1. The Skeletal System
Chapter 2

2. Imaging Consideration
Diagnostic images include soft tissue and bony structure of interest.
Soft tissue areas often hold clues to the diagnosis. Any signs of muscle wasting, soft tissue swelling, calcifications, opaque foreign bodies, or the presence of gas may indicate disease.

3. MRI Magnetic Resonance Imaging
Provides soft tissue detail because of its superior contrast resolution.
Exams: staging of soft tissue tumors of the extremities, joints, bone marrow imaging… just to name a few

4. CT Computed Tomography
Better contrast resolution than radiography.
Exams: trauma, extend of fractures, dislocation, joint abnormalities, excellent ability to display bony margins and trabecular patterns.

5. NM Nuclear Medicine Demonstrates metabolic function Exam: bone scan
Allows the metabolic function of the entire skeletal system to be evaluated at one time. Demonstrates the metabolic processes of the bone caused by disease processes.

6. DEXA Bone Mineral Densitometry
Double-energy x-ray absorbtiometry
Evaluate the bone density by evaluating the bone mass of the distal radius, femoral neck, and lumbar spine

7. Congenital and Hereditary Diseases

8. Osteogenesis Imperfecta

9. Osteogenesis Imperfecta

10. Achondroplasia
Most common inherited disorder affecting the skeletal system
Results in deformity and dwarfism
Cartilage in the epiphyses does not convert to bone normally

11. Congenital Achondroplasia

12. Achondroplasia

13. Osteopetrosis Increased exposure factors are required
Some cases, adequate penetration may never be achieved

14. Infant Osteopetrosis

15. Malformations

16. Syndactyly

17. Polydactyly

18. Clubfoot (talipes)

19. Congenital hip dislocation

20. Congenital scoliosis
Fig AP lumbar spine radiograph demonstrating congenital scoliosis.

21. Scoliosis & Rotoscoliosis

22. bilateral lumbar ribs
Fig AP lumbar spine radiograph demonstrating bilateral lumbar ribs.

23. spina bifida occulta
Fig Abdominal radiograph of a patient with spina bifida occulta of the lower lumbar vertebrae.

24. Fig A normal neural arch in comparison to congenital defects: A, Normal. B, Spina bifida occulta. The median segment of the vertebral arch is missing and covered by skin. C, Meningocele. The arch is mostly absent with a bulging dura; however, the spinal cord remains in the vertebral canal. D, Myelomeningocele with a deformed spinal cord within the protruding dural sac. E, Myelocele: the area is totally exposed.

25. fetus with anencephaly
Fig Abdominal radiograph of a pregnant woman carrying a fetus with anencephaly. Notice the lack of the cerebral cranial bones.

26. Inflammatory Disease

27. Chronic osteomyelitis
Fig A Chronic osteomyelitis demonstrated in a knee with prior fusion. An involucrum surrounded by fluid densities is seen in the middle of a large intramedullary cavity approximately 3 cm above the fusion site.

28. rheumatoid arthritis “swan sign”

29. rheumatoid arthritis
Fig A PA hand image demonstrating advanced rheumatoid arthritis with subluxation of the first metacarpophylangeal joint.

30. R.A.
Fig B Lateral hand image demonstrating advanced rheumatoid arthritis with subluxation of the first metacarpophylangeal joint.

31. Arthritis –joint inflammation

32. Arthritis

33. Cystic Arthritis

34. Arthritic Dislocation - Patella

35. ankylosing spondylitis
Fig B Lateral lumbar spine radiograph on a 64-year-old man with ankylosing spondylitis. Notice the fusion of the vertebrae into a solid block of bone.

36. Ankylosing Spondylitis

37. osteoarthritis
Fig AP and oblique ankle radiographs demonstrating osteoarthritis.

38. chronic bursitis calcium deposits
Fig Shoulder radiograph demonstrating radiopaque calcium deposits within the bursa caused by chronic bursitis.

39. gout
Fig A PA foot radiograph demonstrating bony erosion of the tarsal bones from gout.

40. gout
Fig B Lateral foot radiograph demonstrating bony erosion of the tarsal bones from gout.

41. Metabolic Disease

42. osteopenia steroid use
Fig A AP lumbar spine radiograph demonstrating osteopenia secondary to long-term steroid use.

43. osteopenia A radiographically visible decrease in bone density
Bone loss must be at least 30% to radiographically demonstrate
Fig B Lateral lumbar spine radiograph demonstrating osteopenia secondary to long-term steroid use.

44. Ostopenia

45. Rickets or Osteomalacia

46. Paget’s disease
Fig Lateral skull radiograph depicting an advanced proliferative phase of Paget’s disease. Notice the changes within the inner and outer tables of the skull.

47. Paget’s disease

48. Paget’s disease

49. Arachnodactilia from Acromegaly

50. Marfans Syndrome

51. Bone Spur

52. spondylolisthesis
Fig L5-S1 spot radiograph of a woman complaining of low back pain, demonstrating spondylolisthesis of this joint.

53. spondylolisthesis

54. spondylolisthesis

55. Neoplastic Disease

56. Bone Cyst

57. Bone Cyst

58. simple bone cyst FX ?
Fig AP radiograph demonstrating a well-circumscribed radiolucency consistent with a simple bone cyst.

59. Ostocondroma

60. Ostocondroma

61. Osteosarcoma

62. metastatic disease
Fig AP hip radiograph demonstrating metastatic disease from a primary breast cancer.

63. Dislocation

64. Dislocation

65. Dislocation of the Patella

66. osteosarcoma
Fig B Follow-up MRI of the knee reveals an osteosarcoma that has replaced the distal femoral condyle.

67. osteosarcoma

68. Trauma & other stuff

69. Dislocation

70. Dislocation

71. Dislocation

72. Fat Pad Sign

73. Fracture?

74. Diabetic Changes

75. Avascular Necrosis

76. Avascular Necrosis

77. Free air from puncture wound

78. Calcified Bakers Cyst

79. Calcified Bakers Cyst

80. Syphilis