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MSK Week 4 2017/18 > 5: Radiology - spine, arthritis > Flashcards

5: Radiology - spine, arthritis Flashcards

1
Q

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

A

structures

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2
Q

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

A

Bones themselves

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3
Q

What do CT scans pick up?

A

Bones

Some soft tissue

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4
Q

What do MRI scans pick up?

A

Bone

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

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5
Q

What general shapes of the spine are seen on imaging?

A

Cervical lordosis

Thoracic kyphosis

Lumbar lordosis

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6
Q

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

A

vertebral body

posterior arch

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7
Q

Vertebrae are held together anteriorly by ___ ___.

…and posteriorly by ___ joints.

A

anteriorly - intervertebral discs

posteriorly - facet joints

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8
Q

Consecutive vertebrae should be (similar / different) sizes.

A

similar sizes

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9
Q

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

A

Ribs

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10
Q

What are some notable features of C1?

And of C2?

A

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

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11
Q

Difference in vertebral size indicate ___.

A

pathology

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12
Q

What is a Hangman’s fracture?

A

Fracture of both pedicles of C2

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13
Q

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

A

CT scan

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14
Q

What structures are responsible for spinal stability?

A

Ligaments

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15
Q

Normal vertebral alignment usually implies that the ___ are intact.

A

ligaments

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16
Q

Abnormal vertebral alignment usually implies that the ___ are damaged.

A

ligaments

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17
Q

Name the ligaments holding vertebrae together.

A

Supraspinous

Interspinous

Ligamentum flavum

Posterior longitudinal

Anterior longitudinal

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18
Q

What scan can used to see spinal ligaments?

A

MRI scan

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19
Q

On MRI, what colour are:

a) normal
b) damaged ligaments?

A

a) black

b) white

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20
Q

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

A

Normal / abnormal alignment usually gives info on ligament damage

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21
Q

When is MRI used in patients with suspected spinal injury?

A

Neuro symptoms not explained by X-ray / CT

22
Q

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

A

Bone sclerosis (INCREASED DENSITY)

Bone destruction (REDUCED DENSITY)

Pathological fractures

23
Q

How do tumours look on MRI?

A

Early - infiltration of bone marrow

Late - compression of spinal cord

24
Q

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

A
25
Q

What do intervertebral discs look like on X-ray?

A

You can’t see them

Space only

26
Q

What scans are used to view intervertebral disc prolapse?

A

MRI

CT scan

i.e soft tissue stuff

27
Q

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

A

hydration

28
Q

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

A

MRI scan

29
Q

Is sciatica caused exclusively by prolapsed discs?

A

No, include tumours and other swellings

30
Q

What is the role of imaging in arthritis?

A

Making diagnosis in the first place

Monitoring disease activity and treatment response

31
Q

What are the main arthritidies seen in radiology?

A

OA

RA

Seronegative arthritidies

Gout

32
Q

Which joints are affected by OA?

A

Weightbearing / active joints

i.e spine, hip, knee, thumbs, DIPs

33
Q

Is OA symmetrical or asymmetrical?

A

Usually asymmetrical

34
Q

What wears away in OA?

What’s the result?

A

Cartilage

Loss of joint space

35
Q

Inflammation causes what sign in OA X-rays?

A

Increased bone turnover

causing SCLEROSIS

36
Q

What causes subchondral cysts?

A

Leakage of synovial fluid into bone

37
Q

What causes osteophyte formation?

A

Stimulation of periosteum at margins due to joint destruction

38
Q

Where does bone sclerosis occur in OA?

A

Cortex

i.e subchondral, above and below joint

39
Q

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

A

Symmetrical bone involvement

40
Q

Which joints are chiefly affected by RA?

Which joints are spared?

A

Synovial (inflammation of synovium)

DIPs spared

41
Q

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

A

Soft tissue swelling

due to inflammation in early RA

42
Q

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

A

Osteoporosis

43
Q

What is a pannus?

What does it do to bone?

A

Inflamed, thickened synovium full of immune cells

Destroys bone

44
Q

Pannus attacks bone (centrally / marginally).

A

marginally

45
Q

What occurs at joints in late stage RA?

A

Subluxation

Tendons fail

46
Q

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

A

Ankylosis

47
Q

What are the typical features of seronegative arthritis on imaging?

A

SI joint / spine involvement

Ankylosis

Periarticular bone formation - osteophytes

48
Q

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

A

Syndesmophytes

49
Q

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

A

Bamboo spine

50
Q

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

A

Bone scans and ultrasound (to see increased vascularity secondary to synovitis)

MRI for bone marrow oedema

MSK Week 4 2017/18 (10 decks)

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