Bone and Joint Imaging

1454 Pages·2004·87.26 MB·English

by  Donald L. Resnick, Mark J. Kransdorf

Bone and Joint
IMAGING
T H I R D E D I T I O N
Donald Resnick, MD
Chief, Musculoskeletal Imaging
Professor of Radiology
University of California, San Diego
San Diego, California
Mark J. Kransdorf, MD
Chief, Musculoskeletal Imaging
Mayo Clinic
Jacksonville, Florida
Professor of Radiology
Mayo Clinic College of Medicine
Rochester, Minnesota
The Curtis Center
170 S Independence Mall W 300E
Philadelphia, Pennsylvania 19106
BONE AND JOINT IMAGING ISBN 0-7216-0270-3
Copyright © 2005, 1996, 1989 by Elsevier Inc.
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NOTICE
Radiology is an ever-changing field. Standard safety precautions must be followed, but as new research
and clinical experience broaden our knowledge, changes in treatment and drug therapy may become
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Library of Congress Cataloging-in-Publication Data
Resnick, Donald.
Bone and joint imaging/Donald Resnick, Mark J. Kransdorf. – 3rd ed.
p.; cm.
Includes bibliographical references and index.
ISBN 0-7216-0270-3
1. Bones—Imaging. 2. Joints—Imaging. 3. Bones—Diseases—Diagnosis.
4. Joints—Diseases—Diagnosis. I. Kransdorf, Mark J. II. Title.
[DNLM: 1. Bone Diseases—diagnosis. 2. Diagnostic Imaging—methods.
3. Joint Diseases—diagnosis. WE 141 R434b 2005]
RC930.5.R47 2005
616.7′10754–dc22 2003070436
Executive Editor:Allan Ross
Senior Developmental Editor:Janice M. Gaillard
Project Manager:Linda Lewis Grigg
Design Manager:Gene Harris
Printed in USA
Last digit is the print number: 9 8 7 6 5 4 3 2 1
To our residents and fellows
— for their motivation, enthusiasm, and, most important, inspiration
CONTRIBUTORS
Ronald S. Adler, M.D., Ph.D. Jerry R. Dwek, M.D.
Professor of Radiology, Cornell University Joan and Sanford Assistant Clinical Professor, University of California,
I. Weill Medical College and Graduate School of Medical San Diego, School of Medicine, La Jolla;
Sciences; Attending Radiologist, Hospital for Special Surgery, Department of Orthopaedic Surgery,
New York, New York Veterans Affairs San Diego Healthcare System,
San Diego, California
Diagnostic Ultrasonography
Developmental Dysplasia of the Hip
Wayne H. Akeson, M.D.
Emeritus Professor of Orthopaedics, University of California, Michael D. Fallon, M.D.*
San Diego, School of Medicine, La Jolla; Chief of Former Assistant Professor of Pathology, University of
Orthopaedics, Veterans Affairs San Diego Healthcare System, Pennsylvania School of Medicine, Philadelphia, Pennsylvania
San Diego, California *deceased
Articular Cartilage: Morphology, Physiology, and Function Histogenesis, Anatomy, and Physiology of Bone
Robert Downey Boutin, M.D. Frieda Feldman, M.D.
Executive Musculoskeletal Radiologist, Med-Tel International, Professor of Radiology, Columbia College of Physicians and
McLean, Virginia Surgeons; Attending Radiologist, New York Presbyterian
Muscle Disorders Hospital, New York, New York
Tuberous Sclerosis, Neurofibromatosis, and Fibrous Dysplasia
William Bugbee, M.D.
Assistant Professor, Department of Orthopaedics, Steven R. Garfin, M.D.
University of California, San Diego, Chairman, Department of Orthopaedic Surgery, University of
School of Medicine, La Jolla, California California, San Diego, University of California, San Diego,
Articular Cartilage: Morphology, Physiology, and Function Medical Center, San Diego, California
Imaging after Spinal Surgery
Constance R. Chu, M.D.
Assistant Professor, University of Pittsburgh School of Thomas G. Goergen, M.D.
Medicine; Director, Cartilage Restoration, University of Associate Clinical Professor, University of California,
Pittsburgh Medical Center, Pittsburgh, Pennsylvania San Diego, School of Medicine, La Jolla; Palomar Medical
Articular Cartilage: Morphology, Physiology, and Function Center, Escondido, California
Physical Injury:Concepts and Terminology
Christine B. Chung, M.D.
Assistant Professor of Radiology, University of California, Amy Beth Goldman, M.D.
