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Diagnostic Imaging EBM > Diagnostic Imaging EBM Exam > Flashcards

Diagnostic Imaging EBM Exam Flashcards

1
Q

What is the acronym for soft tissue tumors of the foot and ankle?

A

MaGiC SPELLS

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2
Q

What are your DDx for soft tissue tumors of the foot and ankle?

A 
MaGiC SPELLS
Malignant fibrous histiocytoma
ganglion cyst
clear cell sarcoma
synovial chondromtosis
pigmented villonodularsynovitis (PVNS)
plantar fibromatosis
epitheloid sarcoma
ewing's sarcoma
liposarcoma
leiomyosarcoma
synovial sarcoma
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3
Q

What is the classification system for stress fractures?

A

Wilson-Katz

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4
Q

What is the classification system for osteomyelitis?

A

Cierny-Mader

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5
Q

What radiographic finding are you evaluating on lateral view if you suspect Lisfranc injury?

A

normally, the plantar aspect of med cuneiform is dorsal to plantar aspect of 5th met (if it is reversed, this would suggest Lisfranc injury)

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6
Q

What are the 4 phases of bone scans?

A

1- blood flow
2- blood pool (tissue phase)
3- bone imaging
4- delayed phase

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7
Q

What does Tc-99 localize to?

A

hydroxyapatite crystals of bone (primarily osteoblasts)

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8
Q

Why is there a fourth phase to the bone scan?

A

for patients with poor circulation that need more time for the radionuclide to disperse

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9
Q

what is the lethal dose of radiation?

A

300 rad

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10
Q

How can you tell a medial oblique xray from a lateral oblique xray?

A

medial oblique demonstrates the lesser metatarsals and cuboid better than the lateral oblique (which shows the 1st and 2nd met-cuneiform columns better)

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11
Q

What is the “C-sign”?

A

radiographic finding seen in talocalcaneal coalition that represents coalition of sustentaculum tali and posteromedial process of the talus

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12
Q

What chemical is Tc-99 bound to during the 3 phase bone scan?

A

MDP (methylene diphosphate)

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13
Q

what is teh chemical in Ceretec scan?

A

HMPAO (hexamethylpropyleneamine oxime)

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14
Q

What does the Ceretec scan label?

A

leukocytes

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15
Q

What does rarefaction mean?

A

localized loss of bone density

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16
Q

What does gallium-67 localize to?

A

leukocytes
bacterial uptake by phagocytes
lactoferrin binding at the site of injection

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17
Q

What is a STIR image?

A

180 degree pulse followed by a 90 degree pulse; used to generate a T2 image where you want fat suppressed and want to maximize the brightness of the fluid

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18
Q

what radiographic findings do you look for on AP radiograph if you suspect a Lisfranc injury?

A

fleck sign
if 2nd met deviates laterally
M1-M2 asymmetry with widening > 1mm

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19
Q

what is the fleck sign?

A

avulsion fx (of lisfranc ligament) tears bone off the medial cuneiform or 2nd met

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20
Q

what radiographic finding do you look for on a medial oblique view if you suspect a Lisfranc injury?

A

alignment of lateral margins between Cu2-M2 and Cu3-M3 should be near perfect in a normal foot.

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21
Q

What radiographic finding do you look for on lateral view if you suspect a lisfranc injury?

A

plantar aspect of med cuneiform should be dorsal to plantar aspect of 5th met
-normal talometatarsal angle

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22
Q

What stress exams are used to evaluate a Lisfranc injury?

A

abduction and adduction stress test

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23
Q

What are you examining for on an abduction stress test for Lisfranc injury?

A

transverse instability (C2-M2 tarsometatarsal widening)

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24
Q

What are you examining for on an adduction stress test for Lisfranc injury?

A

longitudinal instability (C1-C2 intercuneiform widening )

