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(3) Musculoskeletal Imaging > S1_L4: Anatomy, X-ray, CT Scan, & MRI of the Cervical Spine > Flashcards

S1_L4: Anatomy, X-ray, CT Scan, & MRI of the Cervical Spine Flashcards

1
Q

The following are indications for radiographic examination, except:
A. Trauma
B. Evaluation of primary or secondary malignancies
C. Shoulder/Arm pain
D. Limitation of motion
E. None

A

E. None

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2
Q

The following are indications for radiographic examination, except:
A. Occipital headache
B. Arthritis
C. Planned or prior surgery
D. Evaluation of spinal abnormality seen on other imaging studies
E. None

A

E. None

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3
Q

The following are indications for radiographic examination, except:
A. Suspected congenital anomalies
B. Syndromes associated with spinal abnormality
C. Follow-up of known abnormality
D. Suspected spinal instability
E. None

A

C. Follow-up of known abnormality

It should be follow-up of unknown abnormality

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4
Q

Modified TF
A. The goal of radiographic examination of the cervical spine is to identify disease processes in the spine.
B. It also aims to identify or exclude anatomic/structural abnormalities.

A

TT

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5
Q

Modified TF
A. Oblique projection/view may be used to view the lateral flexion position of the spine.
B. Intervertebral foramina where the spinal nerves exit can be appreciated in this view.

A

TT

Note: Oblique projection can be used to see if there is bony encroachment which may be causing cervical radiculopathy, etc.

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6
Q

TRUE OR FALSE: Basic projections and radiologic observations on x-rays are taken from the craniocervical junction (atlanto-occipital joint) to the superior endplate of the T1 (connection between C7-T1).

A

True

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7
Q

Modified TF
A. CT scans of the cervical spine are taken from the base of the skull to at least the first or second cervical vertebrae.
B. These images may be viewed as axial slices, reconstructed into 3D, or reformatted into coronal or sagittal views.

A

FT

A: from the base of the skull to at least the first or second thoracic vertebrae

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8
Q

MRI Image Interpretation

  1. Assessed in the sagittal view
  2. Assess for irregular signal intensities signifying disease or infection
  3. Assess disk height

A. Alignment
B. Bone signal
C. Canal space
D. Disk integrity
E. Soft tissues

A
  1. A (similar to lateral in x-ray)
  2. B
  3. D
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9
Q

MRI Image Interpretation

  1. Examination of paravertebral soft tissues for the presence of edema due to trauma, primary neoplasms, infection, or extension of masses
  2. Evaluate hydration of nucleus pulposus

A. Alignment
B. Bone signal
C. Canal space
D. Disk integrity
E. Soft tissues

A
  1. E
  2. D
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10
Q

Choice for imaging intervertebral disk degeneration

A. MRI
B. CT Scan
C. Conventional radiograph

A

A. MRI

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11
Q

It is the best choice for assessing normal spinal alignment or problems in alignment that signal fracture, dislocation, or destruction of bone.

A. MRI
B. CT Scan
C. Conventional radiograph

A

A. MRI

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12
Q

TRUE OR FALSE: In MRI, the image may be manipulated after the patient’s procedure.

A

False: In MRI, tissue specific sequences are chosen before the procedure. In CT scan, the image may be manipulated after the procedure.

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13
Q

CT Image Interpretation

  1. Assess posterior & posterolateral margins of the disk
  2. Assess spinal alignment, fractures, dislocations, or bone destruction

A. Alignment & Anatomy
B. Bone density
C. Canal space
D. Disk integrity
E. Soft tissues

A
  1. D
  2. A
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14
Q

CT Image Interpretation

  1. Assess cortical (dense) and cancellous (less dense) bones
  2. Assess prevertebral soft tissues (muscles, ligaments)
  3. Check for presence of edema

A. Alignment & Anatomy
B. Bone density
C. Canal space
D. Disk integrity
E. Soft tissues

A
  1. B
  2. E
  3. E
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15
Q

Modified TF: Canal Space
A. Effacement is mechanical widening due to degenerative changes such as disk disease, arthritic facet joints, free fragments, and ligamental thickening.
B. Effacement may also lead to intramedullary disease, that can be demyelinating, neoplastic, degenerative, inflammatory, or congenital.

