0:00

To finish up hyperthyroidism.

0:03

Now you all learn about this disease

0:05

as resonance in in radiology.

0:08

Uh, I can remember very clearly,

0:10

I think it was in the first week, whether I was a ra,

0:12

a radiology resonance.

0:14

I learned about subperiosteal resorption of bone

0:18

and I was taught to look at the hands,

0:20

to look at the phalanges, to look at the terminal tufts

0:23

for the classic features.

0:25

But as I show you here with this list, bone resorption

0:29

and hyper power thyroidism can indeed involve different

0:33

types of resorption, intracortical, endo,

0:38

sub ligamentus, SubT tenderness and sub conval.

0:42

So if you ever wondered why the sacroiliac joints widened in

0:46

primary or secondary hyperparathyroidism

0:49

or the synthesis pubis widens,

0:52

that's not subperiosteal resorption.

0:54

That's sub conval bone resorption, typically bilateral

0:59

and symmetrical.

1:01

It can simulate early stages of sacroiliitis as shown here.

1:06

And just to show you the same phenomenon occurring

1:09

elsewhere, these are the Sterno

1:12

Pav joints you can see here by uh, image

1:17

and also in a specimen subcon bone resorption

1:22

involving the clavicle

1:23

and sternum widening

1:25

of the corresponding interosseous spaces,

1:28

erosions surface irregularity and bone sclerosis.

1:32

Same thing occurs about the acromioclavicular joints.

1:38

Beautiful example.

1:39

Uh, Karen Chen, uh, showed this one not too long ago.

1:42

This is all subcon bone resorption,

1:45

bilateral sacroiliac joint involvement,

1:48

symmetric simulating sacroiliitis.

1:52

This is related to chondral bone resorption in the glenoid.

1:56

Here you can see the irregular surface of the femoral head,

2:00

subc chondral bone resorption in hyperparathyroidism.

2:03

And another phenomenon to remember,

2:06

you get subc chondral bone resorption in this disease

2:09

in the vertebral bodies.

2:11

So multiple and large cartilaginous

2:15

or sch smalls nodes may be seen particularly in those

2:19

patients with chronic renal disease.

2:21

And you can see that nicely in this example.

2:25

And then to finish up our talk infection, of course,

2:27

the classic distribution

2:29

and infection is unilateral involvement

2:32

in the peripheral skeleton monoarticular involvement.

2:36

So to show you a couple of examples here,

2:40

septic arthritis involving a sacroiliac joint

2:43

with all the classic features that you would expect,

2:46

the unilateral distribution being very, very important.

2:51

And then one further example shown here,

2:53

unilateral involvement, in this case,

2:56

the right siliac joint. You can see

2:58

The changes on the fluid sensitive sequence.

3:01

And here with gadolinium,

3:03

this is an abscess present anterior

3:06

to the involved sacroiliac joint.

3:10

So what I've done over a period of 45 minutes is

3:13

to fulfill hopefully three objectives.

3:17

We studied the anatomy of the sacroiliac neuros space,

3:22

emphasizing the true portion, the sacroiliac joint,

3:26

and then the adjacent ligaments.

3:28

We've reviewed imaging methods throughout,

3:30

although I have emphasized MR.

3:32

Imaging in this particular talk,

3:34

and we documented some

3:36

of the characteristic morphologic features.

3:39

But most importantly, we documented the distribution,

3:43

distribution, distribution, distribution,

3:46

very important in the differential diagnosis

3:49

of sacroiliac joint disease.