Imagingofmusculoskeletalsystem骨肌系統影像學：正常及變異

醫學影像學教研室吳仁華第1頁WhatisRadiology.Radiation(usesanddangers)TypesofimagingmodalitiesKnowledgeofAnatomy,physiology,pharmacology,clinicalmedicineimportant.Physiology,pharmacology,anatomy,pathologytoexplainchangesonX-raysWhydoneedtoknowaboutradiologyYouasaphysicianwillneedknowledgeofallmodalitiesforpatientssymptoms.AsasubspecialtycareerImagingofmusculoskeletalsystem第2頁?Youallwillhavegraduatedandbeephysicians?Patientswillvisityouinyournewoffice.?Theywillhaveallkindsofsymptoms!SeveralYearsLater第3頁Visitingaphysicianforfollowingreasons:1:Yearlycheckup2:Surveillancefordetectingdiseaseearly

(e.g–bonetumor)3:Chronicsymptoms

(e.g-chronicbackpain)4:Acutesymptoms

(e.g-fracture)Whypatientvisitsadoctor第4頁Investigatingpatient'ssymptoms1:Historytaking2:Physicalexamination3:Laboratorytests(e.g.bloodwork)4:X-rayinvestigations5:Treatment(medicalorsurgical)第5頁X-rayInvestigations1:WhatareX-rays2:Differenttypesofradiologictests3:Examplesofclinicalscenarios&radiologicinvestigations第6頁“IhavediscoveredsomethinginterestingbutIdonotknowwhetherornotmyobservationsarecorrect”.WilhelmConradRoentgen,1895ThediscovererofX-RAYS第7頁WhatareX-Rays?

Aformofelectromagneticradiationwithshortwavelength(between10-2and10nm)X-raysaregeneratedbyusingahighvoltagecurrenttoaccelerateelectronswithinevacuatedglasstubes,towardsatungstentargetcathodeAnode陽極evacuatedglasstube真空球管X-raysX線tungstentarget鎢靶electronbeam電子束第8頁18952023TheX-rayLabThen&NowRoentgen’sFirstLabX-rayLabof2023第9頁TheFamousFirstRadiographRadiographbyRoentgenon22December19851895TheradiographofMrs.Roentgen'shand.Radiographofhand2023第10頁Photographofahandduringprogressiveradiationexposureresultinginnecroses.EffectsofRadiationRadiosensitiveorgans

-Ovaries,testis軟巢睪丸

-Thyroid甲狀腺 -Fetus胎兒 -GItract胃腸道

RadiationdamageisDosedependentFactorstoreducedoseReduceunnecessarystudiesUsenon-radiationstudiesUltrasound,MRI第11頁X-RAYSULTRASOUNDPUTEDTOMOGRAPHY(CT)NUCLEARMEDICINEANGIOGRAPHYMAGNETICRESONANCEIMAGING(MRI)POSITRONEMISSIONSCANNING(PET)TYPESOFIMAGINGINRADIOLOGYDEPARTMENT第12頁HowisanX-rayImageobtainedTheX-rayspassthroughthebodyandaredetectedonphotographicfilmplacedbehindthepatientX-raycassette暗盒(withfilm)X-rayTubeX-rayphotons第13頁第14頁Howandwhydoradiographsappearblack&whiteItstartedwiththeX-rayfilm(GELATINWITHSILEVRBROMIDEcyrstals)Filmhassilverhalide鹵化物

X-raybeamhitthesilverbromide溴化銀turnsintoblackwhendevelopedWhennox-rayphotonstrikesthefilm,itremainswhiteTheBlackandWhiteofRadiographs第15頁leadbariumsulfatebonemuscleliver(eg)fatairX-rayfilmWHATFACTORSDETERMINETHEBLACK&WHITEDifferentmaterialsabsorbX-raystodifferingdegreesDependsontheatomicnumberofelement第16頁WhatisUltrasound?SoundwaveswithfrequenciesabovetherangeofhumanhearingultrasoundAnarrowbeamofhighenergysoundwavesisdirectedintothepatient’sbodyThemannerinwhichthesoundisreflectedbackfromvarioustissuesisrecorded第17頁WhyUseUltrasound?

