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CMED 311 > WEEK 3: Radio of the Skull, Brain and Spine > Flashcards

WEEK 3: Radio of the Skull, Brain and Spine Flashcards

1
Q

Energy used to produce the image must be capable of

penetrating tissues. T or F?

A

T

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2
Q

High frequency sound waves

A

ultrasound

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3
Q

basically an electrode pair inside a glass

vacuum tube.

A

Xray machine

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4
Q

Anode or cathode? Electric current passes through the filament, heating it
up
o Heat sputters electrons off the filament surface

A

cathode

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5
Q

Anode or cathode? o Flat disc mode if tungsten.

o Draws electrons across the tube.

A

anode

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6
Q

negative part of the xray tube?

A

Cathode

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7
Q

Radiolucent or radiopaque?
o Transmitted radiation
▪ Passes through the patient and interacts with the
detector to create the image

A

Radiolucent

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8
Q

absorbed radiation or scattered radiation? Interacts with the tissues of the patient depositing
energy in tissues.

A

absorbed

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9
Q

what is the density of water?

A

1

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10
Q

white to black on Xray?

A 
Bone
Soft tissue
Water
Fat
Air
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11
Q

T or F? the thicker the object the more radiopaque it is.

A

T

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12
Q

▪ Passes through the patient, but changes its original
path, leaving the patient along a different course
▪ Can degrade the quality of the image
▪ Can be exposure source to personnel

absorbed radiation or scattered radiation?

A

scattered radiation

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13
Q

Radiography is usually used for

A
  • Broken bones
  • Cavities
  • Foreign objects
  • Lungs
  • Blood vessels (angiography)
  • Breasts (mammography)
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14
Q

liquids that absorb x-rays more effectively than surrounding tissue
▪ To bring organs in the digestive tract into focus typically a barium compound will be swallowed or introduced

A

Contrast media

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15
Q

gadolinium based agents with T1 relaxation time shortening effects

A

MRI

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16
Q

micro-bubbles which have higher echogenicity compared to human tissue are injected into the patient’s vein.

A

Ultrasound

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17
Q

A narrow beam of x-ray scans across a patient in synchrony with a radiation detector on the opposite side of the patient.
• Internal structure of an object is reconstructed from multiple projections

A

CT

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18
Q

uses of angiography

A

Diagnosis of primary vascular disease
• Pre-operative definition of vascular anatomy
• Diagnosis of vascular complications

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19
Q

A quantity used in CT to express CT numbers in a standardized and convenient form

A

Hounsfield unit

Created by and named after Sir Godfrey Hounsfield

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20
Q

Radiodensity of distilled water at STP

A

0 HU

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21
Q

Radiodensity of air at STP

A

-1000 HU

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22
Q

HU of fat

A

-200 - -50

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23
Q

Aka grey-level mapping, contrast stretching, histogram modification

A

Windowing

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24
Q

o Can detect diffuse and focal changes
o Bone window can detect fracture

what CT?

A

Plain CT

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25
Q

When to use MRI?

A

• Soft tissue details in areas such as the brain, internal pelvic organs, and joints (such as knees & shoulders) can often be better evaluated by MRI.
• In pregnant women, while CT can be performed safely, other imaging exams not involving radiation, such as ultrasound or MRI, are preferred but only if they are likely be as good as CT in diagnosing your condition.
• A person who is very large may not fit into the opening of a conventional CT scanner or may be overweight the limit – usually 450 lbs. – for the moving table (gantry)
 Gantry/table won’t move if px is >450 lbs.