San Diego, School of Medicine, La Jolla; Department of New York, New York
Radiology, Veterans Affairs San Diego Healthcare System,
Heritable Diseases of Connective Tissue, Epiphyseal
San Diego, California
Dysplasias, and Related Conditions
Developmental Dysplasia of the Hip
Guerdon D. Greenway, M.D.
James M. Coumas, M.D. Associate Clinical Professor, Department of Radiology,
Musculoskeletal Radiologist, Carolina Hospital Authority, University of California, San Diego, School of Medicine,
Charlotte, North Carolina La Jolla, California; Clinical Associate Professor, Department
Interventional Spinal Procedures of Orthopaedic Surgery, University of Texas Southwestern
Medical Center, Dallas; Attending Physician, Department of
Radiology, Baylor University Medical Center, Dallas, Texas
Murray K. Dalinka, M.D.
Professor of Radiology, Hospital of the University of Tumors and Tumor-like Lesions of Bone: Imaging and
Pennsylvania, Philadelphia, Pennsylvania Pathology of Specific Lesions
Radiation Changes
v
vi Contributors
W. Bonner Guilford, M.D. William H. McAlister, M.D.
Musculoskeletal Radiologist, Charlotte Radiology, Professor of Radiology and Pediatrics, Washington University
Carolina Healthcare System, Charlotte, North Carolina School of Medicine and Mallinckrodt Institute of Radiology;
Radiologist-in-Chief, St. Louis Children’s Hospital, St. Louis,
Interventional Spinal Procedures
Missouri
Parviz Haghighi, M.D., F.R.C.P.A. Osteochondrodysplasias, Dysostoses, Chromosomal
Aberrations, Mucopolysaccharidoses, and Mucolipidoses
Professor of Clinical Pathology, University of California,
San Diego; Staff Pathologist, Veterans Affairs Medical Center,
San Diego, California William A. Murphy, Jr., M.D.
John S. Dunn, Sr., Distinguished Chair and Professor of
Lymphoproliferative and Myeloproliferative Disorders
Radiology, University of Texas M. D. Anderson Cancer
Center, Houston, Texas
Tamara Miner Haygood, M.D., Ph.D.
Temporomandibular Joint
Radiology Associates, Corpus Christi, Texas
Radiation Changes
M. B. Ozonoff, M.D.
Salt Lake City, Utah
Thomas E. Herman, M.D.
Spinal Anomalies and Curvatures
Associate Professor, Mallinckrodt Institute of Radiology
and Washington University School of Medicine; Radiologist,
St. Louis Children’s Hospital, St. Louis, Missouri Mini N. Pathria, M.D.
Professor of Clinical Radiology, University of California,
Osteochondrodysplasias, Dysostoses, Chromosomal
San Diego, School of Medicine, La Jolla, California
Aberrations, Mucopolysaccharidoses, and Mucolipidoses
Imaging after Spinal Surgery; Physical Injury: Spine
Brian A. Howard, M.D., M.B.C.H.B.
Musculoskeletal Radiologist, Charlotte Radiology, Michael J. Pitt, M.D.
Carolina Healthcare System, Charlotte, North Carolina Professor of Radiology, University of Alabama School of
Medicine; Staff, University Hospital, UAB Children’s Hospital
Interventional Spinal Procedures
of Alabama, Birmingham, Alabama
Phoebe A. Kaplan, M.D. Rickets and Osteomalacia
Montreal, Quebec, Canada
Jeffrey S. Ross, M.D.
Temporomandibular Joint
Head, Radiology Research, and Staff Neuroradiologist,
Cleveland Clinic Foundation, Cleveland, Ohio
Michael Kyriakos, M.D.
Professor of Surgical Pathology, Washington University Spinal Imaging
School of Medicine; Senior Pathologist, Barnes Hospital,
St. Louis, Missouri David A. Rubin, M.D.
Associate Professor of Radiology, Washington University
Tumors and Tumor-like Lesions of Bone: Imaging
and Pathology of Specific Lesions School of Medicine; Director, Musculoskeletal Section,
Mal&linckrodt Institute of Radiology, St. Louis, Missouri
Laurence A. Mack, M.D.* Magnetic Resonance Imaging: Practical Considerations
Former Professor of Radiology, Adjunct Professor of
Orthopedics, and Director of Ultrasound, University of David J. Sartoris, M.D.*
Washington, Seattle, Washington Former Professor of Radiology, University of California,
*deceased San Diego; Chief, Quantitative Bone Densitometry,
UCSD Medical Center; Professor of Radiology, Veterans
Diagnostic Ultrasonography
Affairs Medical Center and Scripps Clinic, Green Hospital,
La Jolla, California
John E. Madewell, M.D.
