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1、骨骼和肌肉系统Musculoskeletal System,邹月芬,The diseases of musculoskeletal system are very common and complex.They are included trauma,infection,tumor,degeneration disease,metabolic and endocrine disease,congenital anomalies and so on.,Various imaging examinations are available for the evaluation of bones,jo
2、ints,and soft tissues.Some are general examinations used for the patients with many types of disorders.Others have more limited indications.Plain film radiography is routine technique in clinical practice.CT and MRI are used more and more now,because of its cross-sectional display,excellent contrast
3、 resolution,and ability to measure specific attenuation values.,Examination Techniques,X-ray Plain film,fluoroscopy,angiographyCT：plain scan,enhancementMRI：plain scan,enhancement,X-ray,Plain film(basic examination)Routine radiographic evaluation of the bones should consist of anteroposterior(or post
4、eroanterior)and lateral views,which should include one joint and soft tissue Oblique and tangent views may be necessary in specific situations.,Knee of anteroposterior and lateral views,Lumbar spine,血管造影(angiography)For vascular diseases and bone tumor 关节造影(arthrography)For joint diseases,very few u
5、sed now,angiography,Computed Tomography,plain scanInclude bone window and soft tissue windowenhancement-For differential diagnosisCT myelography,L4-5 CT soft tissue window and bone window,Knee:CT soft tissue window and bone window,Magnetic Resonance Imaging,plain scan and enhancement SE,TSE or GRE a
6、re basic sequences.Fat suppression sequences and use of intravascular contrast agents further increase the ability to accentuate tissue contrast.,Lumbar spine sagittal view(T1WI,T2WI),Ultrasonography,Ultrasonography is noninvasive and painless to the patient.Furthermore,it is less expensive,safer,an
7、d performed more rapidly than most alternative studies.Because it allows localization of lesions in three dimensions,sonography is a useful technique for guiding percutaneous aspiration or biopsy and for mapping radiation portals.,Normal Imaging Anatomy,Form,structure and develop of bone form：long b
8、one,short bone,tabular bone,unregular boneStructure:compact bone,spongy bone,periosteum,medullary cavity of bonedevelop：intramembranous ossification(skull,facial bones)，endochondral ossification(trunk,limbs,base of skull,ethmoid)，ossification center,Long bone Developing bonediaphysis：compact bone,me
9、dullary cavetymetaphysis：spongy boneEpiphysis:secondary ossification center epiphyseal plate：bone age：the age of creating secondary ossification in the epiphyses and the age of combining epiphysis with diaphysis,Matured bone：diaphysis:cortex of bone,spongy bone,Medullary cavity of bone,vascular chan
10、nel extremities:joint sesamoid bone,CT and MRI,bone windowCortex,trabecula,medullary cavitysoft tissue windowMuscle,tendons,cartilage,股骨下段CT 骨窗、软组织窗,Headline,SOMATOM Emotion 16 8.5 sec for 102 mm16 x 0.6 mmPitch 1.2Rotation 0.6 sec130 kV77 effective mAs,Courtesy of Jiangsu province people hospital/N
11、anjing,China,Headline,SOMATOM Emotion 16 53.8 sec for 318 mm16 x 0.6 mmRotation 1.0 sec130 kV123 effective mAs,Bone removal,Courtesy of Jiangsu province people hospital/Nanjing,China,MRI检查,骨骼、关节、肌肉等软组织有良好MRI自然对比，能三维显示上述各种正常、异常结构，MRI增强扫描能提高诊断正确率。,Ultra-High Resolution 3TT1 VIBE 3D with Isotropic 0.4
