Bones – general

image of Bones – general
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Bone is a dynamic organ that is constantly being renewed and remodelled. It is responsive to mechanical stimuli and to metabolic, nutritional and endocrine influences. It acts as a storage reservoir for calcium, phosphorous and other minerals as well as haemopoietic tissue. Bone is relatively light with a high tensile and compressive strength and at the same time retains an appropriate degree of elasticity. This chapter provides information on normal bone formation and anatomy, alternative imaging techniques and abnormal image findings.

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7.1 Schematic representation of the different regions and blood supply of a long bone in an immature (top) and mature (bottom) long bone. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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7.2 ML view of the radius and ulna from an immature large-breed dog. Note the cutback zone of the distal ulnar metaphysis (arrowed) and the olecranon apophysis (*).
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7.3 Polyostotic bone pathology involving both femoral shafts due to haematogenous fungal osteomyelitis.
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7.4 Artefactual increase in bone opacity due to superimposition of fracture ends. (a) Craniocaudal (CrCd) view of the tibia with two transverse lines of increased opacity in the tibial diaphysis. (b) The ML view shows slight over-riding of the tibia fracture edges.
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7.5 An ivory-like opacity is seen with complete mineralization of the osteoid matrix in an osteoma of the frontal bone. The radiograph was deliberately underexposed to show the peripheral pathology.
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7.6 Osteosarcoma of the distal tibia. (a) ML view of the distal tibia. Fairly solid periosteal reactions, permeative to moth-eaten lysis and neoplastic endosteal medullary new bone are seen at level b. (b–d) Transverse CT images made at the locations shown in (a). The fibula is on the left of the image and cranial is to the top. Note the medullary new bone formation and solid periosteal reaction thickening the cortex in (b). In (c) and (d) the periosteal reaction ranges from thick lamellar to immature solid. Note that medullary new bone clearly seen on the CT images is difficult to appreciate on the radiograph. Image (b) is in a soft tissue window and (c) and (d) are in a bone window.
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7.7 ML view of a skeletally immature canine distal radius and ulna with a fibrous cortical defect (ossifying fibroma) of the caudal metaphyseal ulna. The fibrous matrix results in the radiolucent defect, which will eventually fill up with bone.
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7.8 Schematic representation of periosteal reactions from least to most aggressive. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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7.9 (a) Focal anaerobic osteomyelitis of the caudal ulna with a mature solid periosteal reaction. (b) Hypertrophic osteopathy with immature solid periosteal reactions on the abaxial surfaces of metatarsals II and V.
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7.10 Focal soft tissue swelling and lamellar periosteal reaction cranially on the radius. Radiograph deliberately underexposed.
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7.11 Post-mortem specimen of a proximal femur with fungal osteomyelitis resulting in a lamellated periosteal reaction.
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7.12 Thick brush-like periosteal reaction on the abaxial surface of metacarpal V in a dog with hypertrophic osteopathy.
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7.13 Thin brush-like periosteal reaction of the abaxial surface of metatarsals II and V in a case of hypertrophic osteopathy.
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7.14 Osteosarcoma of the frontal bone with a sunburst periosteal reaction.
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7.15 Proximal tibial osteosarcoma with amorphous bone formation seen lateral to the proximal fibula. A solid periosteal reaction (Codman’s triangle, arrowed) is present on the lateral cortex of the proximal tibial diaphysis.
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7.16 CrCd view of the distal radius of a dog with an elongated radiolucency in the distolateral radius adjacent to the ulna, which correlates to the soft tissue depression seen in this region of the limb.
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7.17 Disuse osteoporosis of the manus.
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7.18 Graphic representation of focal bone destruction from least to most aggressive. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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7.19 Geographic bone lysis of the distal fourth metatarsal bone. Note also the cortical thinning and expansion.
