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MSK > Radiology > Flashcards

Radiology Flashcards

1
Q

Bones are shown by what scans?

A
  • xrays (radiography)
  • CT
  • MRI
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2
Q

Soft tissues are shown by what scans?

A
  • CT

- especially MRI

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3
Q

What are the normal spinal curvatures?

A
  • cervical lordosis
  • thoracic kyphosis
  • lumbar lordosis
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4
Q

The neural foramen lies inferior or superior to the pedicle?

A

Inferior

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5
Q

Normal spinal anatomical features can be identified in which view?

A

Lateral view

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6
Q

What scan is most sensitive for spinal fractures?

A

CT

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7
Q

When is CT used to image spinal trauma?

A
  • xray shows fracture but more detail required, ?any more fractures present
  • xray normal but high clinical suspicion of fractures
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8
Q

Describe intervertebral ligaments

A
  • ligaments tether vertebrae together and are responsible for spinal stability
  • ligaments are not seen on xray or CT but seeing normal vertebral alignment on these test implies intact ligaments and a stable spine
  • abnormal vertebral alignment on xray or CT implies ligament damage and an unstable spine
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9
Q

Ligaments are only seen directly on which scan

A
  • MRI
  • normal ligaments are black on MRI scans
  • damaged ligaments are light on MRI
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10
Q

When is MRI used to image spinal trauma?

A
  • occasionally to provide detail of the spinal ligaments
  • in patients with neurological deficit, which is not explained by xray or CT, to show soft tissue abnormality such as; acute prolapsed intervertebral disc, epidural haematoma, spinal cord damage
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11
Q

Describe the imaging features of vertebral tumours

A
  • xray and CT findings; bone sclerosis (increased bone density), bone destruction (reduced bone density), vertebral collapse (pathological fracture)
  • unique MRI findings; early (bone marrow infiltration), late (extradural mass and spinal cord compression)
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12
Q

Describe imaging intervertebral discs

A
  • discs are invisible on xrays
  • xrays may show disc space narrowing but this correlates poorly with symptoms of sciatica
  • CT shows lower lumbar disc prolapses
  • MRI is best, showing all disc prolapses and even the disc dehydration which precedes this
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13
Q

The spinal cord is only adequately shown by what?

A

MRI

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14
Q

Name some intrinsic causes of spinal cord disease

A
  • demyelination
  • ischaemia
  • MRI may be used to detect this
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15
Q

What is the role of imaging in arthritis?

A
  • to detect features of disease in order to make a diagnosis and monitor disease activity and response to treatment
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16
Q

Describe the radiographic features of OA

A
  • in healthy joints, hyaline cartilage creates a lucency between corticated bone ends on xrays
  • this is referred to as the joint space
  • in OA, asymmetric cartilage wear leads to asymmetric joint space reduction
  • increased subchondral bone cellularity and vascularity drives new bone formation leading to sclerosis of subchondral bone, seen as an increase in bone density
  • synovial fluid dissects into bone, forming cysts
  • periosteal stimulation leads to marginal osteophyte formation
  • weakened bone caves in, resulting in gross joint deformity
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17
Q

Describe diagnostic features of RA

A
  • synovial proliferation and reactive joint effusion cause soft tissue swelling
  • osteopenia; hyperaemia causes bone demineralisation resulting in periarticular osteoporosis
  • erosion; inflamed thickened synovium (pannus) destroys bone, initially at the joint margins
  • marginal erosion is the hallmark of RA
  • with time, bone erosion progresses, spreading across the joint
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18
Q

Describe RA deformity

A
  • erosion ‘shortens’ the bones, producing lax ligaments and joint capsule
  • inflammation softens ligaments which stretch further
  • joint subluxation and deformity develop
  • tendon failure may exacerbate this
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19
Q

Describe ankylosis of RA

A
  • exposed eroded bone ends occasionally fuse

- ankylosis is much more typical sero-negative arthritis

20
Q

Seronegative arthritides are characterised by what?

A
  • synovitis (inflammation of joint and tendon sheath linings)
  • enthesitis (inflammation at sites where ligaments and tendons attach to bone)
21
Q

Name characteristic distribution and radiographic features of seronegative arthritis

A
  • sacroiliac joint and spine involvement
  • ill defined periarticular new bone formation
  • tendency to ankylosis of ligaments and across joints
22
Q

For which areas of the body is two views required?

