BONE IMAGING Presented by Dr Dalia Al –Falaki Department of Radiology Colleage of medicine

NORMAL X-RAY OF PELVIS FRONTAL VIEW 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) IMAGINGULTRASOUND 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 PERKINS LINE HELGENREINER LINE PERKINS LINE ACETABULAR ANGLES

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: 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 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 : 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 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. 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. 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