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Skeletal Radiology I > Unit 1 > Flashcards

Unit 1 Flashcards

1
Q

Conventional Tomography

A

Used to evaluate structures or abnormalities.
Blurs out objects above and below plane of interest
Fulcrum/pivot is level of interest

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2
Q

Computed Tomography (CT, CAT)

A

Most images obtained in axial plane
Excellent spatial relationships
Based on tissue attenuation
Components - Gantry houses tube and sensors; table; x-ray generator; data processor
Cross-sectional cuts 0.2-1.3cm
Tissues expressed in Hounsfield Units (Hu)

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3
Q

Bone Scintigraphy

A

Radionuclide bone scanning (skeleton, heart, lung, kidneys, brain)
Organ/system uptake of Technetium-99m methylene diphosphate (99mTc-MDP) is MC radioactive agent
Extremely sensitive; lacks specificity
Look for “hot spots”

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4
Q

Magnetic Resonance Imaging (MRI)

A

Based on re-emission of an absorbed radiofrequency while pt is in strong magnetic field
Spin echo T1 & T2 images, STIR, FLAIR, FSE, GRE are ex. Of pulse sequences
T1 is fat sequence; T2 is water sequence

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5
Q

Categorical Approach to Bone Disease Pneumonic: CATBITES

A 
Congenital
Arthritis
Trauma
Blood
Infection
Tumor
Endocrine, nutritional, metabolic
Soft tissue
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6
Q

Number of lesions: Solitary lesion

A

Simple Bone Cyst (SBC)

Osteosarcoma

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7
Q

Number of Lesions: Multiple Lesions (Multiplicity)

A

Metastatic Disease
Multiple Myeloma
HME (Hereditary Multiple Exostosis)
Enchondromatosis

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8
Q

Monostotic

A

Single bone

Suggests tumor or infection

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9
Q

Polyostotic

A

Multiple bones

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10
Q

Osteoma (location)

A

Frontal sinus (skull; common location)

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11
Q

Hemangioma (location)

A

Spine (MC benign tumor of spine)

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12
Q

Bone marrow tumors

A

Myeloma

Lymphoma

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13
Q

Chordoma (location)

A

Cranial and caudal cord limits
Remnants of primitive notochord

Most tumors are radiolucent

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14
Q

Diaphyseal tumors

A

Ewing’s Sarcoma

Multiple Myeloma

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15
Q

Diametaphyseal tumors

A

NOF (Non-Ossifying Fibroma)

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16
Q

Metaphyseal tumors

A

Osteosarcoma (malignant)

Simple Bone Cyst (SBC; benign)

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17
Q

Epiphyseal tumors

A

Chondroblastoma

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18
Q

Metaphyseal-Epiphyseal Tumors

A

Giant-Cell tumor

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19
Q

Axial orientation: Central

A

Centrally located on both AP and Lat Views

Ex: SBC, Chondrosarcoma, Fibrous Dysplasia

20
Q

Axial orientation: Eccentric

A

Still medullary in location, but not centered in 1 view

Ex: Giant Cell, Chondromyxoid fibroma, ABC (Aneurysmal Bone Cyst)

21
Q

Axial orientation: Cortical

A

Overlies the cortex on at least one view; may see cortical thickening, expansion, destruction, periosteal response

Ex: Osteoid osteoma, FCD (Fibrous Cortical Defect)

22
Q

Axial orientation: Parosteal

A

Close approximation but definite separation from majority of underlying bone; notable lesion in soft tissue w/ little bony abnormality

Ex: Juxtacortical chondroma, parosteal osteosarcoma

23
Q

Axial orientation: Extraosseous (Soft Tissue)

A

Distant location from bone or adjacent cleft separates mass from cortical surface

Ex: Myositis ossificans (aka Heterotopic Bone Formation)

24
Q

Size and shape of lesion: malignant

A

Most malignant or aggressive lesions tend to be large at time of discovery ( >6cm). Exceptions: Fibrous dysplasia; SBC, ABC, Giant-Cell.

Slow-growing lesions usually progress along long-axis of bone. Fast growing tumors are often pleomorphic or round-ish in shape.