*deceased
Professor of Radiology and Director of Clinical Radiology
Operations, University of Texas M. D. Anderson Cancer Developmental Dysplasia of the Hip
Center, Houston, Texas
F. William Scheible, M.D.
Osteonecrosis: Pathogenesis, Diagnostic Techniques,
Specific Situations, and Complications Radiology Consultants of Iowa, Cedar Rapids, Iowa
Diagnostic Ultrasonography
Stavros C. Manolagas, M.D., Ph.D.
Professor of Medicine and Director, Division of Robert Schneider, M.D.
Endocrinology and Metabolism, University of Arkansas for Associate Professor of Radiology, Cornell University Joan
Medical Sciences, Little Rock, Arkansas and Sanford I. Weill Medical College and Graduate School of
Histogenesis, Anatomy, and Physiology of Bone Medical Sciences; Attending Radiologist, Hospital for Special
Surgery, New York, New York
Radionuclide Techniques
Contributors vii
Carolyn M. Sofka, M.D. Barbara N. Weissman, M.D.
Associate Professor of Radiology, Cornell University Joan Professor of Radiology, Harvard Medical School; Vice Chair
and Sanford I. Weill Medical College and Graduate School for Ambulatory Services, Brigham and Women’s Hospital,
of Medical Sciences; Assistant Attending Radiologist, Boston, Massachusetts
Hospital for Special Surgery, New York, New York
Imaging after Surgery in Extraspinal Sites; Imaging of Joint
Diagnostic Ultrasonography Replacement
Donald E. Sweet, M.D.*
Former Clinical Professor of Pathology, Georgetown University
School of Medicine, Washington, D.C.; Clinical Professor
of Pathology, Uniformed Services University of Health
Sciences, Bethesda, Maryland; Chairman, Department of
Orthopedic Pathology, Armed Forces Institute of Pathology,
Washington, D.C.
*deceased
Osteonecrosis: Pathogenesis, Diagnostic Techniques,
Specific Situations, and Complications
PREFACE
Nine years after the publication of the second edition of niques, and postoperative imaging serve as introductory
Bone and Joint Imaging and a few years after the material; this material is then followed by sections deal-
publication of the fourth edition of the larger Diagnosis ing with imaging of most of the important diseases that
of Bone and Joint Disorders, the third edition of Bone affect the musculoskeletal system. Key images have been
and Joint Imaging is now ready for dissemination. In selected to illustrate the most important of the imaging
common with the first and second editions of this text, findings, and a short but appropriate bibliography is
the purpose of this book is to present in a logical manner included in each chapter. As before, we have included
and easy-to-read format the information that we, the shortened versions of many chapters written by experts in
authors, believe is essential for those learning muscu- the field that were part of the larger multivolume text-
loskeletal imaging for the first time or for those review- book. When compared with the second edition, however,
ing the subject one more time. The subject of muscu- there are significant changes in this third edition. Many
loskeletal imaging is ever changing and constantly subjects appear for the first time, countless new and
growing in scope. Much of this growth relates not to the improved illustrations are included, and references are
discovery of new processes or disorders but rather to the updated. And to do this properly and on time, two editors
development and refinement of advanced imaging methods rather than one have accomplished this task.
and techniques. Diagnostic methods now applied routinely Both of us are confident that we have succeeded in
to the analysis of musculoskeletal disorders include far condensing the essential material related to musculoskeletal
more than conventional radiography: CT scanning, MR imaging in a manageable textbook. But it is the readers
imaging, ultrasonography, radionuclide studies, and who are the ultimate judge. We are hopeful that whether
arthrography are among the additional methods that it is used for consultation on an intermittent basis or read
must be mastered by those interpreting images related to in its entirety, the readers will enjoy the experience and
bone, joint, and soft tissue disorders. To summarize ade- be wiser for it.
quately the many imaging techniques and findings in a
text any shorter than this, in our view, would not be DONALDRESNICK
appropriate or even possible. MARKJ. KRANSDORF
The organization of the text follows that of the previous
edition. Basic anatomy and physiology, diagnostic tech-
ix
ACKNOWLEDGMENTS
We are greatly indebted to a number of individuals with- We would also like to acknowledge those individuals
out whom this project would not be possible. This includes whose dedication, commitment, and energy often go
our many contributing authors, all of whom are highly unnoticed but who keep the system running smoothly
regarded educators and experts in their respective fields. and on time: our administrative assistants Michael
Their efforts are very much appreciated. Holbrook, Debra Trudell, and Pamela J. Chirico.
