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Imagerie ostéo-articulaire. METHODES DE RADIO-IMAGERIE. RADIOGRAFIA STANDARD/DIGITALA; ULTRASONOGRAFIA=>P.MOI ARTICULARE CT; IRM; SCINTIGRAMA OSOASA;. ANATOMIE RADIOLOGICA : STRUCTURA HAVERSIANA NORMALA. CT-VERTEBRO DISCALA: Hernie de disc. T 1. T 2. SAGITAL. Hernie discala.

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Imagerie ostéo-articulaire


METHODES DE RADIO-IMAGERIE

  • RADIOGRAFIA STANDARD/DIGITALA;

  • ULTRASONOGRAFIA=>P.MOI ARTICULARE

  • CT;

  • IRM;

  • SCINTIGRAMA OSOASA;


ANATOMIE

RADIOLOGICA:

STRUCTURA

HAVERSIANA

NORMALA


CT-VERTEBRO

DISCALA:

Hernie de disc


T 1

T 2

SAGITAL

Hernie discala

IRM:STUDIUL COL.VERTEBRALE & CANAL RAHIDIAN


Focar de necroza in scafoid

B

A

menisc

IRM:PUMN CORONAL(A)

GENUNCHI SAGITAL(B)


SEMIOLOGIE RADIOLOGIQUE DE L’ OS

MODIFICATIONS DE STRUCTURE:1. Résorption: l'ostéoporose                                        -Lysis                                        -ostéonécrose2.OSTEOCONDENSATION (OSTEOSCLEROSE)                                        -PERIOSTOSE                                        -ENDOSTOSE                                        -SPONGIOSCLEROSE


NORMAL

OSTEOPOROZA:STUDIU COMPARATIV PE RADIOGRAFIE STANDARD.


OSTEOLIZA VERTEBRALA

(metastaze osoase)


RAHITISM FLORID

PSEUDARTROZA

SEMEIOLOGIE RADIOLOGICA:osteoporoza, osteocondensare,

scoliostoza, oedostoza


SEMEIOLOGIE:

SCOLIOSTOZA,

OSTEOPOROZA,

OSTEOSCLEROZA

(remaniere complexa)

BOALA PAGET


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


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.


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.


PROFIL

PA

Ostéomyélite:

EXTENZIA

DIAFIZO-METAFIZARA

Focar de osteoliza metafizar

Reactie periostala si abces subperiostic


Geoda +sechestru

CT,RECONSTRUCTIE 3 D:

Ostéomyélite


Ostéomyélite:

COMPLICATII:

artrita sold,necroza

capului femural,

subluxatie coxo-fem.

secundara,tulb.de

crestere femur.


Tija centromedulara

Reactie

periostala

osteoliza

OSTEITA/MIELITA POST -INTERV.CHIRURGICALA (fractura)


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


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.


OSTEOM DE SINUS FRONTAL


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.


OSTEOFIBROM EXTREMITATE INFERIOARA FEMUR


TUMORI OSOASE BENIGNE

FIBROM OSOSCHIST OSOS ESENTIAL


Encondrom

radiografie

IRM,T 1/T 2,CORONALA


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


TUMORA CU MIELOPLAXE EXTREMITATEA SUPERIOARA TIBIE


omoplat

TUMORA

CU

MIELOPLAXE


T.MIELOPLAXE

SACRUM


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.


OSTEOCONDENSANT

OSTEOSARCOM:

TIPURI SI VARIANTE

RADIOLOGICE

OSTEOLITIC

PERIFERIC

OSTEOLITIC

CENTRAL

PERIFERIC,RADIAR


OSTEOSARCOM OSTEOPLASTIC RADIUS


OSTEOSARCOM

PERIFERIC FEMUR

TIP RADIAR


OSTEOSARCOM:CT EVALUEAZA EXTENZIA


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.


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.


normal

SARCOM EWING FEMUR: RADIOGRAFIE DIGITALA & CT


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


MIELOM MULTIPLU; leziuni osteolitice craniu + CV


MIELOM MULTIPLU; leziuni osteolitice craniu + humerus


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.


