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Module 9 > Radiology > Flashcards

Radiology Flashcards

1
Q

What is the most common tumour?

A

Odontoma

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2
Q

What are the 2 subtypes of odontoma?

A

Complex (posterior mandible)
Compound (anterior maxilla)

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3
Q

What is the second most common tumour?

A

Ameloblastoma

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4
Q

What is idiopathic osteosclerosis?

A

Localised area of increased bone density of unknown cause.
No association with inflammatory, neoplastic or dysplastic processes.
Normally an incidental finding.

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5
Q

What is sclerosing osteitis?

A

Localised area of increased bone density in response to inflammation.

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6
Q

What would the radiographic presentation be of sclerosing osteitis?

A

Well-defined or poorly defined radiopacity
Directly associated with source of inflammation. E.g apex of necrotic tooth, infected cyst.

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7
Q

What is hypercementosis?

A

Excessive deposition of cementum around root. Non-neoplastic and asymptomatic.

PDL space should continue around the hypercementosis.

Cause is unknown but more common in certain conditions such as Pagets disease or acromegaly.

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8
Q

What is a cementoblastoma?

A

Benign odontogenic tumour of cementum.
Occurs around a root of a tooth which remains vital.
Often painful
Can displace teeth and bone.
Thin radiolucent margin continuous with PDL space of root.

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9
Q

What is an osteoma?

A

Benign tumour of bone, not neoplastic or tumours. Hard, asymptomatic, slow growing lump.

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10
Q

What is the radiographic presentation of an osteoma?

A

Entirely cortical bone or a mix of cortical and trabecular.
Sessile or pedunculated
Rounded, smooth margins
No potential for malignancy.

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11
Q

What is multiple osteomas called?

A

Gardners syndrome.

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12
Q

What are other clinical presentations of gardners syndrome apart from odontomas?

A
  • colorectal polyposis (become cancerous)
    -soft tissue tumours e.g epidermoid cysts.
    Also tend to have supernumeraries.
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13
Q

What is cleidocranial dysplasia?

A

Rare genetic condition with various skeletal defects (including teeth and jaws).

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14
Q

What are clinical features of cleidocranial dysplasia ?

A
  • Generally delayed eruption
  • Multiple supernumerary teeth
  • Multiple unerupted secondary teeth
  • Hypoplastic maxilla with high arched palate.
  • Increased prevalence of cleft palate
  • Coarse trabecular pattern.
  • absent clavicles
  • small maxillary sinuses
  • bossing of the skull
  • hypertelorism
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15
Q

What is osteomyelitis?

A

Inflammation of the bone and bone marrow due to bacterial infection.

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16
Q

What is osteoradionecrosis?

A
  • Bone death resulting from irradiation
  • Requires high energies of radiation e.g radiotherapy.
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17
Q

Medication-related-osteonecrosis of the jaw. (MRONJ)

A

Bone death associated with anti-resorptive or anti-angiogenic drugs.

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18
Q

What is some radiographic features of osteomyelitis and osteoradionecrosis of the bone.

A
  • osteolysis and osteonecrosis of affected region:
    = Irregularities of inner and outer aspect of the bone
    = Sequestration of bone
    = Periosteal bone reaction
    = Loss of lamina dura around teeth
    = Pathological fracture of bone
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19
Q

What is central giant cell granuloma?

A

Reactive lesion with benign tumour like behaviour
- slow growing lesion causing expansion of bone and displacement of teeth.
- minority of cases more aggressive and grow rapidly
- Often asymptomatic but may be tender to palpation
- May invade into the overlying soft tissues.

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20
Q

What is the most common site of a central giant cell granuloma?

A

Radiolucent unilocular lesion anterior to molars.

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21
Q

What is the difficult in histology when diagnosing fibro-osseous lesions?

A

Can be difficult to distinguish. Radiology plays a big part in diagnosis.

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22
Q

What are the 3 forms of cemento-osseous dysplasia?