12、mm3,T1 3D VIBE water excitationTA 5:44,eff.SL 0.4 mm,matrix 512,partitions 112,FoV 100 mm,方法,常用T1WI、T2WI及T2WI抑脂像，矢、轴、冠状位扫描。PDWI、DWI、T2MAP等正常：躯干、四肢骨关节软组织结合正常解剖所见，病理发现异常病变,Ultra-High Resolution 1.5TT2 DESS with isotropic 0.7 mm,T2 3D DESS coronal isotropic necrosis,PAT 2 with GRAPPAeff.SL 0.7 mm,parti
13、tions 104,matrix 576,FoV 340 mm,Sagittal MPR of T2 3D DESS,Courtesy Dr.Tallal C.Mamisch,Newsyngo MR B13,Now you can evaluate smallest menisceal tears with a single sequence,PD SPACE PAT2-isotropic resolution 0.84 mm MAGNETOM Avanto,PD SPACE with FatSatPAT2-isotropic resolution 0.84 mm MAGNETOM Avant
14、o,Joint,关节分类不动关节(immovable joint)微动关节(amphiarthrodial joint)能动关节(movable joint),Joint,关节间隙（joint space)关节面(articular surface)关节囊(joint capsule)韧带(ligament)关节软骨(articular cartilage),儿童踝关节,儿童膝关节,儿童髋关节,后交叉韧带posterior cruciate ligament,前交叉韧带Anterior cruciate ligament,股四头肌腱quadriceps femoris tendon髌韧带pat
15、ellar ligament,半月板meniscus,髌股关节Patellofemoral joint,Spine,cervical vertebrae,thoracic vertebrae,lumbar vertebrae,sacral vertebrae,coccygeal vertebraephysiocurvature vertebra：vertebral body,vertebral arch,spinous process,transverse process,articular process,intervertebral discparavertebral soft tissu
16、e,CT,MRI T1WI,T2WI,多发性骨髓瘤,Soft tissue,X-ray:limitedCT:betterMRI:best,前交叉韧带完全撕裂2,左膝内上部软组织血管瘤,Essential lesion of bone,osteoprosisosteomalaciaBone destructionhyperostosisPeriosteal proliferation,calcificationosteonecrosismineral depositionBone deformationSoft tissue lesion,CT,Similar to X-ray film app
17、earenceCT is better than X-ray film CT contrast enhancement for tumor differentiation,MRI,Soft tissue contrast is better than CTCalcification and ossification is not sensitive in MRIMetastasis is more sensitive in MRI than CTMRI contrast enhancement is useful in diagnosis,OsteoporosisTotal body limi
18、ted,骨密度分析区（五点修饰轮廓）模板的水样部分模板的骨样部分,Osteomalacia:mineral decrease,Bone destruction,隐性骨转移,脊柱结核,Hyperostosis,Osteosclerosis,颈椎骨赘形成,椎间盘突出椎管狭窄,Periosteal proliferation,Codeman triangle,Chondral calcification,软骨肉瘤,Osteonecrosis,mineral deposition,bone malformation,surrounding soft tissue,上臂脂肪瘤,右小腿平滑肌肉瘤,男性77
19、岁右小腿肿块1年，近一月来进行性增大肿块质硬，压痛不明显。,滑膜肉瘤,关节基本病变,关节肿胀(swelling of joint)关节破坏(destruction of joint)关节退行性变(degeneration of joint)关节强直(ankylosis of joint)关节脱位(dislocation of joint),Swelling of joint,destruction of joint,degeneration of joint,ankylosis of joint,dislocation of joint,级撕裂（b级）,A,B,桶柄样撕裂内侧较外侧多见。半月板
20、首先是纵向撕裂，主要是垂直型，若撕裂线内侧的半月板碎片向内移位，形成类似桶柄形态。矢状面像上半月板体部失去正常的双凹镜形态，前后角萎缩或截断并见信号改变，在近髁间嵴层面见低信号的半月板碎片。冠状面像上半月板分为两个部分，原位部分（桶）明显萎缩，向内移位半月板碎片（柄）位于髁间棘旁,M,柄,桶,内侧副韧带损伤,内侧副韧带撕裂后，内侧支持带松弛,*,*,MRI,Better soft tissue contrastInjuryMetastasis is sensitive in MRIRange of the lesion is more clear,异常MRI征,骨骼：骨水肿、骨增生、骨破坏、骨
21、膜增生，骨髓异常，骨梗死关节：关节肿胀、软骨破坏、骨性关节破坏、半月板损伤、韧带损伤、关节退变、关节脱位软组织：（另述）,骨挫伤,前交叉韧带完全撕裂2,关节软骨变薄,关节软骨消失,关节软骨肿胀,Other advanced applicationT2-Mapping with Tools for T2 Time calculation,Spin Multi Echo with up to 32 echoes to form individual images with different echo time.T2-time calculation in dynamic analysissyng
22、o Fusion for T2-maps with coloured overlay onto anatomical images,T2 map,T2 map,早期OA，T2 map显示外侧髌股关节面软骨T2时间变长（绿色）,创伤性出血性关节腔积液,Essential lesion of soft tissue,soft tissue swellingsoft tissue masscalcification and mineralizationgas in soft tissue,血 肿,膝前皮下软组织脓肿,前臂血管瘤(hemangioma in forearm),足底血管瘤(hemangioma in sole of foot,髌下滑液囊肿Synovial cyst,calcification and mineralization,Make Diagnosis,Location(部位)Range(范围)Border(边缘)Character(特征)Number(数目)Clinical(临床),Thank you!,