A

FT

A: Effacement is mechanical narrowing due to those degenerative changes

Note: These degenerative changes can have spinal canal stenosis, but its not very common in the cervical region.

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16
Q

Modified TF: Canal Space
A. CT Scan is used to check for encroachment into the spinal canals or lateral recesses for neural impingement.
B. The canal space is seen on the axial view of the CT scan.

A

TT

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17
Q

Modified TF: Canal Space
A. MRI is used to check the size of the spinal canal, and its contents, such as the spinal cord and nerve roots.
B. CT scan is used to check for effacement.

A

TF

B: MRI is used to check for effacement.

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18
Q

Modified TF: MRI
A. T1 weighted imaging is used to detect abnormal fluid or edema in the cervical spine.
B. T2 weighted imaging is used to define anatomical structures of the cervical spine.

A

FF

A: T2 weighted imaging is used to detect abnormal fluid or edema in the cervical spine.
B. T1 weighted imaging is used to define anatomical structures of the cervical spine.

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19
Q

Modified TF
A. In basic MRI protocol of the cervical spine, the image extends from the atlanto-occipital joints to at least the C7 to T1 intervertebral disk.
B. Axial and sagittal slices are more commonly obtained than coronal slices.

A

TT

20
Q

Modified TF
A. For preoperative assessment for vertebroplasty/kyphoplasty, the CT scan is more preferred over the MRI.
B. MRI is indicated for intrinsic spinal cord pathology, including demyelinating disease.

A

FT

A: MRI is more preferred

21
Q

The following are indications for MRI of the cervical spine, except:
A. Degenerative disk disease
B. Extramedullary tumors
C. Extradural soft tissue and bony neoplasm
D. None

A

B. Extramedullary tumors

It should be intramedullary tumors

22
Q

The following are indications for MRI of the cervical spine, except:
A. Intradural extramedullary masses
B. Treatment fields for radiation therapy
C. Extradural masses or leptomeningeal disease
D. None

A

C. Extradural masses or leptomeningeal disease

It should be intradural masses or leptomeningeal disease

Note: Intradural extramedullary masses are within the dural space but found outside the spinal cord.

23
Q

The following are indications for MRI of the cervical spine, except:
A. Spinal infections
B. Congenital spinal abnormalities/scoliosis
C. Meningeal abnormalities
D. None

A

D. None

24
Q

The following are indications for MRI of the cervical spine, except:
A. Post operative intraspinal fluid or post operative tissue changes
B. Spinal vascular malformations and/or occult subarachnoid hemorrhage
C. Syringohydromyelia
D. None

A

D. None

Note: Syringohydromyelia is when both hydromyelia and syringomyelia are present.
Hydromyelia = CSF accumulates in the central canal of spinal cord, cavity is lined by ependymal cells.
Syringomyelia = CSF accumulates into surrounding white matter to form a paracentral cavity & none of the cavity is lined by ependyma.

25
Q

Posterior / posterolateral / lateral extension of disc material into the spinal canal or into the intervertebral foramen

A. Protrusion
B. Extrusion
C. Herniation
D. Diffuse posterior disk bulging
E. Sequestration

A

C. Herniation

26
Q

Disk moves into the spinal canal and this condition is not often associated with nerve root compression

A. Protrusion
B. Extrusion
C. Herniation
D. Diffuse posterior disk bulging
E. Sequestration

A

D. Diffuse posterior disk bulging

27
Q
  1. Annulus fibrosus is perforated/ruptured and discal material (part of the nucleus pulposus) moves into the epidural space
  2. Posterior bulging, there is convexity of the nucleus pulposus but it stays within its boundaries and the annulus fibrosus is not ruptured
  3. Formation of discal fragments from the annulus fibrosus and nucleus pulposus outside the disc proper

A. Protrusion
B. Extrusion
C. Herniation
D. Diffuse posterior disk bulging
E. Sequestration

A
  1. B
  2. A
  3. E
28
Q

TRUE OR FALSE: Separation of the attachments between the atlas and axis will result in laxity between the transverse ligament, which can lead to instability and fracture.

