1. LOUISIANA STATE UNIVERSITY MEDICAL CENTER School of Medicine in New Orleans LOUISIANA STATE UNIVERSITY MEDICAL CENTER School of Medicine in New Orleans Michael Maristany MD Contributions from Carlos R. Giménez, MD Michael Maristany MD Contributions from Carlos R. Giménez, MD

2. DIAGNOSIS & TREATMENT CLINICAL HISTORY RADIOLOGYRADIOLOGY PATHOLOGYPATHOLOGY DIAGNOSISBONELESION

3. Diagnostic modalities

4. DIAGNOSTIC IMAGING SKELETAL PLAIN RADIOGRAPH NUCLEAR MEDICINE CT MRI ANGIOGRAPHY BIOPSY PLAIN RADIOGRAPH NUCLEAR MEDICINE CT MRI ANGIOGRAPHY BIOPSY

5. Diagnostic algorithm Yes>>>stopYes>>>stop nono CT for assessing matrix Composition Composition MRI for assessing bone & soft tissue Component Component Nuclear medicine for Assessing asymptomatic Multiplicity or activity Nuclear medicine for Assessing asymptomatic Multiplicity or activity MRI/CTCHARACTERIZATIONMRI/CTCHARACTERIZATION Radiographs Radiographs of the symtomatic area of the symtomatic area >>> diagnosis >>> diagnosis Radiographs Radiographs of the symtomatic area of the symtomatic area >>> diagnosis >>> diagnosis

6. CONVENTIONAL Rx IT REMAINS AS THE MOST RELIABLE IN THE HISTOLOGIC NATURE OF A SPECIFIC LESION 4 DETECTION 4 LOCALIZATION 4 CHARACTERIZATION IT REMAINS AS THE MOST RELIABLE IN THE HISTOLOGIC NATURE OF A SPECIFIC LESION 4 DETECTION 4 LOCALIZATION 4 CHARACTERIZATION

7. Tid bits 3 It is always a good idea to start with a radiograph of the area in question. Proceed with MRI if you are concern with ligaments or soft tissue problems, occult fracture or characterization A CT if you are more concern with bony problems Sometimes you need both. 3 It is always a good idea to start with a radiograph of the area in question. Proceed with MRI if you are concern with ligaments or soft tissue problems, occult fracture or characterization A CT if you are more concern with bony problems Sometimes you need both.

8. Ligament injuries 3 CT is more optimal than MRI 3 True or False 3 CT is more optimal than MRI 3 True or False

9. 3 For the evaluation of Disc disease, ligamentous or spinal cord injury in trauma MRI is preferred 3 For the evaluation of vertebral fractures in spine trauma CT is preferred. 3 Point: Both are use in evaluation of the spine in trauma.! 3 For the evaluation of Disc disease, ligamentous or spinal cord injury in trauma MRI is preferred 3 For the evaluation of vertebral fractures in spine trauma CT is preferred. 3 Point: Both are use in evaluation of the spine in trauma.!

10. DIAGNOSTIC RADIOLOGY ANATOMY- MORPHOLOGY PHYSIOLOGY/FUNCTION 3 X- ray 3 CT Nuclear Medicine D Ultrasound D MRI ANATOMY- MORPHOLOGY PHYSIOLOGY/FUNCTION 3 X- ray 3 CT Nuclear Medicine D Ultrasound D MRI

11. TRANSMISSION IMAGING (X-RAY) 3 X-Ray tube outside the body 3 Patient is positioned in front of the source 3 Image is recovered on X-Ray film or Matrix which is positioned behind the patient. is positioned behind the patient. 3 X-Ray tube outside the body 3 Patient is positioned in front of the source 3 Image is recovered on X-Ray film or Matrix which is positioned behind the patient. is positioned behind the patient.

12. 3 An advantage of radionuclide bone scanning is that the entire osseous system is demonstrated. that the entire osseous system is demonstrated. 3 It relatively nonspecific and the history and correlation with other imaging modalities is correlation with other imaging modalities is necessity. necessity. 3 An advantage of radionuclide bone scanning is that the entire osseous system is demonstrated. that the entire osseous system is demonstrated. 3 It relatively nonspecific and the history and correlation with other imaging modalities is correlation with other imaging modalities is necessity. necessity.

13. 32 yo s/p trauma

14. TRAUMA

15. Indirect Signs of Thoracic Indirect Signs of Thoracic Spine Injury Spine Injury 3 Paravertebral hematoma 3 Mediastinal widening 3 Pleural fluid (hemothorax) 3 Sternal fracture 3 Rib fractures & costovertebral dislocations dislocations 3 The double spinous process sign

16. DEGENERATIVE CHANGES / ARTHRITIS

17. 5 2 Extruded disc

18. L 5 - S 1 HERNIA

19. MIGRATED L5-S1 HERNIA C # 1765

20. CYST SUBCHONDRAL SCLEROSIS ARTICULAR SPACE NARROWING ARTICULAR SPACE NARROWING OSTEOPHYTE BUTTRESS SUPERIOR AND LATERAL MIGRATION

21. HAND X-RAY: THUMB OSTEOARTHRITIS, SPACE NARROWING, OSTEOPHYTES, CYSTS, SCLEROSIS, TRAPEZIUS DEFORMITY. HAND X-RAY: THUMB OSTEOARTHRITIS, SPACE NARROWING, OSTEOPHYTES, CYSTS, SCLEROSIS, TRAPEZIUS DEFORMITY.

23. RA CARPAL DESTRUCTION PENCILINGRA PENCILING C # 2520

24. GOUT: CRYSTAL DEPOSITS AND MARGINAL EROSIONS C # 794

25. METABOLIC DISEASE/ OSTEOMALACIA

26. BONE DENSITOMETRY OF THE LUMBAR SPINE AP AND LATERAL VIEWS VALUES WITHIN THE INFERIOR NORMAL LIMIT. BONE DENSITOMETRY OF THE LUMBAR SPINE AP AND LATERAL VIEWS VALUES WITHIN THE INFERIOR NORMAL LIMIT.

27. D SMALL EPIPHYSIS C METAPHYSEAL DEFORMATION (CUP) B IRREGULAR METAPHYSIS A PROVISIONAL CALCIFICATION E CORTICO-MEDULLARY INDIFFERENTIATION E CORTICO-MEDULLARY INDIFFERENTIATION RICKETSRICKETS

28. TUMORS

29. NON OSSIFYING FIBROMA FIBROMA 1 A: GEOGRAPHIC WELL DEFINED, SCLEROTIC MARGINS 1 A: GEOGRAPHIC WELL DEFINED, SCLEROTIC MARGINS

30. NON OSSIFYING FIBROMA FIBROMA 1 A: GEOGRAPHIC WELL DEFINED, SCLEROTIC MARGINS 1 A: GEOGRAPHIC WELL DEFINED, SCLEROTIC MARGINS

31. CENTRALOSTEOSARCOMA OF THE FEMUR, SKIP MTT CENTRALOSTEOSARCOMA OF THE FEMUR, SKIP MTT 1 2 2 3 3 2 2 2 2 4 4

32. Hx OF INDOLENT PAIN Hx OF INDOLENT PAIN

36. Fractures