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MSK/Derm > SM 226: MSK Imaging > Flashcards

SM 226: MSK Imaging Flashcards

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1
Q

What is the common first-line test for assessing the MSK test?

A

Conventional radiography = Xray

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2
Q

What are the advantages of Xray?

A

Inexpensive
Reproducible - universal technology
Minimal radiation

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3
Q

What are the disadvantages of Xray?

A

Cannot visualize occult fractures
Limited evaluation of soft tissues
Always need at least 2 views

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4
Q

Explain the “One view is no view” idea?

A

With Xray, a 3D structure is compressed into a 2D view, so always need at least two images to get a good picture

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5
Q

Can Xray determine the mechanism of underlying injury?

A

No, but it can suggest underlying soft tissue injury based on the pattern of bone deformities

Ex = shoulder dislocation from displaced Humerus

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6
Q

What should be done if an Xray suggests an underlying soft tissue injury?

A

Follow up with an MRI on the same patient to determine the cause of the bone change on Xray

Ex = displaced shoulder on Xray may show a torn ligament on MRI

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7
Q

When should CT be performed?

A

Do a CT after you see an abnormality on XR, or a history strongly suggests an abnormality

Also for pre-op planning, better detail of a fracture found on XR, and occult fractures not seen on XR

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8
Q

What are the advantages of CT?

A

Superior spatial resolution than XR, especially for bone
Able to create mutliplanar reformatted images
Widely accessible tech with rapid exam time

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9
Q

What are the limitations of CT?

A

Expensive
Ionizing radiation
Artifact with metal

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10
Q

What is the ideal imaging modality for soft tissue?

A

MRI > XR and CT

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11
Q

What are the advantages of MRI?

A

Superior contrast
No radiation
Multiplanar imaging like CT

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12
Q

What are the limitations of MRI?

A

Expensive
Not patient friendly - claustraphobia
Longer scan times
Contraindications

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13
Q

Can MRI be used on pregnant women? Can CT?

A

MRI yes, b/c no radiation

CT no, b/c radiation

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14
Q

Which provides multiplanar imaging, MRI or CT?

A

Both

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15
Q

What are absolute contraindications for MRI?

A

Pacemakers/stimulators
Metal in the eye
Weight limits

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16
Q

What are relative contraindications for MRI?

A

Aneurysm clips

Metal

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17
Q

What joints are commonly assessed with MRI?

A 
Knee MRI (ex ligament tears)
Shoulder MRI (ex tendon tears)
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18
Q

What is ultrasound good for?

A

Ultrasound is good at assessing superficial soft tissues like ligaments, tendons, and nerves

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19
Q

What are the advantages of ultrasound?

A

Patient friendly
No radiation or contrast
Dynamic imaging
Inexpensive

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20
Q

Why is dynamic imaging needed?

A

Some pathologies can only be seen when a patient is moving

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21
Q

What are the limitations of ultrasound?

A

User dependent

Limited evaluation of bone since ulltrasound can’t penetrate bone

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22
Q

Can ultrasound evaluate bone?

A

Not particularly, since the waves don’t penetrate bone

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23
Q

Why do we measure bone density?

A

Detect osteoporosis and bone fracture risk via DXA

24
Q

What is DXA?

A

Uses low res CT to image the density of bones and score them with a T and Z score

25
Q

What are the pros of DXA?

A

Short exam time, widely available, inexpensive

26
Q

What are the limitations of DXA?

A

Cannot detect overlying calcifications and compression fractures because it as a 2D representation of a 3D structure

27
Q

What is a DXA T-score?

A

The difference between bone mineral density of a patient and a healthy young adult population

28
Q

How is the DXA T-score graded?

A

< 1 St. Dev = normal
1 - 2.4 St. Dev = Osteopenia
> 2.5 St. Dev = Osteoperosis
> 2.5 St. Dev + Fractures = Severe Osteoperosis

29
Q

What does a Bone Scintigraphy scan detect?

