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Advanced Imaging TQ Prep > TQ Emphasis > Flashcards

TQ Emphasis Flashcards

1
Q

Low field strength (in Tesla)

A

0.3-0.5 Tesla

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2
Q

Intermediate field strength (in Tesla)

A

0.5-1.0 Tesla

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3
Q
  • High field strength (in Tesla)
  • How many degrees Fahrenheit does high field strength raise the body temperature?
A
  • 1.5-3.0 Tesla

- 2˚

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4
Q
  • What is the highest Tesla field strength that can be seen by the human eye?
  • How many degrees Fahrenheit does this field strength raise the body temperature?
A
  • 4 Tesla

- 4-5˚ (we stop at 3 Tesla because this is too high of a temperature for the body to endure)

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5
Q

Small extremities should be obtained on high field strength magnets…what is considered “small”?

A

Small = elbows to fingers & ankles to toes

Need high field strength, 1.5-3.0 Tesla, to detect these small ligaments

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6
Q

When sending a patient for an MR with a Traditional Bore Magnet, what is a crucial question to ask them first?

A

Are you claustrophobic?…if yes, they would do better with open magnet

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7
Q

What are the 3 things that determine image quality?

A

1) Field strength — higher field strength = prettier image
2) Coil — should be dedicated coil for specific body part
3) Post-imaging software — changes ~ every 10 years (upgrades cost ~$100k)

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8
Q

What is one of the most recently added contraindications to MR?

A

Lycra (found in clothing materials such as yoga pants)

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9
Q

What type of metals are contraindications to MR?

A

Ferromagnetic

Note: most metals used in surgery are NOT ferromagnetic

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10
Q

Terminology: Time from excitation to detection of signal

A

TE/Time Echo

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11
Q

Terminology: Time between excitation pulses

A

TR/Repetition time

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12
Q
  • Shorter TE & TR =
  • Longer TE & TR =
A
  • T1

- T2

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13
Q

Terminology: Uses MULTIPLE echos between repetition time making it faster with good resolution (like a loop/overlap of echos)

A

FSE/Fast Spin Echo

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14
Q

Terminology: Frequency of precision of a proton (is what determines radio frequency)

A

Larmor Frequency

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15
Q

Terminology: The energy that excites the protons

A

RF/Radio Frequency

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16
Q

Abbreviations:

  • TE =
  • TR =
  • FSE =
  • RF =
A
  • Time Echo
  • Repetition Time
  • Fast Spin Echo
  • Radio Frequency
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17
Q
  • Hypo-intense =
  • Hyper-intense =
  • Iso-intense =
A
  • Darker
  • Brighter
  • Same
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18
Q

MR sequence for best ANATOMICAL detail

A

T1

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19
Q

MR sequence for best PHYSIOLOGIC info

A

T2

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20
Q

Best for cartilage evaluation (and used for brain imaging)

A

PD/Proton Density

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21
Q

What does STIR stand for?

A

Short T1 Inversion Recovery

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22
Q

What is a faster/quicker study: STIR or FS PD FSE?

A

STIR takes LONGER to do than FS PD FSE

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23
Q

What does FS PD FSE stand for?

A

Fat Suppressed Proton Density Fast Spin Echo

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24
Q

When is Gadolinium administered?

A

At the END of a study with T1 image

Regular water black, enhance accumulation of fluid

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25
Q

Use Gadolinium when you have clinical suspicion of: (3 things)

A
  • Tumor/METs/pt with hx of aggressive tumor
  • Infection
  • Prior surgery in area of complaint
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26
Q

How do we differentiate between scar tissue and discs on MR?

A

Gadolinium contrast needed to differentiate scar tissue and discs.

  • scar tissue has MORE blood supply than the disc…will accumulate gadolinium on T1
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27
Q

On what view and where would you look for Lateral Recess Stenosis (LRS)?

A

Transaxial view, just BELOW the disc/endplate (right where the spinal nerve comes out)

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28
Q

Landmarks:

  • on an axial image, “25R” indicates what?
A

You are 25mm to the R of midline

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29
Q

Landmarks:

  • What is the best way to find your placement in the lumbar spine?
A

Go to the lowest lumbar and count up

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30
Q

Transaxial image is viewed as if you are looking through…

A

The patients feet, towards their head

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31
Q
  • Where do you look for a PARS defect?
  • Is MR a good modality to look for a PARS defect?
A
  • Location: PARS defect is right where the Pedicle meets the Lamina (near the IVF)
  • MR is NOT good for visualizing PARS defects
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32
Q

Sagittal view: what is the oblique line running through the spinal nerve/IVF?

