Musculoskeletal 3 - MBD Radiology Flashcards
List the imaging types to assess bone density
- X rays
- CT
- Bone densitometry
List the imaging techniques that are not used to assess bone density
- MRI (Biochemical composition)
- Radionuclide bone scans (bone turnover)
Define radiological sign
A change in imaging appearance, whether structual or functional, that may point towards a pathology
List the T scores in osteopenia and osteoporosis
- -1.5 to -2.5 osteopenia
- Less than -2.5 osteoporosis
What is seen in patients with osteoporosis?
- Loss of cortical bone/ thinning of cortex
- Decreased quantity of bone mass, with a normal microstructure
- Deformity and pain
- Loss of trabeculae
- Insufficiency fractures
What is seen in radiology of osteomalacia?
- Mature skeleton
- Osteopenia
- Looser’s zones
- Codfish vertebrae
- Bending deformities
What is seen in radiology of rickets?
- Before growth plate closure
- Radiological signs centred mainly to growth plates
- Changes of osteomalacia
What are looser’s zones?
- Pseudo/insufficiency fractures at high stress areas
- Medial proximal femur, lateral scapula, pubic rami, posterior proximal ulna, ribs
- Short lucent lines with irregular sclerotic margins
What are codfish vertebrae?
- Biconcave defomity of vertebrae
- Seen in osteoporosis and osteomalacia
What is rickets?
- Abnormal bone mineralisation
- Indistinct/frayed metaphyseal margin
- Widened growth plate without calcification
- Cupping/splaying metaphyses due to weight baring
- Enlargement of anterior ribs
- Osteopenia
What is affected by bone resorption in primary and secondary HPT?
- Subperiosteal
- Subcondral
- Intracortical
- Brown tumours (collection of giant cells)
What is renal osteodystrophy?
- Osteomalacia and osteoporosis
- Secondary hyperparathyroidism (subperiosteal errosions, brown tumours, sclerosis, soft tissue calcification - vessels or cartilage)
What is seen in radiology of pagets?
- Cortical thickening
- Bone expansion
- Coarsening of trabeculae
- Osteolytic, osteoclerotic and mixed lesions
- Osteoporosis circumscripta (large dark areas in the skull)
How is osteoporosis diagnosed?
- Duel-energy absortiometry (DEXA scan)
- Usually illiac crests
What are insufficiency fractures?
- Normal stress on abnormal bone
- X-ray/CT scans will show initially they look normal, but as time goes on there is periosteal reaction and callus. Increased sclerosis around fracture lines.
- MRI - bone oedema
- Bone scan - increased bone turnover
