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Imaging Techniques for Musculoskeletal Disorders

 

Method

Current Indications

Ultrasound

  1. Synovial cysts
  2. Rotator cuff tears
  3. Tendon injury

99mTc Radionuclide scintigraphy

  1. Metastatic bone survey
  2. Evaluation of Paget's disease
  3. Acute and chronic osteomyelitis

111In-WBC Radionuclide scintigraphy

  1. Acute infection
  2. Prosthetic infection
  3. Acute osteomyelitis

67Ga Radionuclide scintigraphy

  1. Acute and chronic infection
  2. Acute osteomyelitis

CT

  1. Herniated intervertebral disk
  2. Sacroiliitis
  3. Spinal stenosis
  4. Spinal trauma
  5. Osteoid osteoma
  6. Stress fracture

MRI

  1. Avascular necrosis
  2. Osteomyelitis
  3. Intraarticular derangement and soft tissue injury
  4. Derangements of axial skeleton and spinal cord
  5. Herniated intervertebral disk
  6. Pigmented villonodular synovitis
  7. Inflammatory and metabolic muscle pathology
  1. Important D/Ds:

QDiffuse osteosclerosis ( increased bone density)

  1. Metastases
  2. Myelofibrosis
  3. Melorheostosis
  4. Mastocytosis
  5. Metabolic (Fluorosis)
  6. Hyperparathyroidism with renal osteodystrophy
  7. Hypervitaminosis
  8. Hypothyroidism
  9. Phosphorus poisoning
  10. Osteopetrosis
  11. Paget’s disease
  12. Pyknodysostosis
  13. Sickle cell disease, and tuberous sclerosis.

QPatchy sclerosis of skeleton

  1. Mast cell reticulosis/Mastocytosis/Urticaria pigmentosa
  2. Fluorosis
  3. Carcinomatosis/Metastasis
  4. Myelosclerosis
  5. Lymphoma
  6. Multiple myeloma

Lytic bone lesion surrounded by marked sclerosis are seen in:

  1. Brodie's Abscess (metaphyseal) Q
  2. Osteoblastoma (diaphyseal)
  3. Osteoid osteoma Q
  4. Stress fracture
  5. Tuberculosis

Causes of multilocular expansile osteolytic lesion of bone include:

  1. Aneurysmal bone cyst (diaphyseal)
  2. Giant cell tumor (epiphyseal) Q
  3. Fibrous dysplasia (diaphyseal)
  4. Simple bone cyst (meta or diaphyseal)

Causes of multiple lytic lesions in bone are:

  1. Metastasis (epiphyseal/diaphyseal)
  2. Fibrous dysplasia (diaphyseal/epiphyseal)
  3. Enchondroma (diaphyseal)
  4. Eosinophilic granuloma (epiphyseal)
  5. Hyperparathyroidism (Brown tumor)
  6. Hemangiomas
  7. Infection (epiphyseal)
  8. Multiple myeloma (epiphyseal)

Expansile lytic (bubbly) osseous metastases:

  1. Renal cell carcinomaQ                
  2. Carcinoma of Thyroid (Follicular type)
  3. Carcinoid tumor                   
  4. Osteosarcoma
  5. Choriocarcinoma                  
  6. Islet cell carcinoma of pancreas

Causes of lucent metaphyseal linesQ

  1. Normal variant                    
  2. Growth lines
  3. Leukemia                            
  4. Infection (congenital syphilis)               
  5. Neuroblastoma metastasis           
  6. Rickets                        
  7. Scurvy

Causes of dense metaphyseal bandsQ

  1. Normal variant                    
  2. Stress lines          
  3. Heavy metal poisoning         
  4. Hypervitaminosis D              
  5. Hypothyroidism                   
  6. Scurvy                 
  7. Treated rickets

Causes of cupped and frayed metaphyses are:Q

  1. Congenital infections (rubella, syphilis)         
  2. Hypophosphatasia
  3. Achondroplasia                                    
  4. QRickets
  5. Metaphyseal dysplasia                         
  6. Scurvy




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