A

Fascicles

Disc bulge can compress fascicles —> leg pain

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33
Q

Sagittal: What is the tiny dark circle running along the bottom of the IVF?

A

Vascular tissue (vessels)

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34
Q
  • What color are vessels on T2 images?
  • What is the modality of choice to view vessels?
A
  • DARK ((because they’re moving fast—can be visualized (bright) IF the blood is flowing slow enough))
  • MRA (magnetic resonance ANGIOGRAPHY)
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35
Q

What does fatty infiltrate of the erector spinae (or any muscle) indicate?

A

Atrophy. Indicated chronic back pain if in spinal muscles.

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36
Q

If the posterior aspect of the disc and vertebral body are not in a straight line, what does this indicate?

A

Disc bulge

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37
Q

How well does MRI image strains/sprains in the spine?

A

NOT WELL AT ALL

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38
Q

What does Inverted Bun Sign indicate on Transaxial image?

A

Facet dislocation

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39
Q

With Lateral Recess Stenosis, what spinal ROM compresses the nerve?

A

Lateral bending and Rotation

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40
Q

What is the most common cause of leg pain in the world?

A

Lateral Recess Stenosis

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41
Q

Is MRI a good modality to evaluate IVF narrowing and reveal OA?

A

NO. MRI is NOT a good modality to evaluate IVF narrowing.

Plain film or CT are best for this

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42
Q

Sagittal: Cerebellum breaks the foramen magnum line. What does this indicate?

A

Arnold Chiari Malformation

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43
Q

The dens is imaging dark/black on all MR sequences. What does this indicate?

A

NORMAL.

No fatty marrow inside dens—will be black on all MR sequences.

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44
Q

What is the modality of choice for assessing the dens?

A

CT

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45
Q

If a transaxial image looks “cut off” or black on one side, what does this indicate?

A

Improper coil used

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46
Q

What ages do disc bulges occur?

A

ANY age!

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47
Q

Is a degenerative disc bulge the same as a herniation?

A

No

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48
Q

What sagittal MR sequence is better for evaluating disc bulge: T1 or T2?

A

T2 – bulge (degenerated disc) will be dark (due to lack of nutrition/water), CSF will be bright white

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49
Q

What is the difference between a bulge and a herniation?

A
  • Bulge: CIRCUMFERENCE of disc is bigger than circumference of endplate
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50
Q

Is MR necessary to prove disc herniation?

A

No. MR is NOT necessary to prove disc herniation.

Plain film is NOT diagnostic, either. Rely on clinical findings.

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51
Q

What does a recent (≤6 weeks) annular tear look like on a T2 sagittal image?

A

Bright signal within posterior aspect of disc bulge or herniation.

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52
Q

What MR view is needed to ddx a disc bulge from a disc herniation?

A

Transaxial: lateral collection of disc will be extending into the IVF.

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53
Q 
***
A recent (≤6 weeks) annular tear looks increased signal within herniation on a T2 sagittal image. What is this area of increased signal called?
A

High intensity zone (HIZ) — indicates recent annular tear

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54
Q

Can significant annular tears result in reduced nerve conduction velocities?

A

Yes

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55
Q

What are the 3 locations of disc herniations?

A
  • foraminal/far out
  • central
  • paracentral
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56
Q

What percentage of the disc is displaced in each type of displacement:

  • LOCAL
  • BROAD BASED
  • CIRCUMFERENTIAL
A
  • Local = 0-25% (This is where and how we see herniations)
  • Broad based = 26-50% (Bulge sticking out around half of the disc)
  • Circumferential = ≥ 51% (Bulge sticking out around entire circumference of disc)
57
Q

Define:

  • Disc Protrusion
  • Disc Extrusion
  • Disc Sequstration
A
  • Protrusion: Width of the base is WIDER than the length of posterior extension
  • Extrusion: Width of the base is NARROWER than the length of the posterior extension
  • Sequstration: DISPLACED disc material lost continuity with parent disc (can migrate…lead to cauda equina syndrome—911!)
58
Q
  • Are disc PROTRUSIONS aways symptomatic?