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26
Q

o Can detect and characterize focal lesions
o Majority of pathological lesions have a predominantly arterial supply, and thus “enhance”

What CT

A

Contrast CT

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27
Q

Process in which the image greyscale component of an image is manipulated via CT numbers
• Will change the appearance of the picture to highlight particular structures
• Brightness of the image is adjusted via window level
• Contrast is adjusted via the window width

A

windowing

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28
Q

CT is more versatile than X-rays and usually used for

A 
o Presence, size and location of tumors
o Organs in the pelvis, chest and abdomen
o Colon health (CT colonography)
o Vascular condition/blood flow
o Pulmonary embolism (CT angiography)
o Abdominal aortic aneurysms ( CT angiography)
o Bone injuries
o Cardiac tissue
o Traumatic injuries
o Cardiovascular disease
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29
Q
  • Does not use ionizing radiation
  • Images are created using radiofrequency energy emitted by hydrogen protons when strong magnetic fields generated around a patient are manipulated
A

MRI

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30
Q

Identify if CT or MRI? x-ray beams

A

CT

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31
Q

Identify if CT or MRI? fast scan time

A

CT

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32
Q

multiplanar: CT or MRI?

A

BOTH

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33
Q

superior soft tissue differentiation: CT OR MRI?

A

MRI

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34
Q

density: CT or MRI?

A

CT. MRI y intensity

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35
Q

Lower time to relax, lower time to emit ratio. T1 or T2?

A

T1. T1 has lower TR and TE

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36
Q

Grey matter is both isointense in T1 and T2. T or F?>

A

t

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37
Q

White matter, because of their fat content (rich in myelin, lipid filled) is bright on T1 and hypointense on T2. T or F?

A

T

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38
Q

Ventricles which is mainly composed of water is black on T1 and white on T2. T or F?

A

T. World War 2 mnemonic WW2, water is white on T2

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39
Q

White areas on sulci are CSF which are in the subarachnoid space.

A

T

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40
Q

why is blood both black on T1 and T2?

A

Blood are both black on T1 and T2 because of the principle of how you measure, blood flows so when it’s measured the molecule measured is no longer there after few secs.

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41
Q

identify the intensity in T1 and t2: gray matter

A

isointense on T1 & T2

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42
Q

identify the intensity in T1 and t2: White matter

A

bright on T1, dark on T2

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43
Q

identify the intensity in T1 and t2: Ventricles/CSF

A

black on T1, white on T2

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44
Q

identify the intensity in T1 and t2: Blood vessels (flowing blood)

A

black on T1 & T2.

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45
Q 
Gray Matter
o Higher blood flow
o Isointense on T1
▪ Darker/brighter than ventricles?
o Isointense on T2
▪ Darker/Brighter than ventricles?
A

Brighter;

Darker

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46
Q

• CSF
o 99% water
o Black on T1
o White on T2

is this true?

A

T

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47
Q

Appearance of all cortical bone in all sequences?

A

DaRK

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48
Q

is fat bright or dark in T1?

A

bright;

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49
Q

T or F? Brain lesions usually produce edema?

A

T

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50
Q

Most lesions are dark on T2. T or F?

A

F. Bright

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51
Q

T or F? We always look on T2 first, if there’s any funny looking on T2 we confirm it on T1

A

T.

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52
Q

Identify the image characteristics on ultrasound: Air

A

poor qulaity d/t scatter

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53
Q

Identify the image characteristics on ultrasound: water

A

anechoic (black)

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54
Q

Identify the image characteristics on ultrasound: blood

A

Anechoic (black)

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55
Q

Identify the image characteristics on ultrasound: fat

A

Hypoechoic to isoechoic (dark to lighter gray)

56
Q

Identify the image characteristics on ultrasound: muslce

A

isoechoic (lighter gray)

57
Q

Identify the image characteristics on ultrasound: bone

A

Hyperechoic (bright white)

58
Q

Usual uses of Utz?

A

• Abnormalities in the heart and blood vessels
311-026 RADIOLOGY OF THE SKULL, BRAIN, & SPINE (1 OF 2) 8 of 15
• Pleural effusion and other collection quantification
• Organs in the pelvis and abdomen (e.g., pregnancy)
• Superficial neck
• Tendon/ligament tears and joint effusion
• Small superficial masses
• Neonatal brain

59
Q

T or F?If you see a fluid structure like this and it’s intensified we call it posterior acoustic enhancement that’s a cyst.

