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Radiology Tumors > Tutoring Session > Flashcards

Tutoring Session Flashcards

1
Q

what are characteristics of benign vs malignant lesions

A

benign - single, geographic, short zone, respecting borders, well defined, no pain**

malignant - mutliple, long zone, moth eaten, permeative, periosteal reaction, destroying borders, ill defined, pain**

** pain is subjective but most commonly benign are not painful and malignant are painful

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2
Q

what tumor causes cachexia and pain

A

multiple myeloma

cachexia - wasting of the body

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3
Q

what tumor occurs in and affects the red marrow of bone causing osteopenia

A

multiple myeloma

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4
Q

what is needed to confirm diagnosis of multiple myeloma

A

aspiration and biopsy of bone marrow

sternum and ilium

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5
Q

what are rare sclerotic lesions of multiple myeloma called

A

POEMS

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6
Q

what malignant tumor spares the pedicles

A

multiple myeloma

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7
Q

what are risk factors for multiple myeloma

A

farmers, exposure to wood dust, nuclear exposure

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8
Q

what is the mnemonic for lytic lesions

A

fog machines
feg nomashic

fibrous dysplasia
enchondroma
giant cell tumor

non ossifying fibroma 
osteoblastoma 
myeloma 
ABC 
simple bone cyst 
hyperPTH 
infection 
chondroblastoma
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9
Q

what is the most common sclerotic lesion tumor

A

central osteosarcoma

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10
Q

central osteosarcoma typically results in what issues in the limbs

A

asymmetry or taller limb

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11
Q

what part of the bones does central osteosarcoma affect

A

metaphysis

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12
Q

where will central osteosarcoma not spread to

A

physis - limits spread of tumor

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13
Q

what tumor will metastasize to the lungs via the blood

A

central osteosarcoma

“cannonball mets”

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14
Q

what tumor can cause a pneumothorax

A

central osteosarcoma - mets to lungs via blood “cannonball mets”

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15
Q

what tumor can cause skip lesions in the spine via mets

A

central osteosarcoma

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16
Q

condmans triangle and spiculated cortex describes what type of tumor

A

central osteosarcoma

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17
Q

what does central osteosarcoma look like on MRI sequences T1, T2, STIR

A

t1 - low
t2 - high
stir - high

high due to edema

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18
Q

secondary osteosarcoma arises from what

what is the most common

A

benign bone tumor

pagets bone 44%

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19
Q

what lab value can help monitor if pagets bone has gone malignant

A

alkaline phosphatase

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20
Q

what is the process of thinking to know what a tumor is

A

benign or malignant

matrix - bone, fibrous, cartilage

location

unique features

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21
Q

what is advantage of conventional radiography

A

non invasive

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22
Q

what percent of bone needs to be diminished in order to observe it on xray

A

30-50%

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23
Q

how long may it take to visualize osteomyelitis in peripheral bone in xray

A

10-14 days

occult fracture - 7-10 days
spinal osteomyelitis - 21 days
aggressive tumors - 4-6 weeks

24
Q

what agent is used for radionucleotide bone scan

A

technetium methylene disphosphate

25
Q

what is the difference between enchondral, intramembranous, and appositional bone formation

A

enchondral - develops from cartilage, requires cartilaginous template, forms the physis or growth plate, forms most of skeleton, controls bone lengthening

intramembranous - develops from mesenchyme/connective tissue, no cartilage stage, forms the flat bones, mandible. skull, clavicle

appositional - controls width of the bone via periosteal activity

26
Q

what are characteristics of different layers of bone

A

periosteum - surrounds bone except at ends, not seen on imaging unless inflamed or pathology present

epiphysis - located at ends of long bones, preformed cartilage slowly ossifies, supports joints

apophysis - sites of muscle attachment

physis - growth plate, area of maturing cartilage that develops into bone, trauma alters growth

zone of provisional calcification - radiopaque band on either side of physis, calcification to mature bone, disease may alter and arrest growth forming harris growth arrest lines

metaphysis - most metabolic active portion of bone, most common area for tumors and infection, contains trabeculae that bears stress and weight

diaphysis - shaft of bone, thick cortex with decreased medullary cavity

27
Q

what diseases affect the metaphysis

A 
mutiple myeloma 
ewings sarcoma 
NHL 
adamantinoma 
infection
28
Q

most common location for tumor inside a bone

A

metaphysis

metabolically active

29
Q

diaphyseal tumors indicates what kind of disease

A

bone marrow disease

30
Q

what is difference between wide and narrow zone of transition

what does each indicate

A

wide - little or no sclerosis around it - indicates malignancy

narrow - sharp sclerotic rings around it - indicates benign

31
Q

what is difference between moth eaten and permeative

A

moth eaten is larger multiple irregular holes in bone - 2-5 cm

permeative is tiny multiple pinholes in bone - very aggressiv and rapidlly forming