- How much of the population is walking around with disc protrusions?

A
  • Disc protrusions are NOT always symptomatic (MOST ARE symptomatic, but not all)
  • ⅓ of the population is walking around with disc protrusions (and are Asymptomatic)
59
Q

What % must a central disc protrusion shrink for symptoms to cease?

A

20% shrinkage

60
Q

Is MRI necessary to diagnose a disc herniation?

A

NO. Follow clinical criteria.

61
Q

List the 5 signs/criteria for diagnosing disc herniation:

A

Need 3/5 consistent to same nerve level)

  • Primarily leg pain
  • Leg pain confined to dermatome
  • Neural stretch tests recreate pain
  • At least 2/4 neuro findings consistent with dermatome
    • muscle weakness
    • decreased reflex
    • abnormal pinwheel
    • atrophy
  • MR or CT correlating to dermatome (NOT NECESSARY for dx)
62
Q

When would you order an MR to evaluate disc herniation?

A

If there is progressive neurological deficit (this is the pt that will need surgical intervention)

63
Q

Modality (or modalities) to evaluate loss of disc height:

A
  • X-ray
  • MR
  • CT
64
Q

Modality (or modalities) to evaluate vacuum phenomenon:

A
  • X-ray

- CT

65
Q

Modality (or modalities) to evaluate disc calcification:

A
  • X-ray

- CT

66
Q

Modality (or modalities) to evaluate posterior spur/osteocartilagenous ridge:

A
  • X-ray
  • MR
  • CT
67
Q

What type of modic endplate change can be stopped and is reversible?

A

Modic Type 1 endplate changes can be stopped and is reversible

68
Q

What type of modic endplate changes can be stopped without progression (NOT reversible)?

A

Modic Type 2 endplate changes can be stopped but is not reversible.

69
Q

What type of modic endplate changes cannot be stopped (NOT reversible)?

A

Modic Type 3 endplate changes cannot be stopped (NOT reversible)

70
Q

What type of modic endplate changes are associated with painful discs?

A

Modic Type 1

71
Q

What type of modic endplate changes are involved with change in nutrition to the disc?

A

Modic Type 2

72
Q

What type of modic endplate changes show sclerosis on x-ray?

A

Modic Type 3

73
Q

How do the MR sequences image with Type 1 Modic Endplate Changes?

A
  • Decreased T1

- Increased T2

74
Q

How do the MR sequences image with Type 2 Modic Endplate Changes?

A
  • Increased T1

- Isointense/slightly decreased T2

75
Q

How do the MR sequences image with Type 3 Modic Endplate Changes?

A
  • Decreased T1

- Decreased T2

76
Q

What area of the spine does Lateral Recess Stenosis occur?

A

ONLY the lumbar spine

77
Q

How does the potential for Lateral Recess Stenosis appear on AP lumbar x-ray?

A

Facet joints OUTSIDE of the VB disc (joints enlarged & project lateral to disc-body junction)

78
Q

What type of leg pain does degenerative Spondylolisthesis of the lumbar spine present with? Can the pain be reproduced?

A

Scleratogenous leg pain—cannot be reproduced with provocative tests.

79
Q

How to clinically differentiate Degenerative Spondy and disc herniation:

A

Degenerative spondy does NOT have any neurological findings (disc herniation does have neuro findings)

80
Q

Modality of choice to view degenerative spondy?

A

X-ray

MR can be done to ease patient’s concerns…not necessary for dx thought

81
Q

Is “cancer phobia” a reason to take MR?

A

YES.

82
Q

Degenerative Spondylolisthesis:

  • What grade is most common?
  • Average % of forward slippage?
  • Most common spinal level?
A
  • Grade 1
  • 10% forward slippage
  • Most common at L4
83
Q

The “4 F’s” are risk factors for _____?

A

Degenerative Spondy

84
Q

Goal for degenerative spondy care: (what % of improvement are we looking for?)

A

50% improvement (objectively and subjectively)

85
Q

How do we age compression fractures with MR?