A

Bone Scintigraphy uses a radionucleotide tracer to identify areas with high bone turnover:

Healing fracture, infection, cancer

30
Q

What are the test characteristics of Bone Scintigraphy and how do they guide treatment?

A

Bone Scintgraphy is sensitive but not specific, so abnormal findings tend to be abnormal, but can’t determine a specific pathological cause

Ned followup imaging

31
Q

What are limitations of Bone Scintigraphy?

A

Radiation due to tracer

Time intensive because tracer needs to distribute throughout entire body

32
Q

What is fluoroscopy?

A

A real time low resolution Xray used for and during procedures

33
Q

What are the advantages of Fluoroscopy?

A

Dynamic imaging allows for real time guidance of procedures

34
Q

What are the limitations of Fluoroscopy?

A

Radiation exposure to patient and operator

35
Q

What are common imaging guided procedures?

A

Biopsies
Arthography
Myelogram
Therapeutic injections and lavages

36
Q

What are the benefits of image guided biopsy?

A

Safer alternative to open biopsy and outpatient procedure

37
Q

What are image guided biopsies used for?

A

Determine the cause of a lesion of unknown etiology
Confirm a diagnosis (cancer)
Stage a diagnosis (cancer)

38
Q

What is Arthography?

A

A technique used to introduce contrast into a joint

39
Q

What type of contrast does Arthography introduce for CT?

A

Iodinated contrast

40
Q

What type of contrast does Arthography introduce for MRI?

A

Gadolinium

41
Q

What is Arthography good for?

A

Evaluating joints and their components

42
Q

What are contraindications for Arthography?

A 
CT-Arthography = contrast allergy
MRI-Arthography = MRI contraindications
43
Q

What is a Myelogram?

A

A procedure used to introduce contrast into the Thecal sac

44
Q

What are advantages of a Myelogram?

A

Useful if MRI in contraindicated
Evaluate bone
Dynamic imaging

45
Q

What are limitations of Myelogram?

A

Contrast allergy
Radiation
Invasive
Inferior to MRI for soft tissue evaluation

46
Q

What’s more useful, MRI or Myelogram?

A

MRI > Myelogram unless the patient is contraindicated for MRI

47
Q

What are examples of image-guided therapies?

A

Corticosteroid injections
Calcific tendinitis lavage - remove Ca deposits
Vertebroplasty - stabilize fracture
Thermal ablation - tumors

48
Q

What two factors should be considered when thinking about imaging?

A

Index of suspicion - high = jump to a specific modality, low = start with XR

If study wont change management, don’t do the imaging

49
Q

Describe the imaging algorithm for chronic back pain?

A

Adult:

Plain radiograph - bone damage
MRI - Radiograph negative, suspect soft tissue or disc damage

Child:

Plain radiograph
MRI - suspect bone fracture

50
Q

Describe the imaging algorithm for acute back pain?

A

Plain radiograph first
Consider CT if related to direct trauma
MRI if soft tissue injury is suspected

51
Q

Describe the imaging algorithm for neck pain?

A

Plain radiographs first

Consider MRI if pain/symptoms persist

52
Q

Describe the imaging algorithm for joint pain?

A

Plain radiographs first

Consider MRI if looking for soft tissue injury, especially deeper tissues

53
Q

Describe the imaging algorithm for neoplasm?

A

Plain radiography first - find bone destruction
MRI with Contrast - look for blood flow abnormalities
Nuclear medicine study - metastatic spread of Cancer

54
Q

Describe the imaging algorithm for occult fracture?

A

Plain radiograph first

If Xray normal: CT, then MRI, then nuclear medicine

55
Q

Describe the imaging algorithm for Osteomyelitis?

A

In Diabetics:

Plain radiograph
MRI - degree of osteomyelitis (no contrast due to Renal Failure in Diabetics)
Nuclear Medicine study - sources of infection

Non-diabetics:

Plain radiograph
MRI with contrast

MSK/Derm (46 decks)

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