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fall A 2024 > imaging midterm > Flashcards

imaging midterm Flashcards

1
Q

fluffy texture

A

both osteoblastic and osteoclastic activity

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2
Q

smudged texture

A

osteomalacia

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3
Q

coarsening

A

chronic renal failure and osteoporosis

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4
Q

lacy, delicate texture

A

thalassemia

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5
Q

sclerosis

A

normal local increases due to increases physical stress

reactive: in diseased area

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6
Q

4 periosteal rections

A

solid: benign
laminated or onion skin: repetitive injury
spiculated or sunburst: malignant bone lesions
codman’s triangle: triangular shape

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7
Q

6 categories of skeletal pathology

A

congenital
inflammatory
metabolic (only diffuse)
neoplastic (only diffuse)
traumatic
vascular

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8
Q

distribution of lesion

A

monostatic or monoarticular: one bone or joint
polyostotic or poly articular: multiple bones/joints
diffuse: nearly all bones or joints

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9
Q

behavior of lesions

A

osteolytic: destroyed by osteoclastic activity
osteoblastic: new bone present
mixture

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10
Q

osteolytic lesions (3 forms of destruction)

A

geographic: sharp borders - benign
moth-eaten: ragged borders - malignant
permeative: poorly defined borders - malignant

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11
Q

crossed joint space

A

tumors do not cross the joint space
infections do cross the joint space

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12
Q

buttressing

A

osteophytes at joint margins to strengthen

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13
Q

tumor matrix

A

chondroid: cartilaginous - stippled, popcorn shaped
osteoid: bony - white, cloud-like, fluffy

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14
Q

purposes of written radiology report

A

link radiologic signs
comparison of other radiographs
permanent record
expedites treatment
research
communication

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15
Q

findings in radiology report

A

body of report
complete sentences
do not state diagnosis
paragraphs based on ABCS

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16
Q

conclusion of radiology report

A

state diagnosis here in order of severity

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17
Q

vision statement 2020

A

doctors of PT
new technologies … provide direct care
comprehensive level of professional care

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18
Q

military PTs providing primary care since

A

early 1970s

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19
Q

do you see superimposition with CT?

A

CT’s are relatively free of superimposition

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20
Q

CT radiodensities

A

dense: white or light gray
less dense: dark

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21
Q

pixel

A

represents a slice anywhere from 0.1 to 10 mm thick

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22
Q

voxel

A

product of pixel and slice thickness
can contain different tissues in single voxel

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23
Q

volume averaging

A

radiodensity is average for all radio-densities in that voxel
can result in loss of contrast resolution
can be solved with thinner slices, but loss of image quality

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24
Q

scout image

A

small locator image inserted into image for each slice

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25
Q

windowing

A

range of radiodensities displayed in an image

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26
Q

examples of image degradation

A

hardening
streak artifacts
motion artifacts

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27
Q

hardening

A

as photons pass through structures such as the skull, beam becomes harder since lower-energy photons are absorbed more readily

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28
Q

artifacts: metals

A

lead to streaking represented by bright lines in image

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29
Q

motion artifacts

A

pt moves leading to shading or streaking in image

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30
Q

slice thickness

A

thinner: less radiodensity and increases “noise”, require greater radiation to produce same image quality

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31
Q

what does CT image best?

A

bone:
fractures
degenerative changes
may be first choice in serious trauma
spinal stenosis (myelography)
condition of IVD (diskogram)
evaluation of loose bodies in joint
less time consuming than MRI or US
measurements of osseous alignement
less expensive than MRI
less problematic for claustrophobia

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32
Q

limitations of CT

A

histological makeup due to reliance on radiodensities
relatively high radiation exposure

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33
Q

planes of MRI

A

coronal: from front, facing pt
axial: from below
sagittal: left to right for either side of body

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34
Q

T1 weighted image

A

much of energy from RF pulse remains in tissues
fat gives high signal intensity
water gives low signal
red bone marrow - intermediate signal
yellow marrow - high

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35
Q

T2 weighted image

A

low energy levels
grainer and display less spatial resolution
fat gives low signal
water gives high signal

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36
Q

what structures give low signal on both T1 and T2?

A

tendons
ligaments
menisci
cortical bone - very low

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37
Q

what structures give intermediate signal on both T1 and T2?

