Imagerie ostéo-articulaire

1. Imagerie ostéo-articulaire

2. METHODES DE RADIO-IMAGERIE • RADIOGRAFIA STANDARD/DIGITALA; • ULTRASONOGRAFIA=>P.MOI ARTICULARE • CT; • IRM; • SCINTIGRAMA OSOASA;

3. ANATOMIE RADIOLOGICA: STRUCTURA HAVERSIANA NORMALA

4. CT-VERTEBRO DISCALA: Hernie de disc

5. T 1 T 2 SAGITAL Hernie discala IRM:STUDIUL COL.VERTEBRALE & CANAL RAHIDIAN

6. Focar de necroza in scafoid B A menisc IRM:PUMN CORONAL(A) GENUNCHI SAGITAL(B)

7. SEMIOLOGIE RADIOLOGIQUE DE L’ OS MODIFICATIONS DE STRUCTURE:1. Résorption: l'ostéoporose                                        -Lysis                                        -ostéonécrose2.OSTEOCONDENSATION (OSTEOSCLEROSE)                                        -PERIOSTOSE                                        -ENDOSTOSE                                        -SPONGIOSCLEROSE

8. NORMAL OSTEOPOROZA:STUDIU COMPARATIV PE RADIOGRAFIE STANDARD.

9. OSTEOLIZA VERTEBRALA (metastaze osoase)

10. RAHITISM FLORID PSEUDARTROZA SEMEIOLOGIE RADIOLOGICA:osteoporoza, osteocondensare, scoliostoza, oedostoza

11. SEMEIOLOGIE: SCOLIOSTOZA, OSTEOPOROZA, OSTEOSCLEROZA (remaniere complexa) BOALA PAGET

12. PATHOLOGIE DE L’OS • TRAUMATISME:-fracturi,luxatii,entorse; • BOLI INFLAMATORII:acute,cronice;osteite,osteomielite; • TUMORI:benigne;potential maligne;maligne:primitive,metastatice • NECROZE ASEPTICE • DISPLAZII;DISTROFII

13. PATHOLOGIE OSTEO-ARTICULAIRE Maladies articulaires aigue:             -Nesuppure: => RAA             -suppuré => arthrite (stafilo / streptomycine)Les maladies chroniques communes:             -Nesuppure: PR, SA, l'arthrose, métaboliques, neuropathique;             -suppuré: à confirmer.

14. Ostéomyélite • ASPECTE RADIOLOGICE • DEBUT:osteoporoza localizata metafizar;dg.dificil=>IRM, • scintigrafie polinucleare marcate Ga-67; • STARE:-osteoliza “patata”; • -tumefactie de parti moi; • -necroza septica=>halou + sechestre; • -periostita=>mansoane,grosiera,extenzie diafizara; • -abces subperiostal; • -fistulizare in partile moi periosoase.

15. PROFIL PA Ostéomyélite: EXTENZIA DIAFIZO-METAFIZARA Focar de osteoliza metafizar Reactie periostala si abces subperiostic

16. Geoda +sechestru CT,RECONSTRUCTIE 3 D: Ostéomyélite

17. Ostéomyélite: COMPLICATII: artrita sold,necroza capului femural, subluxatie coxo-fem. secundara,tulb.de crestere femur.

18. Tija centromedulara Reactie periostala osteoliza OSTEITA/MIELITA POST -INTERV.CHIRURGICALA (fractura)

19. OS TUMEURS BENIGNE PRIMAREMALIGNE PRIMARE OSTEOM OSTEOSARCOM FIBROM FIBROSARCOM HEMANGIOM ANGIOSARCOM CONDROM CONDROSARCOM T.MIELOPLAXE SARCOM MEDULAR -EWING; -JAKSON-PARKER MIELOM MALIGNE SECUNDARE: metastaze,leucemii,limfoame

20. OSTEOM ORIGINE:Tesut osos adult, supercompact, benign. CLINIC: lent evolutiv;nu metastazeaza! SEDIU: sinus frontal, oase craniene. ASPECT RADIOLOGIC: osteocondensat, compact, intens opac, omogen, oval / rotund, contur policiclic; DG.DIFERENTIAL: meningiom osteoplastic. VARIANTA:OSTEOMUL OSTEOID=>unii anat.patologi sustin ca este o displazie sau osteita cronica si nu tumora…! SEDIU: diafiza os lung ASPECT: focar osteolitic 4-10 mm(NIDUS), cu sechestru mic central; hiperostoza / scleroza in jur, bombeaza subperiostal, in partile moi.

21. OSTEOM DE SINUS FRONTAL

22. FIBROM ORIGINE: Tesut conjunctiv neosificat-intraosos SEDIU:-metafiza / diafiza oaselor lungi -mandibula=>”epulis” ASPECT RADIOLOGIC:-zona osteolitica, cu inel net de scleroza in jur; -contur ciclic -osul adiacenr nemodificat -fara reactie periostala.

