Bone Path II

Question 0

What are the categories of bone disease

Answer 0

Congenital
Arthritis
Tumor
Blood
Infection
Trauma
Endocrine
Soft tissues

Question 1

3 Most common causes of Ivory Vertebra

Answer 1

• Osteoblastic metastasis
• Paget’s disease: cortical thickening, expansion
• Hodgkin’s lymphoma: anterior body scalloping

Question 2

CT is better for what kind of detail?

Answer 2

Osseous

Question 3

What is brighter w/ a T1 weighted MRI? T2?

Answer 3

T1= Fat is brighter
T2= fluid is brighter

Question 4

What kind of imaging is better to evaluate a lesion in the marrow?

Answer 4

MRI

Question 5

What will be a “hot spot” in a bone scan?

Answer 5

Areas of increased metabolic activity

Question 6

Carcinoma definition

Answer 6

any of various types of malignant neoplasm derived from epithelial tissue (skin, colon, bronchi, prostate, breast, etc)

Question 7

Malignant definition

Answer 7

locally invasive, destructive growth, metastasis

Question 8

Characteristics of a primary malignancy

Answer 8

Expansion of bone
Periosteal response
solitary lesion
Lesion over 10 cm
Soft tissue mass

Question 9

Characteristics of metastasis

Answer 9

70% malignancies
2-4 cm lesions
Multiple lesions

Question 10

“winking owl” sign

Answer 10

Missing pedicle due to an osteolytic lesion

Question 11

40% of metastasis occurs where?

Answer 11

Spine

Question 12

Does metastasis involve the IVD?

Answer 12

very rarely

Question 13

Spinal metastasis most commonly affects what?

Answer 13

vertebral body

Question 14

Skeletal metastasis occurs where?

Answer 14

Spine- 40%
Ribs and sternum- 28% (ribs 4x to spine)
Pelvis- 12%
Skull- 10% - usually well defined lytic lesions
Long tubular bones- 10%- mostly femur and humerus

Question 15

What are the 4 most common primary malignancies of bone?

Answer 15

Multiple myeloma (50-70 y.o.)
Osteosarcoma (10-25 y.o.)
Chondrosarcoma (40-60 y.o.)
Ewing's sarcoma (10-25 y.o.)
            MOCE

Question 16

Characteristics of multiple myeloma

Answer 16

• Anemia -Lytic destruction
• Abnormal serum protein -Renal disease
• BONE PAIN (worse in day, w/ exercise)
• Pathologic fx (20%) -Weight loss
• Fever -Cachexia -Osteoporosis -amyloidosis
• Bacterial infections (esp. respiratory)

Question 17

What is strongly diagnostic for multiple myeloma?

Answer 17

Bone marrow aspiration, also a protein electrophoresis w/ an “M-spike” is diagnostic

Question 18

What kind of plain film findings will you see for multiple myeloma?

Answer 18

multiple, well-defined, round osteolytic lesions; “punched out” (80%); no reactive sclerosis

Question 19

Most frequent sites of multiple myeloma?

Answer 19

Same as mets; axial skeleton and long bones, with active hematopoetic tissue