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Radiology Tumors > Nutritional Metabolic and Endocrine > Flashcards

Nutritional Metabolic and Endocrine Flashcards

1
Q

what is the most common metabolic bone disorder

A

osteoporosis

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2
Q

what is defined as skeletal disease characterized by low bone mass and micoarchitectural deterioration of bone tissue with increase in bone fragility and susceptibility to fracture

A

osteoporosis

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3
Q

what is osteoporosis

what bones are affected

A

reduction in bone quantity - decreased bone density -
normal bone just not enough of it

axial skeleton and long bones

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4
Q

what is osteopenia

A

poverty of bone causes increased radiolucency of bone

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5
Q

what is regional osteoporosis

what is this due to

A

decrease bone density in region or segment of body - limb or portion of limb

immobilization after fracture

complex regional pain syndrome - reflex sympathetic dystrophy

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6
Q

transient osteoporosis of the hip is seen on what imaging

A

bone scan - hot

T1 - diffuse zone of low signal intensity - edema

T2- high signal - edema

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7
Q

what is localized osteoporosis

causes

A

focal loss of bone density affecting a small area of bone

inflammatory arthropathy
neoplasm
infection

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8
Q

what is senescent osteoporosis

A

senile or old age osteoporosis

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9
Q

what does bone mass start decreases

what percent is lost per year? cortical and trabecular

what percent is lost by age 65

at menopause, bone loss accelerates to what fold? what percent per year

A

> 35 years old

1% of bone mass lost per year of cortical bone

2% of bone mass lost per year of trabecular bone

20-40% of bone mass lost by age 65

menopause - 10 fold increase - 20 fold increase in lumbar spine - 6% lost per year

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10
Q

reduction in skeletal mass is gradual and is clinically evident in the __ decades of females life and __ decades of males

A

females - 5th and 6th decade

males - 6th and 7th decade

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11
Q

are men or women more affected by osteoporosis

at what age is the ratio equal

A

women MC 4:1

age 80 M=F

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12
Q

what are the risk factors and things than prevent osteoporosis

A 
stay active and get exercise 
eat protein, calcium, vitamin c
dont drink excessively 
take estrogen after menopause 
vitamin d
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13
Q

what are complications of osteoporosis

A

spinal cord compression fractures
increase thoracic kyphosis
fractures - femur, ribs, humerus, radius

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14
Q

incidence of __ fracture __ every __ years after the age of __ with osteoporosis

A

hip fracture
doubles
5 years
age 60

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15
Q

what are complications of bisphosphonates

example of drug

A

subtrochanteric femoral fracture - atypical stress fractures in femur diaphysis

alendronate
fosamax
actonel

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16
Q

what is the swedish study

A

2009 swedish study

study performed by Aspberger

incidence of mid femur stress fracture is 50x higher for patients on bisphosphonates

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17
Q

if osteoporotic patient presents with pain on coughing sneezing and straining what should you consider

A

acute compression fracture

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18
Q

progressive angular kyphotic deformity within a year of spinal compression fracture results in what

A

spinal stenosis

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19
Q

neurological abnormalities are __ with spinal compression fractures

A

infrequent

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20
Q

what is (percutaneous) vertebroplasty

results

complications

A

polymethylmethacrylate PMMA (acrylic bone cement) is injected into vertebral body to stabilize and strengthen collapsed vertebrae - outpatient

immediate and substantial results in perception of pain and function - strengthen and stabilize vertebrae

may have nerve root pain from leakage of injected material

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21
Q

20% of patients with osteoporosis compression fracture will experience what within 1 year

A

another fracture

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22
Q

what uses a balloon dilatation of vertebral body with subsequent instillation of polymethylmethacrylate

A

kyphoplasty

emphasis on balloon

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23
Q

what is a kyphoplasty procedure like

A

surgeon inserts catheter into vertebrae and then inserts and inflates a small balloon - this creates a cavity as it inflates - balloon is deflated and withdrawn from vertebrae - surgeon inserts needle into catheter to deliver cement into cavity - cement hardens and provides immediate stability

