15: Musculoskeletal Imaging Flashcards Preview

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Flashcards in 15: Musculoskeletal Imaging Deck (41)
1

Deciding on modalities for imaging

Body part of interest
DDx
Age
Pt Hx
Cost of exam
radiaiton dose
availability

2

Guidelines for choosing a modality

Whats the clinical question
What test will mostly likely answer this question
If more than one will work: which is safest and cost effective?

3

What do we search for in imaging

fractures, hardware fail, calcifications, tumors, degenerative arthritis
**Hardware, joints, bones, soft tissues**

4

Pitfalls of musculoskeletal radiology

wrong study/ poor quality satisfaction of search/ timing of exam/ lack of correlation btwn image findings and clincial findings

5

embedded w/in a tendon where the tendon passes over a joint

sesamoid bone

6

Key points for a DDx

Vindicate Vascular/infection/ neoplasm/ drugs/ inflamatory/ congenital/autoimune/ trauma/ endocrine

7

Benign vs malinant

Benign: lesion well circumscribed, no soft mass, no periosteal involvement.
Malignant: no nice margins, goes out of bone, soft mass around it is fluffly and is periosteal rxn

8

Codmans triangle

seen in matrix and periosteal reactions; periosteum is pushing out

9

Calcifications

non malignant but cause pain and look suspicious on xray; Aunt Minnie
crest syndrome is on DIPs
Soft tissue hemangiomas in

10

Effusions

seen in joints: knee, elbow, ankle, wrist, fingers

11

If you see fat and blood in joint and the are different layers could be

lipohemarthrosis: there was a break in the bone and marrow leaked out. once you see it, you should think there is a fracture somewhere

12

Transverse fracture of proximal diaphysis of 5th metatarsal base, outside of joint. hard to heal and need to follow up with ortho

Jone frx

13

intrareticular joint frx through the first metacarpal bone at base of the thumb, needs a pin... hard to heal

Rolando fracture

14

bone fracture which occurs when a fragment of bone tears away from the main mass of bone as a result of physical trauma

Avulsion fracture

15

avulsion fracture (soft tissue structures tearing off bits of their bony attachment) of the lateral tibial condyle of the knee, immediately beyond the surface which articulates with the femur.

Segond Fracture

16

see osteophytes, asymmetric joint loss and predictable pattern

Osteoarthritis (most common arthritis)

17

Rheumatiod, Seronegative syndromes and deposition diesease all examples of

inflammatory arthritis

18

Gout and pseudogout are examples of

deposition diseases

19

Good for initial exam of many musculoskeletal complaints but often limited: you can eval most every part of body with this but has varying sensitivity.

Radiographs

20

Pros of radiographs

cheap, readily available, many different views and techniques, good initial test

21

Cons of radiographs

radiation dose, limited sensitivty, doesn't work on all areas equally

22

allows real time eval of structures and can be used intra operatively, to set fractures and guide procedures

Fluroscopy

23

Used a lot for intervential radiology, GI and GU radiology, lumbar punctures, joint injections and biopsies

Fluroscopy

24

Pros of Fluroscopy

allows real time eval, procedural guidance, placement of needles, tubes, stents and catheters

25

Cons of Fluroscopy

radiation exposure, image quality is limited

26

Very cost effective and no radiation when doing a musculoskeleteal system eval

ultrasound

27

Used to guide procedures, biopsies, aspirations, joint injections; also to eval tendons and ligaments

ultrasound

28

Use it to eval cortical surface of bone for erosions in disease like RA

ultrasound

29

Pros of Ultrasound

no radiation, portable, take up little space, no special prep

30

Cons of ultrasound

use dependent and can't eval all structures

31

Used to eval for further and characterize osseous lesions and fractures, to eval for superficial and deep infections, eval post traumatic and devo deformities

CT

32

Can look at soft tissues but not that great

CT

33

Pros of CT

fast and available, covers lots of anatomy, great for procedures

34

Cons of CT

over utilized, $$, meta artifacts, radiation dose

35

Gold standard for eval of muscles, tendons, ligaments, joints as well as eval of cortical bone and marrow

MRI

36

Pros of MRI

great soft tissue detail, no radiation, images in any plane

37

Cons of MRI

$$$, long exams, metal artifacts, claustrophobia

38

less anatomy driven and more of a focus on physiology and function

Nuclear medicine

39

radioactive material injected into patient and imaging shows distribution in the body

Nuclear medicine

40

Pros of Nuclear medicine

Provides functional data, can direct future radiolgy exams, high sensitiviy

41

Cons of nuclear medicine

poor anatomic detail, radiation dose, low specificity, $$$