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7.20 Proximal tibial ossifying fibroma with more aggressive geographic bone lysis than in Figure 7.19 . There is still a large focal lytic lesion but with cortical destruction (white arrows) and minimal sclerosis. (a) ML view; (b) CrCd view; (c) sagittal ultrasonographic image over the medial aspect of the tibia with the white arrows corresponding to those in (b) and the black arrow indicating the normal solid cortex more distally. Note that the lesion has not extended into the adjacent soft tissues and that the thin remnant cortical bone allows transmission of the sound waves into the subcortical neoplastic tissue (*).
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7.21 Proximal humerus osteosarcoma in an 11-year-old dog. Note the areas of moth-eaten lysis and minimally displaced pathological fracture. The focal lytic area at the caudal supraglenoid tuberosity is unlikely to be part of the tumour.
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7.22 Schematic representation of the location of lysis in cortical bone destruction (e.g. moth-eaten or permeative) and scalloping. (a) Lateral view of a long-bone diaphysis. The lytic areas appear to be in the medulla but are in the superimposed cortex. (b) Cross-section of the bone in (a). The lytic areas are actually in the cortex but are superimposed on the medulla. Bear in mind that opacity is influenced by tissue thickness. Thus, as distances a and b combined are about half of distance c (radiologically seen cortex) they appear relatively radiolucent on the lateral view. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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7.23 ML view of the proximal humerus with a highly aggressive osteosarcoma and pathological fracture. Note the permeative lysis in the proximal diaphysis extending into the meta- and epiphyseal regions where the foci of lysis coalesce to form a large lytic defect.
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7.24 Close-up ML view of the distal tibia with mild permeative lysis and marked subperiosteal scalloping of the cranial cortex, indicative of osteomyelitis.
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7.25 Close-up view of a post-mortem femur specimen showing endosteal scalloping resulting in a cortical spike proximally. Permeative lysis and a sunburst periosteal reaction are also present.
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7.26 Highly aggressive osteosarcoma of the distal radius with a segmental pathological fracture (white arrows). Note how the medial radial cortex has been partly destroyed in the region of the endosteum (endosteal scalloping: black arrow) and how the lateral cortex is almost completely destroyed, with total cortical destruction more distally. The solid periosteal reaction on the ulna is secondary to the surrounding neoplastic tissue.
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7.27 CrCd view of a distal femur with chronic osteomyelitis. Noteis also present more proximally the radiolucent cloaca with a cortical defect and rounded edges (arrowed). A solid periosteal reaction .
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7.28 (a) Sagittal and (b) transverse CT images in a bone window of the tibial osteosarcoma in Figure 7.15 . Note how well defined the tibial moth-eaten lysis is, when compared with the radiograph. (c) Vascular enhancing (reddish hue) volume-rendered CT image of the same area, showing the vascularity of the neoplastic tissue that has invaded the surrounding soft tissues from the tibia.
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7.29 Dobermann with progressive pelvic limb spastic paresis. (a) Lateral view of cranial thoracic vertebrae (* = T2), which look normal. Myelography showed that the contrast column stopped at T2 (image not shown). (b) Sagittal reconstructed CT image in a bone window shows marked lysis of the T2 vertebral body. (c) Transverse CT image of T2 with hypoattenuating neoplastic tissue invading the vertebral canal and displacing the cord dorsally. The cord is surrounded by a thin layer of hyperattenuating subarachnoid contrast medium from the myelogram. CT is much more sensitive than radiographs for the detection of small amounts of contrast medium.
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7.30 Ultrasound image of the angular process area of the mandible that showed a draining tract and mild periosteal reaction on radiographs. The 26 mm inciting porcupine quill is readily seen between the markers.
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7.31 ML view of a humeral osteosarcoma with a solid periosteal reaction caudally but with underlying permeative to moth-eaten lysis, making it overall an aggressive lesion despite the benign solid periosteal reaction.
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7.32 Range of possible changes used to judge whether bone pathology is aggressive or non-aggressive.
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