A

T

60
Q

Can detect a frequency shift in echoes, and determine whether the tissue is moving toward or away from the transducer
• For evaluation of some structures such as blood vessels or the heart

A

Doppler utz

61
Q

why is the UTZ Not an ideal imaging technique for air-filled bowel or organs obscured by the bowel

A

UTZ waves are disrupted by air or gas

62
Q

What fontanel?
o persist until 1.5-2y
o becomes bregma

A

anterior (frontal) fontanel

63
Q

What fontanel?

o persist until ~3mos
o becomes lambda

A

posterior (occipital) fontanel

64
Q

What fontanel?

o persist until 6mos
o becomes pterion

A

anterolateral (sphenoidal) fontanels

65
Q

What fontanel?

o persist until 2y
o becomes asterion

A

posterolateral (mastoid) fontanels

66
Q

what view of the skull? o non-angled lateral radiograph
o overview of entire skull
o does not attempt to highlight any region

A

lateral view

67
Q

What view to use when there are facial fractures?

A

PA axial view

68
Q

o Angled anteroposterior radiograph, used to evaluate for fractures and neoplastic change
o To visualize the petrous portions of the temporal bones, the dorsum sellae, and the posterior clinoid processes
▪ Visible in the shadow of foramen magnum

A

AP Axial View?

69
Q

AKA AP Axial View?

A

Towne View

70
Q

o Caudally angled posteroanterior radiograph, to better visualize the paranasal sinuses, especially the frontal sinus
o Petrous ridges are below orbits

A

PA Axial View

71
Q

AKA PA Axial view?

A

Caldwell view

72
Q

On Caldwell view the orbits are above the overlapping maxillary and petrous ridges. T or F?

A

T

73
Q

o Angled posteroanterior radiograph
▪ Patient gazing slightly upwards
o To assess for facial fractures as well as acute sinusitis
o Petrous ridges are below maxillary sinuses

A

OCCIPITOMENTAL VIEW

74
Q

AKA OCCIPITOMENTAL VIEW

Patient gazing slightly upwards

A

WATERS VIEW

75
Q

o Back of patient is arched as far as possible so that the base of the skull is parallel to film
o Primarily taken to demonstrate sphenoid sinuses and zygomatic arches

A

Submentovertex view

76
Q

Usually done to see zygomatic arch, mandibular symphysis and skull base lesions but never do this unless you clear the patient for a cervical spine fracture

A

Submentovertex view

For trauma, to check for the facial bone and the skull usually you do the lateral view and the water’s view and if you have one more you do an AP view.

77
Q

• Intracranially it is formed by two layers:
o Outer endosteal layer
▪ Continuous with the periosteum
o Inner meningeal layer
▪ Continuous inferiorly with the spinal cord theca

A

Dura mater

78
Q

ICA Segments?

A 
Bouthillier classification:
o Cervical segment
o Petrous (horizontal) segment
o Lacerum segment
o Cavernous segment
o Clinoid segment
o Ophthalmic (Supraclinoid) segment
o Communicating (Terminal) segment
79
Q

Ophthalmic artery is a branch of the

A

cavernous segment

80
Q

Vertebral artery segments

A

V1 (preforaminal)
Origin to transverse foramen of C6

V2 (foraminal)
From transverse foramen of C6 to the transverse foramen of C2

V3 (Atlantic, extradural or extraspinal)
From C2 to the dura

V4 (intradural or intracranial)
From dura to their confluence, from basilar artery

81
Q

Origin: vertebral artery confluence
• Course: ventral to pons in the pontine cistern
• Branches: numerous to cerebellum and pons
• Termination: division into the two posterior cerebral arteries.

A

Basilar Artery

82
Q

Arises from the anterior cerebral artery and acts as an anastomosis between the left and right anterior cerebral circulation.
• Demarcates the junction between the A1 and A2 segments of the anterior cerebral artery.