A

Bone marrow edema usually gone within 6 weeks:

  • if T1 signal decreased (dark) = recent (water/edema dark)
  • if T2 signal increased (bright white) = recent (water/edame bright)
86
Q

Osteoporosis: results of Bone Scan & Blood/Urine Labs

A

(-) Bone scan (except at fracture site)

(-) Blood & Urine

87
Q

METS: results of Bone Scan & Blood/Urine Labs

A

(+) Bone scan

(-) Blood & Urine

88
Q

MM: results of Bone Scan & Blood/Urine Labs

A

(-) Bone Scan

(+) Blood & Urine Labs

89
Q

5 indicators of normal marrow (osteoporosis) compression fracture:

A
  • focal involvement
  • NO pedicle involvement
  • posteriorly angulated fragment
  • NO soft tissue mass
  • FLUID SIGN
90
Q

5 indicators of abnormal marrow (METS/MM) compression fracture:

A
  • multifocal involvement
  • pedicle involvement
  • posterior CONVEXITY
  • soft tissue mass
  • NO fluid sign
91
Q

How many millimeters is a Type 1 Arnold-Chiari Malformation? Type 2?

A
  • Type 1: 1-4mm

- Type 2: 5mm

92
Q

If a patient is <50yoa an has balance issues, you should suspect:

A

Arnold-Chiari Malformation

93
Q

If BOTH Occipitilization and C2/3 blocked vertebra are present, suspect:

A

Arnold-Chiari Malformation

94
Q

Visualized field necessary when taking MR of Syrynx/Syringomyelia:

A

Must see top & bottom of syrynx to be sure there’s no tumor

95
Q

Signs & Symptoms of Syrynx/Syringomyelia:

A
  • sensation loss over trapezius

- cuts/bruises/burns on hands (can’t feel their hands)

96
Q

Modality of choice for tumors

A

MR with contrast (fat suppressed)

97
Q

Most common tumor of the spine? How does it present on MR?

A

Hemangioma:

  • Decreased T1
  • Increased T2
98
Q

Modality of choice to evaluate spinal METS (or other aggressive tumors):

A

T1 with Gadolinium

T2 is good too, but T1 w/contrast is best

99
Q

Modality of choice to evaluate ACUTE brain bleed?

A

CT

100
Q

Modality of choice to evaluate SUBACUTE & CHRONIC brain bleeds:

A

MRI

101
Q

Types of brain bleeds:

A
  • Hemorrhagic stroke

- Torn dura (trauma-related)

102
Q

Modality of choice to evaluate torn EPIDURAL vessels:

A

CT (acute)

  • epidural vessels are large—bleed fast
103
Q

Modality of choice for SUBDURAL vessels:

A

MRI

  • slow bleed, pt usually asymptomatic for 3-5 days
104
Q

What modality evaluates how water moves and is helpful in brain injuries to assess neural flow?

A

DFI (Diffusion Tensor Imaging)

105
Q

Modality of choice for evaluating brain tumors:

A

MRI

106
Q

Modality of choice for evaluating MS:

A

MRI (high signal plaques, ESPECIALLY on T1

Note: BRAIN MRI, not cervical MRI

107
Q

What % of Tarlov/Meningial Cysts are located in the sacral canal? If not in the sacral canal, where are else would they be located?

A
  • 99% in sacral canal

- can be located in Lumbar Spine (called Arachnoid cysts here)

108
Q

Are Tarlov/Meningial Cysts asymptomatic?

A

Yes, Tarlov cysts are almost ALWAYS asymptomatic

109
Q

Are Tarlov Cysts a contraindication to chiropractic?

A

NO. Normal variant.

110
Q

Modality of choice for evaluating Tarlov/Meningial Cysts:

A

MRI

NOT visible on plain film x-ray, confusing when appear on CT

111
Q

Synovial Cysts act like a disc herniation in some instances…what is the prognosis compared to disc herniation? Are synovial cysts a contraindication to chiro?

A

Synovial Cysts have a MUCH BETTER prognosis than disc herniation. NOT a contraindication to chiro are.

112
Q

What is the Gold Standard to evaluate vasculature?

A

Digital Subtraction

  • MRA (Magnetic Resonance ANGIOGRAPHY): almost as detailed as digital subtraction, can be done w/o contrast (though faster w/Gadolinium), image can be spun and viewed in many planes.
113
Q

What does MOTSA stand for?

