Khurana Jasvir S. - Diagnostic Imaging of Musculoskeletal Diseases: a Systematic Approach
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With the advent of new technologies, the field of musculoskeletal radiology has grown to include not only diseases that affect the skeleton, but also those that affect muscles, ligaments, tendons and also the cartilaginous structures within joints. Diagnostic Imaging of Musculoskeletal Diseases: A Systematic Approach is a useful and worthy teaching textthat is at once readable by the radiology resident rotating through themusculoskeletal radiology and thorough enough to be used by the practicingradiologist. Written by authors who are well established in the field ofmusculoskeletal radiology and pathology, this volume provides readers with apractical and systematic approach to think about diagnosis of pathologic conditions that affect the musculoskeletal system, thus making the material easier to learn and synthesize. Chapters are organized by major categories of disease: trauma, infection, tumors and tumor-like conditions, metabolic diseases, dysplastic diseases andarthritis. Additional chapters examine basic interventional techniques that apply to musculoskeletal imaging and in recognition of the importance of orthopedic procedures, information is included on the use, imaging, appearance, and pathology affecting prostheses and fixation devices. Diagnostic Imaging of Musculoskeletal Diseases: A Systematic Approach is an exceptionally important new text that contains information essential to the practice of modern radiology.;1. Anatomy, Embryology and Physiology of Musculoskeletal Tissues -- 2. Metabolic Bone Disease -- 3. Skeletal Dysplasias -- 4. Infections -- 5. Bone and Soft-Tissue Tumors and Tumorlike Lesions -- 6. Arthritis -- 7. Imaging of Bone and Soft-tissue Trauma -- 8. Interventions and Procedures -- 9. Imaging of Endoprostheses and Implants -- 10. Miscellaneous Diseases and Conditions.
Khurana Jasvir S.: author's other books
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Khurana Jasvir S.
Pradip R. Patel
Hector Ferral
Glenn Garcia
Felix S. Chew
Jamshid Tehranzadeh
William E Brant
Wilbur L. Smith
Hongjun Li (editor)
Minna J. Kohler (editor)
Jeffrey Klein MD
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Akbar Bonakdarpour , William R. Reinus and Jasvir S. Khurana (eds.) Diagnostic Imaging of Musculoskeletal Diseases A Systematic Approach 10.1007/978-1-59745-355-4_1 Springer Science+Business Media, LLC 2009
1. Bone Structure and Function
Fayez F. Safadi 1
(1)
Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, PA 19140, USA
(2)
Department of Pathology, Temple University School of Medicine, Philadelphia, PA, USA
Fayez F. Safadi (Corresponding author)
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Jasvir S. Khurana Associate Professor
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Abstract
This chapter discusses the normal structure and function of the skeleton and the various ways it is regulated. The skeleton is both an organ and a type of connective tissue. Knowledge of its various identifiable parts greatly facilitates an understanding of skeletal function and also the disease processes that can occur. Normally, the major skeletal processes of resorption and formation are tightly coupled. This feature plays a role in the normal function of skeletal renewal. Disturbances of the remodeling cycle can be seen in a number of generalized skeletal disorders including metabolic bone disease and conditions such as Paget disease. This chapter discusses the macroscopic and microscopic anatomy of the skeleton as well as its biochemical makeup. It introduces the emerging information about the molecular control of bone cells and the skeletal processes.
Keywords
Remodeling Coupling Formation Resorption Mineralization Cortical Trabecular Epiphysis Metaphysis Diaphysis Periosteum Endosteum Woven Lamellar Osteoblasts Osteoclasts Receptor activator of nuclear factor kappa B (RANK) Transforming growth factor-beta (TGF-) Bone morphogenetic proteins (BMPs) Platelet-derived growth factors (PDGFs) Insulin-like growth factors (IGFs) Calcium hydroxyapatite Collagen Alkaline phosphatase Glycosaminoglycans Proteoglycans Non-collagenous proteins Osteopontin Osteocalcin Vitamin D Vitamin A Estrogen Androgen Parathyroid hormone Wolffs lawIntroduction
The Skeleton
Apart from functioning as a major endocrine, hematopoietic, and reticuloendothelial organ, the skeleton serves as the bodys structural support and locomotion system. It has mechanisms to grow and change in shape and size to suit varying stressors including the ability to resist mechanical forces. It is also a major organ in the homeostasis of calcium/phosphate balance and in the detoxification of heavy metals.
