第四章骨健康的临床评价.pptVIP

Two Pictures are present. Osteopenia is subjective and technique dependent and requires ~ 30% BMD loss. There are two possible findings on plain films in patients with osteoporosis: The first is osteopenia or reduced radiographic density of the bony structures (not the same as osteopenia by DXA). Osteopenia on x-rays is technique dependent. However, if present further evaluation with bone densitometry may be needed. Plain films are essential for diagnosis and follow up of fractures. This does not compete with densitometry because it indicates advanced disease. Vertebral fractures are very important to recognize on x-rays. Fractures may be of the mobile type. Standing lateral radiographs are compared to supine cross-table lateral views. A bolster is placed beneath the spine, caudal to the fracture, to hyperextend the designated vertebral compression fracture to allow for gravity assisted vertebral body extension. Dynamic mobile fractures are seen in the standing lateral films but recover a significant proportion of their height in the gravity assisted cross-table lateral supine films. Intravertebral clefts (“Kummels sign”) are associated with dynamic mobile fractures due to osseous necrosis. They appear as vacuum phenomenon. They appear as signal void on MRI. Important to identify fragility fractures since this is a major risk factor for subsequent fractures. HCFA and many other organizations recognize osteopenia on x-rays as an indication for bone density testing. Sometimes findings on x-rays may help determine the cause of low BMD on bone densitometry (e.g., in myeloma showing multiple lytic lesions). Osteomalacia: coarsened indistinct trabeculae, unsharp delineation of cortical bone, insufficiency fractures, vertebral compression fractures, psuedofractures (Looser’s zones due to accumulations of osteoid in compact bone at right angles of the long axis) are bilaterall and symmetric. MRI discloses hypointensity or isointensity on T1-weighted images and hyperinte