A

ACoA

83
Q

Originates from the posterior aspect of the C7 (communicating) segment of the internal carotid artery and extends posterior medially to anastomose with the ipsilateral posterior cerebral artery and from part of the circle of Willis.
• Branches:
o Many fine, scarcely visible, perforating branches
o Largest perforating branch is called the premamillary or anterior thalamo perforating artery
• Vascular territory
o Posterior part of the optic chiasm and optic tract
o Posterior part of the hypothalamus and mammillary bodies
• Part of the thalamus

A

PCoA

84
Q

The vein that connects superior sagittal sinus to inferior sagittal sinus

A

Vein of Trolard

85
Q

The internal cerebral vein, the biggest one

A

Vein of Labbé

86
Q

The most common cause of subarachnoid hemorrhage

A

is trauma.

87
Q

Most common non-traumatic cause of SAH is

A

ruptured aneurysm.

88
Q

“3H” we are looking for in the imaging tumor

A

Hemorrhage
Hydrocephalus
Herniation

89
Q

Posterior acoustic shadowing vs posterior acoustic enhancement

A

posterior acoustioc shadowing means that it is a stone or calcification kasi ung nasa liko nya would be black.

posterior acoustic enhancement means it is a cyst, nagiging white ung nasa likod nya.

90
Q

what are the membranous part of the cranium? (4)

A
  • Paired frontal bones
  • Paired parietal bones
  • Squamous parts of the temporal bones
  • Interparietal part of occipital bone
91
Q

what are the cartilaginous part of the cranium? (4)

A
  • Ethmoid bone
  • Sphenoid bone
  • Petrous parts of the temporal bone
  • Occipital bone surrounding the foramen magnum
92
Q

connective tissue patches where more than two sutures meet

A

fontanels

93
Q

suture that separates paraietal to temporal?

A

squamous suture

94
Q

suture that separates the parietal to occipital bones

A

lambdoid

95
Q

metopic suture?

A

separates 2 frontal bone

96
Q

On _______ view the orbits are above the overlapping maxillary and petrous ridges.

A

caldwell view

97
Q

If looking for fractures in the occipital bone or the petrous portions use ________ rather than AP view or other views

A

Towne view

98
Q

To assess for facial fractures as well as acute sinusitis

o Petrous ridges are below maxillary sinuses

A

Waters view

99
Q

T or F? For trauma, to check for the facial bone and the skull usually you do the lateral view and the water’s view and if you have one more you do an AP view.

A

T

100
Q

aka pachymeninx?

A

Dura mater

101
Q

aka leptomeninx

A

arachnoid mater and pia mater

102
Q

Spaces where the pia mater and arachnoid membrane are not in close approximation.

A

Subarachnoid cisterns

103
Q

connect cortex with other areas in CNS; may be efferent (motor) or afferent tracts (sensory)

A

projection tracts

104
Q

tracts connecting different areas in the same hemisphere (intrahemispheric tracts)

A

association tracts

105
Q

▪ arcuate fasciculus
▪ superior and inferior occipito-frontal fasciculi
▪ cingulum, uncinate and inferior longitudinal bundle

these are examples of?

A

association tracts

106
Q

o tracts connecting the same cortical area in opposite hemispheres

A

commisural tracts

107
Q

• encloses the third ventricle
• connected above and in front with the cerebral hemispheres
• connected behind with the mid-brain
• upper surface is concealed by the corpus callosum
• covered by a fold of pia mater
o named the tela choroidea at the third ventricle
• inferiorly it reaches to the base of the brain

A

diencephalon

108
Q

neural arch is composed of?

A

pedicles and lamina

109
Q

what are the 4 processes in the vertebra?

