Neck and Shoulder Imaging and Complaints Flashcards
1
Q
Indications for spine radiography
A
- Trauma: C1-C2, C6-C7 are most frequently injured levels win the cervical spine
- Shoulder or arm pain (radiculopathy)
- Occipital headache (upper cervical instability)
- Limitation in motion
- Planned or prior surgery
- Malignancy
- Arthritis
- Congential anomalies
- Spinal abnormality
- Suspected instability
2
Q
What and how many views for a routine cervical spine radiologic evaluation
A
- 3-5 projections
- AP lower cervical spine
- Lateral view
- Sometimes AP open mouth and R/L oblique
3
Q
Describe a AP view of the cervical spine
A
- Chin is projected over base of skull (chin up)
- Angled x-ray beam is parallel to cervical disc
- Best view for alignment & to observe oblique fractures
4
Q
Describe the lateral view of the cervical spine
A
- Best initial view to evaluate alignment, spacing, soft tissues, & vertebrae
- “Lines of Life” these lines should demonstrate: slight lordotic curve, smooth & without step-offs; any malalignment in any degree of neck motion should be considered evidence of bony or ligamentous injury
5
Q
Describe oblique view of the cervical spine
A
- Done only after fracture or dislocation injuries are ruled out
- Can assist with identification of neural foramina narrowing
6
Q
Describe an open mouth view of the cervical spine
A
- Teeth are projected over the base of skull (mouth is open)
- Axis & atlas projected between upper & lower teeth
- Demonstrates C1-2 alignment
7
Q
Describe dens/Odontoid fractures
A
- in younger patients they are typically the result of high-energy trauma which occurs as a result of motor vehicle or diving accidents
- in elderly pop. the trauma can occur after lower energy impacts such as falls from a standing position
- Most common MOI is a hyperextension of the cervical spine pushing the head & C1 vertebrae backward (most common C2 fracture)
8
Q
Describe a Jefferson fracture
A
- Typical MOI is diving head first into shallow water
- Axial loading along the axis of the cervical spine results in the occipital condyles being driven into the lateral masses of C1
- Not normally associated with neurological deficit although spinal cord injury may occur if there is a retropulsed fragment affecting the cervical cord
9
Q
Describe a trauma screen
A
- Series of radiographs & selected advanced imaging (CT) to screen & prioritize injuries in a trauma vicim
- Cross table lateral view for fx or dislocation of cervical spine
- Indicators: abnormal soft tissues, abnormal vertebral alignment, abnormal joint positions
- Role of MRI is to aid in characterization of soft tissue injury, neural element injury, disk injury, or neurological deficit
10
Q
Radiologic signs of cervical trauma
A
- Abnormal vertebral alignment, soft tissue, or joint relationship
- Stable injury = intact posterior spinal ligaments
- Unstable injury = displacement
- Lower c-spine =higher frequency of injury in adults
- Upper c-spine = higher frequency of injury in children; SCIWORA = spinal cord injury w/o radiographic abnormalities
11
Q
Signs of abnormal vertebral alignment
A
- Loss of parallelism (3 lines)
- Loss of lordosis
- Acute kyphotic angulation
- Rotation of vertebral body
- Loss of facet joint articulation indicating dislocation
12
Q
Describe abnormal joint relationship
A
- Widened atlantodental interface: degeneration, stretching, rupture of the transverse ligament
- Widened interspinous process space (“fanning”)
- Widened or narrowed intervertebral disc space
- Loss of facet articulation
13
Q
Signs of abnormal soft tissue
A
- Widened retropharyngeal or retrotracheal spaces
- Displacement of the trachea or larynx
- Displacement of the pre vertebral fat pad
14
Q
What are the ABCDs of cervical spine radiograph interpretation
A
- Alignment and Anatomy
- Bone density
- Canal space: free fragments from disc
- Disc integrity
- Soft tissue: edema
15
Q
NEXUS (National Emergency X-Radiography Utilization Study) meet all low-risk criteria
A
