Spine Imaging Flashcards
(38 cards)
HIGH quality indications for spinal plain film radiographs include (10)
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
INTERMEDIATE quality (situationally justifiable) indicators for radiographs (7)
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)
UNDESIREABLE attempted justifications for plain films (9)
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
Protrusions are
Focal extensions of nucleus pulposus beyond the endplate, but contained beneath outer annular fibers
Subligamentous protrusions are
Protrusions when the PLL is the only thing containing it
Extrusions
Escaped beyond the margin of the annulus
What type of imaging is preferable (MRI or CT) in evaluating disc lesions
MRI > CT, but both are acceptable
Disc bulges are
> 25% of annular ring beyond endplate margin
T/F stenosis as a diagnosis is fraught with inconsistencies
True
What imaging technique is preferable in characterizing the effects of compression on the cord/nerve roots
MRI>plain CT
What imaging technique is preferable for finding surgical level
CT myelography > MRI
Note: the degree of difference is only critical if multiple levels are present
What imaging technique is preferable in identifying the causal stenosis level
MR myelography > CT, but not widely performed yet
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.
Conventional myelography
What is conventional myelography excellent at? Accurate at?
Excellent: Evaluating canal stenosis
Accurate: localization for neural neoplasms
What is Conventional myelography poor at
Intervertebral foraminal pathology
Radiopaque contrast media is injected into the nucleus pulposus using a fine-gauge needle under fluoroscopic guidance and then viewed under fluoroscopy
Discography
How long is the contrast introduced with discography?
Until a positive-pressure environment is created within the nucleus cavity of the disk
What is a gold standard for confirming the presence of discogenic pain and internal derangement of the disc (but rarely anything else)
Discography
Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? trauma sufficient to cause fracture
High quality
Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? History of malignancy
High quality
Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Unexplained weight loss greater than 10%
High quality
Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Night pain
High quality
Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Neuromotor deficit
High quality
Is this high quality/situationally justifiable/undesirable attempted justifications for spinal plain film? Suspect inflammatory arthritis
High quality
