Musculoskeletal Imaging: Spine and Pelvis

Question 2

When examining images in MSK, we use AABCSS, which 2 of the following are the As?

1 - A = adequacy
2 - A = autonomy
3 - A = alignment
4 - A = asymmetry

Answer 2

1 - A = adequacy
- cover area required, correct patient position

3 - A = alignment
- are bones aligned the correct way

Question 3

When examining images in MSK, we use AABCSS, what does the B stand for?

1 - B = bilateral symmetry
2 - B = bony landmarks included
3 - B = bones
4 - B = both limbs imaged

Answer 3

3 - B = bones
- draw around cortical bone looking for break
- look inside trabecular bone for tumours or breaks

Question 4

When examining images in MSK, we use AABCSS, what does the C stand for?

1 - C = cartilage or joint
2 - C = contrast
3 - C = complete image
4 - C = correct patient

Answer 4

1 - C = cartilage or joint
- narrowing of the joint
- aligned and even throughout

Question 5

When examining images in MSK, we use AABCSS, which 2 of the following do the SS stand for?

1 - S = superior and inferior views
2 - S = satisfaction of search
3 - S = swelling and oedema
4 - S = soft tissue

Answer 5

2 - S = satisfaction of search
- double check everything, even if there is a very obvious fracture

4 - S = soft tissue
- swellings
- tissue damage that indicate bone damage

Question 6

According to NICE guidelines which imaging modality is best following trauma for the spine and hips?

1 - ultrasound
2 - X-ray
3 - CT
4 - MRI

Answer 6

3 - CT

MRI would be preferred, but difficult to get in trauma setting

Question 7

In anteroposterior imaging, do the beams pass from front to back or back to front?

Answer 7

• front to back as the name suggests

Question 8

Is the standard imaging of the spine and hips anteroposterior (AP) or posterioranterior (PA)?

Answer 8

• anteroposterior (AP)
• lateral is also important for the spine

Question 9

Which 2 of the following is MRI best for in terms of the spine?

1 - trauma
2 - metastases
3 - metabolic
4 - degenerative

Answer 9

2 - metastases
4 - degenerative

Question 10

What type of fracture can we see in the image below?

1 - osteoarthritic
2 - osteoporotic
3 - ankylosing spondylitis
4 - RA

Answer 10

2 - osteoporotic
- low bone mineral ontent

Question 11

What can we see in the image below?

1 - osteoarthritic
2 - kyphosis
3 - ankylosing spondylitis
4 - scoliosis

Answer 11

4 - scoliosis

Question 12

What can we see in the image below?

1 - osteoarthritic
2 - kyphosis
3 - ankylosing spondylitis
4 - scoliosis

Answer 12

2 - kyphosis

Question 13

What can we see in the image below?

1 - osteoarthritic
2 - kyphosis
3 - ankylosing spondylitis
4 - scoliosis

Answer 13

3 - ankylosing spondylitis

• syndesmophytes – extend vertically and leads to bamboo (rigid) spine
• ossification of spinal ligaments and annulus fibrosus
• osteophytes are often larger and more horizontal

Question 14

What can we see in the image below?

1 - osteoarthritic
2 - osteoporotic
3 - osteomyelitis
4 - osteomalacia

Answer 14

1 - osteoarthritic
- typically asymmetrical

Use LOSS mnemonic:
- L = loss of joint space
- O = osteophytes
- S = subchondral sclerosis
- S = subchondral cysts

Question 15

What can we see in the image below?

1 - osteoarthritic
2 - rheumatoid arthritis
3 - osteomyelitis
4 - osteomalacia

Answer 15

2 - rheumatoid arthritis
- bilateral effects

• femoral head pushes into ring of pelvis
• reduced joint space

Question 16

What can we see in the image below?

1 - pagets disease
2 - rheumatoid arthritis
3 - osteomyelitis
4 - osteomalacia

Answer 16

1 - pagets disease

• common in men, usually >50yrs
• loss of normal bone architecture
• coarse trabecular pattern and bony expansion
• bones are weakened

Question 17

What can we see in the image below?

1 - pagets disease
2 - rheumatoid arthritis
3 - osteomyelitis
4 - avascular necrosis

Answer 17

4 - avascular necrosis
- head of femur on left hip

Question 18

What can we see on the images below?

1 - cord compression
2 - kyphosis
3 - ankylosing spondylitis
4 - scoliosis

Answer 18

1 - cord compression
- likely to be due to melanoma with multiple metastases of the spine

Question 19

What can we see on the images below?

1 - cord compression
2 - kyphosis
3 - ankylosing spondylitis
4 - cauda equina lesion

Answer 19

4 - cauda equina lesion

• L5/S1 level

Question 20

What can we see on the images below?

1 - cord compression
2 - spondylodiscitis
3 - ankylosing spondylitis
4 - cauda equina lesion

Answer 20

2 - spondylodiscitis

• Infection of the intervertebral disc and adjacent vertebrae
• In adults, endplates are infected first then the discs
• In children the disc is usually infected first
• X rays are less sensitive in the early stages, MRI is the best modality