A

muscles - slightly lower on T2
cartilage

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38
Q

what does MRI image best?

A

sensitive for changes in bone marrow
soft tissue detail
can replace invasive diagnostics in detection of meniscal tears
disk herniations and other nerve root impingement
can stage neoplasms in bone and ST

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39
Q

contraindications for MRI

A

ferrous metals:
~ ferromagnetic surgical clips can be displaced
~ orthopedic hardware can distort image, but
generally no health risk
pacemakers may malfunction due to magnet
claustrophobia
may need to sedate those who cannot stay still

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40
Q

who gives guidelines for spine radiology?

A

american college of radiology (ACR)
none from APTA

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41
Q

goal of cervical spine radiographic examination

A

ID or exclude anatomic abnormalities or disease processes or spine

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42
Q

indications of cervical spine radiologic examination

A

trauma
shoulder or arm pain
occipital headache
limitation on motion
planned or prior surgery
eval or primary or secondary malignancies
arthritis
suspected congenital anomalies and syndromes with
spinal abnormality
eval of spinal abnormality seen on other iamges
follow up of known abnormality
suspected spinal instability

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43
Q

basic projections (cervical)

A

AP
lateral
AP open mouth - as needed
swimmer’s lateral - if needed to assess lower cervical
segments and cervicothoracic junction
bilateral oblique - if needed to assess neural foramina
flexion-extension - to assess instability

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44
Q

canadian C-spine rule

A

alert and stable
sustained traumatic injury
3 questions

  1. are there any high risk factors that mandate radiography? if yes, obtain
  2. any low risk factors that allow safe assessment of ROM? if no, obtain
  3. is pt able to rotate neck actively at least 45 degrees to right and left? if no, obtain. if yes, no need.

100% sensitivity
43% specificity

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45
Q

NEXUS
National Emergency X-radiography Utilization Study

A

low risk criteria to help identify pts following trauma that do not need imaging based on clinical presentation.
must meet all five for no imaging

  1. no posterior midline cervical tenderness
  2. no evidence of intoxication
  3. normal level of alertness and consciousness
  4. no focal neurological deficit
  5. no painful distracting injuries

99.6% sensitivity
12.9% specificity

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46
Q

ACR guidelines for suspected spinal trauma recommends:

A

CT with sagittal and coronal reformatting ot both CT and MRI to assess instability or myelopathy

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47
Q

cross table lateral

A

performed on supine, immobilized patient
preliminary diagnostic screen

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48
Q

lateral flexion and extension stress views

A

give joints more opportunity to reveal instability by imposing mechanical stress

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49
Q

radiologic signs of cervical spine trauma

A

soft tissues: widened retropharyngeal and retrotracheal spaces, displacement of trachea, larynx or prevertebral fat pad (6mm at C2 and 22mm at C6)

vertebral alignment: loss of parallelism or lordosis, acute kyphosis, rotation of vertebral body

joint signs: widened ADI, widened interspinous process space, widened IVD space, narrowed IVD space, loss of facet joint articulation

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50
Q

stable injuries

A

protected from significant bone or joint displacement by intact posterior spinal ligaments

compression fractures, traumatic disk herniations

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51
Q

unstable injuries

A

significant displacement initially or have potential to become displaced with movement

dislocations

52
Q

potential injury to spinal cord and nerves

A

C1-C2 and C6-C7 most frequently injured
40% incidence of associated neurological injury
approximately 2/3 of all spinal cord injuries in C-spine

53
Q

SCIWORA syndrome
spinal cord injury without radiographic abnormalities

A

spinal cord injured without fracture or dislocation
predominant in children

causes ligamentous injury and cartilaginous vertebral endplate fractures

in adults, buckling of ligamentum flavum by posterior vertebral body osteophytes can result in central cord syndrome

54
Q

MOI of c spine fractures

A

either direct force (blow to head) or indirect force (rapid accel or decel in motor vehicle accident)

55
Q

characteristics of c spine fractures

A

alvusion: fragment pulled off by violent muscle contraction

compression/impaction: adjacent vertebrae forced together
~ axial: burst fracture
~ flexion: compresses vertebral body into an anterior
wedge shape
~extension: force fractures and compresses articular
pillars

56
Q

wedge fracture (C3-C7)