A
  • cervical spine; AP, lateral, odontoid peg

- scaphoid; AP, lateral, two obliques

23
Q

What is a comminuted fracture?

A

Three or four fragments

24
Q

Describe impaction fractures

A
  • axial forces through the bone, bone appears denser than normal
25
Q

In what ways can fracture appearance is variable?

A
  • lucency crossing bone
  • cortical expression
  • spiral / transverse
  • comminution
  • joint involvement
  • angulation
  • displacement
  • impaction
  • avulsion
26
Q

Name some avulsion fracture mimics

A
  • sesamoid bones
  • accessory ossification centres
  • old non-united fractions
27
Q

Describe the posterior fat pad sign

A
  • fat density may be seen anterior to the distal humerus on normal xrays, as shown opposite
  • if an elbow effusion is present, and trauma is a common cause of an effusion, a displaced fat pad becomes visible posterior to the distal humerus, the posterior fat pad sign
28
Q

Describe pelvic soft tissue injury

A
  • sports related pelvic soft tissue injury is common
  • acutely, this is typically due to muscle tear or tendon avulsion
  • chronic overuse can cause bone or soft tissue pain at site of tendon or ligament attachment
  • US can show acute injuries affecting superficial structures
  • MRI is imaging method of choice as it provides more complete assessment of all soft tissues and bones
29
Q

Is a visible posterior fat pad abnormal or normal?

A

Always abnormal

30
Q

Name some examples of bony rings

A
  • spinal canal
  • pelvis
  • forearm and lower leg
31
Q

Why might there be a skeletal weakening leading to a pathological fracture?

A
  • focal as in the metastatic deposit causing a clavicle fracture
  • diffuse due to osteoporosis or other metabolic bone disease
32
Q

What view should you obtain for posterior shoulder dislocation?

A
  • when the humerus dislocates posteriorly, the lack of displacement makes it difficult to appreciate on an AP xray
  • an oblique view (on right) should always be obtained, and shows abnormal humeral displacement posterior to the articular surface of the glenoid
33
Q

Describe intra-capsular fractures

A
  • interfere with blood supply to femoral head prone to femoral head AVN or non-union typically treated by hemiarthroplasty
34
Q

Describe extra-capsular fractures

A
  • don’t affect blood supply to femoral head don’t get femoral head AVN or non-union treated by internal fixation using DHS
35
Q

A standard trauma xray series for knees comprises what?

A
  • AP

- horizontal beam lateral

36
Q

Describe tibial plateau fracture

A
  • 80% affect lateral condyle, following valgus force with foot planted (‘bumper injury’)
  • variable appearance, from obvious fracture line to subtle subchondral sclerosis
  • the area of condylar involvement / depth of depression guides treatment, and is well shown by CT
37
Q

Describe knee soft tissue injuries

A
  • acute intra-articular soft tissue injuries may also be difficult to assess clinically due to swelling and pain
  • these are well shown y MRI, which has become a common test in acute knee trauma
38
Q

What can MRI show for knee soft tissue injuries?

A
  • meniscal tears
  • cruciate, collateral or other capsular / ligamentous injuries
  • hyaline cartilage damage
  • subtle fractures
39
Q

What is the usual injury mechanism for ankles?

A

Inversion or eversion

40
Q

What type of ankle fractures have a particular tendency to instability?

A

Trimalleolar fractures

41
Q

Describe 5th metatarsal base fractures

A
  • follows inversion and clinically resembles
42
Q

Describe calcaneal fractures

A
  • usually follows axial compression, such as falling from height onto the heel
  • calcaneal compression fracture causes loss of bohers angle and increased bony density
43
Q

What is the os trigonum ?

A

An accessory ossification centre commonly seen posterior to the etalus

44
Q

Where are rounded sesamoid bones found?

A
  • may arise at multiple sites within the foot, but ar invariably present on the medial and lateral plantar aspects of the 1st metatarsal head
45
Q

How is complete from partial tears distinguished?

A

Possible with US or MRI

MSK (10 decks)

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