A
  1. Focal
  2. Periapical
  3. Florid.
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23
Q

What are the radiographic appearances of cemento-osseous dysplasia?

A

Well-defined radiolucency containing varying amounts of well-defined radiopaque material
- Appearance depends on stage of lesion maturation
- Fully mature lesions can appear entirely radiopaque
- Lamina dura lost
- PDLs often unaffected
- Rare to have tooth displacement
teeth are vital

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24
Q

What is the management of cemento-osseous dysplasia?

A

Usually no management required.
- Removal only recommended if exposed by extraction, mandibular atrophy, trauma etc
- Risk of secondary infection following interventions.
- biopsy best avoided unless atypical presentation.
- Ideally avoid dental extractions of involved teeth.

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25
Q

What is the different forms of fibrous dysplasia?

A
  1. Monostotic (single bone affected)
  2. Polyostotic (multiple lesions affecting multiple bones)
  3. Craniofacial (typical single lesion affecting multiple (fused) bones.
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26
Q

Where does fibrous dysplasia usually favour in site?

A

Posterior maxilla

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27
Q

What is the radiological appearance of fibrous dysplasia?

A

-Altered bone pattern
- Highly variable: granular, “orange peel”, “swirling”, “wispy”, amorphous
- Radiodensity increases as lesion matures
- Bone enlarges but maintains rough anatomical shape.
- Margins indistinct and blend into adjacent bone.

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28
Q

What is the management of fibrous dysplasia?

A

No management required if no functional or aesthetic problems.
Recontouring or radical resection only if necessary.
Lesions normally stop growing but may reactivate, typically after a precipitating event.

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29
Q

What is an ossifying fibroma?

A

Fibro-osseous neoplasm occuring most often in tooth-bearing areas.
Majority occur in mandible
Rare cases in other craniofacial bones.

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30
Q

What is the radiographic presentation of ossifying fibroma?

A
  • rounded expansile lesion
  • affected teeth displaced and may be resorbed
  • ranges from entirely radiolucent to entirely radiopaque (radiodensity depends on stage of maturation).
  • margins usually well-defined
  • Surrounding bone may be sclerotic.
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31
Q

What is the management of ossifying fibroma?

A

Removal indicated due to progressive growth
Surgical enucleation or resection.
Usually enucleates in one piece.
12% recurrence rate.

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32
Q

What is Pagets disease of bone?

A

Chronic condition causing disordered remodelling of bone.
- Affects multiple bones at the same time.
- Results in enlargement of bones, malocclusion, nerve impingement (e.g cranial nerve deficits), brittle bones.
- Majority asymptomatic.

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33
Q

What is radiographic appearance of Pagets disease of bone?

A
  • General enlargement of bones
  • Abnormal bone pattern e.g cotton wool appearance
  • Osteolytic or osteosclerotic patches of bone
  • Radiodensity of altered areas linked to stage of disease.
  • Dental issues (migration, hypercementosis, loss of lamina dura.
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34
Q

What are the 3 phases of Pagets disease of bone?

A
  1. Early/osteolytic
  2. Intermediate/fixed
  3. Late/osteosclerotic
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35
Q

What is osteoporosis?

A

Decreased bone mass. Age related or secondary due to nutritional deficiencies, medications etc.

36
Q

What are some radiographic features of osteoporosis?

A
  • Thinned cortices (e.g inferior border of the mandible)
  • Sparse trabecular bone pattern
  • General radiolucent appearance
  • Thinned lamina dura around teeth
37
Q

What are 3 different types of obstruction of saliva glands.

A
  • Sialoliths
  • Mucous plugs
  • Neoplasia
38
Q

What are different imaging modalities we can use for salivary glands?

A
  • Plain radiograph techniques
  • Ultrasound
  • Injection of iodinated contrast (sialography)
  • CT (computed tomography)
  • MRI (magnetic resonance imaging)
  • Nuclear Medicine
39
Q

What 3 main views can be taken in plain film radiography to view saliva glands?