A

when interposed vertebra is compressed anteriorly by two adjacent vertebrae owing to hyperflexion forces
~2/3 of these are at C5-C7
~may be stable because ligamentous structures at
least partially intact

57
Q

burst fracture (C3-C7)

A

occurs when IVD axially compressed and NP driven through an adjacent vertebral endplate, causing literal bursting apart of vertebral body and resulting in comminution
~ can be stable or unstable

58
Q

teardrop fracture (C3-C7)

A

occurs when triangular fragment of bone becomes separated from anteriorinferior corner of vertebral body because of either avulsion or compression force
~ flexion fracture most severe
~ potentially unstable

59
Q

articular pillar fracture (C3-C7)

A

fractures by a compressive hyperextension force combined with a degree of lateral flexion
~ most frequently at C6 and usually stable

60
Q

Clay Shoveler’s fracture (C3-C7)

A

avulsion fracture of spinous process produced by hyperflexion forces or forceful muscular contraction of trapezius/rhomboids often associated with repetitive heavy labor or upper extremities
~ most frequently at C6-T1
~stable

61
Q

transverse process fracture (C3-C7)

A

uncommon fracture but usually occurs at largest transverse process in c-spine (C7)
~ usually from lateral flexion forces causing avulsion at tip of contralateral TP

62
Q

dislocations (C-spine)

A

direction that superior vertebra of segment moved

63
Q

what is the most serious and life-threatening injuries to c-spine?

A

fracture-dislocations
~ fracture through base of dens combines with
ligament rupture
~hangman’s fracture associated with anterior
dislocation of C2 on C3

64
Q

dislocations not associated with fractures

A

either complete or self-reducing
~ SR return to normal alignment once force dissipates

65
Q

locked facets

A

inferior articulating process of uppermost vertebra will lie in front of superior articulating process of subjacent vertebra
~ locking joint out of normal articulation

66
Q

facet dislocations

A

unilateral: tear one facet capsule and posterior ligaments. stable in absence of vertebral body subluxation
bilateral: unstable due to extensive disruption of posterior ligaments, facet joint capsules, annulus fibrosus and sometimes anterior longitudinal ligament

67
Q

C1-C2 rotary subluxation and dislocation

A

forces of flexion or extension combine with rotation to cause one inferior facet of C1 to slip anterior to superior facet of C2 and become fixed in this position

68
Q

hyperflexion sprains (c-spine)

A

disrupt posterior ligament complex
~ tears of posterior ligs allow superior vertebra of
segment to rotate anteriorly on its subjacent
vertebra

69
Q

hyperextension sprains (c-spine)

A

when neck forced past end ranges of extension
~ isolated injury or rebound action
~ disrupt anterior ligs and ST, posterior sublux

70
Q

treatment of c-spine sprains

A

immobilization
pain management
rehabilitation

71
Q

intervertebral disk herniation

A

resulting in nerve root compression uncommon in c-spine
~ may cause posterior or lateral disk herniation resulting in neural compression
~ pt seeks medical attention for radiation arm pain
~ more commonly herniate without causing neural compression

images are of little diagnostic value

72
Q

treatment of IVD herniation

A

NSAIDs
modalities to relieve symptoms
~ spinal traction, joint mobilization
surgery if conservative fails

73
Q

degenerative diseases of c spine

A

~ degenerative disk disease
~ degenerative joint disease
~ foraminal encroachment - diminished dimensions
~~ only ossified changes shown on radiograph
~ spondylosis - osteophyte formation
~ spondylosis deformans - advanced spur formation
~ diffuse idiopathic skeletal hyperostosis - flowing ossification along anterior vertebral bodies and disk spaces

74
Q

schmorl’s nodes

A

intravertebral herniation of NP through endplate into spongiosa of vertebral body

75
Q

rehabilitation of c-spine can include:

A
  1. segmental mobilization techniques to restore joint mobility
  2. therapeutic exercise to balance muscle strength and flexibility
  3. promote optimal posture
  4. pt education on occupational and leisure activity accommodations that decrease stressful postures or maladaptive behaviors
  5. therapeutic modalities such as cervical traction, heat/cold, and ultrasound to provide relief of acute symptoms
76
Q

goal of T-spine radiologic examination

A

identify or exclude anatomic abnormalities or disease processes of spine

77
Q

routine t-spine projections

A

AP and lateral

78
Q

swimmer’s lateral view (t-spine)