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24
Q

in weight bearing joints, preferential resorption of non essential supporting trabeculae occurs during bone loss with sparing of the most important trabeculae that are oriented ___

A

vertically - most important - they are spared in osteoporosis

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25
Q

what are some features of single photon absorptiometry

A
  • high false negative rates - unreliable
  • 2-5 mRad
  • single photon emitted that is attentuated through bone - calcaneus or radius
  • equal degree of association with vertebral osteoporosis
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26
Q

what are some features of dual photon absorptiometry

A
  • photons emitted at 2 different levels
  • applied to spine and proximal femur
  • influenced by osteophytes, scoliosis, vascular calcifications, sclerosis
  • 5-15 mRad
  • low radiation dose to the patient
  • high resolution images have been useful for evaluating vertebral fractures

ALSO CALLED DEXA!
dual energy xray absorptiometry

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27
Q

DEXA scores are reported as what

and what do these scores mean

A

T score and Z score

T score - comparison of bone density with that of a 30 year old of the same sex

Z score - comparison of bone density with that of an average person of same age and sex

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28
Q

what do the T scores of a DEXA scan indicate

A

T score
> -1 = normal
-1 to -2.5 = osteopenia
< -2.5 = osteoporosis

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29
Q

what do the Z scores of a DEXA scan indicate

A

< -2 = may indicate something other than the aging process is causing abnormal bone loss

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30
Q

what is a quantitative CT scan

A

MC used to assess the strength of vertebrae in assessment of fracture

measurements correlate with prevalence of fracture

200-250 mRAD!! alot of radiation

calibration with standard, dual photon beam passes through vertebral body, then compared to patient density with phantom density

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31
Q

what is used to assess bone mineral density as a diagnostic tool for osteoporosis and other related fractures

A

due to lower radiation dose and cost, DEXA scan remains the dominant screening tool

quantitative CT has increased with advent of new developments in CT technique

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32
Q

what are the advantages of quantitative CT over DEXA scan

A
  1. ability to separate cortical and trabecular bone
  2. provides true volumetric density in units of mg/cc
  3. no errions due to spinal degeneration cahanges or aortic calcification
  4. information on bone morphometry
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33
Q

what are the roentgen signs of osteoporosis

A

decrease bone density and mass - bone density approaches that of soft tissues

cortical thinning - pencil thin cortices, endosteal scalloping

altered trabecular pattern - trabecular resorption with accentuation of remaining trabeculae weigh bearing regions of bones, washed out appearance in severe stages

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34
Q

what is the generic term for bone loss

A

osteopenia

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35
Q

what percent of bone mass needs to occur before you see it on xray? appendicular skeleton? axial skeleton?

A

30-50% of bone mass needed to see on xray in appendicular skeleton

50-70% of bone mass loss needed to see on xray in axial skeleton

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36
Q

what are the features of osteoporosis in the spine

A 
decreased bone density 
cortical thinning - end plates 
trabecular changes 
altered vertebral body shape 
increased kyphosis 
scoliosis due to compression fractures 
resorption of trabeculae
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37
Q

resorption of trabeculae due to osteoporosis will occur in what trabeculae first

what appearance does this give to the vertebral body

A

transverse vertebral body trabeculae resorbed first

pseudohemangioma appearance

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38
Q

osteoporosis can result in compression fractures of anterior and posterior portion of the vertebral body giving it the name of

A 
vertebral plana 
or 
pancake vertebrae 
or 
crush
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39
Q

when you see pancake vertebrae or vertebral plana you must rule out what other conditions

how do we rule out

A

lymphoma
multiple myeloma
metastatic disease

lab studies

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40
Q

what is it called when there is loss of anterior vertebral body height

what is this due to

A

wedge vertebrae

may be due to trauma with normal bone mineralization or no trauma and poor bone mineralization

