15: Musculoskeletal Imaging

Question 1

Deciding on modalities for imaging

Answer 1

Body part of interest
DDx
Age
Pt Hx
Cost of exam
radiaiton dose
availability

Question 2

Guidelines for choosing a modality

Answer 2

Whats the clinical question
What test will mostly likely answer this question
If more than one will work: which is safest and cost effective?

Question 3

What do we search for in imaging

Answer 3

fractures, hardware fail, calcifications, tumors, degenerative arthritis
Hardware, joints, bones, soft tissues

Question 4

Pitfalls of musculoskeletal radiology

Answer 4

wrong study/ poor quality satisfaction of search/ timing of exam/ lack of correlation btwn image findings and clincial findings

Question 5

embedded w/in a tendon where the tendon passes over a joint

Answer 5

sesamoid bone

Question 6

Key points for a DDx

Answer 6

Vindicate Vascular/infection/ neoplasm/ drugs/ inflamatory/ congenital/autoimune/ trauma/ endocrine

Question 7

Benign vs malinant

Answer 7

Benign: lesion well circumscribed, no soft mass, no periosteal involvement.
Malignant: no nice margins, goes out of bone, soft mass around it is fluffly and is periosteal rxn

Question 8

Codmans triangle

Answer 8

seen in matrix and periosteal reactions; periosteum is pushing out

Question 9

Calcifications

Answer 9

non malignant but cause pain and look suspicious on xray; Aunt Minnie
crest syndrome is on DIPs
Soft tissue hemangiomas in

Question 10

Effusions

Answer 10

seen in joints: knee, elbow, ankle, wrist, fingers

Question 11

If you see fat and blood in joint and the are different layers could be

Answer 11

lipohemarthrosis: there was a break in the bone and marrow leaked out. once you see it, you should think there is a fracture somewhere

Question 12

Transverse fracture of proximal diaphysis of 5th metatarsal base, outside of joint. hard to heal and need to follow up with ortho

Answer 12

Jone frx

Question 13

intrareticular joint frx through the first metacarpal bone at base of the thumb, needs a pin… hard to heal

Answer 13

Rolando fracture

Question 14

bone fracture which occurs when a fragment of bone tears away from the main mass of bone as a result of physical trauma

Answer 14

Avulsion fracture

Question 15

avulsion fracture (soft tissue structures tearing off bits of their bony attachment) of the lateral tibial condyle of the knee, immediately beyond the surface which articulates with the femur.

Answer 15

Segond Fracture

Question 16

see osteophytes, asymmetric joint loss and predictable pattern

Answer 16

Osteoarthritis (most common arthritis)

Question 17

Rheumatiod, Seronegative syndromes and deposition diesease all examples of

Answer 17

inflammatory arthritis

Question 18

Gout and pseudogout are examples of

Answer 18

deposition diseases

Question 19

Good for initial exam of many musculoskeletal complaints but often limited: you can eval most every part of body with this but has varying sensitivity.

Answer 19

Radiographs

Question 20

Pros of radiographs

Answer 20

cheap, readily available, many different views and techniques, good initial test

Question 21

Cons of radiographs

Answer 21

radiation dose, limited sensitivty, doesn’t work on all areas equally

Question 22

allows real time eval of structures and can be used intra operatively, to set fractures and guide procedures

Answer 22

Fluroscopy

Question 23

Used a lot for intervential radiology, GI and GU radiology, lumbar punctures, joint injections and biopsies

Answer 23

Fluroscopy

Question 24

Pros of Fluroscopy

Answer 24

allows real time eval, procedural guidance, placement of needles, tubes, stents and catheters

Question 25

Cons of Fluroscopy

Answer 25

radiation exposure, image quality is limited

Question 26

Very cost effective and no radiation when doing a musculoskeleteal system eval

Answer 26

ultrasound

Question 27

Used to guide procedures, biopsies, aspirations, joint injections; also to eval tendons and ligaments

Answer 27

ultrasound

Question 28

Use it to eval cortical surface of bone for erosions in disease like RA

Answer 28

ultrasound

Question 29

Pros of Ultrasound

Answer 29

no radiation, portable, take up little space, no special prep

Question 30

Cons of ultrasound

Answer 30

use dependent and can’t eval all structures

Question 31

Used to eval for further and characterize osseous lesions and fractures, to eval for superficial and deep infections, eval post traumatic and devo deformities

Answer 31

CT

Question 32

Can look at soft tissues but not that great

Answer 32

CT

Question 33

Pros of CT

Answer 33

fast and available, covers lots of anatomy, great for procedures

Question 34

Cons of CT

Answer 34

over utilized, $$, meta artifacts, radiation dose

Question 35

Gold standard for eval of muscles, tendons, ligaments, joints as well as eval of cortical bone and marrow

Answer 35

MRI

Question 36

Pros of MRI

Answer 36

great soft tissue detail, no radiation, images in any plane

Question 37

Cons of MRI

Answer 37

$$$, long exams, metal artifacts, claustrophobia

Question 38

less anatomy driven and more of a focus on physiology and function

Answer 38

Nuclear medicine

Question 39

radioactive material injected into patient and imaging shows distribution in the body

Answer 39

Nuclear medicine

Question 40

Pros of Nuclear medicine

Answer 40

Provides functional data, can direct future radiolgy exams, high sensitiviy

Question 41

Cons of nuclear medicine

Answer 41

poor anatomic detail, radiation dose, low specificity, $$$