A

pt’s arm overhead to remove superimposition of shoulder from obscuring lower cervical and upper thoracic

79
Q

oblique t-spine

A

demonstrate facet joints

80
Q

thoracolumbar or other coned views (t-spine)

A

close up view
cone refers to circular aperture on xray tube which limits expose field

81
Q

recommended rib projections

A

done in sections due to superimposition
entire rib cage not radiographed

AP or PA
oblique for axillary ribs
PA chest to rule out pneumothorax or hemothorax

82
Q

AP view demonstrates

A

thoracic vertebral bodies
IVD spaces
alignment of pedicles
spinous processes
transverse processes
articular processes
costovertebral joints and posterior ribs

83
Q

AP thoracic patient position

A

supine

84
Q

width between opposing paired pedicles in t-spine

A

20mm

85
Q

lateral thoracic spine demonstrates

A

thoracic vertebral spaces
IVD spaces
intervertebral foramina

uppermost 2-3 vertebrae not well visualized because of superimposition

86
Q

lateral thoracic patient position

A

side-lying or upright

87
Q

most common force of trauma at thoracic spine

A

flexion forces account for 90% of compression fractures

88
Q

which vertebrae is most frequently injured?

A

12th thoracic and 1st lumbar

neuro injury complicates 15-20% of fractures

89
Q

imaging for trauma of thoracic spine

A

assessed with thorax-abdomen-pelvis body (TAP) CT scans

can reformat to evaluate spine without additional radiation exposure

90
Q

is CT or radiograpghs better in detection for spinal fractures

A

CT

91
Q

MRI is the primary modality to evaluate …

A

neural compromise
cord edema
cord contusion
epidural hematoma
nerve root involvement
ligamentous disruption

92
Q

if the CT is normal, is MRI indicated?

A

no

93
Q

what is the most common spinal injury detectable on radiographs in all age groups?

A

anterior compression fractures

94
Q

mechanism of injury for older adults in t-spine

A

pre-existing osteoporosis is a significant factor in vertebral body collapse

95
Q

why are anterior compression fractures considered stable fractures?

A

only anterior column is involved

can become unstable if both columns are involved

96
Q

compression fractures increase in incidence with age due to…

A

demineralization: bone becomes less elastic, more brittle, more prone to failure

dehydration of nucleus pulpus renders disks less resilient to compression

97
Q

radiographic signs of compression fractures (6)

A

step defect: anterior cortex of body first structure to undergo strain and suffer greatest stress. best seen on lateral view.

wedge deformity: collapse of anterior body creates triangular or trapezoidal body. apparent on lateral view. ~30% loss of height required for deformity to be present.

linear zone of impaction: linear band of increased density apparent beneath involved endplate. callus formation in healing fracture

displaced endplates: anterior shearing of IVD may avulse bony rim of endplate or displace it anteriorly. appearance on lateral view.

loss of IVD height: intact disk inferred from well-preserved potential space between vertebrae and proper alignment.

paraspinal edema: paraspinal soft tissue edemas or hematomas often associated with compression fractures. best seen on AP view.

98
Q

healing of vertebral body fractures

A

endosteal and periosteal callus formation
union occurs in 3-6 months
anterior height of body rarely returns to normal
mildly damaged disks MAY revascularize and function
normally

99
Q

treatment of vertebral compression fractures

A

non-operative is standard of care
pain control and fit patient for thoracolumbar spinal orthosis (TLSO)
~ bracing trunk in extension relieves pain by
unloading anterior vertebral bodies (younger)
~ brace for 4-6 weeks
~ bracing not effective for elderly

100
Q

when do the most severe symptoms of anterior compression fractures resolve?

A

10-14 days

101
Q

osteoporosis

A

threat for 1/2 americans 55 and older
1 in 2 women and 1 in 4 men will have osteoporosis-related fracture in lifetimes

102
Q

clinical presentation of vertebral compression fractures

A

chronic back pain
limited spine mobility
social isolation

existence of one previous vertebral fracture increases risk for subsequent fractures at multiple levels fivefold

103
Q

generalized osteoporosis anywhere in skeleton demostrates classic radiologic hallmarks of:

A

increased radiolucency: empty box appearance
cortical thinning
trabecular changes: distinct vertical striations

104
Q

endplate deformities

A

smooth indentations seen in endplates centrally
sclerosis along endplates most common in thoracic and lumbar spines

105
Q

schmorl’s nodes

A

focal intrusion of nuclear material into vertebral body through structurally weakened endplates results in these radiolucent nodes

106
Q

what is the primary focus for treatment of vertebral fractures?

