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Diagnostic Imaging EDITABLE > Radiologic Eval of Knee > Flashcards

Radiologic Eval of Knee Flashcards

1
Q

list radiologic views that are including during a routine exam of the knee

A
  1. AP
  2. Lateral
  3. PA axial “tunnel” view of the intercondylar fossa
  4. Tangential view of patella
  5. Other
    1. WBing posterioanterior axial view of the intercondylar fossa
    2. oblique view
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2
Q

describe the tangential view of the patellofemoral joint

A
  • x-ray path superioinferior (merchant view) or inferiosuperior
  • Spatial relationships
    • patellar subluxations
    • sulcus angle
    • congruence angle
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3
Q

what is the norm for the sulcus angle?

A

138 +/- 6 degree

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4
Q

what is the norm of the congruence angle?

What congruence angle would be associated with lateral subluxation?

A

-6 degree normal

+16 deg associated with lateral subluxation

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5
Q

general guidelines for imaging at the knee

  • what is typically the first study?*
  • What is commonly used for defining complex fractures?*
  • What is commonly used for defining soft tissue injuries?*
  • What can be used for superficial soft tissue abnormalities?*
A
  1. X-rays typically first study for suspected bony and soft tissue abnormalities
    1. diagnosis
    2. directs further imaging
  2. CT commonly used for defining complex fractures
  3. MRI commonly for defining soft tissue injuries
  4. USI possibly for superficial soft tissue abnormalities
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6
Q

general indications for CT of the knee

A
  1. severe trauma
  2. fracture alignment/displacement
  3. loose bodies within joint
  4. tibial plateau depression fractures
  5. health conditions typically viewed with MRI when MRI is contraindicated
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7
Q

what can be seen with an axial CT of the knee?

A
  1. Depression/split fractures of tibial plateau
  2. Segond fracture
  3. Tibial tuberosity hypertrophy or fragmentation (Osgood-Schlatter’s)
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8
Q

what can be seen with a sagittal CT of the knee?

A
  1. position of the patella
  2. fragmentation/ossification of inferior patella/patellar tendon
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9
Q

what can be seen with a coronal CT of the knee? (5)

A
  1. intercondylar/condylar spilt fractures involving femoral condyles
  2. osteochondral lesions
  3. fractures of intercondylar eminence
  4. ACL avulsion
  5. Segond fractures with lateral capsule sign
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10
Q

list general indications for MRI of the knee

A
  1. soft tissue injuries
  2. staging disease
  3. specific clinical scenarios
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11
Q

list soft tissue indications for MRI at the knee

A
  1. Meniscal lesions
  2. Ligament abnormalities
  3. Extensor mechanism abnormalities
  4. Osteochondral lesions
  5. Articular cartilage abnormalities
  6. Loose bodies
  7. Synovial disorders
  8. Marrow abnormalities
  9. Muscle and tendon disorders
  10. IT band syndromes
  11. Neoplasms
  12. Infections
  13. Congenital/developmental conditions
  14. Vascular conditions
  15. Neurogenic conditions
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12
Q

list staging disease indications for MRI of the knee

A
  1. inflammatory arthropathies
  2. bone/soft tissue tumor
  3. fractures/dislocations
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13
Q

list specific clinical scenarios that call for MRI of the knee

A
  1. prolonged, unexplained knee pain
  2. acute trauma
  3. mechanical symptoms
  4. instability/dislocation
  5. malalignment
  6. following complications with knee arthropathy
  7. limited/painful ROM
  8. swelling/enlargement/mass
  9. planned arthroscopy
  10. residual/new symptoms following surgery
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14
Q

what can be seen with an axial slice of a knee MRI? (9)

A
  1. articular cartilage
  2. patellofemoral ligament
  3. patellar retinaculum
  4. ACL/PCL
  5. Joint effusion
  6. Popliteal bursa
  7. popliteus
  8. pes anserine, inserting muscle/tendon
  9. muscle bulk
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15
Q

what can be observed with a sagittal slice of a knee MRI?

A
  1. articular cartilage
  2. bone marrow
  3. menisci
  4. ACL/PCL
  5. extensor mechanism
  6. Hoffa’s fat pad
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16
Q

what can be observed with a coronal slice of a knee MRI?

A
  1. articular cartilage
  2. ACL/PCL
  3. MCL/LCL
  4. menisci
  5. bone marrow
  6. popliteus
17
Q

list different types of fractures of the distal femur

A
  1. non-displaced
  2. impacted
  3. displaced
  4. comminuted
  5. condylar
  6. intercondylar
18
Q

list types of tibial plateau fractures

A
  1. Type I - Split
  2. Type II - Split-depression
  3. Type III - Central-depression
  4. Type IV - Split fracture, medial plateau
  5. Type V - Bicondylar fracture
  6. Type VI - dissociation of metaphysis and diaphysis
19
Q

list types of chondral fractures at the knee

A
  1. osteochondral body, intact articular cartilage
  2. osteocartilaginous flap
  3. detached osteochondral fragment
  4. detached osteochondral fragment in joint
20
Q

list the Ottawa Knee Rules

A
  1. age 55 or older
  2. isolated tenderness of patella (no bone tenderness of knee other patella)
  3. tenderness of head of fibula
  4. inability to flex to 90 degrees
  5. inability to bear weight both immediately and in the ED for 4 steps (unable to to transfer weight twice once each lower limb regardless of limping)
21
Q

what initial imaging is most appropriate for an adult or child greater than or equal to 5 years of age with chronic knee pain

A

radiography knee

22
Q

what next imaging procedure is most appropriate for an adult (or child greater/equal to 5) with chronic knee pain and initial knee x-rays being negative or demonstrating joint effusion?

A

MRI knee

23
Q

what next imaging procedure is most appropriate for an adult (or child greater/equal to 5) with chronic knee pain and initial knee x-rays demonstrating osteochondritis dissecans (OCD), loose bodies, or a history of cartilage or meniscal repair?

A

MRI knee

24
Q

what initial imaging procedure is most appropriate for an adult (or child aged 5 or older) who fell or had an acute twisting trauma to the knee with no focal tenderness or effusion and is able to walk?

A

No imaging required

X-rays may be appropriate but not always

25
Q

what initial imaging procedure is most appropriate for an adult (or child aged 5 or older) who fell or had an acute twisting trauma to the knee with one or more of the following: focal tenderness or effusion and inability to bear weight?

A

Radiographs of knee

26
Q

what follow-up study is most appropriate for an adult or skeletally mature child who has suffered a fall or an acute twisting trauma to the knee and no fracture was detected on radiographs but you suspect an occult fracture or internal degeneration?

A

MRI knee

27
Q

what initial imaging is most appropriate for a child up to age 5 who has an acute limp with nonlocalized symptoms and there is no concern for infection?

A

radiographs of tibia/fibula

28
Q

what initial imaging is most appropriate for a child up to age 5 with an acute limp, localized symptoms, and no concern for an infection?

A

Radiographs of LE area of interest

Diagnostic Imaging EDITABLE (16 decks)

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