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）21.Musculoskeletal Imaging4

Teaching Plan Name Ma Fang-fang Academic Year 2012-2013 Term two Date 2013-6-4 Period 3-4 Textbook Radiology a 2010 MBBS autumn (students) Content Bone tumor 2 Objectives To introduction the imaging of Bone tumor Key points Osteoma and Giant cell tumor Pontsiff to under Giant cell tumor CT&MRI 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 Osteoma Osteoma is a benign mass protruding from osseous tissue that generally arises from membranous bones and is composed of dense.compact osseous tissue. 10min Presentations bulky osteomas may develop from the cortical surface of the clavicle, innominate bone and tubular bones. .Osteomas can also develop in soft tissues.generally in the head.but the tumors have been described in the thigh as well Most common tumor of the paranasal sinuses.most frequently seen in the frontal sinus and ethmoids. 10min Diagnosi Two varieties are described: the dense'ivory'type consisting of lamellar bone

Teaching Plan Name_Ma Fang-fang Academic Year_2012-2013 Term_two Date_2013-6-4 Period_3~4 Textbook Radiology Specialty and Stratification 2010 MBBS autumn (international students) Content Bone tumor Teaching hours 2 Objectives To introduction the imaging of Bone tumor Key points Osteoma and Giant cell tumor Points difficult to understand Giant cell tumor CT&MRI 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 Osteoma ⚫ Osteoma is a benign mass protruding from osseous tissue that generally arises from membranous bones and is composed of dense, compact osseous tissue. Presentations ⚫ bulky osteomas may develop from the cortical surface of the clavicle, innominate bone and tubular bones . ⚫ Osteomas can also develop in soft tissues, generally in the head , but the tumors have been described in the thigh as well ⚫ Most common tumor of the paranasal sinuses, most frequently seen in the frontal sinus and ethmoids. Diagnosis Two varieties are described: ⚫ the dense 'ivory' type consisting of lamellar bone, 10min 10min

Outlinesreqrments and time alltio 'cancellous'osteoma showing predominantly a lamellar structure Giant cell tumor Giant cell tumor is a locally aggressive neoplasm composed of connective tissue.giant cells and stromal cells. 10min Presentations Earliest manifestations include pain,local swelling.limitation of motion and pathologic fractures. The sites affected most frequently are the long tubular bones.bones about the knee,spine,and innominate bone. Diagnosis 10min On radiographs.the long and short tubular bones reveal eccentric osteolytic lesions extending to the subchondral bone A delicate trabecular pattem results from subsequent cortical thinning and expansion. Violation of the cortical surface and spread into contiguous soft tissues is striking evidence of the aggressiveness of some giant cell tumors. Tumors involving the flat bones may also be osteolytic.vertebral collapse may occur if the spine is affected. Osteoid osteoma 10min Osteoid osteoma is a benign osteoblastic tumor composed of a central coreof vascular osteoid tissue and a peripheral zone of sclerotic bone. The precise relationship of osteoid osteoma to a second lesion of bone.the osteoblastoma,is not well understood. The tumors are painful and may be accompanied by soft tissue swelling and

Outlines, requirements and time allocation ⚫ 'cancellous' osteoma showing predominantly a lamellar structure. Giant cell tumor ⚫ Giant cell tumor is a locally aggressive neoplasm composed of connective tissue, giant cells and stromal cells. Presentations ⚫ Earliest manifestations include pain, local swelling, limitation of motion and pathologic fractures. ⚫ The sites affected most frequently are the long tubular bones, bones about the knee, spine, and innominate bone. Diagnosis ⚫ On radiographs, the long and short tubular bones reveal eccentric osteolytic lesions extending to the subchondral bone ⚫ A delicate trabecular pattern results from subsequent cortical thinning and expansion. ⚫ Violation of the cortical surface and spread into contiguous soft tissues is striking evidence of the aggressiveness of some giant cell tumors. ⚫ Tumors involving the flat bones may also be osteolytic; vertebral collapse may occur if the spine is affected. Osteoid osteoma ⚫ Osteoid osteoma is a benign osteoblastic tumor composed of a central core of vascular osteoid tissue and a peripheral zone of sclerotic bone. ⚫ The precise relationship of osteoid osteoma to a second lesion of bone, the osteoblastoma, is not well understood. ⚫ The tumors are painful and may be accompanied by soft tissue swelling and tenderness. . 10min 10min 10min

