Diagnostic Imaging of Endocrine bone disease
-
Upload
mohamed-zaitoun -
Category
Health & Medicine
-
view
293 -
download
0
Transcript of Diagnostic Imaging of Endocrine bone disease
Musculoskeletal
Endocrine Bone Disease
Mohamed Zaitoun
Assistant Lecturer-Diagnostic Radiology Department , Zagazig University Hospitals
EgyptFINR (Fellowship of Interventional
Neuroradiology)[email protected]
Knowing as much as possible about your enemy precedes successful battle
and learning about the disease process precedes successful management
Endocrine Bone Diseasea) Hyperparathyroidismb) Thyroid Acropachyc) Acromegaly
a) Hyperparathyroidism :1-Incidence2-Types3-Radiographic Features
1-Incidence :-Increased levels of parathyroid hormone
(PTH) lead to increased osteoclastic activity
-The resultant bone resorption produces :a) Cortical thinning (subperiosteal
resorption)b) Osteopaenia
2-Types :a) Primary HPT :-Adenoma , 85% (single, 90 %)-Hyperplasia , 12%-Parathyroid carcinoma , 1%-3%b) Secondary HPT :-Most often secondary to renal failurec) Tertiary HPT :-Results from autonomous glandular function after
long-standing renal failure
3-Radiographic Features :1-General osteopenia2-Bone resorption 3-Rogger Jersey Spine4-Brown Tumors5-Salt & Pepper Sign in Skull6-Superior & Inferior Rib Notching7-Findings in secondary (and tertiary)
hyperparathyroidism
1-General osteopenia2-Bone resorption is virtually
pathognomonic: a) Subperiosteal bone resorption :
classically affects the radial aspects of the proximal and middle phalanges of the 2nd and 3rd fingers
b) Phalangeal tufts (Acro-osteolysis)
-N.B. :*Differential Diagnosis of Acro-osteolysis : PINCH FO1-Psoriasis2-Injury (thermal /frostbite)3-Neuropathy (congenital insensitivity to pain, diabetes,
leprosy & myelomeningocele)4-Collagen vascular disease (Scleroderma, Raynaud's)5-Hyperparathyroidism6-Familial 7-Other (Polyvinyl chloride exposure , snake/scorpion
venom)
Subperiosteal resorption
Subperiosteal resorption
Subperiosteal resorption that has resulted in severe tuftal resorption (white arrows) , also note the subperiosteal and intracortical resorption of the middle phalanges (black arrows)
Subperiosteal resorption that has resulted in severe tuftal resorption (arrows)
Acroosteolysis (also subperiosteal resorption)
3-Rugger Jersey Spine :-Sclerotic bands along the superior and
inferior endplates give a striped appearance to the vertebral bodies with a relative band of lucency at the center of each vertebral body
Rugger Jersey Sign
Rugger Jersey Spine
4-Brown Tumors :-Also known as osteitis fibrosa cystica-Can be found anywhere in the skeleton but
especially in the pelvis, jaw and femur-Well-defined purely lytic lesions
Brown tumor
Brown tumor
Brown tumor
Brown tumors
5-Salt & Pepper Sign in Skull :-Multiple tiny hyperlucent areas in the skull
vault caused by resorption of trabecular bone
Salt & Pepper skull
6-Superior & Inferior Rib Notching :-Rib notching refers to deformation of the
superior or inferior surface of the rib-It can affect single rib (from trauma or
solitary masses e.g. schwannoma) or can affect multiple ribs
a) Superior Rib Notching :1-Abnormal osteoblastic activity :-Osteogenesis imperfecta2-Connective tissue diseases :-Rheumatoid arthritis-Systemic lupus erythematosus (SLE)-Marfan syndrome-Sjogren's syndrome3-Abnormal osteoclastic activity :-Hyperparathyroidism4-Miscellaneous :-Neurofibromatosis type 1-Restrictive lung disease-Poliomyelitis
b) Inferior Rib Notching : (Roesler sign)1-Enlarged collateral vessels :-Coarctation of the aorta-Interrupted aortic arch-Subclavian artery obstruction : Takayasu disease-AVM of the chest wall -SVC obstruction with enlarged venous collaterals-pulmonary AVM2-Neurogenic Tumors :-Schwannoma (usually single)c) Superior & Inferior Rib Notching :-Hyperparathyroidism
Rib Notching in coaractaion of aorta
7-Findings in secondary (and tertiary) hyperparathyroidism :
-Are often associated with the osteosclerosis of renal osteodystrophy, soft tissue calcifications and the osteomalacia of vitamin D deficiency
b) Thyroid Acropachy :1-Incidence2-Radiographic Features
1-Incidence :-One of the extra-thyroidal manifestations of
autoimmune thyroid disease-Occurs in about 1% of patients with Grave’s
Disease-Almost always associated with ophthalmopathy
and thyroid dermopathy (pretibial myxedema) -May occur after radioactive treatment for
hyperthyroidism
2-Radiographic Features :-Thick periosteal reaction of phalanges and
metacarpals-Soft tissue swelling
Thick wavy periosteal reaction is seen along the shafts of the 1st through 4th metatarsals bilaterally (white circles)
c) Acromegaly :1-Incidence2-Radiographic Features
1-Incidence :-Elevated growth hormone (adenoma,
hyperplasia) results in :*Children (open growth plates) : gigantism*Adults (closed growth plates) : acromegaly
= gradual enlargement of hands and feet and exaggeration of facial features
-It most commonly affects adults in middle age
2-Radiographic Features :a) Skull :-Calvarial thickening, enlarged sinuses and
an enlarged sella turcica-Prognathic jaw
Thickened calvarium with pituitary enlargement
Enlarged sella with double flooring , thickened skull vault , pneumosinus dilatans and prognathism
b) Hands :-Terminal phalangeal tufts become
hypertrophied and have a spade appearance which is called spade phalanx sign
-Joint spaces may be minimally enlarged-Premature osteoarthritis can set in the
advanced stages of acromegaly
Widening of the terminal tufts (between long arrows) , bases of the distal phalanges , thickening of the digit soft tissues (between arrowheads) and widening of the metacarpophalangeal joints (between short arrows)
c) Feet :-Heel pad thickness may be increased
(more than 25 mm)
d) Enlarged pituitary with uptake of gadolinium :
-The MR diagnosis of a pituitary macroadenoma is relatively straightforward
-Dynamic contrast enhanced MR increases the sensitivity to detect microadenomas , which are hypoenhancing as compared to the normal pituitary gland
Pituitary macroadenoma
Pituitary microadenoma