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Clin Med Exam 3 > MSK Imaging > Flashcards

MSK Imaging Flashcards

1
Q

Initial modality for MSK complaints

A

Plain radiographs (x-rays)

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2
Q

X-ray density

A 
air = black
white  = bone
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3
Q

X-ray indications

A

first line before other imaging; fracture, dislocations, bone fixation, arthritis, bone tumors, skeletal dysplasia

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4
Q

X-ray contraindications

A

exclusive soft tissue injuries, early presentation of certain soft tissue condition, primarily medullary bone diseases, caution with excessive repeat images and unnecessary radiation

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5
Q

X-ray advantages

A

readily available, reproducible, inexpensive, patient ease (seconds to capture), technical training not required to interrupt, real-time radiography

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6
Q

X-ray limitation

A

images larger than subject and must be calibrated; superimposed structures (2D image), radiation exposure, low-sensitivity for subtle fractures and soft tissue injuries

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7
Q

CT method

A

X-rays in sections that can create 3D image

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8
Q

Contrast mediums for CT

A

iodinate materials, barium and air

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9
Q

CT indications

A

combined w/ injection medium to image joints, stereotactic frame (biopsies, surgical planning, radiation therapy), angiography, staging of complex fractures, small intraarticular fragments/loose bodies, fracture healing, bone tumors

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10
Q

Contraindications for CT

A

unnecessary imaging, significant metal in area, allergy or inability to tolerate contrast (renal insufficiency), pregnancy should be avoided except extreme circumstances

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11
Q

CT Advantages

A

tomography, best bone assessment modality, higher contrast resolution images (avoid overlapping), reconstruction, interventional options, well tolerated and only 5-10 minutes

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12
Q

Best bone assessment modality

A

CT

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13
Q

CT limitations

A

artifacts (blurring from pt. movement, beam hardening from hardward), limited for soft tissue, requries large physical site, body habitus 300-400 lbs, cost (higher than x-ray, less than MRI), radiation exposure, claustrophobia

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14
Q

Radiation modalities

A

X-ray, CT

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15
Q

CT planes

A

sagittal (R vs. L), coronal (anterior vs. posterior), axial (superior vs. inferior)

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16
Q

CT contrast

A

increase density differences; iodine-based (similar to x-ray)

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17
Q

Interpretation of CT

A

Right side of patient is left side of screen; Sagittal (looking from the side), coronal (patient is facing you), axial (looking from patient’s feet toward the head)

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18
Q

MRI method

A

strong magnetic field with radio-frequency pulses; collects differences in tissue signal intensity

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19
Q

MRI advantages

A

superior contrast resolution, ideal for SOFT TISSUE and still good for bone, highly snesitive, contrast compounds safer than CT contrast (gadolinium -based)

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20
Q

MRI limitations

A

more severe artifact than CT, large, shielded imaging suite, magnetic field, claustrophobia, expensive, one exam = one body part, average 45 minutes

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21
Q

Timing of modalities

A

x-ray < CT < MRI

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22
Q

Artifact depending on modalities

A

CT

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23
Q

Contrast differences between CT and MRI

A

CT: iodinate, barium and air
MRI: gadolinium-based (safer)

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24
Q

MRI indication

A

intraarticular soft tissue structures, MR arthrography, superior sensitive in diagnosis of early detection of bone marrow conditions, stress fractures, osteomyelitis, and malignancy; problem solver tool rather than initial screening

