Musculoskeletal Imaging Flashcards
How do you decide on appropriate modality?
- Body part of interest
- Diff dx considerations
- Age of patient
- Pt. history
- Cost
- Radiation dosing
- Availability
What questions should you be asking to pick a modality?
- What is the clinical question?
- What test is most likely to answer this question (out of those available)?
- If multiple tests will work
- Safety?
- Cost?
What is a search pattern for imaging?
Consistent pattern of evaluation
Order of evaluation: Hardware (metal) - Joints - Bones - Soft tissues
Look for: Fractures, hardware failure, calcifications, tumors, degenerative arthritis
How many radiographs do you need at least?
TWO
Pitfalls of diagnostic imaging
- Inappropriate study (or projection)
- Poor quality exam (can be due to size of patient)
- Satisfaction of search
- Timing of exam
- Lack of correlation between imaging and clinical findings
Specific difficult cases to image
Vascular Channels
Accessory bones
Devo abnormalities
What is a sesamoid bone?
Bone embedded within a tendon where the tendon passes over a joint
What is the biggest sesamoid bone?
Patella
What should you look for and consider in your diff dx?
VINDICATE
- Vascular
- Infection
- Neoplasm
- Drugs
- Inflammatory/idiopathic
- Congenital
- Autoimmune
- Trauma
- Endocrine/metabolic
Important imaging pearls to look out for
- Benign vs. malignant
- Matrix and periosteal reaction
- Calcifications (i.e. calcific tendonitis)
- Effusions
- Lipohemarthrosis
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Descriptors of Fractures
- Location
- Orientation
- Displacement
- Apposition
- Angulation
- Intraarticular involvement
- Communication
- Open vs. Closed
- Associated injuries
Differences between Arthritis types
Osteoarthritis
- Osteophytes
- Asymmetric joint loss
- Predictable pattern
Inflammatory arthritis
- Rheumatoid arthritis
- Seronegative syndromes
- Ankylosing Spondylitis
- Reactive Arthritis
- Psoriatic Arthritis
- Deposition diseases
- Gout
- Pseudogout