Diagnosis 10min The classic radiographic appearance is that of a centrally located,oval or round surrounded by a zone of uniform bone sclerosis;this combination is virtually diagnostic of osteoid osteoma Bone cyst Bone cyst is a usually cavitary lesion of bone. Causes 10min Bone cysts may occur after trauma and in osteoarthritis.rheumatoid arthritis. neurofbromatosis and calcium pyrophosphate dihydrate crystal deposition disease. Pathological Types 10min Simple bone cysts:These cysts occur most frequently in long tubular bones especially the metaphysis,and in the bony pelvis. Radiographically.these lesions appear radiolucent and are located centrally. with cortical thinning and mild expansion of the bone Aneurysmal bone cysts:They occur most frequently in the spine and long tubular bones,particularly the metaphysis.and in most cases result from trauma Radiographically the lesions tend to be eccentric and occasionally trabeculated Epidermoid cysts:They occur almost exclusively in the terminal phalanges an skull.These cysts are well-defined osteolytic lesions with sclerotic margins and frequently soft tissue swelling. Intraosseous ganglion cysts:They occur predominantly in subchondral regions of tubular bones.carpal bones,and acetabulum.These osteolytic lesions are usually solitary.are sharply circumscribed,and vary in size

Outlines, requirements and time allocation Diagnosis ⚫ The classic radiographic appearance is that of a centrally located, oval or round radiolucent area ⚫ surrounded by a zone of uniform bone sclerosis; this combination is virtually diagnostic of osteoid osteoma Bone cyst Bone cyst is a usually cavitary lesion of bone. Causes ⚫ Bone cysts may occur after trauma and in osteoarthritis, rheumatoid arthritis, neurofibromatosis and calcium pyrophosphate dihydrate crystal deposition disease. Pathological Types ⚫ Simple bone cysts: These cysts occur most frequently in long tubular bones, especially the metaphysis, and in the bony pelvis. ⚫ Radiographically, these lesions appear radiolucent and are located centrally, with cortical thinning and mild expansion of the bone ⚫ Aneurysmal bone cysts:They occur most frequently in the spine and long tubular bones, particularly the metaphysis, and in most cases result from trauma. ⚫ Radiographically the lesions tend to be eccentric and occasionally trabeculated ⚫ Epidermoid cysts: They occur almost exclusively in the terminal phalanges and skull. These cysts are well-defined osteolytic lesions with sclerotic margins and frequently soft tissue swelling. ⚫ Intraosseous ganglion cysts: They occur predominantly in subchondral regions of tubular bones, carpal bones, and acetabulum. These osteolytic lesions are usually solitary, are sharply circumscribed, and vary in size 10min 10min 10min

Outlines requirements and time allocation 10min Diagnosis Radiographically.these lesions appear radiolucent and are located centrally, with cortical thinning and mild expansion of the bone CT scanning and MR imaging with contrast enhancement reveal presence of fluid within the lesion Osteosarcoma Osteosarcoma is a malignant neoplasm of bone composed of proliferating 10min tumor cells that in most instances immature bone Pathological Types intramedullary or central.intracortical,surface.periosteal.or parosteal high grade or low grade single or multicentric Diagnosis On the radiograph,the tumor may be purely lytic or sclerotic,or a mixture of the two a very thin periosteal reaction overlying the lesion with very little evidence of new bone formation The sclerotic osteogenic sarcomas may produce a region of dense sclerosis with loss of the inner cortical margins .'sunburst'appearance

Outlines, requirements and time allocation Diagnosis ⚫ Radiographically, these lesions appear radiolucent and are located centrally, with cortical thinning and mild expansion of the bone ⚫ CT scanning and MR imaging with contrast enhancement reveal presence of fluid within the lesion Osteosarcoma ⚫ Osteosarcoma is a malignant neoplasm of bone composed of proliferating tumor cells that in most instances produce osteoid or immature bone Pathological Types ⚫ intramedullary or central, intracortical, surface, periosteal, or parosteal ⚫ high grade or low grade single or multicentric Diagnosis ⚫ On the radiograph, the tumor may be purely lytic or sclerotic , or a mixture of the two ⚫ a very thin periosteal reaction overlying the lesion with very little evidence o f new bone formation ⚫ The sclerotic osteogenic sarcomas may produce a region of dense sclerosis with loss of the inner cortical margins ⚫ ‘sunburst' appearance 10min 10min