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25
MRI contraindications
pacemakers, mechanical pumps, electronic stimulators, foreign bodies in the eye, metal products (including tattoos or cosmetics containing metal)
26
MRI planes
sagittal, coronal, axial
27
TI MRI
fat is white, fluid is dark (gadolinium is bright); better for anatomic assessment
28
T2 MRI
fluid is white (adding "fat saturation" allows for fat to be dark); better for fluid assessment; highlights soft tissue injuries
29
soft tissue injury MRI
T2
30
US method
transducer transmit sounds and detects reflected sound waves
31
tomographic
CT, US
32
Echogenicity frequency of sound waves
low: cystic high: solid mass
33
US advantages
soft tissue (tendons/muscles), low cost, well tolerated, no known harmful effects (children & pregos), highly portable, unossified epiphyses
34
US limitations
artifacts, not available everywhere, limited by skills of provider, minimal use in evaluating bone
35
US indications
infants, soft tissue conditions in adults, guided assistance for joint injections, biopsies, soft tissue drainage
36
Contraindications for US
None.
37
Most common nuclear scitingraphy
Bone scan
38
Bone scan method
IV injection of radioisotope bound to phosphate (tracer), imaging may be completed at diff. phases between 1 minute and 24 hours following injection, tracer distributes in metabolically active bone at 2-4 hours
39
Bone scan projection
single or cross-sectional views
40
Bone scan indications
Osteomyelitis, metastases, bone tumors, occult fractures (stress or insufficiency)
41
Bone scan contraindications
avoid in children and pregnant women when possible
42
Avoid in pregos
CT, bone scan
43
Most sensitive for bone pathology
bone scan
44
Bone scan advantages
very sensitive to skeletal pathology, mildly sensitive to soft tissue
45
Bone scan limitations
non-specific, lack detail, lower sensitive in early fractures with slow healing potential, used in combo with other imaging, radiation exposure
46
Radiation modalities
X-ray, CT, bone scan
47
Patient info to obtain
Who (gender, age), when, MOI, description of x-ray
48
Simple complete fractures
transverse, oblique, spiral, avulsion, comminuted
49
incomplete fractures
torus (buckle), greenstick, bowing
50
Fractures only in kids
bowing, torus (buckle), greenstick
51
Periosteum
a dense layer of vascular connective tissue enveloping the bones except at the surfaces of the joints
52
Periosteum
metabolically more active (promotes callus formation, remodeling ability); thicker and more durable (less likelihood of displacement); unique fractures (buckle, bowing, greenstick)
53
Additional fractures
compression, stress, articular extension, physeal involvement, pathologic
54
Buckle fracture
looks like crushed can
55
Articular extension fracture
break crosses into surface of a joint; always results in damage to cartilage
56
Salter-Harris Classification
``` I- Seperate (straight across) II- Above (most common), into metaphysis III- Lower (into epiphysis) IV- Through (both metaphysis and epiphysis) V- Reduced (crush) ```
57
Concerning features of bone tumors/lesions
indistinct margin, abnormal periosteal reaction, soft tissue mass/invasion, rapid growth, pathologic fracture
58
Bone tumors/lesions
Osteosarcoma, infection, eosinoph granuloma
59
Bone displacement description
angulation, translation; describes distal fragment (medial, lateral, distracted, overriding with posterior and superior displacement, distracted and rotated laterally)
60
Displacement terms
displace vs. non-displaced; translation (displacement), angulation, rotation, shortening, bayonetted, distracted/impacted
61
Bayonetted
pieces are next to each other
62
Fracture healing
cellular stage --> vascular stage --> primary callus --> bony callus --> mature callus
63
cellular stage of healing
hematoma and granulation tissue
64
vascular stage
fracture pieces resorption, beginning of fibroblastic and chondroblastic proliferation
65
primary callus
may be see as hazy density matrix in radiograph but usually not visible; fibrocartilage proliferation
66
Bony callus
osteoid replaced with mature bone; fracture is stable
67
Mature callus
months to years, new bone laid down along stress line, compact bone at fracture site
68
Occult fracture
hidden fracture that requires more imaging; seen when it starts to heal
69
Fracture malunion/nonunion contributing factors
use of oral steroids, poor bone contact, loss of bone, interruption of blood supply, excessive motion, age, poor nutrition, tobacco use

Clin Med Exam 3 (7 decks)

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