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Musc > Radioloy of metabolic bone disease > Flashcards

Radioloy of metabolic bone disease Flashcards

1
Q

Imaging used in bone

A 
X ray 
CT
Bone densitometry 
MRI 
radionuclide bone scans
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2
Q

Which scans are based on density

A

X ray
CT
Bone densitometry

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3
Q

What is MRI bone scan based on

A

Biochemical composition

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4
Q

What are radionuclide scans based on

A

Bone turnover (bone formation, purely osteoclastic resorption won’t show up)

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5
Q

What colour would fat show up as on mri

A

white

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6
Q

Why would the inside of a vertebral bone be dark on MRI

A

Should be white (to show bone marrow which is fatty….) if dark… oedema or soft tissue lesion e.g. tumour

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7
Q

What can happen on the bone marrow following radiotherapy

A

`Fatty changes to bone marrow

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8
Q

In radionuclide bone scans, which areas appear dark

A

Increased bone turnover regions

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9
Q

Which areas might have increased bone turnover and thus show up dark on nuclear medicine scan

A

Joints (bit of wear and tear)
Metabolic bone disorders
Fractures
Tumours

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10
Q

Differentiate radiological sign with pathology

A

Pathology: A disease process that gives rise to symptoms, signs, biochemical disturbances and changes in imaging appearance.

Radiological sign  A change in imaging appearance, whether structural or functional, that may point towards a pathology

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11
Q

What does microstructure of osteoporotic bone look like

A

Completely normal, just a lot less of it

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12
Q

What happens to bones in osteoporosis

A

Fragility fractures, deformity otr pain

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13
Q

Differentiate T score and Z score in dexa scans

A

▪ T-score (ref database white adult premenopausal females) ▪ Z-score (ref database age and sex matched)

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14
Q

T score range for osteoporosis and osteopenia

A

T-score -1.5 to -2.5 = osteopenia; less than -2.5 = osteoporosis

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15
Q

Which areas are commonly assessed on DEXA

A

Vertebrae and pelvis

look specifically at L2-L4

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16
Q

T/F how low the BMD is (t score) is reflective of fracture risk and severity of osteoporosis

A

F

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17
Q

What is used to assess risk of fracture

A

FRAX, BMD put in along with other risk factors, gives 10 year fracture risk

then look at nogg guidelines

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18
Q

Radiology signs for osteoporosis (not DEXA but imaging)

A

Loss of cotical bone/thinning of cortex
Loss of trabeculae
Insufficiency fracture

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19
Q

What is insufficiency fractures

A

Stress fractures: normal stress on absormal bone

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20
Q

Common site for insufficiency fractures

A

Sacrum, underside of femoral head, vertebral bodies, pubic rami

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21
Q

What is seen in insufficiency fractures:
XR/CT

MRI

BONE SCAN

A

XR/CT = normal initially, periosteal reaction/callus, increased sclerosis around fracture line (major)

MRI= Bone oedema i.e. low signal on T1, high signal on T2 and STIR

Bone scan= osteoblastic activity as bones try to heal

22
Q

Sign for insufficiency fracture at back of pelvis

A

Honda sign

23
Q

What is the pathology in osteomalacia

A

Unmineralised bones

osteopaenic and soft bones

24
Q

What zones do you get in osteomalacia

A

looser’s zones

25
Q

Radiology for osteomalacia depends on what

A

 Biochemistry: vit d low, calc: N/low, PTH up  Inadequate or delayed mineralisation

 Radiology depends on age and closure of growth plate

26
Q

What may be found in osteomalacia

A
  • looser’s zone
  • osteopenia
  • mature skeleton
  • codfish vertebrae
  • bending deformity
27
Q

What might be seen in rickets

A

Before growth plate closure 

Radiological signs centred mainly to growth plates 

Changes of osteomalacia

28
Q

What are Looser’s zone where do they occur

A

Pseudofractures
Are also types of insufficiency fracture

Medial proximal femur  Lateral scapula 
Pubic rami 
Posterior proximal ulna 
Ribs

29
Q

What do looser zones look like

A

At right angle do the bone
Irregular sclerotic margins
Bone may be osteopaenic/expanded

30
Q

When are codfish vcertbrae seen AND WHAT IS IT

A

Osteoporosis and ostoepaenia

Biconcave vertebrae

31
Q

Ricket what is seen on imaging

A

Frayed metaphyseal margin

Widened growth plate without calcification

Cupping/splaying metaphyses due to weight bearing

Enlargement of anterior ribs 
Osteopenia

32
Q

What is seen on imaging with primary and secondary HPT

A

Primary - increased bone resopriton

Secondary- increased bone resorption and increased density

33
Q

Types of bone resorption

A

Subperiosteal 
Subchondral 
Intracortical 
Brown tumours (if large)

34
Q

What does sub-periosteal resorption look like

A

No straightened edge to the bone (not like wavey but just not a definitive line)

35
Q

What do circular lucencies or small speckles of black on skull bone represent

What is the name for lots of little spckles on skull

A

Intracortical

Pepper pot sign

36
Q

Give an example of a lytic bone lesion found in primary HPT

A

Brown tumour

37
Q

t/f radiology can easily identify the cause of a lytic bone lesion

A

F…. look like infection, malignancy or brown tumour

38
Q

Outline pathogenesis of renal osteodrystrophy

A

Cannot excrete phosphate due to renal failure

Phosphate can bind calcium (i.e. anion bound) so low free (ionised) calcium

High phosphate and the low free calcium increases PTH which increases bone resorption

Vit D decreases due to renal failure also increasing PTH

Therefore you get

  1. Osteoporosis due to increased bone resorption
  2. Osteomalacia due to reduced bone mineralisation due to vit D decificiency

SECONDARY HPT

39
Q

Which lesions could be seen in renal osteodystroph u

A

Subperiosteal erosions,
brown tumours,
Sclerosis – vertebral endplates giving a rugger jersey spine, 
Soft tissue calcification (vessels, cartilages)

40
Q

What is rugger jersey sign

A

Occuring in renal osteodystrophy due to secondary HPT

Increased density at the end plates and then increased lucency in between

41
Q

Giver an example of soft tissue calcification in secondary HPT

A

Menisci in the knee are white

42
Q

Differentiate density of sclerotic vs lytic lesions

A

Sclerotic is hardened and dense

Lytic is not

43
Q

Outline the stages of pagets

A

lytic
mixed lytic and sclerotic
sclerotic

44
Q

Symptoms of pagets, bone and other wise

A

Bone: pain, derformity, fracture (same as osteoporosis)

Other: NERVE ENTRAPMENT, spinal stenosis and deadness

45
Q

Biochemical signs in pagets

A

Increased Alk Phos.

46
Q

What are patients with pagets prone to

A

Osteogenic sarcoma

47
Q

Radiological signs in paget’s

A

Cortical thickening 
Bone expansion 
Coarsening of trabeculae 
Osteolytic, osteoclerotic and mixed lesions 
Osteoporosis circumscripta (in lytic part)

48
Q

How can u distinguish pagets from the other diseases

A

Usually focal, not usually present in adjacejnt bone

49
Q

T/f the osteoporosis circumscripta is related to osteoporosis

A

f….. THIS IS JUST THE NAME FOR LUCENCY IN PAGET’S DISEASE

50
Q

Sign for the increase bone turnover sometimes seen in the spine in radionuclear medicine scans in pagets

A

Micky mouse sign

Musc (12 decks)

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