A

o Transverse processes
o Inferior articular processes
o Superior articular processes
o Spinous process

110
Q
  • Large anterior cylindrical portion

* Predominantly responsible for bearing the weight of the spine and body above it

A

vertebral body

111
Q

o Short, thick bilateral processes from the posterolateral corner of the vertebral body
o Form lateral walls of vertebral foramen and join with lateral aspects of laminae posteriorly

A

Pedicle

112
Q

Bilateral, flattened plates that extend posteromedially from posterior margin of pedicles
o Meet in the midline forming the posterior wall of the vertebral foramen

A

Lamina

113
Q

Project posterolaterally from where the pedicles and laminae fuse

A

transverse process

114
Q

what vertebra?

o Small, oval-sized vertebral bodies
o Relatively wide vertebral arch with large vertebral foramen
o Relatively long, bifid inferiorly pointing spinous processes
o Transverse foramina protecting the vertebral arteries and veins

A

typical cervical

115
Q

what are the typical and atypical cervical vertebra?

A

Typical: C3 to C6
Atypical: C1, C2, C7

116
Q
  • Articulates with occiput to allow flexion, extension, and lateral flexion of head
  • Transverse ligament: holds the dens of the axis against the anterior arch.
A

atlas

117
Q

what view best appreciates the atlanto-axial joint

A

Open mouth AP

118
Q

what type of atlas fracture is jefferson fracture?

A

Type 3

119
Q

Communicated lateral mass fracture what type of atlas fracture?

A

type 4

120
Q

Plays an important role in rotation of the head with the majority of movement occurring around the dens at the atlanto-axial joint

A

Axis

121
Q

Spinous process ends in a rounded tubercle (not bifid)
• Transverse foramina are small, and do not transmit the vertebral artery
• Anterior tubercles are small

A

C7

122
Q

standard projections in cervical spine radiography?

A
  • AP
  • Lateral
  • Odontoid
  • AP oblique
  • PA oblique
123
Q

additional view in cervical spine radiography

A
  • Cervicothoracic view (Swimmer’s view)
  • Modified lateral
  • Flexion-extension lateral
  • Fuchs view
124
Q

85% to 90% of spinal injuries are evident on this view:

A

Lateral

125
Q

85% to 90% of spinal injuries are evident on this view:

A

AP

126
Q

Demonstrates intervertebral foramina of side positions further from the image receptor.

A

AP oblique

127
Q

To visualize the C7/T1 junction

A

cervicothoracic view (swimmer’s view)

128
Q

Non-angled AP radiograph of C1 and C2

A

Fuchs views

129
Q

most common MOI of cervical spine fracture?

A

flexion

130
Q

MOI of hangman’s fracture?

A

hyperextension

131
Q

MOI of jefferson’s fracture?

A

axial loading/compression

132
Q

• Traumatic spondylolisthesis of the axis
• Involves pars interarticularis of C2 on both sides
• Results of hyperextension and distraction
• Neurological impairment is seen only in 25% of patients
• Radiologic fractures:
o Bilateral lamina and pedicle fracture at C2
o Usually associated with anterolisthesis of C2 on C3
o Extension of the fracture to the transverse foramina should be sought, raising the possibility of vertebral artery injury.

A

Hangman Fracture

133
Q
  • Fractures of the spinous process of a lower cervical vertebra
  • Often these injuries are unrecognized at the time and only found incidentally years later when the cervical spine is imaged for other reasons
A

Clay shovelers fractures

134
Q

o Medium-sized, heart shaped vertebral bodies
o Medium-sized vertebral canal
o Prominent transverse processes with costal facets
o Long spinous processes angulating downwards.

A

Thoracic vertebra

135
Q

what are the typical thoracic vertebra?

A

t2 to t8

136
Q
  • A.k.a seatbelt fracture
  • Flexion-distraction type injuries of the spine that extend to involve all thre spinal columns
  • Unstable injuries and have a high association with intra-abdominal injuries
  • Most commonly occurs about the upper lumbar spine (with the thoracolumbar junction accounting for 50% of cases), but it may be observed in the mid lumbar region in children.
A

Chance fractures

137
Q

A type of compression fracture related to high-energy axial loading spinal trauma that results in disruption of the posterior vertebral body cortex with retropulsion into the spinal canal.

A

Burst Fracture

CMED 311 (47 decks)

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