A
  1. DPT
  2. Lower true occlusal
  3. Lateral oblique
40
Q

What are other calcifications that could be mistaken for sialoliths?

A
  • Phleboliths
  • Tonsilloliths
  • Calcified plaques in carotid artery
  • Normal anatomy (hyoid bone)
  • Elongated/calcified stylohyoid ligament
  • Calcified lymph nodes
41
Q

What is ultrasound?

A
  • No ionising radiation
  • High frequency sound waves
  • Sound waves have short wave lengths which are not transmittable through air
  • Require coupling agent to help sound waves get into tissues.
42
Q

What does hypoechoic mean?

A

Dark on ultrasound

43
Q

What does hyperechoic mean?

A

Bright on ultrasound

44
Q

Whys is ultrasound good for saliva glands?

A

Glands are superficial apart from deep lobe of parotid.

Can assess vascularity, ductal dilitation or neoplastic mass.

45
Q

What symptoms would you expect to see in a patient with obstructive disease in salivary glands?

A
  • pain at mealtimes
  • prandial swelling and pain
  • “rush of saliva into mouth”
  • Bad taste in mouth
  • Thick saliva
  • Dry mouth
46
Q

What is sialography?

A

-injection of iodinated radiographic contrast into salivary duct to look for obstruction.
- Done either with panoramic (DPT), skull views, or fluoroscopic approach.
- No local anaesthetic
- Very small volume of contrast injected (0.8-1.5ml).

47
Q

What are some indications of sialography?

A
  • Looking for obstruction or stricture (narrowing) of salivary duct which could be leading to prandial symptoms.
  • Planning for access for interventional procedures (basket retrieval of stones or balloon dilatation of ductal strictures.
48
Q

What are some risks of sialography?

A

-discomfort
-swelling
- infection
- any stone could move
- allergy to contrast (very rare)

49
Q

What is an advantage of fluoroscopic sialography?

A

You can watch the contrast entering the duct in “real time”

50
Q

What is a disadvantage of fluoroscopic sialography?

A

Increased radiation dosage.

51
Q

What are the 3 phases of sialographic technique?

A
  1. Pre-contrast (exclude other pathology which could account for symptoms.
  2. Contrast/filling phase - contrast is being injected via cannula.
  3. Emptying phase (Roughly 5 minute time delay following removal of cannula).
52
Q

What is the contrast that is used in sialography

A

Iodine aqeous based solution.

53
Q

What does a normal submandibular glands look like in sialography?

A

bush in winter

54
Q

What does a normal parotid gland look like in sialography?

A

tree in winter

55
Q

What does any acinar changes look like in sialography?

A

snow storm appearance

56
Q

What is the selection criteria for stone removal?

A
  1. stone must be mobile
  2. stone should be located within lumen on main duct distal to posterior border of mylohyoid
  3. stone should be distal to hilum or at anterior border of the gland (parotid)
  4. duct should be patent and wide to allow passage of the stone)
57
Q

What are patients with Sjogrens syndrome more likely in developing in their lifetime?

A

Lymphoma

58
Q

what is the primary imaging modality used for Sjogrens syndrome?

A

Ultrasound

59
Q

What is scintography?

A

IV injection of radioactive technetium 99m pertechnetrate. half life is 6 hours.

60
Q

What does an early stage malignancy in saliva glands mimic?

A

benign tumours therefore it is important to biopsy every lesion

61
Q

What is the primary imaging modality of neoplasms?

A

MRI or CT

62
Q

What imaging modalities can capture the TMJ?

A
  • Plain film
  • CBCT
  • CT
  • MRI
  • Nuclear Medicine
63
Q

What are some examples of plain film radiography that can be used to view the TMJ?

A
  • DPT
  • PA mandible
  • Reverse Townes
  • Lateral oblique
64
Q

OPT for TMJ assessment usually isnt indicated due to the majority of cases are from of muscle origin. However in what cases what a OPT assessment be indicated for the TMJ?

