Radiologic Evaluation, Search Patterns, and Diagnosis

Question 1

What 3 things does alignment (A) analysis include?

Answer 1

• General Skeletal Architecture
• General Contour of Bone
• Alignment of Bones Relative to Adjacent Bones

Question 2

When analyzing general skeletal structure, what should you look for?

Answer 2

• Aberrant size of bones
• Supernumerary bones
• Congenital anomalies
• Absence of any bones
• Developmental deformities

Question 3

Sharp angles in the cortex may be a sign of _____ fractures.

Answer 3

impaction

Question 4

If there is noted trauma at the attachment sites of muscles, tendons, and ligaments it may be a sign of an _____ fracture

Answer 4

avulsion

Question 5

What 3 things does bone density (B) analysis include?

Answer 5

• General Bone Density
• Textural Abnormalities
• Local Density Changes

Question 6

A healthy bone cortex shows up with _____ density than cancellous bone and appears ____.

Answer 6

greater

white

Question 7

What bony feature should you asses when looking for textural abnormalities?

Answer 7

trabeculae

Question 8

What does fluffy trabeculae represent?

Answer 8

random proliferation of both osteoblastic and osteoclastic activity

Question 9

What types of diseases are fluffy trabechulae present?

Answer 9

In the skulls of patients with Paget’s disease and in hyperparathyroidism

Question 10

Smudged trabeculae is a characteristic of what disease?

Answer 10

osteomalacia

Question 11

What types of diseases are coarsening trabechulae present?

Answer 11

patients with chronic renal failure and osteoporosis

Question 12

Why do trabeculae appear coarsened?

Answer 12

The loss of surrounding trabeculae cause remaining trabeculae to appear prominent

Question 13

Lacy or delicate trabeculae is a characteristic of what disease?

Answer 13

thalassemia (Cooley’s anemia)

Question 14

Sclerosis is a sign of what?

Answer 14

Repair

Question 15

When does reactive sclerosis occur?

Answer 15

When the body acts to surround and contain a diseased area, such as a tumor or infection

Question 16

What 3 things does cartilage spaces (C) analysis include?

Answer 16

• Joint Space Width
• Subchondral Bone
• Epiphyseal Plates

Question 17

How can you tell the difference between degenerative arthritides (OA) and inflammatory arthritides (RA or gout) on a plain film?

Answer 17

• In OA subchondral bone becomes increasingly sclerotic as new bone formed to help withstand increased stresses directed at it because of loss of articular cartilage
• In RA or gout there is erosion of the subchondral bone and formation of radiolucent cysts

Question 18

What are the 4 types of periosteal reactions?

Answer 18

• solid
• laminated/onion skin
• spiculated/sunburst
• Codman’s triangle

Question 19

What does a solid periosteal reaction indicate?

Answer 19

a benign process

- seen in fracture healing and osteomyelitis

Question 20

What does a laminated/onion skin periosteal reaction indicate?

Answer 20

repetitive injury

- seen in battered child syndrome and sarcomas

Question 21

What does a spiculated/sunburst periosteal reaction indicate?

Answer 21

malignant bone lesions

- seen in osteogenic sarcomas and in metastatic squamous cell tumor

Question 22

What does Codman’s triangle periosteal reaction indicate?

Answer 22

Present in a variety of conditions, including tumor, subperiosteal hemorrhage, and battered child syndrome

Question 23

What does gas in soft tissue indicate?

Answer 23

gas gangrene or trauma

Question 24

What are calcifications within soft tissue the result of?

Answer 24

old trauma whereby bloody hemorrhage has coagulated and calcified

Question 25

What are the 6 basic categories of pathology in classification of skeletal diseases?

Answer 25

- Congenital - Inflammatory - Metabolic - Neoplastic - Traumatic - Vascular

Question 26

What are the 3 types of lesion distributions? Explain each...

