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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
Q

MRI contraindications

A

pacemakers, mechanical pumps, electronic stimulators, foreign bodies in the eye, metal products (including tattoos or cosmetics containing metal)

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26
Q

MRI planes

A

sagittal, coronal, axial

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27
Q

TI MRI

A

fat is white, fluid is dark (gadolinium is bright); better for anatomic assessment

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28
Q

T2 MRI

A

fluid is white (adding “fat saturation” allows for fat to be dark); better for fluid assessment; highlights soft tissue injuries

29
Q

soft tissue injury MRI

A

T2

30
Q

US method

A

transducer transmit sounds and detects reflected sound waves

31
Q

tomographic

A

CT, US

32
Q

Echogenicity frequency of sound waves

A

low: cystic
high: solid mass

33
Q

US advantages

A

soft tissue (tendons/muscles), low cost, well tolerated, no known harmful effects (children & pregos), highly portable, unossified epiphyses

34
Q

US limitations

A

artifacts, not available everywhere, limited by skills of provider, minimal use in evaluating bone

35
Q

US indications

A

infants, soft tissue conditions in adults, guided assistance for joint injections, biopsies, soft tissue drainage

36
Q

Contraindications for US

A

None.

37
Q

Most common nuclear scitingraphy

A

Bone scan

38
Q

Bone scan method

A

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
Q

Bone scan projection

A

single or cross-sectional views

40
Q

Bone scan indications

A

Osteomyelitis, metastases, bone tumors, occult fractures (stress or insufficiency)

41
Q

Bone scan contraindications

A

avoid in children and pregnant women when possible

42
Q

Avoid in pregos

A

CT, bone scan

43
Q

Most sensitive for bone pathology

A

bone scan

44
Q

Bone scan advantages

A

very sensitive to skeletal pathology, mildly sensitive to soft tissue

45
Q

Bone scan limitations

A

non-specific, lack detail, lower sensitive in early fractures with slow healing potential, used in combo with other imaging, radiation exposure

46
Q

Radiation modalities

A

X-ray, CT, bone scan

47
Q

Patient info to obtain

A

Who (gender, age), when, MOI, description of x-ray

48
Q

Simple complete fractures

A

transverse, oblique, spiral, avulsion, comminuted

49
Q

incomplete fractures

A

torus (buckle), greenstick, bowing

50
Q

Fractures only in kids

A

bowing, torus (buckle), greenstick

51
Q

Periosteum

A

a dense layer of vascular connective tissue enveloping the bones except at the surfaces of the joints

52
Q

Periosteum

A

metabolically more active (promotes callus formation, remodeling ability); thicker and more durable (less likelihood of displacement); unique fractures (buckle, bowing, greenstick)

53
Q

Additional fractures

A

compression, stress, articular extension, physeal involvement, pathologic

54
Q

Buckle fracture

A

looks like crushed can

55
Q

Articular extension fracture

A

break crosses into surface of a joint; always results in damage to cartilage

56
Q

Salter-Harris Classification

A 
I- Seperate (straight across)
II- Above (most common), into metaphysis
III- Lower (into epiphysis)
IV- Through (both metaphysis and epiphysis)
V- Reduced (crush)
57
Q

Concerning features of bone tumors/lesions

A

indistinct margin, abnormal periosteal reaction, soft tissue mass/invasion, rapid growth, pathologic fracture

58
Q

Bone tumors/lesions

A

Osteosarcoma, infection, eosinoph granuloma

59
Q

Bone displacement description

A

angulation, translation; describes distal fragment (medial, lateral, distracted, overriding with posterior and superior displacement, distracted and rotated laterally)

60
Q

Displacement terms

A

displace vs. non-displaced; translation (displacement), angulation, rotation, shortening, bayonetted, distracted/impacted

61
Q

Bayonetted

A

pieces are next to each other

62
Q

Fracture healing

A

cellular stage –> vascular stage –> primary callus –> bony callus –> mature callus

63
Q

cellular stage of healing

A

hematoma and granulation tissue

64
Q

vascular stage

A

fracture pieces resorption, beginning of fibroblastic and chondroblastic proliferation

65
Q

primary callus

A

may be see as hazy density matrix in radiograph but usually not visible; fibrocartilage proliferation

66
Q

Bony callus

A

osteoid replaced with mature bone; fracture is stable

67
Q

Mature callus

A

months to years, new bone laid down along stress line, compact bone at fracture site

68
Q

Occult fracture

A

hidden fracture that requires more imaging; seen when it starts to heal

69
Q

Fracture malunion/nonunion contributing factors

A

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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