Studies of bone structure using ultrasound (ultrasound) is impossible. However, the ultrasound method can be used to assess the surface of the bone and cortical layer. Sighting of the bone surface is performed with rheumatoid arthritis, trauma, various infections. Edge erosion and synovial ulceration are best revealed by ultrasound examination.
Methods of ultrasound of bones.
Longitudinal and transverse scans should be performed perpendicular to the bone surface. The mode of tissue harmonics helps to more clearly visualize the contours of bone structures, identify bone fragments, protrusions and depressions. Panoramic scanning mode allows you to display the bone structures on a large extent. The image data is easier to interpret to clinicians, it is possible to obtain sections comparable with MRI and, in addition, there is the possibility of simultaneous evaluation of muscles and tendons.
The echocardiogram of the bone is normal.
The bone structures reflect the ultrasound ray, so only the surface of the bone gets a mapping, which looks like a bright hyperechogenic line. Visualization of the periosteum is possible only with its pathological changes.
Pathology of bone and periosteum.
Fractures. Small fractures or fissures can also be detected by ultrasound. The fracture zone looks like the discontinuity of the contours of the bone surface. With ultrasound angiography in the area of the resulting bone tissue, hypervascularization is seen. With the help of ultrasound, fracture consolidation can be monitored. Two weeks after the fracture, a granulation tissue with a profuse vascular reaction is formed. Then on this place a fibrous tissue with hyperechoic areas is formed. The dimensions of the hyperechogenic zone gradually increase, the acoustic shadow intensifies. Absence of hypervascularization in the fracture zone, hypoechoic tissue in the fracture zone, fluid - signs of poor fracture fusion. This can lead to the formation of a false joint.
Degenerative changes. Degenerative changes are characterized by changes in bone tissue. In this case, the articular surface of the bone becomes uneven, because of the appearance of marginal bone growths on it.
False joints. Formed after improperly fused bone fractures. False joints of the hip are observed after osteosynthesis of closed fractures of the femoral diaphysis, if the operation was complicated by suppuration, osteomyelitis, if bone fragments were removed or sequestered, resulting in the formation of a bone defect. They look like the intermittence of the contour along the course of the bone with the presence of uneven contours and a distal acoustic shade.
Erosions in osteomyelitis. In osteomyelitis, fluid contents can be detected in the periosteal region in the form of a hypoechoic band on the cortical bone surface. In chronic osteomyelitis, the reaction from the periosteum is defined as the thickening of the periosteal plate.
Prostheses. Ultrasound examination after prosthetics with metal structures is the leading in the identification of periarticular complications due to the fact that the MRI is impossible for most of these patients.
To acute complications after prosthetics, the occurrence of hematomas is attributed. The main complications - arising in the long-term period of prosthetics - is the infection and loosening of the joint. In ultrasound, a specific sign of infection is the appearance of fluid around the artificial joint. Another sign is the stretching of the pseudocapsule of the joint.
Tumors. Radiography, CT, MRI and scintigraphy of the bones of the skeleton are techniques widely used for the diagnosis and staging of tumors of bone and cartilaginous tissue. Radiography is used for the primary prediction of the histological form of the tumor (bone-forming, cartilaginous, etc.). In turn, CT is most often used to diagnose tumors that are undetectable by radiography. MRI is the method of choice for staging of sarcomas, lymphomas and benign lesions characterized by rapid growth. In some benign formations accompanied by edema of soft tissues, such as, for example, osteoblastoma, osteoid osteoma, chondroblastoma and eosinophilic granuloma, the assessment of changes is difficult due to the complexity of the picture. Therefore, MRI data should preferably be supplemented by ultrasound. For the tumor lesion of various structures of the musculoskeletal system, a soft tissue component is present, which is clearly visible on ultrasound as an additional formation of "plus tissue"; The violation of the integrity of the bone structure and the presence of a large number of additional tumor vessels are also determined.
Osteogenic sarcoma. Osteogenic sarcoma is one of the most malignant primary bone tumors. The frequency of this tumor among primary tumors of the skeleton reaches 85%. The disease is more likely to affect children and young people. Clinically manifested by pain, which increases with the growth of the tumor. Rapidly increasing and limiting mobility in the joint. Primarily affected metaphyseal sections of long tubular bones (mostly femoral and bolebybertsovoy). Radiologically, the tumor is manifested by the presence of a "peak" on the border of the outer defect of the cortical bone layer and the extraosteal component of the tumor in the form of an osteophyte. The symptom of "needle spicules" characterizes the spread of the tumor beyond the bone. In ultrasound examination, the tumor manifests itself as a local thickening of the bone with a violation of the cortical layer and the presence of hyperechoic inclusions in the central parts of the tumor with a pronounced distal acoustic effect. On the periphery of formation, deformed tumor vessels are usually detected.
Chondrosarcoma. The frequency of chondrosarcoma among primary malignant bone tumors is up to 16% and ranks second in frequency after osteosarcoma. They get sick more often at the age of 40-50 years. The most frequent localization are pelvic bones, ribs, sternum, scapula, proximal femur. Clinically manifested by moderate pain with a significant tumor size. They differ in slow growth. Radiographically difficult to diagnose in the early stages, later revealed due to calcification in the central parts of the tumor.
When ultrasound is defined as a large formation with hilly contours, reduced echogenicity, with microcalcinates in the central sections and feeding deformed tumor vessels. Chondrosarcom surgery is surgical.
Fibrosarcoma. The frequency of fibrosarcoma is up to 6%. The age of patients varies from 20 to 40 years. Almost a quarter of all tumors are located in the distal metaphysis of the femur, less often in the proximal part of the lumbar bone.
Clinically manifested by low-intensity inconsistent pain. As a rule, the tumor is painful on palpation, unbiased with respect to the bone, bumpy. X-ray is characterized by the presence of an eccentrically located focus with indistinct contours, the absence of a zone of sclerosis and calcareous deposits. Sometimes there is a periosteal reaction. Ultrasound characteristics are similar to chondrosarcoma.
Due to the large extent of the tumor, it is recommended to use the panoramic scanning mode to more accurately assess its localization and the relationship with the underlying structures.
In contrast to malignant benign tumors, there are clear, fairly even contours, the preservation of the cortical layer of the bone and the organized character of the vessels. The most typical benign tumors include osteoma, osteoid osteoma, osteoblastoma, chondroma, chondroblastoma, chondromixoid fibroids, osteoblastoklastoma, desmoid fibroids, and others.