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41
Q

wedge vertebraes are most common where

A

mid thoracic
and
TL region

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42
Q

what shaped vertebrae is due to pressure of nucleus pulposus and weakened vertebral endplates

compare disc height to normal

A 
biconcave vertebrae 
or 
hourglass vertebrae 
or 
fish vertebrae

normal disc height

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43
Q

what are schmorls nodes characteristics

A

small but can be large

painful

can trigger premature DDD process due to loss of nuclear pressure

44
Q

there is strong evidence that pain carrying nerve fibers can grow inward, deep into the __ and __

this can cause pain known as __

A

middle annulus and nucleus pulposus

discogenic pain

45
Q

what is our ddx if we see a vertebral body with GAS inside the body

A 
metastatic disease 
myeloma 
radiation 
amyloidosis 
corticosteroid induced AVN
46
Q

gas in a vertebral body will have what signal intensity on MRI

A

low signal

47
Q

what are fractures that are oriented VERTICALLY seen as areas of osteolysis and adjacent areas of sclerosis

A

stress fractures

- sacrum and symphysis

48
Q

insufficiency fractures are confirmed with what

A

MRI ?
bone scan
CT

49
Q

what do sacral insufficiency fractures present as

what do rami fractures present as

A

sacral tenderness

pain in the low back, groin, and hip

some patients may be asymptomatic with both

50
Q

sacral stress fracture has a characteristic ___ pattern that indicates insufficiency fracture

A

H pattern
or
Honda Sign

51
Q

what do stress fractures look like in appendicular skeleton

how do they appear on MRI

A

cortical disruption along with a fine line of increased density - sclerotic bone forms after stress fracture

low signal intensity on T1

52
Q

longitudinal stress fractures that are parallel with the bone appear how on MRI and CT

A

periosteal edema
marrow edema

transverse CT cuts are needed

53
Q

in a running athlete with lower leg pain, the primary differential diagnosis includes

whats in your ddx if they are no distant runners

A

muscle and tendon injury
chronic compartment syndrome
shin splints
stress fracture

intermittent claudication
osteomyelitis
neoplasm

54
Q

what is reflex sympathetic dystrophy syndrome

what is another term

A

complex regional pain syndrome

usually due to trauma

patient > 50

acute onset of painful regional osteoporosis

progressive pain, stiffness, swelling, atrophy, contracture

55
Q

reflex sympathetic dystrophy syndrome or complex regional pain syndrome affects what areas MC

A

hand and shoulder

56
Q

what causes the osteoporosis in complex regional pain syndrome

A

hyperemia of bone augments osteoclastic resorption of bone resulting in rapid progressive osteoporosis

57
Q

what is the recover like for reflex sympathetic dystrophy syndrome

A

slow recovery
may never recover fully
residual dystrophy, contracture, joint stiffness

58
Q

what are the joints and margins like in complex regional pain syndrome

A

joint spaces and margins are normal

59
Q

what are the characteristics of transient osteoporosis of the hip

A
  • left hip exclusively in females - severe osteoprosis of femoral head
  • may have joint effusion
  • unknown etiology
  • 20-40 years old
  • may be associated with pregnancy
  • sudden onset of pain, antalgia, and limp
  • full recovery in 3-12 months
60
Q

what is another name for transient osteoporosis of the hip

why

A

transient bone marrow edema

presents with bone marrow edema in the femoral head and neck

61
Q

what conditions cause transient bone marrow edema

A 
transient osteoporosis of the hip 
AVN 
epiphyseal fractures 
arthropathies 
osteoid osteoma 
infection
62
Q

what does transient osteoporosis of the hip look like on MRI

A

decreased signal on T1

increased signal on t2 (edema)

63
Q

how does disuse and immobilization osteoporosis occur

A

immobilization inhibits osteoblastic activity in bone and accelerates osteoclastic activity of bone