32
Q

describe geographic lesions

A

circumscribed
solitary and uniform
sharp margin - narrow zone of transition
soap bubbly or septated

33
Q

what tumors contain permeative lesions

what tumors contain moth eaten lesions

A

ewings sarcoma
NHL
MM

MM
mets

34
Q

what tumors contain osteoblastic lesions

A

blastic mets - MC - have history of cancer (prostate)

osteosarcoma

pagets disease

35
Q

how long does it take before a periosteal reaction will show up in imaging after stimulus

A

10-21 days

36
Q

what are examples of periosteal reactions

A

solid - benign

laminated - called onion skin appearance, alternating lucent and opaque areas, slow and aggressive tumors

spiculated - aka sunburst reaction, perpendicular brushed whiskers, highly aggressive tumor

37
Q

laminated periosteal reaction is seen in what tumor

A

ewings sarcoma

onion skin

38
Q

how is codmans triangle formed

A

subperisoteal extension of the lesion

39
Q

what are the following lab tests for

CBC 
ESR 
CRP 
serum calcium 
serum phosphorus 
alkaline phosphatase 
acid phosphatase 
total protein
A

CBC - infection
ESR - inflammation
CRP - inflammation - better

serum calcium - indicates lytic bone destruction or PTH dysfunction

serum phosphorus - indicates lytic bone destruction

alkaline phosphatase - indicates osteoblast activity

acid phosphatase - prostate - increased with gauchers and mets

total protein - mets or MM - IgG spike and BJ proteins in urine

40
Q

alkaline phosphatase helps indicate what 3 diseases

A

pagets
mets
lymphoma

41
Q

what is endosteal scalloping

A

thinning of cortex along endosteal surface of bone

slow growing medullary lesions

42
Q

what are the radiographic densities to dark to light

A 
dark- lucent - 
air 
fat 
water 
bone 
metal 
- light - opaque
43
Q

what imaging should always be performed first

what views

A

xray

2 perpendicular views

44
Q

how big does the lesion have to be before it is seen on xray

A

1-5 cm

45
Q

when is special imaging indicated

A

when patient isnt 50% better after 2 weeks

46
Q

what imaging uses iodinated contrast

A

discography

inject into IVD to recreate pain to determine level causing pain

47
Q

bone scan is good for detecting what

what cant it detect

A 
mets 
tumors 
infection 
arthritis 
fractures 
AVN

cant detect MM - no osteoblast activity

48
Q

bone scans are __ but not __

A

sensitive

but not specific

49
Q

bone scans can detect __ % of bone destruction

how many times more sensitive than xray

A

3-5%

10x

50
Q

what are the advantages and disadvantages of ultrasound

A

advantages - good for msk, abdomen, vascular, cyst, guided biopsy

disadvantage - operator dependent and long learning curve

51
Q

what imaging uses mutiplanar reconstruction of images

A

CT

52
Q

what are advantages and disadvantages of CT

A

advantages - bone detail and very quick

disadvantage - high radiation

53
Q

what are advantages and disadvantages of MRI

A

advantages - soft tissue, no radiation, sensitive to marrow, good for spinal disease and discs

disadvantage - claustrophobia, noisy, metallic clips or implants, expensive

54
Q

what is high intensity and what is low intensity on t1 and t2 MRI

A

t1

  • high - bone marrow/fat
  • low - csf, edema, infection

t2

  • high - csf, edema, infection
  • low - bone marrow/fat
55
Q

what tumors occur in the epiphysis

what tumors occur in the diaphysis

A

epiphysis - chondroblastoma, giant cell, CMF

diaphysis - ewings sarcoma, EG, lymphoma

Radiology Tumors (11 decks)

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