Bone tissue is continuously formed and remodeled throughout life. This is necessary since otherwise it would fatigue with the daily repetitive stress and torsion of motion and weight bearing.
Initially, the bone achieves its increase in size and shape through growth (increase in size) and modeling . In late childhood and adulthood there is continuous renewal of the skeleton, by a process termed remodeling. Both modeling and remodeling require two separate processes, namely bone resorption and bone formation, to occur in coordination and simultaneously to be effective. This phenomenon is known as coupling.
Bone Formation and Degradation
The major functions of bone cells include matrix formation (osteogenesis) , mineralization , and degradation (resorption) . Because formation and resorption are antagonistic processes that proceed simultaneously, bone metabolism must be tightly regulated at all times. During the first two decades of life when the skeleton is growing, there is a net increase in bone mass such that bone formation exceeds its degradation. Once the skeleton has reached maturity, the skeleton maintains a constant balance between formation and resorption to ensure that there is no net gain or loss of bone; this regulated balance is called coupling . Uncoupling of formation and resorption is a common feature of most metabolic bone diseases. Among the many effects of aging, the rate of bone formation declines to a greater extent than the rate of resorption, resulting in progressive bone loss as bone remodels.
Bone Architecture
Bone is a composite tissue consisting of mineral, matrix, cells, and water. The mineral is an analog of the naturally occurring crystalline calcium phosphate, hydroxyapatite. The outer cortices of various bones are fashioned in the form of a hollow tube or a bilaminar plate. The architecture is strengthened by internal struts of trabecular bone that are oriented either along or perpendicular to the lines of stress. This kind of design is known in engineering terms as composite and allows bone to take advantage of the strength of components. Thus, bone resists mechanical compression and can deform a great deal before failing. Indeed, it is this ability to deform that allows the skeleton to absorb the forces of movement.
Gross Morphology
There are four kinds of bones: long bones (femur, tibia, ulna, and radius), short bones (carpal and tarsal bones), flat bones (skull, sternum, and scapula), and irregular shaped bones (vertebra and ethmoid). These bones form through different mechanisms during embryonic development. The majority of long bones and flat bones form by endochondral and intramembranous bone formation, respectively (Fig. ). 
Fig. 1.1
( a and b ) Bone is calcified. The crystal structure of calcium hydroxyapatite makes bone growth more difficult as compared to other organs. Large volumetric growth of bone is achieved by having an intermediate non-mineralized structure (or model) which can grow and then later mineralize. This model can be of either fibrous tissue or cartilage bone developing on fibrous tissue is called intramembranous ossification and that on cartilage is enchondral (or endochondral) ossification. ( a ) shows vertebrae of an embryo that are still cartilage. They will eventually be replaced by bone (endochondral ossification). ( b ) shows the mandible forming from fibrous tissue (intramembranous ossification)
Fig. 1.2
Adult long bone. Sagittal section through the proximal femur showing the internal structure of the bone. The outer dense compact bone (cortical bone) and the inner cancellous (trabecular or spongy) bone are filled with spicules or trabeculae
Parts of a Long Bone
Epiphysis
This term refers to the end of a tubular bone, located between the physeal plate (in developing bone) and the articular cartilage. In adults, the physeal plate is absent. The portion of the bone that the epiphysis would have occupied in the growing skeleton is arbitrarily referred to by the same name (Fig. ). 
Fig. 1.3
Schematic of a tibia. The interior of a typical long bone showing middle diaphysis, a growing proximal end (epiphysis) with a still active epiphyseal growth plate, and a distal end with the epiphysis fused to the metaphysic. The diaphysis (shaft) of a long bone contains a large marrow cavity surrounded by thick-walled tube of compact bone. A small amount of spongy bone lines the inner surface of the compact bone. The proximal and distal ends, or epiphyses, of the long bone consist of spongy bone with a thin outer shell of compact bone. The outer surface of the bone is covered by a fibrous layer of connective tissue called the periosteum
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