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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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methodes de radio imagerie
METHODES DE RADIO-IMAGERIE
  • RADIOGRAFIA STANDARD/DIGITALA;
  • ULTRASONOGRAFIA=>P.MOI ARTICULARE
  • CT;
  • IRM;
  • SCINTIGRAMA OSOASA;
slide3

ANATOMIE

RADIOLOGICA:

STRUCTURA

HAVERSIANA

NORMALA

slide4

CT-VERTEBRO

DISCALA:

Hernie de disc

slide5

T 1

T 2

SAGITAL

Hernie discala

IRM:STUDIUL COL.VERTEBRALE & CANAL RAHIDIAN

slide6

Focar de necroza in scafoid

B

A

menisc

IRM:PUMN CORONAL(A)

GENUNCHI SAGITAL(B)

semiologie radiologique de l os
SEMIOLOGIE RADIOLOGIQUE DE L’ OS

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

slide8

NORMAL

OSTEOPOROZA:STUDIU COMPARATIV PE RADIOGRAFIE STANDARD.

slide9

OSTEOLIZA VERTEBRALA

(metastaze osoase)

slide10

RAHITISM FLORID

PSEUDARTROZA

SEMEIOLOGIE RADIOLOGICA:osteoporoza, osteocondensare,

scoliostoza, oedostoza

slide11

SEMEIOLOGIE:

SCOLIOSTOZA,

OSTEOPOROZA,

OSTEOSCLEROZA

(remaniere complexa)

BOALA PAGET

pathologie de l os
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
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.

ost omy lite
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.
slide15

PROFIL

PA

Ostéomyélite:

EXTENZIA

DIAFIZO-METAFIZARA

Focar de osteoliza metafizar

Reactie periostala si abces subperiostic

slide16

Geoda +sechestru

CT,RECONSTRUCTIE 3 D:

Ostéomyélite

slide17

Ostéomyélite:

COMPLICATII:

artrita sold,necroza

capului femural,

subluxatie coxo-fem.

secundara,tulb.de

crestere femur.

slide18

Tija centromedulara

Reactie

periostala

osteoliza

OSTEITA/MIELITA POST -INTERV.CHIRURGICALA (fractura)

os tumeurs
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
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.

fibrom
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.

slide24

TUMORI OSOASE BENIGNE

FIBROM OSOSCHIST OSOS ESENTIAL

encondrom
Encondrom

radiografie

IRM,T 1/T 2,CORONALA

tumora cu mieloplaxe celule gigante
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

slide28

omoplat

TUMORA

CU

MIELOPLAXE

osteosarcom
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.

slide31

OSTEOCONDENSANT

OSTEOSARCOM:

TIPURI SI VARIANTE

RADIOLOGICE

OSTEOLITIC

PERIFERIC

OSTEOLITIC

CENTRAL

PERIFERIC,RADIAR

slide33

OSTEOSARCOM

PERIFERIC FEMUR

TIP RADIAR

sarcom ewing
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.

slide36

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.

slide37

normal

SARCOM EWING FEMUR: RADIOGRAFIE DIGITALA & CT

slide38

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

slide41

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.

slide42

A

B

Cancer mamar

Cancer prostatic

METASTAZE OSOASE: A)OSTEOLITICE;B) OSTEOPLASTICE

slide44

CANCER MAMAR T-4

METASTAZE OSOASE OSTEOPLASTICE:pete de ceara (Reboul)

afectiuni osteo articulare
AFECTIUNI OSTEO-ARTICULARE
  • ARTRITE SUPURATE-ACUTE
  • OSTEO-ARTRITE CRONICE

-NESUPURATE

-SUPURATE:TBC

slide48

SPONDILITA ANKILOZANTA;EXTENZIE

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

sindesmofite

slide49

POLIARTRITA

REUMATOIDA:

DEBUT/STARE

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

slide51

Mina “in grifa”

POLIARTRITA REUMATIDA: STADIU AVANSAT

slide53

-scleroza platourilor; -pensare spatiu discal;-osteofitoza

SPONDILARTROZA DEFORMANTA

slide54

osteofite

SPONDILARTROZA DEFORMANTA

slide56

ARTROZA AVANSATA

DE

GENUNCHI

(GONARTROZA)

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

la tuberculose ost oarticulaire
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.

slide58

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

LAT

AP

MORB POTT:LEZIUNI MINIMALE LOMBARE

slide60

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

Extenzie :focare ischio-pubiene

Artroza/anchiloza

COXITA TBC: EVOLUTIE; COMPLICATII

slide61

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

slide62

OSTEOLIZA EPIFIZARA OLECRAN;osteoporoza

TUBERCULOZA COTULUI:PERIOADA DE STARE

slide63

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 ost o articulaires
Autres maladies ostéo-articulaires
  • HERNIA DISCALA;
  • DISCARTROZA
irm hernie discal
IRM : Hernie discală

Protruzie discală focală

Sectiune axiala

Sectiune sagitala

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