- No posterior midline cervical spine tenderness
- No evidence of intoxication
- Normal level of alertness
- No focal neurological deficit
- No painful, distracting injuries
- If YES meet all low-risk criteria then no radiograph and if NO then radiograph
16
Q
CT indications for cervical spine
A
- Acute trauma in adults
- Degenerative conditions
- Infections of the spine
- Image guidance for injections
- Neoplasms
- Congenital abnormalities
- Developmental abnormalities
- Intrathecal masses
17
Q
ABCDs for cervical spine CT
A
- Alignment & Anatomy: coronal & sagittal view for alignment (fx, dislocation, bone destruction)
- Bone density: cortical bone is dense, cancellous bone is less dense, CT best for fractures & ligamentous considerations
- Canal space: axial view to assess for free space & any fragments
- Disc integrity: posterior & posterior lateral marginal assessment in axial view for herniated disc
- Soft tissue: sagittal view assess for trauma to prevertebral soft tissues
18
Q
Describe Tori and Pavlov’s ratio for CT interpretation
A
- Width of the spinal canal should equal the width of the corresponding vertebra
- Normal ratio is canal diameter ÷ body diameter = 1
- A ratio of <0.85 indicates spinal stenosis
19
Q
Indications for a cervical spine MRI
A
- DDD (degenerative disc disease)
- Masses/tumors in the dura
- Treatment fields for radiation therapy
- Intrinsic spinal cord pathology
- Spinal vascular malformation
- Congential anomalies
- Post operative interspinal changes
- Meningeal abnormalities
- Spinal infections
- Pre-operative assessment for verteboplasty
20
Q
ABCDs for cervical spine MRI
A
- Alignment: sagittal view best for alignment (fx, dislocation, bone destruction)
- Bone signal: assess for any irregular signal intensities
- Canal space/CNS: canal space in sagittal & axial views, look for effacement (indention of theca sac)
- Disk integrity: disk height & hydration of NP; evaluate posterior margins on sagittal & posterolateral margins on axial view
- Soft tissue: evaluate paravertebral structures
21
Q
MR imaging has been proven to be the technique of choice for imaging of
A
- Intervertebral disk degeneration
- Diffuse posterior disk bulging
- Herniation
- Protrusion/extrusion
22
Q
What cervical spine structures can you see in the axial view of an MRI
A
- IV disks
- IV foramina
- Spinal canal, epidural space, theca sac
- Facet joints
- Ligamentum flavum
- Nerve roots
23
Q
Cerviical spine structures seen in sagittal view on MRI
A
- Vertebral bodies/endplates
- Disk signal, height
- Epidural space, nerve roots
- Spinal canal and cord
- Anterior & posterior longitudinal ligaments
- Interspinous & supraspinous ligaments
- Spinous processes
24
Q
Describe DDD (degenerative disc disease)
A
- Present on radiographie in most persons >60 yrs
- Changes in disc include: dehydration, nuclear herniation, annular protrusion, & fibrous replacement of the annulus
- Decreased disc height
25
Q
Describe diffuse idiopathic skeletal hyperostosis (DISH)
A
- Characterized by bony proliferation at sites of tendinous & ligamentous insertion of the spine affecting elderly individuals
- On imaging typically characterized by the flowing ossification of the anterior longitudinal ligament
26
Q
Different spinal fractures
A
- Most commonly occur at C1-C2, C5-C7, T9-L2
- Teardrop fx
- Transverse process fx
- Compression fx: wedge or burst fracture
- Articular pillar
- Hangman fx (posterior C2 fx): hyperextension with axial load
- Clayshoveler’s fx (spinous process fx of C6, C7, T1, T2)
27
Q
Describe cervical spine dislocations
A
- Most serious & life threatening injuries
- Fx through the base of the dens combined with a ligament rupture will cause a fx & dislocation of the atlantoaxial joint (C1-C2)
- Hangman’s fx of the axis ca be associated with anterior dislocation of C2 on C3
- Lower cervical fx of the posterior vertebral structures + tears of the posterior ligaments may cause a vertebral body to displace anteriorly, transecting or contusing the spinal cord