25
Q

Behavior of Lesion

A

Bone lesions may be osteolytic, osteoblastic, or mixed.
Majority of bone tumors are osteolytic.
~30-50% of cancellous bone must be destroyed to see on x-ray.
Three patterns of destruction: geographic; moth-eaten; permeative

26
Q

Pattern of Bone Destruction: Geographic

A

Least aggressive pattern.
Circumscribed & uniformly lytic
Usually solitary >1cm
Usually sharply marginated
May be trabeculated (soap bubble appearance)
Indicative of slow-growing lesion (usually benign)
Ex: ABC (Aneurysmal Bone Cyst)

27
Q

Pattern of Bone Destruction: Moth-Eaten

A 
Multiple small or moderate sized lucencies that may or may not be poorly marginated (2-5cm)
“Punched-out” appearance
Longer ZOT (zone of transition)
Indicative of aggressive lesions
Metastasis
Ex: NHL (Non-Hodgkin’s Lymphoma)
28
Q

Pattern of Bone Destruction: Permeative

A

Multiple holes <1mm in size
Poorly demarcated, not easily separated from normal bone
Areas of destruction my coalesce
Wide ZOT
Indicative of very aggressive lesion
Ex: NHL (Non-Hodgkins Lymphoma); Multiple Myeloma

29
Q

Margination

A

Refers to margin of lesion

Ex: Imperceptible, sharp, wide, narrow

30
Q

Sharp Margination

A

AKA: Narrow ZOT; definite
Line of demarcation between lesion and normal bone is well-defined; may be sclerotic
Indicative of slow-growing process

Ex: Fibrous dysplasia; SBC

31
Q

Imperceptible Margination

A

AKA: Wide ZOT; ill-defined; hazy
Gradation between lesion and normal bone occurs gradually with no distinct line of demarcation
Indicated aggressive or malignant process

Ex: Metastasis; Infections

32
Q

Cortical Integrity: Appearances

A

Key factor in assessing growth rate

Cortical Expansion
Cortical Erosion
Cortical Thinning
Cortical Destruction
Cortical Saucerization
Cortical Thickening
33
Q

Cortical Expansion

A

Result of progressive endosteal erosion together with periosteal bone formation.
Bulging of an intact cortex; slow continued growth, generally benign

Ex: Giant-Cell (when it extends to articular surface); ABC

34
Q

Cortical Erosion

A

Slow growing medullary tumors with lobulated or scalloped appearance
Endosteal scalloping - cartilaginous and fibrous tumors, myeloma

Ex: Enchondroma; Chondrosarcoma

35
Q

Cortical Destruction

A

Strong indicator of aggressive bone disease.
Easier to identify than destruction w/in medulla
May see moth-eaten permeative destruction
Periosteal response and/or soft tissue mass

36
Q

Cortical Thinning

A

Thinning w/out loss of integrity, usually denotes slow growth

Ex: osteoporosis, tumors (localized)

37
Q

Cortical Thickening

A

Thickening of cortex. May be localized

Ex: osteoid osteoma; stress fx; Paget Disease

38
Q

Cortical Saucerization

A

Saucerized destruction of cortex

Ex: Ewing’s Sarcoma

39
Q

Tumor Matrix Types: Osseous

A

Tumor New Bone

  • New bone produced by osteogenic tumors
  • fluffy, cloud-like appearance
  • Ex: Osteosarcoma; calcification of osteoid

Reactive New Bone

  • Body lays down new bone in response to stimulus
  • Ex: Degenerative Sclerosis; metastasis
40
Q

Tumor Matrix Types: Cartilage

A

Endochondral calcification of chondroid nodules.
Stippled, flocculent, arc or ring-like, popcorn-like, comma shaped

Ex: Chondrosarcoma, endochondroma, osteochondroma

41
Q

Tumor Matrix Types: Fibrous

A

Radilucent or slightly hazy. Smoky, hazy, ground glass* due to calcification of osteoid.
Often difficult to identify

Ex: Fibrous dysplasia

42
Q

Tumor Matrix Types: Fat

A

If intraosseous, it is hard to identify on plain-film

43
Q

Periosteal Response

A

Bone forming irritants include: blood, pus neoplasm, edema, granulation tissue

New bone is formed by cambium layer; generally a 10-21 day latent period

44
Q

Laminated Periosteal Response

A

AKA: Layered, onion-skin, lamellated
Alternating layers of radiopacity and lucency (may eventually form solid appearance). Cyclical variation in growth

Ex: Ewing’s Sarcoma, Osteosarcoma

45
Q

Spiculated Periosteal Response

A

AKA: Perpendicular, brushed whiskers, hair-on-end, sunburst
Fine linear spiculations of new bone radiating from point source. Usually indicative of very aggressive bone tumors.

Ex: Osteosarcoma

46
Q

Codman’s Triangle

A

AKA: Codman’s Angle, periosteal cuff, periosteal buttress
Periosteal new bone at peripheral lesion-cortex junction
Results from subperiosteal extension of lesion

Skeletal Radiology I (4 decks)

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