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MSK/Derm > Musculoskeletal Imaging > Flashcards

Musculoskeletal Imaging Flashcards

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1
Q

What is conventional radiography used for in musculoskeletal imaging?

A

gas

foreign bodies

tissue calcification/ossification

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2
Q

In an x-ray how many views must be taken at a minimum?

A

2 views perpendicular to one another

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3
Q

What are the advantages of conventional radiography for musculoskeletal imaging?

A

widely available

reproducible - standard protocols are available

inexpensive

minimal ionizing

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4
Q

What are the limitations of using conventional radiography for musculoskeletal imaging?

A

fractures may be occult if not displaced

importance of more than 1 view

complex bones and superimposed structures may limit evaluation

soft tissues are poorly evaluated with x-ray

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5
Q

What is CT used for in musculoskeletal imaging?

A

excelent evaluation of bone detail and calcifications

used for more detailed evaluation of fractures

preoperative planning

assessment of healing

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6
Q

What are the advantages of CT in musculoskeletal imaging?

A

widely available - short imaging time

excellent spatial resolution - occult fracture detection

can be done with or without contrast

can reformat images

alternative if MRI is contraindicated

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7
Q

What are the limitations of CT in musculoskeletal imaging?

A

ionizing radiation

high cost

soft tissue evaluation is inferior to MRI

metal causes artifact

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8
Q

What are the advantages of using MIR for musculoskeletal imaging?

A

high contrast resolution for soft tissue and bone

shows pathophysiologic events earlier than seen on x-ray

no radiation

widely available

large variety of imaging techniques

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9
Q

What are the limitations of using MRI for musculoskeletal imaging?

A

expensive

not patient friendly - claustrophobia and time intensive

quality varies between institutions and individual magnets

metal causes artifact

several absolute contraindications

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10
Q

What are the absolute contraindications of MRIs?

A

pacemakers - cardiac and GI

electronic stimulators

metallic foreign objects in or around the orbit

weight limit

contrast allergy

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11
Q

What are the relative contraindications for MRIs?

A

aneurysm clips

retained bullet fragments and metallic objects

renal function

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12
Q

What is fluoroscopy used for in musculoskeletal imaging?

A

most commonly used by radiologists for procedures

can be used to evaluate joint motion/dynamic imaging

used frequently by orthopedic surgeons during hardware placement

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13
Q

What are the advantages of fluoroscopy in musculoskeletal imaging?

A

widely available

dynamic imaging

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14
Q

What are the limitations of fluoroscopy in musculoskeletal imaging?

A

ionizing radiation to the patient and the operator

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15
Q

What is the use of ultrasound in musculoskeletal imaging?

A

excelent for superficial soft tissue structures such as tendons and muscles

limited evaluation for the surface of bones but not the test of choice

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16
Q

What are the advantages of ultrasound in musculoskeletal imaging?

A

patient friendly - no radiation or contrast

reproducible

small to moderate expense

widely available equipment

dynamic imaging

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17
Q

What are the limiations of ultrasound in musculoskeletal imaging?

A

extremely user/operator dependent

cannot be transmitted through cortical bone

not the test of choice for medullary space

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18
Q

What are the two most common bone imaging studies used in nuclear medicine?

A

bone density studies and technetium bone scans

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19
Q

What is the most important determining factor of bone fragility?

A

bone mineral density (BMD)

expressed as grams of mineral per area or volume

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20
Q

What is bone density measurement used for?

A

used to identify individuals at risk for developing osteoporosis or fracture

compared to age-matched, ex-matched, and race-matched controls

21
Q

Who gets bone density measurements?

A

all menopausal women 65 years or older

menopausal women with under 65 with risk factors

premenopausal women 65 years or older

premenopausal women with 1 or more low-trauma fractures, women being treated for osteoporosis and people receiving long-term glucocorticoid therapy

22
Q

What is dual x-ray absorptiometry (DXA_

A

uses pulse photons at alternating energies

about 1/1000 radiation of a routine spine film

time of exam is short (2-5 minutes)

standard exam includes imaging of the lumbar spine and proximal femur

23
Q

How are bone density measurements using DXA scored?

A

scoring of bone density using T-score and Z-score

24
Q

Where is osteoporosis most pronounced

A

trabecular bone

25
Q

What are osteoporotic fractures most commonly associated with?