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25
Which soft tissue lesions have bony involvement?
PVNS synovial sarcoma synovial chondromatosis
26
Which soft tissue lesions have bony erosions on alternate sides of the joint?
PVNS | synovial chondromatosis
27
what contrast is used in MRI w/ contrast?
IV gadolinium
28
what adverse effect can result from gadolinium contrast used with MRI?
nephrogenic systemic fibrosis
29
what is teh magic angle effect?
on T1 images, when cartilage or tendon are oriented 55 degrees from the magnetic field, we see increased signal intensity, which represents a false artifact
30
what is the most common soft tissue sarcoma in the LE?
liposarcoma
31
what is the most common soft tissue sarcoma in the foot and ankle?
synovial sarcoma
32
what is the most common malignant soft tissue in the foot?
malignant melanoma
33
Which of the Magic spells mnemonic like to spread through the lymphatic system?
``` CARES acronym: clear cell sarcoma angiosarcoma (aka leiomyosarcoma) rhabdomyosarcoma epithelioid sarcoma synovial sarcoma ```
34
how do you stage soft tissue tumors?
GTNM (grade, tumor, nodal involvement, metastasis)
35
Stage this tumor using AJCC : moderately differentiated, tumor is 6cm, nodal involvement, metastasis.
(G2, T2, N1, M1) | Stage 4b
36
which soft tissue tumor looks like a "bag of bones" on MRI?
synovial chondromatosis
37
how does synovial chondromatosis appear on MRI?
T1- homogenously black | T2- homogenously bright fluid + black calcifications in the middle
38
which soft tissue mass looks like a "blooming flower" on MRI?
PVNS
39
what are teh determinate lesions confirmed by MRI?
ganglion, lipoma, PVNS, aneurysmal bone cyst, hemangioma
40
Name the stages of Cierny-Mader classification of osteomyelitis.
Stage 1: Medullary Stage 2: Superficial- infection of only superficial cortex Stage 3: Localized- infection of only the cortex Stage 4: Diffuse- infection of both cortex and medullary canal
41
what is the most common primary malignancy of bone in foot and ankle ?
chondrosarcoma
42
what is the most common primary malignancy tumor of bone in the body ?
multiple myeloma
43
what is the Most common benign bone tumor in foot and ankle and rest of the body ?
osteochondroma
44
A Well- defined lesion with a narrow margin is what type of lesion?
``` geographic lesion (the lesion is slow-growing and the bone has time to retreat and lay down new bone around the lesion) ```
45
What type of lesion is best represented by multiple myeloma?
moth-eaten lesion: represents several ill-defined areas of lucency ("multiple punched-out lesions"
46
What does a lamellated or "onion-skin appearance" of the periosteum indicate about the lesion?
lesion exhibits on-and-off-growing (periosteum has time to lay down thin shell of calcified new bone before the lesion starts another growth spurt -->leads to concentric shells of new bone over the lesion)
47
if a lesion grows rapidly, what are the 2 types of periosteal reactions that may be seen?
1. sunburst or "hair-on-end" | OR 2. Codman's triangle
48
What is the sunburts or hair-on-end periosteal reaction representative of?
periosteum has no time to lay down bone bc lesion is growing rapidly, but Sharpey’s fibers become calcified and stretched out perpendicular to the bone, and then ossify
49
What is the Codman's triangle periosteal reaction representative of?
only the edges of the raised periosteum will ossify-this little bit of ossification forms a small angle with the surface of the bone, but not a complete triangle
50
a matrix derived from cartilage has what appearance?
speckled
51
a cloud matrix indicates what cell of origin?
bone (osteoblasts)
52
a "ground-glass matrix indicates what type of lesion?
fibrous, cystic (fluid-filled) lesion
53
"long lytic lesion in long bone"
fibrous dysplasia
54
"chicken-wire matrix"
chondroblastoma
55
"hurts like a b and tough to see" | "night pain relieved by NSAIDs"
osteoid osteoma
56
"mosaic glass on MRI" | is filled with blood and appears as many shades of gray on MRI
aneurysmal bone cyst
57
"end of bone with speckled tone"
enchondroma
58
metastasis to the foot/ankle usually involves what systems?
GI/GU tracts (esp colorectal cancer)
59
"at the end of a long fast, teens have a blast"
osteoblastoma
60
brown tumors are indicative of what disease?
hyperparathyroidism
61
most common tumor in teens that affects the ends of long bones
osteoblastoma
62
what is the "cousin of fibrous dysplasia"?
non-ossifying fibroma
63
"endosteal scalloping"
eosinophilic granuloma
64
"massive in metaphysis"
giant cell tumor of bone
65
where is the unicameral bone cyst most likely to be located?
calcaneus (middle facet) | "best bet is middle facet"
66
what malignant lucent bone lesion is likely to affect
neuroblastoma
67
what malignant lucent bone lesion is likely to affect a patient ages 1-10?
Ewing's sarcoma
68
a patient aged 10-30 most likely has what bone tumor?
Ewing's sarcoma, osteosarcoma
69
a patient aged 30-40 most likely has what bone tumor?
fibrosarcoma, lymphoma
70
a patient aged 40+ most likely has what bone tumor?
metastasis, myeloma, chondrosarcoma
71
what is the most common solitary sclerotic lesion of bone?
a benign bone island
72
How do you differentiate between osteochondroma and subungual exostosis?
1. cap: osteochondroma has a hyaline cartilage cap while subungual exostosis has a fibrocartilage cap 2. osteochondroma arises from the physeal plate and grows away from it (whereas subungual exostosis arises from soft tissue under the nail and grows inferiorly towards distal phaalnx)
