5: Radiology - spine, arthritis

Question 1

The type of scan used depends on the ___ you want to see.

Answer 1

structures

Question 2

What is the only thing you can see using X-ray of the spine?

Answer 2

Bones themselves

Question 3

What do CT scans pick up?

Answer 3

Bones

Some soft tissue

Question 4

What do MRI scans pick up?

Answer 4

Bone

Loads of soft tissue structures - discs, ligaments, nerves, spinal cord

Question 5

What general shapes of the spine are seen on imaging?

Answer 5

Cervical lordosis

Thoracic kyphosis

Lumbar lordosis

Question 6

Most vertebrae have the same structure, composed of a vertebral ___ and an (anterior / posterior) ___.

Answer 6

vertebral body

posterior arch

Question 7

Vertebrae are held together anteriorly by ___ ___.

…and posteriorly by ___ joints.

Answer 7

anteriorly - intervertebral discs

posteriorly - facet joints

Question 8

Consecutive vertebrae should be (similar / different) sizes.

Answer 8

similar sizes

Question 9

The transverse processes of the thoracic vertebrae provide articulation with what?

Answer 9

Ribs

Question 10

What are some notable features of C1?

And of C2?

Answer 10

C1 - Atlas - no vertebral body - anterior and posterior arches, articulates with odontoid process of C2 inferiorly and occipital bone superiorly

C2 - Axis - odontoid process forms joint with anterior arch of C1

Question 11

Difference in vertebral size indicate ___.

Answer 11

pathology

Question 12

What is a Hangman’s fracture?

Answer 12

Fracture of both pedicles of C2

Question 13

If an X-ray doesn’t provide enough info about a spinal injury, what is the next scan used?

Answer 13

CT scan

Question 14

What structures are responsible for spinal stability?

Answer 14

Ligaments

Question 15

Normal vertebral alignment usually implies that the ___ are intact.

Answer 15

ligaments

Question 16

Abnormal vertebral alignment usually implies that the ___ are damaged.

Answer 16

ligaments

Question 17

Name the ligaments holding vertebrae together.

Answer 17

Supraspinous

Interspinous

Ligamentum flavum

Posterior longitudinal

Anterior longitudinal

Question 18

What scan can used to see spinal ligaments?

Answer 18

MRI scan

Question 19

On MRI, what colour are:

a) normal
b) damaged ligaments?

Answer 19

a) black

b) white

Question 20

Why isn’t MRI commonly used to view the spine?

Answer 20

Normal / abnormal alignment usually gives info on ligament damage

Question 21

When is MRI used in patients with suspected spinal injury?

Answer 21

Neuro symptoms not explained by X-ray / CT

Question 22

What are some signs of vertebral tumours on X-ray and CT?

Answer 22

Bone sclerosis (INCREASED DENSITY)

Bone destruction (REDUCED DENSITY)

Pathological fractures

Question 23

How do tumours look on MRI?

Answer 23

Early - infiltration of bone marrow

Late - compression of spinal cord

Question 24

owls - pedicles are eyes, if owl is winking at you i.e pedicle is missing, bone destruction

Question 25

What do intervertebral discs look like on X-ray?

Answer 25

You can't see them Space only

Question 26

What scans are used to view intervertebral disc prolapse?

Answer 26

**MRI** **CT scan** i.e soft tissue stuff

Question 27

MRI can pick up the ___ of discs, giving an indication of how damaged they are.

Answer 27

**hydration**

Question 28

What is the only scan which picks up the spinal cord?

Answer 28

**MRI scan**

Question 29

Is sciatica caused exclusively by prolapsed discs?

Answer 29

**No**, include tumours and other swellings

Question 30

What is the role of imaging in arthritis?

Answer 30

**Making diagnosis in the first place** **Monitoring disease activity and treatment response**

Question 31

What are the main arthritidies seen in radiology?

Answer 31

**OA** **RA** **Seronegative arthritidies** **Gout**

Question 32

Which joints are affected by OA?

Answer 32

**Weightbearing / active joints** i.e spine, hip, knee, thumbs, DIPs

Question 33

Is OA symmetrical or asymmetrical?

Answer 33

**Usually asymmetrical**

Question 34

What wears away in OA? What's the result?

Answer 34

**Cartilage** **Loss of joint space**

Question 35

Inflammation causes what sign in OA X-rays?

Answer 35

**Increased bone turnover** causing SCLEROSIS

Question 36

What causes subchondral cysts?

Answer 36

**Leakage of synovial fluid into bone**

Question 37

What causes **osteophyte** formation?

Answer 37

**Stimulation of periosteum at margins due to joint destruction**

Question 38

Where does bone sclerosis occur in OA?

Answer 38

**Cortex** i.e subchondral, above and below joint

Question 39

What is the main difference between OA and RA on X-ray?

Answer 39

**Symmetrical bone involvement**

Question 40

Which joints are chiefly affected by RA? Which joints are spared?

Answer 40

**Synovial** (inflammation of synovium) ## Footnote **DIPs spared**

Question 41

What is the first thing seen on a scan of an RA patient?

Answer 41

**Soft tissue swelling** due to inflammation in early RA

Question 42

What process, affecting density, occurs to the bone in RA patients?

Answer 42

**Osteoporosis**

Question 43

What is a pannus? What does it do to bone?

Answer 43

**Inflamed, thickened synovium full of immune cells** **Destroys bone**

Question 44

Pannus attacks bone (centrally / marginally).

Answer 44

**marginally**

Question 45

What occurs at joints in late stage RA?

Answer 45

**Subluxation** **Tendons fail**

Question 46

What name is given to the process by which eroded bone fuses together?

Answer 46

**Ankylosis**

Question 47

What are the typical features of **seronegative arthritis** on imaging?

Answer 47

**SI joint / spine involvement** **Ankylosis** **Periarticular bone formation - osteophytes**

Question 48

What name is given to ossification of ligaments, often seen in diseases like ankylosing spondylitis?

Answer 48

**Syndesmophytes**

Question 49

What is a straight, ankylotic spine called when seen on X-ray?

Answer 49

**Bamboo spine**

Question 50

What scans are used to identify arthritis BEFORE it has caused joint damage?

Answer 50

**Bone scans** and **ultrasound** (to see increased vascularity secondary to synovitis) **MRI** for bone marrow oedema