Radiology of MSK

Question 1

Radiographs

Answer 1

the most basic radiographic exam
Almost every part of the body can be evaluated with radiographs

Radiographs larges portion of a radiology practice

Initial exam for many msk complaints, often limited and initial exams are often necessary

Pros: cheap , readily available, many different view and techniques, often good initial test

Cons: radiation dose, can be of limited sensitivity, does not work in all areas equally

Question 2

Fluoroscopy

Answer 2

allows real time evaluation of structure, can be used intra operatively, used to set fractures, and to guide procedures

Used extensively for IV radiology, GI and Gu radiology, lumbar puncture, joint injection, and biopsies

PROS: real time eval of structures, procedural guidance, placement of needles, tubes, stents, and catheters

CONS: radiation exposure, image quality is limited

Question 3

ultrasound

Answer 3

no radiation

can be used to guide procedures, including biopsies, aspirations, and joint injections

Use of ultrasound to evaluate tendons and ligaments, continues to become more popular

US can even be used to evaluate the cortical surface of bone for erosions in disease such as Rheumatoid arthritis

PROS: no radiation, portable, small machine, so special room prep

CONS: user dependent, not all structures can be evaluated

Question 4

CT

Answer 4

very powerful, for MSK evaluatation CT is used to evaluate for and further characterize osseous lesions and fractures, to evaluate superficial and deep infections, evaluate post trauma and developmental deformities

CT scans can look at soft tissues, eval of sports type injuries is usually in the realm of MRI

PROS: fast and available, covers large anatomical area, great for procedures

CONS: over utilization, cost, metal artifacts form implanted devices, radiation dose

Question 5

MRI

Answer 5

gold standard for the evaluation of muscles, tendons, ligaments and joints

Excellent at evaluatinf cortical bone and marrow

MRI machines and techniques have improved dramatically and are used to evaluate nearly every part of the body

PROS: great soft tissue details, no radiation, can obtain images in any plane

CONS: expensive, long exams, metal artifacts, claustrophobia

Question 6

Nuclear medicine

Answer 6

division of radiology less anatomy and more physiology and function

Typically a radioactive material is injected into a pt and subsequent imaging shows the distribution of that material in the body

A PET/CT scanner is a tool that combines radiology and nuclear medicine

PROS: provides functional data, can direct future radiology tests, high sensitivity

CONS: often poor anatomic detail, radiation dose, low specificity, expensive