Answer 26

- Monostotic or monoarticular: affect only one bone or one joint - Polyostotic or polyarticular: affect multiple bones or multiple joints - Diffuse: affect all or nearly all bones or joints

Question 27

What are the only 2 disease categories that can occur diffusely?

Answer 27

Neoplastic or Metabolic

Question 28

How many predictor variables may be applied to any bone or joint lesion to assist in making a diagnosis?

Answer 28

11

Question 29

What are the 3 descriptors a bone lesion may occur as?

Answer 29

- Osteolytic - Osteoblastic - Mixture

Question 30

What are the 3 forms in which an osteolytic lesion can take on?

Answer 30

- Geographic destruction Moth-eaten appearance - Permeative destruction

Question 31

Describe geographic destruction of bone

Answer 31

Large areas of bone are destroyed and appear as radiolucent lesion.

Question 32

Sharply defined geographic borders are indicative of a _____ lesion

Answer 32

benign

Question 33

Ragged moth-eaten borders are indicative of a _____ lesion

Answer 33

malignant

Question 34

Describe permative destruction of bone

Answer 34

There is very fine destruction of bone through the haversian system, sometimes requiring magnifying lens to recognize on film

Question 35

Poorly defined permative borders are indicative of a _____ lesion

Answer 35

malignant

Question 36

Where do gout and RA typically manifest?

Answer 36

primarily in small joints of the hands and feet

Question 37

Where foes typically manifest?

Answer 37

in the knees

Question 38

Arthritides have characteristic lesion locations on the articular surfaces of bone. However, what is the difference between the 2?

Answer 38

Osteoarthritis affects weight-bearing areas, whereas rheumatoid arthritis affects entire joint surface

Question 39

In general, margins either sharp and ____ defined or wide and ____ defined.

Answer 39

clearly poorly

Question 40

Sharp, clearly defined, sclerotic borders characteristic of what?

Answer 40

slow-growing or benign lesions

Question 41

Wide, poorly defined borders with minimal or absent reactive sclerosis are characteristic of what?

Answer 41

fast-growing or malignant lesions

Question 42

Lesions that are longer than are wider are likely to be _____. Why?

Answer 42

Benign, because the lesion has grown slowly along with bone

Question 43

Lesions that are wider than they are long are likely to be _____. Why?

Answer 43

Malignant, because they are extending into soft tissue aggressively

Question 44

Do tumors (benign or malignant) cross joint spaces or epiphyseal growth plates?

Answer 44

No

Question 45

What does cross joint spaces?

Answer 45

inflammation

Question 46

What are the 3 types of boy reactions?

Answer 46

- periosteal - sclerosis - buttressing

Question 47

What is sclerosis?

Answer 47

new bone growth established to fortify an area subjected to increased stress, as in sclerosis of subchondral bone in osteoarthritis

Question 48

What is buttressing?

Answer 48

formation of bony exostoses or osteophytes at joint margins, which serve to strengthen architecture of joint

Question 49

A periosteal reaction to a neoplasm is usually characterized as one of what 2 things?

Answer 49

interrupted or uninterrupted

Question 50

What does an interrupted periosteal response suggest?

Answer 50

Either malignant or non-malignant but highly aggressive lesions

Question 51

What does an uninterrupted periosteal response suggest?

Answer 51

benign processes

Question 52

What do uninterrupted periosteal responses look like?

Answer 52

Solid density, either longitudinal, undulated, or buttressing in pattern

Question 53

What is matrix?

Answer 53

intercellular tissue produced by some bone tumors

Question 54

What are the 3 types of tumor matrixes?

Answer 54

- chondroid (cartilaginous) - osteoid (bony) - mixed (combination of cartilaginous and bony)

Question 55

What do chondroid matrixes appear as?

Answer 55

stippled, popcorn-like, or comma-shaped calcifications seen in tumors invading soft tissues

Question 56

What do osteoid matrixes appear as?

Answer 56

white, cloud-like, fluffy density within medullary cavity and in adjacent soft tissue