A

pain reduction

anti resorptive meds and bone forming hormones prescribed to slow or reverse bone loss

107
Q

rehabilitation of vertebral fractures

A

early stages for improvement of posture and general conditioning

later stages provide adaptive modifications to preserve functional independence in ALD’s and ambulation

108
Q

scoliosis

A

lateral deviation of spine from mid-sagittal plane combined with rotational deformities of vertebrae and ribs

109
Q

pathological changes due to compressive forces on concave side of scoliosis curve:

A

narrowed disk spaces
wedge-shaped vertebral bodies
shorter/thinner pedicles and laminae
narrowed IVF and spinal canal spaces

110
Q

pathological changes due to compressive forces on convex side of scoliosis curve:

A

widened rib spaces
posteriorly positioned rib cage (rib hump)

111
Q

prevalence of scoliosis

A

5 degrees: 5% of population
10 degrees: 2-4%
25 degrees: 1.5/1,000 individuals

greater curve, higher female predilection

3-5/1,000 children will develop curves large enough to warrant treatment

112
Q

three types of idiopathic scoliosis

A

infantile: before age three, may include neuro

juvenile: ages 3-10, more often girls, high risk for progression

adolescent: age 10 through skeletal maturity, 7:1 female:male ratio. skeletal maturity arrests progression and effectiveness of treatment

113
Q

four distinct common curve patterns

A

right thoracic curve: most frequent, T4-T6 to T11-L1, secondary minor curves to compensate keeping eyes horizontal

right thoracolumbar curve: T4-6 to L2-4, can appear to either side, but right more common

left lumbar curve: T11-12 to L5, can appear to either side, but left for common

left lumbar, right thoracic curve: two even curves

114
Q

radiologic assessment of scoliosis

A

radiographs most definitive diagnostic modality

determine or rule out etiologies
evaluate curve size, site, flexibility
assess skeletal maturity or bone age
monitor curvature progression or regression

115
Q

diagnostic radiographic series for scoliosis

A

erect AP
erect lateral
erect AP lateral flexion views
PA left hand - provide assessment of skeletal age

116
Q

radiographic indicators of skeletal maturity

A

fusion of vertebral ring apophyses closely parallels end stages of skeletal maturity (solid union os when maturation is complete)

fusion of iliac crest apophysis to ilium appears at end of skeletal maturity

117
Q

risser’s sign

A

process of skeletal maturity as reflected in radiographic appearance of apophyses of iliac crests

apophyses first appear at ASIS and progress over a year’s time to PSIS. fusion completed in an additional 2-3 years

118
Q

progression assigned Risser’s value from 1+ to 5+

A

1+ indicates excursion of apophysis over 25% of crest
2+ means 50% of crest is capped
3+ is 75% capped
4+ is 100% capped
5+ indicates osseous fusion is complete

119
Q

cobb measurement method

A

gives value for curvature in frontal plane, based on AP view

120
Q

how to perform cobb method

A

identify uppermost involved vertebra of curve that tilts significantly toward concavity and draw line along its superior endplate

identify lowermost involved vertebra of curve and draw line along its inferior endplate

draw perpendicular lines through those two lines and measure intersecting angle

121
Q

treatment choices for adolescent idiopathic scoliosis determined by complex equation that factors in:

A

skeletal age
curve magnitude
curve location
potential for curve progression

122
Q

which curve have higher risk for progression

A

thoracic curves

123
Q

treatment for scoliosis

A

minimal magnitude: no active treatment, but close observation

20-40 degrees: spinal bracing combines with exercise until skeletal maturity

curves over 50 degrees: surgical fixation

124
Q

bracing for scoliosis

A

most effective in children with significant growth remaining

goal is to stop progression - any correction of curve considered a bonus

125
Q

surgery to correct scoliosis

A

posterior spinal fusion with paravertebral rods and bone grafts

goal is to prevent curve progression and diminish spinal deformity

if curve to 50+ degrees at skeletal maturity, progression continues

fall A 2024 (10 decks)

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