CheaperthanCTorMRI

Patientisnotexposedtoionizingradiation

Equipmentisveryportable,thereforecanbeusedonpatientstoosickorinjuredtobemovedfromtheirbedsUltrasoundofthefetalhead(inutero)第18頁WhatisComputedTomography?AnX-raybasedtechniqueTheX-raytube,alongwithanarrayofdetectors,arerotatedinaplanearoundthepatientgantryX-raytubedetectorarraydirectionofrotationpatient(doesn’tmove)X-raybeam第19頁CTSCANOFTHEPELVIS第20頁WhatisNuclearImaging?AradioactiveisotopeandinjectedintothepatientTheisotopeistakenupbytheorganortissueofinterest(physiologicexamination)TheisotopeemitsgammarayswhicharethendetectedbyagammacameraAtechnetium锝-99bonescan第21頁WhatisMagneticResonanceImaging?InvolvesmeasuringthebehaviourofprotonsindifferentchemicalenvironmentswhenexposedtoamagneticfieldPatientsarenotexposedtoionizingradiationMid-saggitalMRscanofthehead第22頁TheBenefitsofMRITheidealmodalityforimagingsofttissues第23頁ProtonpossesspositivechargeMagneticfieldsApplyingexternalstrongmagneticfieldtoprotonsMagneticResonanceImagingBasicprinciples第24頁MRI:Femur&Quadricepsmuscle第25頁TRICKSOFTHETRADEUsuallyit’sallinBLACK&WHITE!第26頁Whatdoyousee?Therearetwowomen,ayoungandoldone“YouseewhatyoulookforYourecognisewhatyouknow”第27頁Whatdoyouseehere?MRIScan第28頁SHEEPDOGWhatIsaw!第29頁GlutealmaximusmuscleRectumSacrumLowerbackmusclesMRIofthebuttocks第30頁LearnyouranatomywellImportantininterpretingradiographicstudiesYoumaywanttobeearadiologistANATOMY!ANATOMY!ANATOMY!第31頁AcuteConditions第32頁ClinicalScenarioCaseHistory:YoungpatientplayingbaseballinjuredelbowwhileslidingathomeplateWhattypeofX-raywouldyouorder? -CTscan -Plainfilmoftheelbow -MRI第33頁PATIENTELBOWNormalelbowLATERALVIEWSOFELBOW第34頁HumerusRadiusUlnaHumeralcondylesFracturedislocationoftheelbowjoint第35頁Howwouldyoutreatthispatient?1:DoCTscanofelbow2:Putacast3:CallOrthopedicsurgeon4:Sendpatienthome第36頁Complicationofelbowfracturedislocation-Brachialartery臂動脈injury(Especiallywithfracturesinthearea)第37頁Treatment:PatientwentstraighttosurgeryThedislocationwasreduced第38頁ChronicConditions第39頁ClinicalScenarioCaseHistory:Youngweightlifterwithsuddenonsetofneckpain第40頁PossibleDiagnosis:1:Fracturedcervicalbone骨折2:Slippedvertebraldisc椎間盤滑脫3:Musclesprain扭傷

4:Spinalcordtumor腫瘤第41頁NextInvestigations1:Seeasportsspecialist2:X-rayofthespine3:CTofthespine4:MRIofthespine第42頁DoctorfirstorderedCervicalspinex-rayLateralviewoftheC-spine第43頁LateralviewoftheC-spineSpinousprocessDiscspaceVertebralbodyC2C3C4C7C6C5Occipitalbonemandible第44頁MovietongueVertebralbodySpinalcordMRIoftheCervicalSpineSmalldiscprotrusionsesp.atC5-6levelDiscspaceDiscprotrusionC2C3C4C7C6C5第45頁CONCLUSIONS:1:X-RAYexamswhichusesradiation: -Plainfilm -CT -Nuclearmedicine

2:X-RAYstudiesthatDONOTuseradiation: -Ultrasound -MRI第46頁0510152025ChestSkullBrainCTThoracicspineKUBLumbarspineIVPUGIBariumEnemaCTchestCTAbdomenAPracticalApproachEffectiveDose(mSv)EffectiveRadiationdosesinRadiologicexaminations第47頁1:TherearemanyX-raytestsavailableforpt’ssymptoms2:Choosetherightonethatwouldgivethediagnosisearly3:Alwaysconsultaradiologistforadviceonwhichtestisappropriateforyourpatient.CONCLUSIONS:第48頁Imagingofmusculoskeletalsystem第49頁第50頁206bones.fiveorfourgroupsLongbones長骨

Shortbones短骨

Flatbones扁骨

Sesamoidbones子骨Irregularbones不規則骨第51頁第52頁第53頁第54頁2神經孔6椎小關節第55頁第56頁第57頁APviewLateralview

4髂嵴第58頁第59頁4肩峰突5關節窩6喙突第60頁12滑車13肱骨小頭7三角肌粗隆8內上髁脊15冠狀窩第61頁第62頁8豆9鉤第63頁第64頁第65頁LateralAPOblique第66頁第67頁Normalvariation第68頁Sesamoid子骨第69頁Sesamoid第70頁BoneIsland骨島第71頁AccessoryBones附骨第72頁AccessoryBones第73頁Fracture第74頁BoneIsland第75頁BoneIsland第76頁LumbarSacralization腰椎骶化第77頁Lumbarization骶椎腰花第78頁PermanentOsteoepiphyte永存骨骺第79頁

Diseaseisabnormalandoralteredanatomy

LEARNYOURANATOMYWELLNOW!!!

Itwillpayofflater!!!

Especiallyifyouplantobearadiologist.FINALPEARL第80頁PHYSICSOFRADIOLOGY第81頁PHYSICSOFRADIOLOGYTestyourknowledge X-rayfilmsareblackandwhite

CTscanimagesaremadeupofmanydots

EachdotrepresentsaCTnumbercalledHOUNSFIELDnumber第82頁leadbariumsulfatebonemuscleliver(eg)fatairX-rayfilmWhatareX-Rays?DifferentmaterialsabsorbX-raystodifferingdegrees第83頁LeadBariumBoneMuscleLiverFatAir