A

True

29
Q

TRUE OR FALSE: The atlas (C1) has a vertebral body.

A

False

30
Q

TRUE OR FALSE: The cervical vertebrae have a bifid spinous process.

A

True

31
Q

Modified TF
A. Cervical vertebrae have uncinate processes that are most commonly found at C3-C7.
B. These processes, along with the corresponding inferior shallow concavity of the vertebra above, form the uncovertebral joints.

A

TT

32
Q

TRUE OR FALSE: The sulcus of the spinal nerve, where the spinal nerve passes as it exits the spinal cord, is located on the transverse processes.

A

True

33
Q

Modified TF
A. The vertebral artery passes through the transverse foramen of the cervical spine.
B. The cerebellomedullary cistern transitions into the spinal canal of the spinal cord.

A

TT

33
Q

TRUE OR FALSE: CSF exits the ventricular system through the median aperture (foramen of Magendie) and lateral apertures (foramina of Luschka) of the fourth ventricle into the subarachnoid space.

A

True

34
Q

TRUE OR FALSE: The hyoid bone can be seen in an image taken at the level of C5.

A

True

Note: The hyoid bone is opposite the C3 vertebra

35
Q

Modified TF
A. The anterior part of the foramen magnum is the basion.
B. The posterior part is the opisthion.

A

TT

36
Q

Central x-ray passes through the mouth through the C1-C2 joint space.

A. Anteroposterior open mouth
B. Anteroposterior lower cervical spine
C. Lateral projection
D. Oblique projection

A

A. Anteroposterior open mouth

37
Q
  1. Good for evaluating articulation of the dens to the atlas
  2. Central x-ray passes at a 15-20º angle towards the head and enters below the thyroid cartilage, and passes through the C5-C6 joint space

A. Anteroposterior open mouth
B. Anteroposterior lower cervical spine
C. Lateral projection
D. Oblique projection

A
  1. A
  2. B
38
Q

Modified TF
A. For the posterior oblique view, the central ray is angled 15-20º cephalad, passing through C4.
B. Oblique projections are taken at an angle and the side, so it is rotated a bit and a little more forward.

A

TT

39
Q

Used to see the degree of cervical lordosis, arches, facet joints, disc spaces, hyoid bone, and trachea.
A. Anteroposterior open mouth
B. Anteroposterior lower cervical spine
C. Lateral projection
D. Oblique projection

A

C. Lateral projection

40
Q

The sagittal CT scan can be used to view the following, except:
A. Basion
B. Posterior arch of atlas
C. Spinal canal
D. None

A

D. None

41
Q

The sagittal CT scan can be used to view the following, except:
A. Disc spaces
B. Spinous process
C. Opisthion
D. None

A

D. None

42
Q

The axial CT scan can be used to view the following, except:
A. Entire atlas
B. Ossification and level of maturity of bone
C. Both A and B
D. Neither A or B

A

D. Neither A or B

43
Q

The coronal CT scan can be used to view the following, except:
A. Occipital condyles
B. Transverse process
C. Lateral masses of the atlas
D. None

A

D. None

44
Q

The coronal CT scan can be used to view the following, except:
A. 1st rib connecting to T2
B. IV disk spaces
C. Dens & body of axis
D. None

A

A. 1st rib connecting to T2

It should be 1st rib connecting to T1

45
Q

TRUE OR FALSE: The nucleus pulposus invites water through proteoglycans.

A

True

(3) Musculoskeletal Imaging (25 decks)

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