KESİTSEL ANATOMİ
Transcript of KESİTSEL ANATOMİ
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KESİTSEL ANATOMİ
Doç. Dr. Hatice GümüşRadyoloji AD
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Radyoloji nedir? Kas-iskelet sisteminde kullandığımız
radyolojik görüntüleme yöntemleri nelerdir?
Radyolojik görüntüleme yöntemleri ile kesitsel anatomiyi nasıl inceleyebiliriz?
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Radyolojik Görüntüleme Yöntemleri
Röntgen Grafileri Bilgisayarlı Tomografi (BT) Ultrasonografi Manyetik Rezonans Görüntüleme
(MR)
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Röntgenografi X ışınları kullanılarak görüntü elde edilir. İyonizan ışın içerdiğinden gebelerde tercih
edilmez Kemik ve eklemleri incelemede ilk
basamakdır. Kemik ve eklemleri incelerken genellikle 2
projeksiyonda filmler alınır (Anteroposterior ve Lateral).
Gerekirse oblik projeksiyon da eklenebilir. Ucuz ve kolay görüntüleme yöntemidir
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Omuz, AP Grafisi1. Klavikula.2. Akromion.
3. Greater tubercle.4. Lesser tubercle.5. Humerus boynu.
6. Humerus. 7. Coracoid Process. 8. Axillary border of
scapula. 9. Kosta.
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Lateral Omuz Grafisi
1. Coracoid Process.2. Clavicle. 3. Acromion. 4. Head of Humerus.5. Humerus. 6. Axillary border of
scapula
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Dirsek AP ve Lateral Grafisi
1. Humerus. 2. Medial epicondyle. 3. Lateral epicondyle. 4. Olecranon fossa. 5. Capitellum. 6. Radius. 7. Radial Head. 8. Ulna. 9. Olecranon process. 10. Coronoid process. 11. Anterior fat pad (here:
fat pad sign).
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AP ve Lateral Projection. 1, Humerus. 2, Radius. 3, Ulna. 4 Navicular Bone 5 Lunate Bone. 6 Triquetrum.
•7 Capitatum bone. •8, Metacarpal bone. •9 Metacarpophalangeal joint. •10 Proximal phalangeal joint. •11 Proximal Phalanx. •12 Distal phalanx. Arrow, Fracture. *, Epiphysial plate.
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El Bileği AP Grafisi 1. Ulnar styloid
process. 2. Lunate. 3. Radius. 4. Navicular. 5. Trapezium 6. 1. Metacarpal. 7. Trapezoid 8. Capitate. 9. Hamate. 10. Triquetrum. 11. Pisiform.
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El AP Grafisi 1. Distal phalanx. 2. Distal interphalangeal joint. 3. Middle phalanx. 4. Proximal interphalangeal
joint. 5. Proximal phalanx. 6. Metacarpophalangeal joint. 7. Head of 5th metacarpal.
8. Sesamoid bone.
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Pelvis AP Grafisi 1. Superior Ramus of Right Pubis2. Symphysis Pubis3. Inferior Ramus of Left Pubis4. Left obturator foramen5. Left lesser Trochanter6. Left Greater Trochanter7. Left iliac wing8. Iliac crest9. Vertebral Pedicle (Lumbar Spine)10. Right Sacro-iliac joint 11. Head of right femur
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Kalça AP Grafisi
1. Acetabular fossa.2. Head femoral.3. Greater trochanter.4. Lesser trochanter.5. Femur.6. Obturator foramen.7. Inferior pubic ramus.8. Superior pubic ramus.9. Sacrum.10. Iliac wing.
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Hip radiography, "frog leg" lateral view. 1, Symphysis pubis.2, Obturator foramen.3, Ischium.4, Lesser trochanter.5, Femur.6, Femoral head.7, Anterior inferior iliac spine.8, Acetabular fossa.9, Anterior superior iliac s
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Diz AP Grafisi
1. Lateral condyle of femur.2. Femur. 3. Patella.4. Medial condyle of femur.5. Medial intercondylar tubercle of tibia.6. Tibia.7. Fibula.
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Diz Lateral Grafisi
1. Patella2. Tuberosity of tibia.3. Tibia.4. Femur.5. Medial condyle of femur6. Fibula
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AP projection.1, Tibia.2, Medial Malleolus.3, Fibula.4, Lateral Malleolus.5, Talus.6, 1st Metatarsal Bone.
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Lateral projection1, Cuneiform Bone.2, Navicular Bone.3, Talus.4, Tibia.5, Fibula.6, Calcaneus.7, Cuboid Bone.