A very special thanks must go to Allan Ross, Executive
Editor, and his associates at Elsevier: Janice M. Gaillard,
Senior DevelopmentalEditor; Linda Lewis Grigg, Project
Manager, Book Production; and Walter Verbitski,
Illustration Specialist.
x
SECTION
I
Basic Science
C H A P T E R 1
Histogenesis, Anatomy, and sheetlike arrangement of osseous tissue, termed parallel-
fibered, or lamellar, bone. As a connective tissue, bone is
Physiology of Bone
highly specialized and differs from other connective tissue
by its rigidity and hardness, which relate primarily to the
inorganic salts that are deposited in its matrix. These
Donald Resnick, Stavros C. Manolagas,
properties are fundamental to a tissue that must maintain
and Michael D. Fallon the shape of the human body, protect its vital soft tissues,
and allow locomotion by transmitting from one region of
the body to another the forces generated by the contrac-
tions of various muscles. Bone also serves as a reservoir
SUMMARY OF KEY FEATURES
for ions, principally calcium, that are essential to normal
Bone is a unique tissue that is constantly undergoing fluid regulation; these ions are made available as a response
change. It develops through the processes of to stimuli produced by a number of hormones, particu-
endochondral and intramembranous ossification and is larly parathyroid hormone, vitamin D, and calcitonin.
subsequently modified and refined by the processes of
modeling and remodeling to create a structurally and
HISTOGENESIS
metabolically competent, highly organized architectural
marvel. Its cells, including osteoblasts, osteocytes, and Developing Bone
osteoclasts, reside in organic matrix, primarily collagen,
Bone develops by the process of intramembranous bone
and inorganic material is deposited in a form that
formation (transformation of condensed mesenchymal
resembles hydroxyapatite. The process of mineralization
tissue), endochondral bone formation (indirect conver-
is complex and incompletely understood.
sion of an intermediate cartilage model), or both. At some
Bone is essential in maintaining calcium homeostasis,
locations, such as the bones of the cranial vault (frontal
or stabilization of the plasma level of calcium. Its cells
and parietal bones, as well as parts of the occipital and
are highly responsive to stimuli provided by a number
temporal bones), the mandible and maxilla, and the mid-
of humoral agents, the most important of which are
portion of the clavicle, intramembranous (mesenchymal)
parathyroid hormone, thyrocalcitonin, and 1,25-
ossification is detected; in other locations, such as the
dihydroxyvitamin D. Synthesis and resorption of bone,
bones of the extremities, the vertebral column, the pelvis,
which normally continue in a delicate balance
and the base of the skull, both endochondral and intra-
throughout life, are mediated by the action of such
membranous ossification can be identified. The actual
humoral agents through processes that include
processes of bone tissue formation are essentially the
stimulation of osteoblasts to form bone and stimulation
same in both intramembranous and endochondral ossifi-
of osteoclasts to remove bone.
cation and include the following sequence: (1) osteoblasts
differentiate from mesenchymal cells; (2) osteoblasts
deposit matrix, which is subsequently mineralized; (3)
bone is initially deposited as a network of immature
INTRODUCTION
(woven) trabeculae, the primary spongiosa; and (4) the
Bone is a remarkable tissue. Although its appearance primary spongiosa is replaced by secondary bone,
on radiographs might be misinterpreted as indicating removed to form bone marrow, or converted to primary
inactivity, bone is constantly undergoing change. This cortical bone by the filling of spaces between trabeculae.
occurs not only in the immature skeleton, in which
growth and development are readily apparent, but also in
Intramembranous Ossification
the mature skeleton, through the constant and balanced
processes of bone formation and resorption. It is when Intramembranous ossification is initiated by the prolif-
these processes are modified such that one dominates, eration of mesenchymal cells about a network of capil-
that a pathologic state may be created. In some instances, laries. At this site, transformation of the mesenchymal
the resulting imbalance between bone formation and cells is accompanied by the appearance of a meshwork of
resorption is easily detectable on the radiograph. In others, collagen fibers and amorphous ground substance. The
a more subtle imbalance exists that may be identified primitive cells proliferate, enlarge, and become arranged
only at the histologic level. in groups, transforming into osteoblasts, which are inti-
The initial architecture of bone is characterized by mately involved in the formation of an eosinophilic matrix
an irregular network of collagen, termed woven-fibered within the collagenous tissue. As the osteoid matrix under-
bone, which is a temporary material that is either removed goes calcification with the deposition of calcium phosphate,
to form a marrow cavity or subsequently replaced by a some of the osteoblasts on the surface of the osteoid and
1