A
  1. Recent trauma
  2. Change in occlusion
  3. Mandibular shift
  4. Sensory/motor alterations
  5. Change in range of movements
65
Q

If there has been recent trauma, what are the 2 radiographic modalities of choice for viewing the TMJ?

A
  • PA mandible
  • DPT
66
Q

What would be the procedural error during taking a DPT where the anterior teeth are blurry and wide, ghosting of the mandible and spine, condyles are close to edge of film?

A

Patient is positioned too far backwards.

67
Q

What would be the procedural error during taking a DPT where the maxillary incisors are blurry, hard palate superimposed on roots, flat occlusal plane, mandible is broad and flat, condyles at the edge of the film?

A

Patients chin is tilted upwards.

68
Q

What would be the procedural error during taking a DPT if roots of lower incisors are blurry, mandible shaped like a “V”, too much smile line, condyles at top of the film, spine forms arch.

A

Patients chin is tilted downwards.

69
Q

What would be the procedural error during taking a DPT if anterior teeth are blurry, too small and narrow , spine visible on sides of film?

A

Patient is too far forwards.

70
Q

What is anterior disc displacement with reduction?

A

Will get reciprocal clicks on opening when the disc is recaptured. The disc will sit in an anterior position in closed mouth, then will click into normal place on opening.

71
Q

What is anterior disc displacement without reduction?

A

Limitation on opening and pain. Anterior placement for the disc that does not move on opening.

72
Q

What happens with chronic disc displacement?

A

Loss of joint space resulting in arthritic changes.

73
Q

What does SPECT stand for in Nuclear Medicine?

A

Single Photon Emission CT.

74
Q

When is nuclear medicine or SPECT most commonly used?

A

For condylar hyperplasia.

75
Q

What are some clinical signs and symptoms for malignancy in oral cancer?

A

-Leukoplakia/erythroplakia/erythroleukoplakia
-Non healing socket
- Non-healing ulcer
- Unusually mobile tooth
- Swelling/exophytic mass
-lymphadenopathy
- pain/numbess
- weight loss
- night sweats
- dysphagia
-dysphonia
- loss of hearing
- pathological fracture

76
Q

What are radiographic signs of malignancy?

A
  • Moth eaten bone
  • Non-healing sockets
  • Floating teeth
  • Unusual periodontal loss
  • Spiculated periosteal reaction “sunburn reaction”.
  • Unusual uniform widening of the PDL space
  • Generalised loss of lamina dura
  • Loss of bony outline features e.g walls of antrum
  • Thinning of cortico-endosteal margin.
  • spiking root resorption
77
Q

How would benign lesions affect adjacent structures?

A

Displace due to it slowly growing

78
Q

How would malignant lesions affect adjacent structures?

A

Malignant lesions destroy anatomical structures.

79
Q

What is osteosarcoma?

A

malignancy of bone - typically seen in young adults around age of 30s

80
Q

What are risk factors associated with osteosarcoma?

A
  • Fibrous dysplasia
  • History of radiation
  • Pagets disease
  • Retinoblastoma
  • Previous primary bone cancer
  • Chronic osteomyelitis
81
Q

What is multiple myeloma?

A

Multifocal proliferation of plasma cells in bone marrow leading to over-productions of immunoglobulins.
Solitary lesion= plasmocytoma
Multiple lesion= Multiple myeloma
Typically middle aged adults

82
Q

What are some radiographic features of multiple myeloma?

A

Round/unilocular
Radiolucent
Punched out
Well defined/not corticated
Large lesions can lead to pathological fracture
If multifocal can affect all skeleton

83
Q

What is lymphoma?

A

-lymphoproliferative group of diseases
- typically b cell lymphoma
- can present initially as a soft tissue lump

84
Q

What is langerhans histiocytosis

A

rare condition
proliferation of langerhans cells and eosinophilic leucocytes
3 manifestations

85
Q

Where are the 5 areas you can get bony metastases from?

A
  • lung
  • breast
  • thyroid
  • prostate
  • kidney
86
Q
A

Module 9 (20 decks)

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