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Foot X-ray AP1, Fibula.2, Cuboid.3, 5th metatarsal.4, Tibia.5, Talus.6, Navicular.7, Cuneiform8, 1st metatarsal9, proximal phalanx10, distal phalanx
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Foot X-ray oblique1, Calcaneus.2, Cuboid.3, 5th metatarsal.4, Talus.5, Navicular.6, Cuneiform.7, Interphalangeal joint
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Bilgisayarlı Tomografi (BT)
X ışını kullanılarak elde edilen görüntüleme yöntemidir.
İyonizan ışın nedeniyle gebelerde tercih edilmez.
Çocuklarda dikkatli kullanmak gerekmektedir.
Sagital, aksiyel ve koronal görüntüler elde edilebilir.
Kemikleri değerlendirmede oldukça başarılıdır.
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Kasları görüntülemede MR kadar başarılı değildir.
Kemik iliğini göstermede başarısızdır. Travmalı hastalarda hızlı ve güvenilir
bir yöntemdir.
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Ultrasonografi (US)
Ses dalgaları kullanılarak görüntü elde edilir
İyonizan ışın içermezler Gebelerde ve çocuklarda rahatlıkla
kullanılabilir Ancak kas iskelet sisteminde
kullanımı sınırlıdır.
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Çocukda özellikle DKÇ’da yeni doğan döneminde ve ilk aylarda tercih edilir
Ancak kemiklerin değerlendirilmesinde rolü çok kısıtlıdır
Yüzeyel yumuşak dokuları kolaylıkla gösterebilir.
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Manyetik Rezonans Görüntüleme (MRG)
Elektromagnetik dalgalar kullanılarak görüntüler elde edilir.
Her üç düzlemde (sagital, aksiyel, koronal) görüntü elde edilebilir.
Kas ve kemik doku için diğer görüntüleme yöntemlerine göre daha fazla bilgi verir.
Kemik iliğini en iyi değerlendirebilen yöntemdir. T1, T2 ve proton dansite görüntüler elde edilir. T1 anatomik detayları gösterir. T2 ve Proton dansite patolojiler için önemlidir.
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İyonizan ışın içermez Gebelerde ve çocuklarda tercih
edilebilir MRG’de kullanılan kontrast maddeler
BT’dekine göre daha az yan etkiye sahiptir.
Kemik ve yumuşak doku incelemelerinde uzaysal çözünürlüğü yüksektir.
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Omuz
Rotator Kaf (RK): SupraspinatusİnfraspinatusSubskapularisTeres minör
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MRI of the shoulder. Coronal T1-weighted view.
1. Trapezius muscle 2. Acromion 3. Deltoid muscle 4. Humeral head 5. Supraspinatus muscle 6. Spine of the scapula 7. Infraspinatus muscle.
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MRI of the shoulder. Coronal T1-weighted view.
1. Trapezius muscle 2. Acromioclavicular joint
3. Acromion 4. Deltoid muscle 5. Humeral head 6. Supraspinatus muscle 7. Spine of the scapula 8. Infraspinatus muscle 9. Scapula. 10. Subscapularis muscle. 11. Teres major muscle.
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MRI of the shoulder. Coronal T1-weighted view.
1. Trapezius muscle. 2. Clavicle. 3. Acromioclavicular joint. 4. Acromion. 5. Supraspinatus tendon. 6. Greater tuberosity. 7. Humeral head. 8. Supraspinatus muscle. 9. Glenoid. 10. Spine of the scapula. 11. Infraspinatus muscle. 12. Scapula. 13. Subscapularis muscle. 14. Teres major muscle.
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MRI of the shoulder. Coronal T1-weighted view.
1. Trapezius muscle.2. Clavicle. 3. Supraspinatus
muscle. 4. Glenoid. 5. Deltoid muscle. 6. Humeral head. 7. Subscapularis
muscle. 8. Biceps tendon (long
head). 9. Biceps and
coracobrachialis muscle.
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MRI of the shoulder. Axial T1-weighted view.
1, Axillary vein and artery.
2, Clavicle. 3, Acromioclavicular
joint. 4, Acromion. 5, Supraspinatus muscle.
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MRI of the shoulder. Axial T2 FATSAT.
1. Pectoralis major muscle. 2. Biceps tendon (short
head). 3. Biceps tendon (long
head). 4. Deltoid muscle (ant). , 5. Humeral head. 6. Glenoid. 7. Deltoid muscle. 8. Teres minor muscle. 9. Infraspinatus muscle. 10. Subscapularis muscle. 11. Coracobrachialis
muscle.
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MRI of the elbow, T1, sagittal image.
