Inflammatory Arthritis: radiology imaging

Question 1

What are the types of technical quality?

Answer 1

• PA - pronation
• Norgaard - supination → see in more detail e.g erosions

Question 2

What to look for in imaging?

Answer 2

• ABCDS
  
  • A = alignment of limbs
  • B= bone- any extra or loss of bone
  • C = cartilage = bone space
  • D = distribution - which joint
  • S = soft tissue - shape of soft tissue
    
    • Distribution: RA, OA, Psoriatic, crystal
    • Inflammation (lose function): loss of joint space, osteoporosis ( loss of bone). soft tissue swelling, erosion
    • Degeneration(’loss of time): loss of joint space, osteophytes, subchondral sclerosis, subchondral cysts

Question 3

Which one out of ABCDS goes first and what to look for?

Answer 3

1) distribution: which joints → diffrenciate type

• → distal (toward end) and symmetrical nearer to tumbs - distal fingers associated with OA
• distal and asymmetrical = psoriasis → skin stuff can appear a lot later - can pull skin almost along finer
• proximal and symmetrical = RA → swelling of MPC joint valnular and aulnar → point down and toward outer wrist?
• proximal and asymmetrical = RA too , proximal more affected than distal
• 2nd and 3rd metocarplas = crystal arthritis

Question 4

Which one out of ABCDS goes second and what to look for?

Answer 4

2) Cartilage:

• inflammation vs degeneration
• diffuse vs focal

Question 5

Which one out of ABCDS goes third and what to look for?

Answer 5

3) Bone loss

• looking at bone quality → marrow not as white
• inflammation causes decalcificaiton and degenration of bone
• looking for osteophytes
• entheseal proliferation - curve + attachment site of muscle, ligment or bone where osteophytes is ‘broken bone’
• erosion- hole in a bone, adjacent to a joint with no roof - inflammation within joint and attack points that not covered by synovial fluid - can heal and sclerosis like healing ,
  
  • Cyst- A hole in bone, adjacent to a joint, with a roof - round rim of white around + cartilage wear and tear joint fluid pressure into ‘fisher’ creating space in bone - creating hole
• erosion has no wall - cyst does!
• subchondral sclerosis - degeneration - underneath carilage - thickening of bone as body tried to increase strenght in area

Question 6

Which one out of ABCDS goes fourth and what to look for?

Answer 6

4) soft tissue swelling - allow different amount of x-ray beams to go through