of tibial tubercle ( Osgood,s
disease, Schlatter,s disease:
1- soft tissue lateral film of the area , show
local soft tissue swelling over an
fragmented & dense tuberosity.
Osteochondritis of the head of 2nd metatarsal bone (
Freibergs disease):
1- Condensation , increased density &
fragmentation of the epiphysis .
2-The joint space may be increased in size .
3-The opposing bone surface greatly splayed
& Gradual thickening of the metatarsal neck
& shaft occurs.
Ostochondritis of the navicular bone
( Kohler disease):
The navicular bone become dense , flat , disc
like structure.
Sever,s disease it is osteochondritis of
calcaneum.
Osteochondritis dissecans
Osteochondritis dissecans : affect fragments of the
articular cartilage with or without subchondral
bone, become partially or completely detached at
particular sites.
The separated fragment is avascular, but the bed is
vital, affect convex articular surface , like medial
femoral condyle , capitellum of the humerus &
trochlear surface of the talus.
It may end as loose body inside joint space.

Knee joint
Osteochondral fracture fragment involve lateral aspect of medial
femoral condyle
Axial section of ct scan of knee joint show
the fracture fragment
Coronal section of ct scan of the ankle joint
show fracture fragment involve superior
aspect of the talus tarsal bone