1. Radial head. 2. Supinator muscle. 3. Anconeus muscle. 4. Capitellum. 5. Triceps muscle
(lateral head). 6. Extensor carpi
radialis longus muscle. 7. Biceps brachii
muscle. 8. Cephalic vein. 9. Brachoradialis
muscle.
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MRI of the elbow, T1, coronal cut. 1. Ulna. 2. Radial head. 3. Lateral epicondyle. 4. Extensor carpi radialis longus
muscle. 5. Olecranon fossa. 6. Medial epicondyle. 7. Triceps muscle (lateral
head). 8. Humerus. 9. Triceps muscle (Medial
head). 10. Flexor digitorum
superficialis muscle. 11. Supinator muscle. 12. Extensor digitorum muscle.
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MRI of the hip, axial cut, T1. 1. Iliacus m. 2. Rectus abdominis m. 3. Ilium. 4. Gluteus medius m. 5. Gluteus minimus m. 6. Gluteus maximus m.
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1. Gluteus medius m. 2. Rectus femoris m. 3. Femoral vessels. 4. Urinary bladder. 5. Iliopsoas m.
6. Sartorius m. 7 Tensor fasciae latae m. 8. Femoral head.9. Obturator internus m. 10. Gluteus maximus m.
MRI of the hip, axial cut, T1.
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MRI of the hip, coronal cut, T1.
1. Iliac crest. 2. Iliacus m. 3. Gluteus medius m. 4. Tensor fasciae latae
m. 5. Pectineus m. 6. Urinary bladder. 7. Symphysis pubis. 8. Gluteus minimus m.
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MRI of the thigh, axial cut, T1. 1, Vastus lateralis muscle. 2, Vastus medialis & intermedius
muscles. 3, Rectus femoris muscle. 4, Sartorius muscle. 5, Adductor longus muscle. 6, Adductor brevis muscle. 7, Gracilis muscle. 8, Adductor magnus muscle. 9, Semitendinosus muscle. 10, Gluteus maximus muscle.
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MRI of the thigh, coronal cut, T1.
1, Vastus lateralis muscle 2, Femur. 3, Adductor magnus
muscle. 4, Greater trochanter. 5, Femoral neck. 6, Obturator externus
muscle. 7, Obturator internus
muscle. 8, Left femoral head. 9, Gracilis muscle. 10, Adductor longus
muscle. 11, Sartorius muscle
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MRI of the knee: T2-weighted FATSAT, Sagittal Sections.
1, Vastus medialis muscle. 2, Femur. 3, Medial meniscus,
anterior horn. 4, Tibia. 5, Medial head
gastrocnemius muscle. 6, Medial meniscus,
posterior horn. 7, Semitendinosus tendon. 8, Semimembranosus
muscle.
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MRI of the knee: coronal T1-weighted images.
1, Vastus medialis muscle.
2, Vastus lateralis muscle.
3, Femur. 4, Medial meniscus. 5, Lateral meniscus. 6, Tibia
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MRI of the knee: T2-weighted FATSAT, Axial Sections.
1, Patella. 2, Vastus lateralis muscle. 3, Femur. 4, Vastus medialis
muscle. 5, Sartorius muscle. 6, Gracilis muscle. 7, Semitendinosus muscle
and tendon. 8, Semimembranosus
muscle and tendon. 9, Biceps femoris muscle.
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MRI of the ankle, sagittal cut, T1.
1, Tibia. 2, Talus 3, Lateral
cuneiform. 4, 3rd and 4th
metatarsals. 5, Calcaneus. 6, Achilles tendon. 7, Flexor hallucis
longus tendon & muscle.
8, Soleus muscle.
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MRI of the ankle, Coronal cut, T2 FATSAT.
1, Tibia. 2, Fibula. 3, Talofibular ligament. 4, Peroneus longus tendon. 5, Calcaneus. 6, Abductor digiti minimi
muscle. 7, Flexor digitorum brevis
muscle. 8, Quadratus plantae
muscle. 9, Abductor hallucis
muscle. 10, Talus.
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Sonuç olarak kas iskelet sisteminin radyolojik incelemesinde;
Kemik ve eklemleri değerlendirmede ilk basamak Röntgen Grafileriolmalıdır.
Gereklilik halinde 2. basamak BT olabilir
Kas ve kemik iliğini değerlendirmede tercih edilecek en iyi yöntem MRG’dır.
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Gebelerde ve çocuklarda US, MRG daha güvenlidir
Röntgenografi ve BT iyonizan ışın içerdiğinden gebelerde tercih edilmez, çocuklarda ise dikkatli kullanılmalıdır
US yenidoğanda DKÇ tanısında kullanılmaktadır
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BİTTİ