筋骨格の画像診断、基礎パート2①

ひるけ (ATC)

今回も Robert Boyles先生です。MRIや超音波､CT等、「この場合はMRI ､この場合はCT で」と言った､オーダーを出す側の観点や判断基準、それぞれの利点、欠点のお話しでした。
「MRIの画像あるなぁ。CTの画像あるなぁ。ちょっと見とこうかな｡」くらいにしか思ってなかったのです。「なぜMRIで撮ったのか、CTで撮ったのはなぜか」と言う背景については、あまり考えたことがなかったのです。

先生の似顔絵は、別アングルにしてみました。

2026.08.06 公開

画像診断超音波 bonescan

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ノートテキスト

ページ1:

Chl. Fluoroscopy & nuclear imaging
→
real-time
"Fluoroscopy, & imaging
• X-ray examination in motion.
.
• Used in:
fractures
fracture fixation
dislocation
any
bad motion.
arthrography
myelography
Common in
-diskography
wrist
foot
easy to
-biopsy
ankle
Put on
the machine.
· gastrointestinal evaluation
X-ray
Source
is beneath table.
Nuclear medicines
detects physiologic
changes in tissue
• Radioactive substances for treatment/ diagnosis
fractures
infections
"Nuclear imaging]
a diagnostic procedure
-- metabolic bone conditions.

ページ2:

Ch2. Bone Scan
-Bone Scan (a.k a bone scintigraphy)
Useful for: • Uses maker. to reflect I blood flow & metabolism
•Subtle
fractures
Avascular
necrosis
• blood
flow
• Osteo-
"
"
"Technetium-99m phosphate"
absorbed by hydroxyapatite crystals in bone
in areas of infection, trauma, neoplasms...
• Most reliable for non-displaced scaphoid fractures.
myelitis •Highly sensitive, low specificity
↓
Prosthetic
means
loosening
It'll show you something is going on,
but It won't tell you what it is.
• 3-phase
- 1st phase - immediate
displays blood flow through artery
-
2nd phase 30min.
displays equilibrium throughout the intervascular
volume. (blood pool)
fractures
3rd phase-thr
displays sites where tracer accumulates.
②

ページ3:

Disadvantage
Injection required
-
A/V system
• Low Specificity
• Primary use:
- Localizing bone tumors
-
Skeltal metastases.
- Early diagnosing of stress fractures
Gamma
Camera
After patients
get injected,
*High activity
black dot.
they lay on this.
✓

ページ4:

Ch3. Ultrasound
"Ultrasonography
• Uses Sonar technology from WWI submarines.
• a cross-sectional
imaging.
reflection of sound waves from tissues
Uses:
1- Soft tissue pathology"
eg) tendon/muscle tears
- fluid retention + eg) hematoma, abscess, foreign body
-articular cartilage
nerve entrapment
healing fracture progression. hip
shoulder
rotator
Cuff Tears
Knee
Cartilage thickness
intra-articular fluid
(effusion)
•Congenital hip
dysplasia
iliopsoas bursitis.
(4)
others
-
soft tissue masses
-hematoma
- tendon rupture/ abscesses
foreign body location.

ページ5:

W
Disadvantages
Advantages
• low-cost
• portability
• can modify exam being performed.
•No hazards
·
'
'
can place affected jt in different position.
Can use active muscle contractions during the exam.
can apply traction / compression during exam
can stress ligaments during the exam
• limited field of view.
.
•
•
• more operator-dependent
.
Structures deep to the bone are not visible
doesn't cross the air interface.
• obese patients, image I
ultrasound doesn't
penetrate that deep.