64
Q

when do xray changes occur in disuse and immobilization osteoporosis

does this process last forever

A

7-10 days

pronounced after 2-3 months

no, complete resolution of normal bone density after therapy

65
Q

what are the 4 patterns of disuse osteoporosis

what is the most common pattern or form

A

uniform - all bone involved have similar degree of bone loss - MC form

spotty - localized circular lesions predominate especially in epiphyseal regions

bands - linear transverse subchondral or metaphyseal lucent zones

cortical - lamination or scalloping loss of definition in the outer and inner cortical margins

66
Q

while steroids do decrease inflammation, they can also lead to steroid induced osteoporosis. how does this occur

A

steroids have the following affects:

decrease formation of new bone

increase breakdown of old bone

decrease absorption of calcium from food by the body

67
Q

what is osteomalacia

what does it mean

what is it due to

A

altered quality of bone

means soft bone

lack of calcium deposited in osteoid due to altered calcium, phosphorous, or vitamin D metabolism

68
Q

what are some conditions that can lead to osteomalacia

A

malabsorption syndrome
hypovitaminosis D
renal osteodystrophy
sprue - celiac disease

69
Q

osteomalacia deformities of weight bearing bones are due to what

A

uncalcified osteoid located on surfaces of trabeculae and linings of haverians canals

70
Q

what are the radiographic findings of osteomalacia

A

pseudofractures - also called looser or milkman lines

osteopenia

bone defomities

71
Q

what do the pseudofractures appear like in osteomalacia on xray

A

fractures at right angles to the cortex

uncalcified osteoid

bilateral and symmetrical

72
Q

after you see radiographic findings of osteomalacia, what is the next step

A

confirm with lab dx

73
Q

what is rickets due to

A

due to deficiency of vitamin D, calcium, or phosphate

malabsorption

renal disorders

anticonvulsant drugs - dilantin

lack of sunshine

74
Q

what is a systemic disease of young children and infants

what is the adult version

A

rickets

osteomalacia

75
Q

when does rickets usually occur in children

A

6-12 months of age

76
Q

what are the soft tissue abnormalities that occur in rickets

what are the gross general abnormalities that occur

A

soft tissue swelling around growth plates due to hypertrophied cartilage

rachitic rosary - unmineralized osteoid along anterior rib cage

77
Q

what are characteristics of rickets

A

physis cartilage grow normally but fail to calcify

absent zone of provisional calcification

widening of growth plates due to accumulation of osteoid

irregular, frayed, cupped, metaphyseal margins

“paint brush” frayed zones of provisional calcification

bowing deformities, fractures, osteopenia, scoliosis, pseudofractures, abnormal bone length

78
Q

what does scurvy do to bone

A

supresses osteoblastic activity

decreased production of collagen and osteoid

79
Q

what people get scurvy

A

infants 8-14 months fed only boiled or pasteurized milk

or

long term deficieny of vitamin C

80
Q

in scurvy, you need at least __ (amount of time) of avitaminosis C before symptoms and skeletal changes occur

A

4 months

81
Q

what is the clinical hallmark of scurvy

A

spontaneous hemorrhages due to capillary fragility

82
Q

what are the signs and radiographic findings of scurvy

A

generalized osteopenia due to inhibition of cell activity

white line of frankel - dense zone of provisional calcification

wimbergers rings - dense peripheral ring epiphysis

corner sign - infarction of epiphyseal/metaphyseal margins in irregularity affecting lateral and medial margins of zopc/white line of frankel

pelken spurs - spurs at metaphyseal margins extending perpendicular to cortex

scorburitc zone or trumerfeld zone - poor osteoid located along metaphyseal side of zopc which appears as radiolucent band

subperiosteal hemmorhage - blood elevates periosteum which may calcify when healing occurs