73
What is Martel's sign?
associated with gouty tophi that erodes bone, producing a characteristic overhanging C-shaped edge of bone; This overhanging margin of the new bone along the edge of erosion is called Martel's sign
74
Classify this: radiolucent fx line that appears without evidence of endosteal callus or periosteal reaction?
Wilson-Katz type 1
75
How much Vitamin D supplement should you take daily?
800-2,000 IU Vit D
76
how much calcium supplement is recommended daily? what form of calcium is recommended?
citrate calcium- more readily absorbed compared to calcium carbonate 1200-1500mg Ca2+
77
Classify this: radiosclerotic area of cancellous bone; seen with endosteal callus.
Wilson-Katz type 2
78
Where are Wilson-Katz type 3 stress fractures seen?
diaphyseal area of metatarsals (which is made of cortical bone)
79
Where are Wilson-Katz type 2 stress fx seen usually?
cancellous bone- ex. calcaneus, tibial plafond, tarsal bones, met heads/bases
80
When should you consider initiating treatment given a FRAX score?
T-score of -1 to -2.5 (osteopenia) AND 10 year hip fx prob>3% or 10 year all major osteoporotic-related fx>20%
81
Classify this: medial displacement of 1st met
Hardcastle type B1
82
What is Hardcastle type A?
total displacement of Lisfranc's joint (homolateral) A1= lateral displacement A2= dorsoplantar displacement
83
What is a lateral dislocation of the mets called?
Hardcastle type B2
84
What is Hardcastle type c?
divergent Lisfranc’s joint (1st met deviates medially while lesser metatarsals deviate laterally) ■ C1 = only some of the lesser mets deviate laterally ■ C2 = all lesser mets deviate laterally
85
which type of bone healing is stronger?
secondary bone healing ( stronger callus)
86
which type of bone healing occurs faster histologically?
primary bone healing
87
which type of bone healing appears first on radiograph?
secondary bone healing
88
Sammarco classification of plantar fibromas: | Grade 1
- focal disease - no adherence to skin - no deep extension to flexor sheath
89
Sammarco classification of plantar fibromas: | Grade 2
multifocal disease no adherence to skin no deep extension to flexor sheath
90
Sammarco classification of plantar fibromas: | Grade 3
multifocal disease | EITHER adherence to skin OR deep extension to flexor sheath
91
Sammarco classification of plantar fibromas: | Grade 4
multifocal disease | adherence to skin AND deep extension to flexor sheath
92
Which of the Magic spells soft tissue masses like to spread thru the lymphatic system?
``` *CARES mnmeonic* C- clear cell sarcoma A-angiosarcoma (aka leiomyosarcoma) R-rhabdomyosarcoma E-epithelioid sarcoma S-synovial sarcoma ```
93
Why is chemotherapy not used as often for? What are the 4 chemo drugs that are used?
no evidence for increased survival rate. Radiation is key - ifosfamide - doxorubicin - methotrexate - cyclophosphamide
94
what is the cell of origin for PVNS?
origin of synovium with proliferation of multi-nucleated giant cells and production of large quantities of hemosiderin
95
what is the cell of origin for ganglion cyst?
myxoid degeneration of periarticular CT | *DOES NOT connect to joints
96
What type of stress fx is usually seen in the calcaneus? metatarsals?
calcaneus- Wilson-Katz type 2 (cancellous bone) | metatarsals- Wilson-Katz type 3 (metatarsal shaft)
97
What is the TE and TR time for a T1 image?
short TR 100-1000ms | short TE 20-30ms
98
What is teh TE and TR time for a T2 image?
long TR 1600-3000ms | long TE 70-100ms
99
Where does Indium-111 localize to?
cytoplasmic component of WBC mb | *dependent on the chemotaxis of leukocytes
100
What does Tc-99 sulfur colloid localize to?
reticulocytes (macrophages) inside the bone marrow
101
What is the chemical that Tc-99 is bound to in a Ceretec scan?
HMPAO- hexamethylpropyleneamine oxime
102
What population gets Z-scores?
pre-menopausal women children men
103
Which medication is the only anabolic drug used to treat osteoporosis by rebuilding bone? How is this drug administered?
Teriparatide (Forteo) - 20 mcg SC daily injection
104
which bisphosphonate is administered intravenously?
Zolendronic acid (Reclast )- 5mg IV q12 months (for treatment) or 24 months (for prevention)
105
What is a normal Vit D3 serum level? What does this equate to in IU?
30ng/mL | (every 100 IU = 1ng/mL) So, 30 ng/mL = 3000 IU
106
what oxygen tension conditions favor bone formation?
low oxygen tension levels- this is because bone follows an anaerobic metabolic pathway
107
what pH level favors bone formation?
high pH
108
How are sarcomas different from carcinomas? What are their cell of origin?
sarcomas- arise from mesenchymal CT tissue such as bone, fat, or cartilage carcinomas- arise from epithelial cells
109
How do sarcomas vs. carcinomas spread?
sarcomas spread hematogenously mostly while carcinomas spread thru the lymphatics
110
What malignancies are we concerned about for adults >40 y/o?
metastasis myeloma chondrosarcoma
111
what is the tissue of origin of synovial chondromatosis?
hyaline cartilage
112
what is the tissue of origin of plantar fibromas?
myofibroblasts of plantar fascia
113
which soft tissue masses tend to have bony involvement?
PVNS synovial sarcoma synovial chondromatosis

Diagnostic Imaging EBM (2 decks)

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