A

B

Cancer mamar

Cancer prostatic

METASTAZE OSOASE: A)OSTEOLITICE;B) OSTEOPLASTICE


METASTAZE OSTEOLITICE BASIN


CANCER MAMAR T-4

METASTAZE OSOASE OSTEOPLASTICE:pete de ceara (Reboul)


AFECTIUNI OSTEO-ARTICULARE

  • ARTRITE SUPURATE-ACUTE

  • OSTEO-ARTRITE CRONICE

    -NESUPURATE

    -SUPURATE:TBC


SPONDILITA ANKILOZANTA: SINDESMOFITE


SPONDILITA ANKILOZANTA:SINDESMOFITE CERVICALE


SPONDILITA ANKILOZANTA;EXTENZIE

-artrita coxo-femurala; -anchiloza artrita/artroza sec.

sindesmofite


POLIARTRITA

REUMATOIDA:

DEBUT/STARE

-osteoporoza dominant metafizo-epifizara si carpiana;-micro geode epifizare falangiene;-mici subluxatii interfalangiene;-ingustare a spatiilor articulare interfalangiene


POLIARTRITA REUMATOIDA:PERIOADA DE STARE


Mina “in grifa”

POLIARTRITA REUMATIDA: STADIU AVANSAT


POLIARTRITA REUMATOIDA: mina in “ feuille au vent”


-scleroza platourilor; -pensare spatiu discal;-osteofitoza

SPONDILARTROZA DEFORMANTA


osteofite

SPONDILARTROZA DEFORMANTA


ARTROZA DE GENUNCHI (“GONARTROZA”)


ARTROZA AVANSATA

DE

GENUNCHI

(GONARTROZA)

-productii osoase peri/intraarticulare de tip osteofitic;-deformari ale epifizelor(rotunjire,scleroza subchondrala


La tuberculose ostéoarticulaire

MECANISM:reactivare BK in sinoviala articulatiilor mari =>adolescent, adult; ANAT.PAT.:osteoartrita supurata cronica.

ASPECTE RADIOLOGICE:

DEBUT: -osteoporoza regionala;-pensare spatiu articular;

STARE:-geode / carii osoase ”in oglinda” pe extremitatile articulare, osteoliza progresiva=>caverne epifizare, abcese reci articulare;EVOLUTIE: -prabusiri articulare;disparitia spatiului articular; topiri osteolitice”=>sechestre mici;-ankiloze;-blocuri articulare

FORME TOPOPGRAFICE

1).TBC VERTEBRALA=MORB POTT:-vertebre pereche;”fus” paravertebral (abces rece fuzat=>psoas);-bloc vertebral, cifoza;

2)COXITA (coxalgia): distructie cap femural si acetabul; anchiloza / protruzie in pelvis;

3)”TUMORA ALBA DE GENUNCHI: artrita, fistule, ankiloza.


-pensare spatiu discal; -ostoporoza;-geoda “in oglinda” pe platourile adiacente;-tendinta la sudare vertebrala(“bloc”)

LAT

AP

MORB POTT:LEZIUNI MINIMALE LOMBARE


BLOC VERTEBRAL SECUNDAR MORBULUI POTT


-fractura fundului acetabular ;-protruzie a capului femural in pelvis

Extenzie :focare ischio-pubiene

Artroza/anchiloza

COXITA TBC: EVOLUTIE; COMPLICATII


TUBERCULOZA GENUNCHIULUI: “TUMORA ALBA DE GENUNCHI” ;LUXATIE SECUNDARA


OSTEOLIZA EPIFIZARA OLECRAN;osteoporoza

TUBERCULOZA COTULUI:PERIOADA DE STARE


TUBERCULOZA DE

PUMN

(RADIO-CARPIANA);

PERIOADA DE

STARE

-osteoliza extinsa la multiple oase carpiene;-distructie osteolitica si a epifizelor distale radius si cubitus; -tumefactie evidenta a partilor moi periarticulare;-osteoporoza marcata regionala.


Autres maladies ostéo-articulaires

  • HERNIA DISCALA;

  • DISCARTROZA


IRM : Hernie discală

Protruzie discală focală

Sectiune axiala

Sectiune sagitala


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