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Clinical Neurology > Radiology I > Flashcards

Radiology I Flashcards

Intro to Imaging Procedures

1
Q

What type of imaging is used as an initial study of bone diseases?

A

X-ray 99% seen on conventional radiography

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2
Q

Computed tomography blurs out unwanted sections in its constant movement. What type of imaging is computed tomography?

A

CT scan that shows “thin slices” of anatomical structures in the periphery.

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3
Q

Define attenuation

A

absorbed energy of an x-ray beam after it passes through a given substance.

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4
Q

Name a disadvantage of conventional aka plain film.

A

lacks of ST discrimination, diminished sensitivity, resolution of small lesions, radiographic later period, exposure differences

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5
Q

What is the search pattern for the ABC’s of interpretation?

A

Free search

Directed search

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6
Q

In the ABCs approach of interpretation study what does B and C represent?

A

A=alignment
B=Bone
C=Cartilage
S=Soft tissue

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7
Q

Does CT mean a.conventional tomography or b. computed tomography

A

Computed tomography

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8
Q

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

a. evaluate abnormal structures obscured by overlapping shadows
b. reciprocal, it fulcrum/pivot is at the level of interest
c. tomographic arc

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9
Q

Name the imaging procedure is based on tissue attenuation?

A

CT aka CAT aka Computed Tomography

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10
Q

CTs provides excellent spatial relationships. Most images are obtained in what plane?

A

Axial

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11
Q 
State what each Tissue expressed in Hounsfield units Hu or CT numbers.
Water
Fat
Muscle
Bone
Air
A 
Water 0
Fat -50
Muscle +40
Bone +1000 (more dense)
Air -1000
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12
Q

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

a. Radionuclide bone scanning

b. Technetium-99m methylene diphosphate (99-mTc-MDP) m/c radiopharmaceutical. Extremely sensitive but lacks specificity

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13
Q

The A in ABCs reps alignment. What relationship does it show?

A

relationship between bone (curves, rotation, retro/anterolsthesis etc.)

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14
Q

What shows uptake on a bone scan?

A

Fx, tumors, infections, endocrine, hematologic/arthritic disorders. these areas are aka Hot Spots

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15
Q

What imaging system has signal emitted by hydrogen nuclei and its signal is based on the liquidity of tissue.

A

MRI excellent for ST, bone marrow, disc and ligaments

NO ionizing radiation

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16
Q

What type of imaging has mutiplanar capabilities but does NOT use ionizing radiation?

A

MRI

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17
Q

Arthro-graphy contrast study opacification of what?

A
  • joint cavities
  • ID intra-articular derangements of menisci, cartilage, loose bodies
  • invasive
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18
Q

Angio-graphy contrast studies

A

traumatic ms injuries, tumors, vascular disease

invasive, lots of complications

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19
Q

a. In contrast studies myelography and CTM contrast into what space?
b. Discography contrast into what?

A

a. Subarachnoid

b. nucleus pulposus, morphologic analysis and pain provocation

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20
Q

Metastatic bone disease is due to what?

A

osseous dissemination of cell from primary malignant neoplasm

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21
Q

What is the mc malignancy of bone or mc malignant tumor in the skeleton?

A

Metastatic bone tumors

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22
Q

What is the 3rd mc site of metastatic carcinoma?

A

Bone.

Note: also lung and liver

23
Q

Metastatic bone tumors mc from what type of malignancy?

A

epithelial

24
Q

With mets bone disease what shows abnormal uptake in 85% of carcinoma pts?

A

Scintigraphy

25
Q

What are the mc PRIMARY sites to metastasize to bone?

A

Breast, prostate, lung
colon, stomach, bladder
uterus, rectum, thyroid and kidney in descending order

26
Q

What locations account for 75-80% of skeletal metastasis?

A

Breast, prostate, lung and kidney

27
Q

Do males or females have a 5 fold increase risk of pathological vertebral fx and what locations?

A

Females Breast

Thyroid, kidney and cervix

28
Q

The incidence of bone mets in males is what percentage and what are the locations?

