Part 3. Bones and Joints
Musculoskeletal Imaging Tamara Miner Haygood, MD, PhD Mohamed M. H. Sayyouh, MD
Techniques Conventional Radiography Mammographic Techniques Fluoroscopy Computed Tomography Magnetic Resonance Imaging Nuclear Medicine Biopsy Technique Selection Trauma Bone or Soft-Tissue Tumors
When Wilhelm Conrad Roentgen discovered the x-ray in November 1895, he investigated it thoroughly, testing its ability to penetrate various inanimate objects and observing its effects on fluorescent screens and photographic film. He gazed in amazement at the image of the bones of his own hand as he allowed the new rays to penetrate his flesh. He made a photographic x-ray image of a hand (reportedly his wife’s) and sent prints of it together with his paper describing the new phenomenon to a carefully selected list of scientific colleagues. By mid-February 1896, Roentgen’s paper had not only been published but also reprinted in other scientific journals including the American journal Science. Scientists everywhere repeated Roentgen’s simple experiments and confirmed the truth of his discovery. Within a year, x-rays were in widespread use for medical purposes—chiefly for imaging of the skeleton. Since Roentgen’s time, many new imaging techniques have been developed that allow radiologists to see the muscles and other soft tissues of the musculoskeletal system as well as the bones and to evaluate the amount of metabolic activity in the bones and soft tissues. These techniques make skeletal imag-
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Metastatic Tumors Infection Exercises 6-1 Trauma 6-2 Local Disease 6-3 Systemic Disease
ing an exciting area of radiology that can enhance patients’ quality of life. The techniques can also be very expensive, however. This chapter is intended to introduce you to musculoskeletal imaging techniques and to suggest efficient ways to use them that will help you to make correct diagnoses without excessive cost. Naturally, the suggestions made in these pages must be tailored to the needs of individual patients.
TECHNIQUES Conventional Radiography Conventional radiographs are the most frequently obtained imaging studies. They are chiefly useful for evaluation of the bones, but useful information about the adjacent soft tissues may also be obtained. Gas in the soft tissues may be a clue to an open wound, ulcer, or infection with a gas-producing organism. Calcifications in the soft tissues can indicate a tumor, myositis ossificans, or systemic disorders such as scleroderma or hyperparathyroidism.
