Recognizing What to Order - Musculoskeletal Imaging

Question 1

Acute shoulder pain, any etiology?

Answer 1

CR - MRI if CR is noncontributory or pain is persistent.

Question 2

Shoulder pain, after arthroplasty or rotator cuff repair?

Answer 2

MRI or US. Considered equivalent.

Question 3

Acute knee trauma with clinical findings?

Answer 3

CR - MRI if CR is non contributory or pain is persistent.

Question 4

Chronic ankle, elbow, foot, hip, or wrist pain?

Answer 4

CR - MRI next study under most clinical circumstances (if radiography is unremarkable or equivocal and clinical concerns warrants).

Question 5

Knee pain, non traumatic?

Answer 5

CR - If knee radiograph is NON DIAGNOSTIC –> MRI.

Question 6

Cervical spine trauma, acute; meets clinical criteria for imaging?

Answer 6

CT cervical spine WITHOUT contrast - CR cervical spine lateral only, if CT is not available.
Ligamentous injury suspected –> MRI.

Question 7

Chronic neck pain?

Answer 7

CR - MRI next study under most clinical circumstances.

Question 8

Suspected metastatic bone disease?

Answer 8

Tc99m whole body scan - If negative and results will change treatment, then FDG-PET whole body scan.
Radiographs after bone scan if needed for further lesion characterization.

Question 9

Suspected metastatic disease to spine?

Answer 9

CR - Then MRI if radiographs are negative.

Question 10

MM suspected in spine?

Answer 10

CR - Then MRI if CR negative.

Question 11

Soft tissue mass, clinically suspected?

Answer 11

CR (probably still require additional imaging) - MRI area of interest; US may be used to differentiate solid from cystic masses.

Question 12

Osteomyelitis of foot, suspected in diabetic?

Answer 12

CR followed by MRI WITH contrast, if indicated.

–> Radiographs and MRI are complementary. Both are indicated.

Question 13

Acute hand or wrist trauma?

Answer 13

Conventional Radiographs (CR) - If negative and still suspicious –> Choice of casting with repeat radiograph in 10-14 days or doing MRI or CT.