Musculoskeletal Imaging

Question 1

What are some criteria that help you decide on the appropriate imaging modality?

Answer 1

• Body part of interest
• Differential diagnosis consideration
• Age of patient
• Patient history
• Cost of exam
• Radiation dose
• Availability

Question 2

Guidelines for Choosing a Modality:

Answer 2

1. What is the clinical question?
2. What test is most likely to answer this question? (Which are available?)
3. If more than one test will work – think about safety for the patient first, then think about cost of the procedure

Question 3

What a is good way to approach an imaging study?

Answer 3

Develop a consistent search pattern for evaluation

Question 4

What is a reformated image?

Answer 4

Technology takes the image and reforms it to make it more anatomically relevant

Question 5

How many views do you need in radiographs?

Answer 5

At least two!

One view is NO view.

Question 6

What are some pitfalls of radiography?

Answer 6

Inappropriate projection – pathology may be seen only on one view

Poor quality exam

Satisfaction of search

Timing of exam

Lack of correlation between imaging findings and clincial findings

Specifics: Vascular channels, accessory bones, developmental abnormalities

Question 7

What imaging modality uses radioactive isotopes?

Answer 7

Nuclear medicine

Question 8

What are sesamoid bones? What is the largest sesamoid bone in the body

Answer 8

Bone embedded wtihin a tendon where the tendon passes over a joint.

Patella.

Question 9

What are a couple of examples of developmental anomalies that are seen on x-ray?

Answer 9

Sacral Agenesis

Marfan’s

Limbus vertebral body

Question 10

Pneumonic for going through possible differentials when imaging:

VINDICATE

Answer 10

• Vascular
• Infection
• Neoplasm
• Drugs
• Inflammatory/idiopathic
• Congenital
• Autoimmune
• Trauma
• Endocrine/metabolic

Question 11

What sign can a periosteal reaction around a tumor cause?

Answer 11

Codman’s Triangle

Question 12

What are some examples of abnormal calcifications?

Answer 12

Crest Syndrome

Soft Tissue Hemangiomas

Question 13

What is a helpful sign of injury but doesn’t always manifest radiographically?

Answer 13

Effusions

In knee, elbow, ankle, wrist, fingers

Question 14

What is lipohemarthrosis?

Answer 14

Mixture of fat and blood in joint capsule following trauma – can be seen in radiograph

Question 15

What characteristics should you use to describe a fracture?

Answer 15

• Location
• Orientation
• Displacement
• Apposition
• Angulation
• Intraarticular involvement
• Comminution
• Open vs. closed
• Associated injuries

Question 16

What is a Jone’s Fracture?

Answer 16

Fracture at the base of the 5th metatarsal

Likelihood of non-union needs to be followed

Question 17

What is a Rolando fracture?

Answer 17

A cominuted intra-articular fracture through the base of the 5th metatarsal

Question 18

What is an avulsion fracture?

Answer 18

When a fragment of bone tears away from main mass of bone due to physical trauma (with ligament)

Question 19

What is a Segond fracture? What injury is likely to accompany it?

Answer 19

Avulsion fracture of the knee that involves lateral aspect of the tibial plateau. Frequently associated with ACL tear.

Question 20

What are some radiographic findings with osteoarthritis?

Answer 20

• Osteophytes
• Asymmetric joint loss
• Predictable pattern

Question 21

What are some types of inflammatory arthritis to watch out for?

Answer 21

• Rheumatoid arthritis
• Seronegative syndromes: ankylosing spondylitis, reactive arthritis, psoriatic arthritis
• Deposition diseases: gout, pseudogout

Question 22

Age vs. appearance

Answer 22

When the images do not fit the patient’s age, must consider an alternative diagnosis.