Approach to musculoskeletal imaging Flashcards

0
Q

Types of bone lesions

A
  • fracture
  • sclerotic (pathologic thickening of the bone)
  • lytic (a “punched-out” area of severe bone loss)
  • periosteal new bone
  • exostosis (a benign outgrowth of cartilaginous tissue on a bone)
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1
Q

Factors influencing xray images

A
  • tissue composition (radiodensity
  • tissue thickness
  • position of the object wrt film and X-ray source
  • object shape
  • superimposition of tissues
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2
Q

radiolucent lesion

A

Destructive
lytic
erosive

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3
Q

radio-opaque lesion

A

sclerotic
radiodense
dense
osteosclerotic

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4
Q

different patterns of periosteal new bone

A
  • solid/linear
  • lamellated (onion skin)
  • sunburst (hair on end)
  • codman’s triangle (at an angle)
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5
Q

Structure of long bone

A
  • shaft
  • metaphysis
  • diaphysis
  • epiphysis
  • articular surface
  • elevations
  • facets
  • depressions
  • holes
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6
Q

things to look out for in a bone/joint film

A
  • identity
  • 2 views or more (eg. A-P and lateral)
  • alignment (dislocation or subluxation; developmental deformity? associated with another disease process?)
  • joint surfaces and joint
  • bone outline
  • trabecular bone and lines
  • soft tissues
  • growth plates
  • invisible structures
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7
Q

What are the 2 views normally used in an xray?

A
  • Anteroposterior (A-P)
  • lateral

sometimes:
-swimmer’s view

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8
Q

systematic approach to C-spine xray

A
  1. Coverage - adequate?
  2. Alignment - anterior/ posterior/ spinolaminar
  3. Bones - cortical outline/ vertebral body height
  4. spacing - discs/ spinous processes
  5. soft tissues - prevertebral
  6. edge of image
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9
Q

Things to look out for in alignment

A
  • Joint dislocation or subluxation
  • fracture
  • developmental deformity
  • deformity associated with another disease process?
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10
Q

Important things to look out for in joint xray

A
  • smooth outline subchondral bone
  • symmetrical joint space
  • congruity between articular surfaces
  • fluid, calcification, gas within joint
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11
Q

Things to look out for in the soft tissues in an X-ray film

A
  • masses
  • calcification (fluffy amorphous density)
  • ossification (bone formation in organized pattern with a cortex and medulla)
  • gas
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12
Q

Appearance of fractures on plain film

A
  1. Dark streaks or lines across the bone - line usually transverses both trabecular and cortical bone (break in the cortex)
  2. White line - double density due to bone overlap
  3. Comminuted - more then 1 fracture plane
  4. Deformity - abnormal alignment
  5. Bone ends may be separated by soft tissue swelling and haemorrhage
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13
Q

How to identify fractures?

A

look for

  • break in cortex
  • radiolucent lines across the bone
  • white line or area due to overlap of bone
  • fragments of bone
  • denser white lines where trabecular bone is impacted
  • mal-alignment of bones
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14
Q

Pros and cons of plain films

A
  • good overview of bones and joints
  • Good for alignment
  • Flexibility in positioning
  • less contrast/ spatial resolution than CT
  • radiation, but less then CT
  • Cheap and quick
  • Readily available
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15
Q

Pros and cons of CT

A
  • More detailed (esp complex joints/ fractures)
  • multiplanar imaging
  • More expensive than plain film
  • more radiation
16
Q

Pros and cons of MRI

A
  • Good spatial and contrast resolution
  • good for soft tissue and bone marrow
  • good for inside joints (hidden structures)
  • cross-sectional imaging
  • imaging in multiple planes
  • no radiation
  • limited functional information
  • contraindications (pacemaker, cochlear implant, some aneurysm clips)
  • more expensive
  • longer scan times
17
Q

Pros and cons of ultrasound

A
  • operator dependent
  • high resolution for superficial soft tissue structures (tendons, nerves, ligaments, muscle)
  • small field of view
  • does not see inside the joint or through bone
  • readily available, cheap, dynamic, no radiation
18
Q

Pros and cons of nuclear medicine

A
  • shows increased bone turnover and so activity pf lesions
  • mainly used for metastatic disease, infection, stress fractures, arthritis
  • sensitive but not specific