A

Prostate 60%, lung, bladder

29
Q

What is the incidence of Bone mets in children? What are the ages with associated conditions?

A

a. less than 5 yoa NeuroBlastoma
b. 10-20 yoa Ewings and Osteosarcoma
c. 20-35 yoa Hodgkin’s lymphoma

30
Q

What is the incidence of Osteolytic Mets in a. females

b. males c. children?

A

a. breast 80%, breast 10%
b. lung 75%, prostate 80%
c. neuroblastoma 80%, Hodgkins 50%

31
Q

a. What is the mc clinical feature of bone mets?

b. MC presentation is

A

a. mc after 4th decade

b. progressive bone pain, insidious onset, bouts of exacerbation/remission commonly more severe at night

32
Q

a. Name the clinical feature mc complication for bone mets.

b. What are typical findings?

A

a. pathologic fx

b. swelling, tenderness and local pain

33
Q

What are the possible altered values/features seen on a bone panel, CBC, and ESR for routine lab study?

A 
elevated ESR
calcium osteolytic mets
alkaline phosphatase osteoblastic mets
proteins
uric acids
acid phosphatase and PSA
34
Q

Bone mets common to

A

lungs, liver and red marrow due to rich vascularization

35
Q

Bone tumor cells stimulate what in the host bone?

A

Osteoclastic activity with a progressive displacement of marrow elements

36
Q

Osteolytic destruction tumor emboli deposited in bone marrow displacement. What cortical mets are mc from where?

A

Lung, also breast and kidney

begins in medullary cavity and secondarily destroys the cortex

37
Q

Blastic metastasis is d/t what and has what type of growth?

A

Non-neoplastic new bone

response of osteoid tissue to the tumor

38
Q

Radiographic features cookie-bite lesions is associated with what type of metastasis?
Name the mc primary sites.

A

cortical metastasis

Lung, breast, kidney

39
Q

What is the mc pathway and frequency via Batson’s plexus for bone mets?

A

Hematologic dissemination

lymphatics is uncommon w/osseous mets

40
Q

CT procedure detects/eval which part of bone?

A

cortical and trabecular bone and ST mass

41
Q

MRI procedures are more ___ and ___ than bone scintigraphy.

A

sensitive and specific

42
Q

What are some radiographic features seen in osteolytic bone mets?

A 
cortical and trabecular destruction
moth-eaten/permeative pattern
No periosteal response
Wide ZOT
maybe expansile
small/absent ST mass
43
Q

What is the mc site of Blow-out mets?

What does it look like?

A

Thyroid, kidney and lung

highly expansile and bubbly maybe solitary

44
Q

What is the atypical presentation of osteolytic metastasis?

A

Blow-out mets

45
Q

Expansile osteolytic lesions of bone uses FEGNOMASHIC. what does it mean?

A

**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

46
Q

The following radiographic features indicates what type of mets? Snow-ball, poorly defined margins, ivory vertebrae

A

osteoblastic

47
Q

what is the mc location of origin for osteoblastic mets?

A

Prostate, breast, colon or rectum, carcinoid

48
Q

A mixed mets is a combination of plastic and lytic features. What element is mc from the breast and occasionally the lung?

A

Ca

49
Q

What is the mc site of the spine is most effected by mets?

What is the name of the sign to indicate this destruction?

A

pedicle destruction mc in the Tsp

Winking owl sign or one eyed pedicle sign

50
Q

Name 2 DDX for winking owl sign.

A

Congenital, ABC, osteo-blastoma, osteoid osteoma, mets, myeloma (rare)

51
Q

What is the mc cause of ivory vertebrae?

A

Osteoblastic mets, Pagets, Hodgkins

52
Q

What is the mc cause of extra-pleural sign seen in the ribs and sternum?

A

osteolytic mets

53
Q

Neuroblastoma aka is what?

ITs the second mc abdominal ___ in children called ____.

A

Sympathicoblastoma

neoplasm, Wilms tumore mc

Clinical Neurology (9 decks)

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