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

OSTEOPENIA OSTEOPENIA This is radiological term i.e. reduction in the bone density, which can occur in disease like ricket, osteoporosis, osteomalacia, multiple myeloma & hyperparathyroidism.

RICKET It is disease decrease & deficiency of vitamen D , disease changes are seen in rapidly growing metaphyses like wrists, knee, shoulder joints. Radiological feature: 1- loss of the provisional zone of calcification ( which border the metaphyseal margin of the growth plates ). 2-cupping and splaying of the metaphysic of long bones. 3- the epiphysis are hazy, faint, delayed in eruption. 4- the distance between epiphysis and the metaphysis is increased.

RICKET 5- bone deformities, bowing of the legs, pigeon chest, Harrison sulcus of chest. 6- multiple swellings, bony in texture along costochondral junction called Rickettic rosary. 7- after treatment of ricket by vitmen D , there will be sclerosis at the ends of long bones.

WIDENNING OF WRIST

THICK GROWTH PLATE , METAPHYSEAL FRAYING

HARISON SULCUS

ROSARY BEADS OF RICKET

ROSARY BEADS OF RICKET

FRONTAL BOSSING

BOWING OF LONG BONE

OSTEOMALACIA Deficiency of vitamen D in adult, mature skeleton Radiological feature: 1- general diffuse reduction in bone density. 2- losser,s zones formation is hall mark of osteomalacia, these are small defects or translucency 1-2 mm width in the cortex of bone but not traverce to other cortical margin ( pseudofracture ). Usually they are noted in the axillary border of the scapula, medial margin of femoral neck, pubic, ischial bone, lastly in the long bones.

PSEUDOFRACTURE = LOOSER ZONE

LOOSER ZONE IN SCAPULA

LOOSRE ZONE IN MEDIAL ASPECT OF NECK OF FEMOR

BILATERAL SUBTROCHANTERIC PSEUDOFRACTURES

TRIANGULAR DEFORMED SHAPE PELVIS

OSTEOMALACIA 3-spinal changes: biconcavity of the vertebrae, biconvexity of the disc spaces, result in Cod-fish spine. 4- triradite deformity of the pelvis , become triangular in shape, due to medial invagination of the acetabulum ( result in obstructed labour in female ).

OSTEOPOROSIS It is due to reduction in bone matrix below the normal limit, mostly due to immobilization, endocrine cause, steroid. Radiological feature: 1- general reductin in bone density. 2- prominent dense cortical margin of the vertebrae. 3- multiple wedgings of the spine vertebral bodies. 4- joint spaces are normal.

Hyperparathyroidism. 1- general reduction in the bone density. 2-subperiosteal resorption of the bones. 3-multiple osteolytic lesions in the skull vault (pepper pots). 4- multiple changes in the pelvis. 5- soft tissue calcification, vascular, renal ( nephrocalcinosis ).

SUBPERIOSTEAL RESORPTION

SUBPERIOSTEAL RESORPTION

RESORPTION OF DISTAL END OF CLAVICLE

PPEPER POT SKULL

MEDULLARY NEPHROCALCINOSIS

Acromegaly Excess growth hormone due to pituitary adenoma & its effect on skeleton. Radiological feature: thickened skull vault more than 5 mm. 2-hypertrophy of frontal sinuses. 3-enlarged sella tursica with erosion of its wall. 4- forward protrusion of the lower jaws ( prognathism ). 5- spiking of the posterior occipital protuberance. 6-hypertrophy of the bone & soft tissue of hand & feet with mushroom deformity of the phalangeal terminal tufts. 7- kyphosis & premature osteoarthrosis of the spines.

PITUTARY MACROADENOMA SAGITAL SECTION mri of brain

Balloning of sella tursica

Increase in heal pad thickness more than 23 mm

Mashroom deformity of terminal tufts

Chronic haemolytic anaemia Loss & destruction of RBC lead to bone marrow hyperplasia. Which lead to skeletal changes e.g. Thalacaemia Radiologcal feature of thalacaemia: 1- hand & feet tubular shaped metacarpal and metatarsal bones occur due to bone marrow hyperplasia lead to loss of normal biconcave shaped shafts of these bones.

Radiologcal feature of thalacaemia: 2-skull changes: upward displacement & thinning of outer table of the skull vault with presence of vertical perpendicular parallel trabeculation described as brush border appearance or SUN- RAY appearance or hair on ends. 3-spine: generalized reduction in bone density with prominent coarse trabeculation. 4-ribs are widened with coarse trabeculations.

Multiple myeloma Usually affect patient above 40 years old. Radiological feature: 1- skull changes: multiple osteolytic lesion, which are uniform in size, scattered diffusely described as rain drop appearance. 2-reduction in density of spine with presence of collapsed vertebrae. 3-these osteolytic lesion can affects long bone., ribs.