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Imaging Clinical Decision Making > Spine Imaging > Flashcards

Spine Imaging Flashcards

1
Q

HIGH quality indications for spinal plain film radiographs include (10)

A

1 - Trauma sufficient to cause fracture (recent/old & previously undiagnosed)
2 - History of malignancy
3 - Unexplained weight loss of greater than 10%
4 - Night pain
5 - Neuromotor deficit (objective, not subjective)
6 - Suspect inflammatory arthritis
7 - Fever (>100 ˚F) with back pain
8 - Deformity (Scoliosis, etc.)
9 - Failure to respond to therapeutic trial
10 - Medicolegal implications

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2
Q

INTERMEDIATE quality (situationally justifiable) indicators for radiographs (7)

A

1 - >50 (60?) years of age
2 - Drug or alcohol abuse
3 - Corticosteroid use (anabolic steroids too)
4 - Instability
5 - Unavailable/lost/technically inadequate previous studies
6 - Constitutional/systemic disease
7 - Scoliosis (initial evaluation or substantive change noted over short term)

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3
Q

UNDESIREABLE attempted justifications for plain films (9)

A 
1 - Patient education
2 - Routine screening
3 - Habit/personal uncertainty
4 - Discharge status assessment
5 - Routine biomechanical analysis Technique system
6 - Pre-employment status
7 - Financial gain
8 - Recent high-level radiation exposure (previous radiation therapy) 
9 - Pregnancy
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4
Q

Protrusions are

A

Focal extensions of nucleus pulposus beyond the endplate, but contained beneath outer annular fibers

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5
Q

Subligamentous protrusions are

A

Protrusions when the PLL is the only thing containing it

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6
Q

Extrusions

A

Escaped beyond the margin of the annulus

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7
Q

What type of imaging is preferable (MRI or CT) in evaluating disc lesions

A

MRI > CT, but both are acceptable

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8
Q

Disc bulges are

A

> 25% of annular ring beyond endplate margin

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9
Q

T/F stenosis as a diagnosis is fraught with inconsistencies

A

True

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10
Q

What imaging technique is preferable in characterizing the effects of compression on the cord/nerve roots

A

MRI>plain CT

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11
Q

What imaging technique is preferable for finding surgical level

A

CT myelography > MRI

Note: the degree of difference is only critical if multiple levels are present

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12
Q

What imaging technique is preferable in identifying the causal stenosis level

A

MR myelography > CT, but not widely performed yet

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13
Q

Injection of iodine-based contrast into subarachnoid space of spinal cord - deformity of column of contrast demonstrates space-reducing lesions such as disc protrusions, osteophytes, tumors, etc.

A

Conventional myelography

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14
Q

What is conventional myelography excellent at? Accurate at?

A

Excellent: Evaluating canal stenosis

Accurate: localization for neural neoplasms

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15
Q

What is Conventional myelography poor at

A

Intervertebral foraminal pathology

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16
Q

Radiopaque contrast media is injected into the nucleus pulposus using a fine-gauge needle under fluoroscopic guidance and then viewed under fluoroscopy

A

Discography

17
Q

How long is the contrast introduced with discography?

A

Until a positive-pressure environment is created within the nucleus cavity of the disk

18
Q

What is a gold standard for confirming the presence of discogenic pain and internal derangement of the disc (but rarely anything else)

A

Discography

19
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? trauma sufficient to cause fracture

A

High quality

20
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? History of malignancy

A

High quality

21
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Unexplained weight loss greater than 10%

A

High quality

22
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Night pain

A

High quality

23
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Neuromotor deficit

A

High quality

24
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Suspect inflammatory arthritis

A

High quality

25
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Fever >100˚ F with back pain

A

High quality

26
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Deformity e.g. scoliosis

A

High quality

27
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Failure to respond to therapeutic trial

A

High quality

28
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Medicolegal implications

A

High quality

29
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? >50 or 60 yo

A

Situationally justifiable

30
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Drug or alcohol abuse

A

Situationally justifiable

31
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Corticosteroid use

A

Situationally justifiable

32
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Instability

A

Situationally justifiable

33
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Unavailable/lost/technically inadequate previous studies

A

Situationally justifiable

34
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Constitutional/systemic disease

A

situationally justifiable

35
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Scoliosis

A

situationally justifiable

36
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Patient education, routine screening, habit

A

Undesirable attempt

37
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Pre-employment status, financial gain, pregnancy

A

undesirable attempted justifications

38
Q

Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Discharge status assessment, recent high-level radiation exposure

A

undesirable attempted justifications

Imaging Clinical Decision Making (4 decks)

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