Radiology I Flashcards
Intro to Imaging Procedures
What type of imaging is used as an initial study of bone diseases?
X-ray 99% seen on conventional radiography
Computed tomography blurs out unwanted sections in its constant movement. What type of imaging is computed tomography?
CT scan that shows “thin slices” of anatomical structures in the periphery.
Define attenuation
absorbed energy of an x-ray beam after it passes through a given substance.
Name a disadvantage of conventional aka plain film.
lacks of ST discrimination, diminished sensitivity, resolution of small lesions, radiographic later period, exposure differences
What is the search pattern for the ABC’s of interpretation?
Free search
Directed search
In the ABCs approach of interpretation study what does B and C represent?
A=alignment
B=Bone
C=Cartilage
S=Soft tissue
Does CT mean a.conventional tomography or b. computed tomography
Computed tomography
SPECIAL
a. Conventional tomography is used to do what?
b. Tube and film move in what type of direction?
c. What determines the slice thickness?
a. evaluate abnormal structures obscured by overlapping shadows
b. reciprocal, it fulcrum/pivot is at the level of interest
c. tomographic arc
Name the imaging procedure is based on tissue attenuation?
CT aka CAT aka Computed Tomography
CTs provides excellent spatial relationships. Most images are obtained in what plane?
Axial
State what each Tissue expressed in Hounsfield units Hu or CT numbers. Water Fat Muscle Bone Air
Water 0 Fat -50 Muscle +40 Bone +1000 (more dense) Air -1000
a. What is the aka for Bone scintigraphy
b. What is the name of the radiopharmaceutical used for the principle selective uptake of skeleton, heart, lung, etc?
a. Radionuclide bone scanning
b. Technetium-99m methylene diphosphate (99-mTc-MDP) m/c radiopharmaceutical. Extremely sensitive but lacks specificity
The A in ABCs reps alignment. What relationship does it show?
relationship between bone (curves, rotation, retro/anterolsthesis etc.)
What shows uptake on a bone scan?
Fx, tumors, infections, endocrine, hematologic/arthritic disorders. these areas are aka Hot Spots
What imaging system has signal emitted by hydrogen nuclei and its signal is based on the liquidity of tissue.
MRI excellent for ST, bone marrow, disc and ligaments
NO ionizing radiation
What type of imaging has mutiplanar capabilities but does NOT use ionizing radiation?
MRI
Arthro-graphy contrast study opacification of what?
- joint cavities
- ID intra-articular derangements of menisci, cartilage, loose bodies
- invasive
Angio-graphy contrast studies
traumatic ms injuries, tumors, vascular disease
invasive, lots of complications
a. In contrast studies myelography and CTM contrast into what space?
b. Discography contrast into what?
a. Subarachnoid
b. nucleus pulposus, morphologic analysis and pain provocation
Metastatic bone disease is due to what?
osseous dissemination of cell from primary malignant neoplasm
What is the mc malignancy of bone or mc malignant tumor in the skeleton?
Metastatic bone tumors
What is the 3rd mc site of metastatic carcinoma?
Bone.
Note: also lung and liver
Metastatic bone tumors mc from what type of malignancy?
epithelial
With mets bone disease what shows abnormal uptake in 85% of carcinoma pts?
Scintigraphy
What are the mc PRIMARY sites to metastasize to bone?
Breast, prostate, lung
colon, stomach, bladder
uterus, rectum, thyroid and kidney in descending order
What locations account for 75-80% of skeletal metastasis?
Breast, prostate, lung and kidney
Do males or females have a 5 fold increase risk of pathological vertebral fx and what locations?
Females Breast
Thyroid, kidney and cervix
The incidence of bone mets in males is what percentage and what are the locations?
Prostate 60%, lung, bladder
What is the incidence of Bone mets in children? What are the ages with associated conditions?
a. less than 5 yoa NeuroBlastoma
b. 10-20 yoa Ewings and Osteosarcoma
c. 20-35 yoa Hodgkin’s lymphoma
What is the incidence of Osteolytic Mets in a. females
b. males c. children?
a. breast 80%, breast 10%
b. lung 75%, prostate 80%
c. neuroblastoma 80%, Hodgkins 50%
a. What is the mc clinical feature of bone mets?
b. MC presentation is
a. mc after 4th decade
b. progressive bone pain, insidious onset, bouts of exacerbation/remission commonly more severe at night
a. Name the clinical feature mc complication for bone mets.
b. What are typical findings?
a. pathologic fx
b. swelling, tenderness and local pain
What are the possible altered values/features seen on a bone panel, CBC, and ESR for routine lab study?
elevated ESR calcium osteolytic mets alkaline phosphatase osteoblastic mets proteins uric acids acid phosphatase and PSA
Bone mets common to
lungs, liver and red marrow due to rich vascularization
Bone tumor cells stimulate what in the host bone?
Osteoclastic activity with a progressive displacement of marrow elements
Osteolytic destruction tumor emboli deposited in bone marrow displacement. What cortical mets are mc from where?
Lung, also breast and kidney
begins in medullary cavity and secondarily destroys the cortex
Blastic metastasis is d/t what and has what type of growth?
Non-neoplastic new bone
response of osteoid tissue to the tumor
Radiographic features cookie-bite lesions is associated with what type of metastasis?
Name the mc primary sites.
cortical metastasis
Lung, breast, kidney
What is the mc pathway and frequency via Batson’s plexus for bone mets?
Hematologic dissemination
lymphatics is uncommon w/osseous mets
CT procedure detects/eval which part of bone?
cortical and trabecular bone and ST mass
MRI procedures are more ___ and ___ than bone scintigraphy.
sensitive and specific
What are some radiographic features seen in osteolytic bone mets?
cortical and trabecular destruction moth-eaten/permeative pattern No periosteal response Wide ZOT maybe expansile small/absent ST mass
What is the mc site of Blow-out mets?
What does it look like?
Thyroid, kidney and lung
highly expansile and bubbly maybe solitary
What is the atypical presentation of osteolytic metastasis?
Blow-out mets
Expansile osteolytic lesions of bone uses FEGNOMASHIC. what does it mean?
**Fibrous dysplasia (monostotic)
Enchondroma, Eosinophilic granuloma
Giant cell tumor (GCT)
Non-ossifying fibroma/fibrous cortical defect
osteoblastoma
mets (blow-out)/myeloma (Plasmacytoma)
Aneurysmal bone cyst (ABC)
Simple bone cyst (SBC)
HHPT, Pseudotumore of hemophilia/Hemangioma
Infections
Chondroblastoma, Chondromyxoid fibroma, Chondrosarcoma
The following radiographic features indicates what type of mets? Snow-ball, poorly defined margins, ivory vertebrae
osteoblastic
what is the mc location of origin for osteoblastic mets?
Prostate, breast, colon or rectum, carcinoid
A mixed mets is a combination of plastic and lytic features. What element is mc from the breast and occasionally the lung?
Ca
What is the mc site of the spine is most effected by mets?
What is the name of the sign to indicate this destruction?
pedicle destruction mc in the Tsp
Winking owl sign or one eyed pedicle sign
Name 2 DDX for winking owl sign.
Congenital, ABC, osteo-blastoma, osteoid osteoma, mets, myeloma (rare)
What is the mc cause of ivory vertebrae?
Osteoblastic mets, Pagets, Hodgkins
What is the mc cause of extra-pleural sign seen in the ribs and sternum?
osteolytic mets
Neuroblastoma aka is what?
ITs the second mc abdominal ___ in children called ____.
Sympathicoblastoma
neoplasm, Wilms tumore mc