83
Q

what area may collapse in scurvy

A

corner sign - may collapse or fracture with impaction

84
Q

what is hyperparathyroidism due to

what does excessive PTH due

A

overactive parathyroid gland

initiates osteoclasts to resorption with fibrous tissue replacement causing osteitis fibrosa cystica (soft fragile bone)

85
Q

what is tertiary hyperparathyroidism

A

state of excessive secretion of PTH after a long period of secondary PTH and resulting in high blood calcium levels

unregulated PTH

86
Q

what are characteristics of hyperparathyroidism

A

brown tumors - accumulation of fibrous tissue produces cyst like destructive brown bone lesions

subperiosteal resorption - pathological - occurs along outer cortex at insertional points of ligaments and tendons

87
Q

what are predictable locations for subperiosteal resorption in hyperparathyroidism

A

radial margins of middle and proximal phalanges - 2 and 3 digits

medial metaphysis of humerus and tibia

distal clavicles

trochanters and tuberosities

lacelike appearance of external bone

SI erosion

widening of pubic symphysis and AC joint

88
Q

salt and pepper skull is characteristic of what diseases

A

hyperparathyroidism

salt and pepper - granular appearance of osteopenia

89
Q

what do browns tumors look like in hyperparathyroidism

A

expansile
septated
mimics destructive lesion
fluid levels seen on MRI

90
Q

rugger jersey sign is seen in what condition

A

hyperparathyroidism

seen in vertebrae

91
Q

since blood calcium is increased in hyperparathyroidism, what can occur

A

calcification with tissues and organs

nephrocalcinosis - renal caliculi

chondrocalcinosis

sclerosis of monckenberg

92
Q

monckenberg medial calcific sclerosis is a disease of what

A

medium sized muscular arteries

93
Q

what are characteristics of monkenberg medial calcific sclerosis

A
  • people over 50
  • calcium deposits in tunica MEDIA of artery
  • no intima involvment
  • no vascular narrowing
  • calcium may undergo calcificaiton
  • seen on xray
94
Q

what radiographic feature is pathognomonic for scurvy

A

trummerfeld zones

95
Q

what are the clinical features of hypervitaminosis A

A 
hepatosplenomegaly 
jaundice - yellow skin 
dermatitis 
pruritis 
alopecia 
osteopenia
96
Q

what kind of periosteal reactions are noted on xray in hypervitaminosis A

A

solid periosteal reactions on shafts of long bones

femur, tibia, fibula, metatarsal, humerus, ulna, radius, metacarapals

97
Q

what is the etiology of acromegaly

what does the etiology cause

A

secretory eosinophilic adenoma of anterior pituitary gland

produces intramembranous bone tissue growth and subcutaneous hypertrophy

98
Q

what does secretory eosinophilic adenoma of anterior pituitary gland cause before the closure of growth plates? and after closure of growth plates?

A

before - gigantism

after - acromegaly

99
Q

what are relevant features of acromegaly

A 
heel pad thickness 
enlarged sella turcica 
widened mandible angle 
sinus enlargement 
prominent ungal tufts 
spade like ungal tufts 
premature DJD 
increase ADI due to cartilage overgrowth
100
Q

why is heel pad thickness and ADI increased in acromegaly

what is the heel pad thicknesss in acromegaly

A

cartilage thickening

> 20 mm

101
Q

what is lead poisoning also called

A

plumbism

102
Q

what does plumbism cause

A

dense metaphyseal bands

aka lead lines

103
Q

why is lead put into bone during lead poisoning

A

lead has higher affinity for bone than calcium so it replaces calcium

104
Q

lead poisoning deposits lead into what part of the bone

A

during growing bone, lead is primarily deposited into the metaphysis

105
Q

in children, lead poisoning affects what bones

why

A

metaphysis of distal femur, both ends of tibia, and distal radii

most rapidly growing bones in the body

106
Q

what are clinical features of lead poisoning

A

pica - weird cravings of dirt and clay

Radiology Tumors (11 decks)

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