山东第一医科大学（泰山医学院）：《医学影像学》课程教学资源（授课教案）20..Musculoskeletal Imaging3

Teaching Plan Name Ma Fang-fang Academic Year 2012-2013 Term_two Date 2013-5-31 Period 3-4 Textbook Radiology Suaion 2010 MBBS autumn Content Infection of osteoarticulartissue Teaching 2 Objectives To introduce the imaging of nfection of osoarticular Key points Acute osteomyelitis and Chronic osteomyelitis imaging Pontsiff to unders Brodie's absces imaging Content for self study CT、MRI anatomy Teaching equipment multimedia Related knowledge Medical imaging technique,anatomy,pathology,medicine.urgery Teaching methods Heuristic method ldiscuss Outlines,requirements and time allocation Osteomyelitis Causes: 10min Osteomyelitis is an infection of bone and bone mamrow Pathological Types: 10min which may reveal acute,subacute and chronic clinical stages In some cases chronic osteomyelitis is present at the time of initial evaluation. Occasionally,a sclerotic nonpurulent fomm of osteomyelitis exists,termed Garrs sclerosing osteomyelitis. Imaging feature: 10 min Radiographs performed early in the course of the illness may show subtle deep soft tissue swelling or oedematous subcutaneous soft tissues but radiographs are often normal in the first 7-10 days

Teaching Plan Name_Ma Fang-fang Academic Year_2012-2013 Term_two Date_2013-5-31 Period_3~4 Textbook Radiology Specialty and Stratification 2010 MBBS autumn (international students) Content Infection of osteoarticulartissue Teaching hours 2 Objectives To introduce the imaging of Infection of osteoarticular Key points Acute osteomyelitis and Chronic osteomyelitis imaging Points difficult to understand Brodie’s abscess imaging Content for self study CT、MRI anatomy Teaching equipment multimedia Related knowledge Medical imaging technique, anatomy, pathology, medicine, surgery Teaching methods Heuristic method \discuss Outlines, requirements and time allocation Osteomyelitis Causes : ⚫ Osteomyelitis is an infection of bone and bone marrow, Pathological Types: ⚫ which may reveal acute, subacute and chronic clinical stages. ⚫ In some cases chronic osteomyelitis is present at the time of initial evaluation. ⚫ Occasionally, a sclerotic nonpurulent form of osteomyelitis exists, termed Garrs sclerosing osteomyelitis. Imaging feature: ⚫ Radiographs performed early in the course of the illness may show subtle deep soft tissue swelling or oedematous subcutaneous soft tissues but radiographs are often normal in the first 7~10 days. 10 min 10 min 10 min

Outlines requirements and time allocation Acute osteomyelitis Presentations: 10min With acute osteomyelitis the presenting complaint is usually local pain,swelling and warmth often with associated fever and malaise. Four principal routes of contamination are: haematogenous spread; spread from a contiguous source of infection: direct implantation of infectious material: postoperative spread. Diagnosis: 15min Among the radiographic and pathologic features of osteomyelitis are sequestrum,involucrum,sinus tract,and Brodies abscess a sharply delineated focus of infection in bone Chronic osteomyelitis 10 min Causes: .Chronic osteomyelitis is an untreated or inadequately treated infection of bone. uncommon in modem paediatric radiological practice Imaging feature: Radiographs in chronic osteomyelitis typically show areas of ill defined bone 15 min destruction with florid cortical thickening causing sclerosis and widening of the bone Focal corical defects or lucent foci within the bone may indicate cloacae bu these are better demonstrated on CT or MRI.CTor MRI is likewise indicated to look for sequestra which will be seen on CT as focal areas of high attenuation and on MRI as areas of signal void

Outlines, requirements and time allocation Acute osteomyelitis Presentations： ⚫ With acute osteomyelitis the presenting complaint is usually local pain, swelling and warmth often with associated fever and malaise. ⚫ Four principal routes of contamination are: haematogenous spread; spread from a contiguous source of infection; direct implantation of infectious material; postoperative spread. Diagnosis： ⚫ Among the radiographic and pathologic features of osteomyelitis are sequestrum, involucrum, sinus tract, and Brodies abscess a sharply delineated focus of infection in bone. Chronic osteomyelitis Causes : ⚫ Chronic osteomyelitis is an untreated or inadequately treated infection of bone, uncommon in modern paediatric radiological practice. Imaging feature: ⚫ Radiographs in chronic osteomyelitis typically show areas of ill defined bone destruction with florid cortical thickening causing sclerosis and widening of the bone ⚫ Focal cortical defects or lucent foci within the bone may indicate cloacae but these are better demonstrated on CT or MRI. CT or MRI is likewise indicated to look for sequestra which will be seen on CT as focal areas of high attenuation and on MRI as areas of signal void. 10min 15min 10 min 15 min

Outlines,requirements and time allocation 10 min Brodie's abscess: Which is a sharply delineated focus of infection(abscess)in bone. ● The lesion is frequently surrounded by ebumnated bone ● Which is lined by granulation tissue. The fluid in the abscess may be purulent or mucoid. Diagnosis: 10 min Radiographs show a central oval lucency surrounded by dense reactive sclerosis usually within or close to the metaphysis and the lesion may extend across the physis ● MR imaging shows high signal intensity of granulation tissue surrounded by low signal intensity of bone sclerosis

Outlines, requirements and time allocation Brodie’s abscess： ⚫ Which is a sharply delineated focus of infection (abscess) in bone. ⚫ The lesion is frequently surrounded by eburnated bone ⚫ Which is lined by granulation tissue. ⚫ The fluid in the abscess may be purulent or mucoid. Diagnosis: ⚫ Radiographs show a central oval lucency surrounded by dense reactive sclerosis usually within or close to the metaphysis and the lesion may extend across the physis ⚫ MR imaging shows high signal intensity of granulation tissue surrounded by low signal intensity of bone sclerosis 10 min 10 min