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1、Muscular and Skeleton SystemInfection of bone,joint and soft tissue化脓性骨髓炎(purulent osteomyelitis)金黄色葡萄球菌(staphylococcus aureus)Infection pathway血行感染(haematogenous spread)直接延伸(direct extend)开放性骨折(open fracture)Acute Purulent Osteomyelitisclinicalsymptom：pathology：metaphysiscortexofbonesubperiosteumab
2、scessmedullarycavityofbonesequestrum(死骨）plerosis(修复)Acute Purulent OsteomyelitisX-ray film：Soft tissueMuscle interspace cloudingSubcutaneous fat cloudingboneDestruction of boneSequestrum(死骨)Parallel periosteal proliferation(平行骨膜反应） Acute Purulent OsteomyelitisCTCT：It is better than X-ray plain film.
3、 Acute Purulent OsteomyelitisMRIMRI：It is better than X-ray and CT. It can make early diagnosis, low signal in T1WI and high signal in T2WI. The wall of the abscess should be enhancement after injection of Gd-DTPA.急性化脓性骨髓炎Acute Purulent Osteomyelitis双侧胫骨骨髓炎Both tibiae acute purulent osteomyelitis胫骨中
4、下段感染胫骨中下段感染Chronic Purulent Osteomyelitis X-rayX-ray：bone hyperplasia or sclerosis, diaphysis asper(粗糙)，medullary cavity of bone narrow, destruction of bone, sequestrumCTCT：similar to X-rayMRIMRI：hyperostosis osteosclerosis(骨质增生硬化),sequestrum and periosteal proliferation are low signal. MRI can show
5、 abscess cavity and fistula cannulas(瘘管) high signal.Chronic Purulent Osteomyelitis(慢性骨髓炎)慢性硬化性骨髓炎（Garre Osteomyelitis ）Periostealproliferation(骨膜增生)，cortexthickening，osteosclerosis，medullarycavityconstrictionoremphraxis(闭塞),nodestructionandsequestrum慢性局限性骨髓炎（Brodie abscess of bone）Low toxicity(低毒性)
6、pyogenic infectionMetaphysis(干骺端)Light symptomRound destruction surrounded by osteosclerosis慢性局限性骨髓炎慢性局限性骨髓炎Brodie abscess of bonePyogenic ArthritisX-rayX-ray：articular capsule swelling, joint subluxation or dislocation，bone destruction(首先见于持重面），joint space constriction，even bone stiff(强直)CTCT：simil
7、ar to X-ray filmMRIMRI：MRI can display synovitis, hydrarthrosis, destruction of articular cartilage. It is better than X-ray and CT. 化化脓脓性性关关节节炎炎Pyogenic ArthritisTuberculosis of BoneX-ray filmX-ray filmTB of Long bone: epiphysis and metaphysis osteoporosis and destruction, sediment sequestrum(泥沙样死骨
8、)TB of Diaphysis：metacarpal bone(掌骨), metatarsal bone(跖骨)destruction, “tambour” (骨“气鼓”征)TB of Spine：collapse of vertebra，intervertebral space constriction, vertabral body confluence(融合)，cold abscess, calcification Tuberculosis of BoneCTCT：TB of bone：destruction of bone, sediment sequestrum, soft tis
9、sue swellingTB of spine: bone destruction, sequestrum, cold abscessMRIMRI：TB of spine脊柱结核TB of spineTuberculosis of JointX-ray filmX-ray filmSoft tissue swelling，joint space constriction，articular bone destruction(首先见于非持重面）Synovium TB of jointCT CT similar to X-ray filmMRIMRI hydrarthrosis, synovium
10、 swelling, articular cartilage and bone destruction, cold abscess关节结核(TB of joint) infection of soft tissueCTCT：hyperemia, edema, abscesshyperemia, edema, abscessMRIMRI：it is best for making it is best for making early diagnosis in infection of early diagnosis in infection of soft tissuesoft tissue膝
11、前皮下软组织脓肿膝前皮下软组织脓肿Chronic ArthritisRheumatoid Arthritis RAMultilationdisease(致残性疾病)SymmetricchronicpolyarthropathyIncidencerateisabout1%Episode(发病)age:40-70F/M:2-3/1Smalljoints:hand,wrist,footPIP，MCP（+）DIP（-）Rheumatoid Arthritis RA X-ray plain film X-ray plain film：Symmetrical fusiform(梭形) soft tissu
12、e swellingJoint space: widening-narrowingBone matrix erosion in border of articular sufaceArticular suface clouding，subchondral cysts Regional (periarticular) osteoporosis(骨质疏松)Amyotrophy(肌肉萎缩)，joint deformaton，fibrosum stiff，dislocation or subluxation Rheumatoid Arthritis RAMRIsynovitisearlymanifes
13、tationBoneerosionpannus(血管翳),granulationtissue(肉芽组织)SofttissuelesionEnhancement scanSynoviumenhancement5-10minutsAfterGd-DTPAinjectionDynamicalenhancementMRI clinical applicationEarlierdiagnosisProgressevaluationEffectevaluationRheumatoid Arthritis RARheumatoid ArthritisRheumatoid Arthritis RARheuma
14、toid Arthritis RA平扫增强Bone erosionSubchondral cysts and bone erosionsSESTIRSE C+ankylosing spondylitis(强直性脊柱炎)X-ray：sacroiliitis(骶髂关节炎),smallarthritis,ligamentcalcification“bamboospine”CT and MRI: similar to X-ray appearance骶髂关节解剖Degenerative Osteoarthropathy X-ray film：irregular joint space narrowin
15、g，marginal osteophytes(骨赘),subchondral cysts, joint corpus liberum(游离体)Spine degenerative osteoarthropathy：include disc degeneration, apophyseal joint osteoarthritis, spondylosis(关节强直） 关节软骨变薄关节软骨消失关节软骨肿胀 Metabolic and Endocrine Disease of the Skeleton Metabolic diseasesMetabolic diseasesVitamin D de
16、ficiency rickets：X-rayX-ray：osteomalacia，widening of the physis(骺), irregular metaphyseal margins，splaying and cupping of the metaphyses and costochondral junctions(串珠肋),bowing of the extremities(膝内翻或膝外翻), osteopenia(骨质减少） ischaemic necrosis of boneOsteosclerosis,delayinskeletalmaturationSmallepiphysis，flatfemoralhead，jointspacewideningShortneckoffemur，necrosisareashowhighdensityandcysticlowdensityMRIismoresensitivity79/M52/MSee you again!