A

areas of high trabecular content (vertebral body, femoral neck, distal radius)

26
Q

What is the T-score in bone density measurements? How is it interpreted?

A

T-score is the difference between BMD of the patient and the mean MBD of a standard young adult population matched for sex and ethnicity

more useful than the z-score

osteopenia is defined as BMD between 1 and 2.4 standard deviations below reference mean

<2.5 is osteoporosis

severe osteoporosis is <2.5 and one or more low-trauma fractures

27
Q

What is the Z-score in bone density measurements?

A

the difference between the patient BMD and the mean BMD of age and gender matched controls

28
Q

What are the limitations of dual x-ray absorptiometry (DXA)?

A

severe degenerative disease of the spine

aortic calcifications

compression fracture of the spine

29
Q

What is bone scintigraphy?

A

a photon emitting substance is tagged to a compound and injected intravenously

most common agent used is technetium labeled methylene diphosphonate

sensitive but not specific

30
Q

What conditions are bone scintigraphy sensitive for?

A

conditions which result in bone turnover and increased blood flow, specifically fracture, infection, and blastic metastases (prostate, breast)

they provide physiologic rather than anatomic information

31
Q

What contributes to increased uptake of the agent in bone scintigraphy?

A

increased blood flow

areas and rate of new bone formation

interruption of sympathetic supply

32
Q

What are the limitations of bone scintigraphy?

A

ionizing radiation

time sensitivity - radioisotope is injected and imaging is performed after several hours (3-6 hours)

33
Q

What are the invasive image guided procedures?

A

image-guided biopsy

arthography

myelography

34
Q

What is arthrography?

A

technique used to introduce contrast into a joint

the contrast contains iodinated compound allowing visibility on radiographs, CT, and fluoroscopy

gadolinium injected for MRI imaging

35
Q

What is arthrography best for?

A

evaluation of the joiints:

  • labrum (shoulder and hip)
  • cartilage
  • rotator cuff tendons
  • intrinsic ligaments of the wrist and elbow
36
Q

What are the contraindications of arthrography?

A

contrast allergy

same as for MRI

37
Q

What is myelography?

A

technique used to introduce contrast into the central canal

contrast contains iodinated compound allowing visibility on fluoroscopy and CT

38
Q

What are the advantages of myelography?

A

can be used if MRI is contraindicated

better evaluation of bone and its effects on the neural foramen and central canal

dynamic imaging allows for evaluation of the canal with flexion and extension

39
Q

What are the limitations of myelography?

A

ionizing radiation

contrast allergy

inferior sofy tissue evaluation compared to MRI

invasive

40
Q

What are the uses of image guided biopsy?

A

multiple modality choices

safer alternative to surfical/open biopsy - outpatient procedure

used for lesions of unknown etiology

confirms diagnoses

staging of disease

41
Q

What are the types of image-guided therapy?

A

corticosteroid injections

calcific tendinnitis lavage

vertebroplasy

thermal ablation

42
Q

What is the plan of action for imaging of chronic back pain?

A

plain radiographs and then MRI in an adult

plain radiographs and then nuclear medicine exam or MRI in children

43
Q

What is the imaging procedure for acute back pain?

A

plain radiograph

consider CT if related to direct trauma

MRI

44
Q

What is the imaging procedure for neck pain?

A

plain radiograph series

if normal bit still significant pain/symptoms consider MRI

CT useful in acute setting/trauma patient

45
Q

What is the imaging procedure in joint pain?

A

plain radiographs

consider MRI if looking for soft tissue injury of ligament, cartilage, tendon, or muscle

46
Q

What is the imaging procedure for neoplasms?

A

plain radiograph

MRI with contrast - if osseous, just image “joint to joint” and evaluate for skip lesions

CT

nuclear medicine study - osseous metastasis

47
Q

What is the imaging procedure for occult fractures?

A

plain radiographs

if x-ray normal - CT, MRI, or nuclear medicine study

48
Q

What is the imaging procedure for osteomyelitis?

A

in a diabetic patient, use plain radiograph, MRI, or nuclear medicine study

in non-diabetic patients, use plain radiograph or MRI with contrast

MSK/Derm (54 decks)

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