23. OSTEOFIBROM EXTREMITATE INFERIOARA FEMUR

24. TUMORI OSOASE BENIGNE FIBROM OSOSCHIST OSOS ESENTIAL

25. Encondrom radiografie IRM,T 1/T 2,CORONALA

26. TUMORA CU MIELOPLAXE(CELULE GIGANTE) SEDIU:epifiza oase lungi(tibie, femur), os plat. ASPECTE RADIOLOGICE:-zona osteolitica cu septuri fine, (“bule de sapun”), bombare periostica epifizo-metafizara, -aspect multiloculat, contur net corticala subtiata dar vizibila, aspect de “os suflat” EVOLUTIE:-PUSEE OSTEOLITICE=>septurile se subtiaza/ raresc, dispar; corticala poate fi lizata complet pe alocuri; tumora se extinde in partile moi; degenerescenta maligna. DG. DIFERENTIAL:-mielom solitar, encondrom, chist osos esential

27. TUMORA CU MIELOPLAXE EXTREMITATEA SUPERIOARA TIBIE

28. omoplat TUMORA CU MIELOPLAXE

29. T.MIELOPLAXE SACRUM

30. OSTEOSARCOM ORIGINE: osteocit matur; monostic, monotop; agresiv, metastaze TIPURI: osteolitic, osteoplastic SEDIU: metafiza oaselor lungi; distruge corticala, invazie parti moi ASPECT RADIOLOGIC:TIP OSTEOLITIC:- la debut- perferic sau central; lacuna cu contur neregulat -pinten sarcomatos CODMANN (“triunghiul mortii”)=reactia periostala limitata + decolarea periostului / distructie periostala; TIP OSTEOPLASTIC: osteoliza + reactie periostala exuberanta, cu aspect radiar (“spiculi perpendiculari pe diafiza”,in perie”); respecta epifiza EVOLUTIE:- METASTAZEAZA RAPID (pulmon, creier, ficat) - fracturi patologice; invazia articulatiei vecine.

31. OSTEOCONDENSANT OSTEOSARCOM: TIPURI SI VARIANTE RADIOLOGICE OSTEOLITIC PERIFERIC OSTEOLITIC CENTRAL PERIFERIC,RADIAR

32. OSTEOSARCOM OSTEOPLASTIC RADIUS

33. OSTEOSARCOM PERIFERIC FEMUR TIP RADIAR

34. OSTEOSARCOM:CT EVALUEAZA EXTENZIA

35. SARCOM EWING ORIGINE: SARCOM MEDULOGEN; reticulosarcom infantil SEDIU: metafizo-diafizar, tibie, femur, coaste; ASPECT RADIOLOGIC:-osteoliza central medulara -uzura compactei din interior -reactie periostala “in foi de bulb de ceapa” (mansoane fine, concentrice); -”suflare”, “in butoi” a diafizei (OEDOSTOZA). EVOLUTIE: -metastazeaza in acelasi os si in alte oase, in viscere.

36. Reactie periostala ”foi de ceapa” SARCOM EWING: SCHITA osteoliza -zona de osteoliza centrala,ce distruge compacta dinspre canal; -extenzie metafizo-diafizara; -reactie perostala tipica,”in foi”-mansaoane fine suprapuse.

37. normal SARCOM EWING FEMUR: RADIOGRAFIE DIGITALA & CT

38. MIELOM (PLASMOCITOM) ESTE CEA MAI FRECVENTA TUMORA MALIGNA PRIMARA A OSULUI ORIGINE:-celule plasmocitare medulare (monoclonala) -marker: proteinurie BENCE JONES. SEDIU:-maduva hematogena=>adult Tip multiplu => b. RUSTITKI-KHALER Tip solitar => PLASMOCITOM (rara) ASPECT RADIOLOGIC: -zone osteolitice -aspect de “panou gaurit” (tipic la craniu) -tasari vertebrale;coaste, os lung cu aspect suflat

39. MIELOM MULTIPLU; leziuni osteolitice craniu + CV

40. MIELOM MULTIPLU; leziuni osteolitice craniu + humerus

41. TUMORI MALIGNESECUNDARE METASTAZE OSOASE (cancer osos metastatic) CLINIC: cancer declarat / operat / ocult (cauta sin, prostata, pulmon, tiroida, rinichi etc). LOCALIZARE:coloana vertebrala, basin, coaste. TIPURI:OSTEOLITICE, OSTEOPLASTICE, MIXTE OSTEOLITICE:-osteoliza progresiva: zone lacunare fara delimitare, fara reactie periostala -fracturi secundare=>paraplegii, pareze etc. OSTEOPLASTICE: -zone dense , patate (“pete de ceara” descrise de REBOUL), confluate; rare= cancerul prostatei, vezicii, sinului. MIXTE:-alternanta liza / condensare pe aceleasi sedii topogr.

42. A B Cancer mamar Cancer prostatic METASTAZE OSOASE: A)OSTEOLITICE;B) OSTEOPLASTICE

43. METASTAZE OSTEOLITICE BASIN

44. CANCER MAMAR T-4 METASTAZE OSOASE OSTEOPLASTICE:pete de ceara (Reboul)

45. AFECTIUNI OSTEO-ARTICULARE • ARTRITE SUPURATE-ACUTE • OSTEO-ARTRITE CRONICE -NESUPURATE -SUPURATE:TBC

46. SPONDILITA ANKILOZANTA: SINDESMOFITE

47. SPONDILITA ANKILOZANTA:SINDESMOFITE CERVICALE

48. SPONDILITA ANKILOZANTA;EXTENZIE -artrita coxo-femurala; -anchiloza artrita/artroza sec. sindesmofite

49. POLIARTRITA REUMATOIDA: DEBUT/STARE -osteoporoza dominant metafizo-epifizara si carpiana;-micro geode epifizare falangiene;-mici subluxatii interfalangiene;-ingustare a spatiilor articulare interfalangiene

50. POLIARTRITA REUMATOIDA:PERIOADA DE STARE