A

Multiple Overlapping Thin Slab Acquisitions

114
Q

Initial modality to assess Vertebral Artery Dissection.

A

MRA (does NOT always accurately dx VAD)

115
Q

Where is the only place you’ll see coracoclavicular ligament of shoulder?

A

1st or 2nd slice of Coronal Oblique View (MR)

116
Q

Where to look for Rotator Cuff Tears (RCT) on MR:

A

11:00 or 1:00 positions on coronal oblique view

117
Q

What can you see attaching to the labrum on the anterior part of 11 or 1:00 on coronal oblique view?

A

Intercapsular portion of biceps tendon

118
Q

How does the labrum appear on MR?

A

Triangle of solid black

119
Q

What is the only type of RCT visible via arthroscopic surgery?

A

Under surface tear (bottom, partial thickness tear)

120
Q

Modality of choice to view RCT? Be specific.

A

MRI: T2 (synovial fluid and edema will be bright)

121
Q

What does SLAP stand for? What is the AKA of SLAP lesion?

A
  • Superior Labral Anterior to Posterior Lesion

- AKA Peel-Back Lesion

122
Q

Best view to evaluate SLAP Lesion:

A

Coronal Oblique MRI

123
Q
  • What position of the clock can we view SLAP 1 Lesions?

- What position of the clock can we view SLAP 2 Lesions?

A
  • SLAP 1 = 11-1:00 (only shows up on a couple of slices!!!)

- SLAP 2 = 11 through 1:00 (shows up throughout)

124
Q

What is the modality of choice for evaluating the labrum of the shoulder (& hip)? Be specific.

A

MR-Arthrogram (saline fluid injected into joint, T2 will show saline in tear/joint space as white)

125
Q

If fracture is suspected in the shoulder/humeral head (or the hip/femoral head), what should we automatically suspect?

A

Labral tear

126
Q

Do SLAP 1 and SLAP 2 have different prognoses?

A

No. Both respond well to conservative care.

127
Q

What does GIRD stand for?

A

Glenohumeral Internal Rotation Deficit

128
Q

GIRD: Repetitive tensile load during the ___(a)___ phase of throwing is causing thickening of the ___(b)___?

A

(a) follow-through

b) PIGHL (Posterior Inferior Glenohumeral Ligament

129
Q

GIRD: Tight, thick PIGHL (Posterior inferior glenohumeral ligament) leads to shift of the _____ contact point.

A

Glenohumeral

130
Q

GIRD: In the ___(a)___ phase of throwing, the thick PIGHL is beneath the humeral head and pushes it ___(b)___.

A

(a) late cocking

(b) Posterior Superior

131
Q

GIRD: The displaced humeral contact point and/or excess _____ rotation causes twisting of biceps and Peel-Back SLAP tear.

A

External rotation (increased)

132
Q

GIRD: …leads to ___(a)___ external rotation of humerus & ___(b)___ internal rotation of humerus

A

(A) Excessive external rotation

(B) Decreased internal rotation

133
Q

3 Causes of RCT:

A
  • GIRD
  • Overuse
  • Bad Mechanics
134
Q

GIRD present in what % of each of these populations:

  • College & Pro baseball players
  • High school baseball players
  • Little Leaguers
A
  • 100% of College & Pro baseball players
  • 75% High school baseball players
  • 50-75% Little Leaguers
135
Q

What % of difference between shoulders (rotation) is positive for GIRD?

A

≥ 10% difference (some say 25˚ or greater)

136
Q

Best modality, view & location to evaluate Anterior Labral Tear:

A

MR-Arthrogram (w/saline contrast)—Transaxial view @ 3 or 9:00 (equator)

137
Q

Best modality, view & location to evaluate Posterior Labral Tear:

A

MR-Arthrogram (w/saline contrast)—Transaxial view @ 3 or 9:00 (equator)

138
Q

Modality of choice, view, and location to evaluate Full Thickness RCT with Retraction:

A

MRI, coronal oblique (11 & 1:00)

139
Q

Full thickness RCT with Retraction: A tear greater than how many centimeters worsens the surgical outcome?

A

A tear >5cm worsens the surgical outcome of Full thickness RCT with retraction

Advanced Imaging TQ Prep (1 decks)

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