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NYCC Bone & Joint > (2,3) Radiologic Predictor Variables > Flashcards

(2,3) Radiologic Predictor Variables Flashcards

1
Q

What general acronym should you use when building a differential diagnosis?

A

VINDICATES

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2
Q

What does VINDICATES stand for?

A

Vascular
Infectious
Neoplastic
Degenerative/drugs
Inflammatory/iatrogenic
Congenital
Autoimmune
Trauma
Endocrine/nutritional/metabolic
Sych (psychological)

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3
Q

What clinical data should be considered when building a differential diagnosis?

A
  • age
  • sex
  • race
  • history
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4
Q

What acronym should be used for radiologic analysis of tumors?

A

L’PoD’Z PMS

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5
Q

What factor should you always start with when analyzing lesions?

A

age

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6
Q

What features of a clinical presentation would increase concern for malignancy, warranting a radiograph?

A
  • unable to recreate pain on ortho. tests (non-mechanical pain)
  • night pain
  • deep boring bone pain
  • night sweats
  • unexplained weight loss
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7
Q

What 6 features should you consider when examining lesions on an x-ray?

A

L’PoDZ PMS:
- Location
- Pattern of Destruction
- Zone of transition
- Periosteal reaction
- Matrix pattern
- Soft tissue mass

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8
Q

What should you consider when describing the location of a lesion?

A
  • what bone(s) are involved
  • where in the bone
  • central/eccentric
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9
Q

What should you consider when describing what bones are involved in radiographic lesions?

A
  • how many bones
  • what areas of the body
  • endochondral vs intramembranous ossification
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10
Q

When examining radiographic lesions, what should you consider when describing what part of the bone is affected?

A
  • epiphysis/apophysis (secondary oss.)
  • metaphysis
  • diaphysis
  • central/medullary
  • eccentric/cortical
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11
Q

Tuberosities, trochanters, and epicondyles are examples of what part of a bone?

A

apophysis

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12
Q

Carpals and tarsals are considered ____ equivalents

A

epiphyseal

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13
Q

Carpals and tarsals undergo ____ ossification

A

endochondral

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14
Q

Lesions that prefer ____ will also affect the carpals and tarsals

A

epiphyses and apophyses

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15
Q

A lesion located in the middle of the medullary canal is termed ____

A

central

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16
Q

A lesion that is cortically-based is termed ____

A

eccentric

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17
Q

What are the 2 general categories for pattern of destruction in bone?

A

osteolytic
osteoblastic

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18
Q

Osteolytic lesions appear ____ radiographically

A

radiolucent

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19
Q

Osteoblastic lesions appear ____ radiographically

A

radiopaque

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20
Q

What are the osteolytic patterns of destruction?

A
  • permeative
  • motheaten
  • geographic
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21
Q

What are the osteoblastic patterns of destruction?

A
  • focal/localized
  • multifocal
  • diffuse
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22
Q

TRUE/FALSE:
The terms “benign” and “malignant” can be used when describing lesions radiographically

A

FALSE
need biopsy to use these terms

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23
Q

Which osteolytic pattern(s) of destruction are considered aggressive?

A
  • permeative
  • motheaten
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24
Q

Which osteolytic pattern(s) of destruction are considered non-aggressive?

A

geographic (generally)

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25
What osteolytic pattern of destruction is described by a "dipped in acid" appearance?
permeative
26
What does a permeative pattern of destruction look like?
- individual pinhole lesions <1mm diameter (can conglomerate and appear larger) - ill-defined border - "dipped in acid" appearance
27
What does a motheaten pattern of destruction look like?
individual holes >1mm diameter (can conglomerate and appear larger)
28
____ and ____ destruction are a continuum of eachother
permeative & motheaten
29
What pattern of destruction is described as an "island of disease"?
geographic lytic
30
As a general rule, are blastic patterns of destruction aggressive or non-aggressive?
more aggressive
31
What does a focal pattern of destruction look like?
one lump of (blastic) disease
32
What does a multifocal pattern of destruction look like?
multiple individual/focal (blastic) lesions
33
What does a diffuse pattern of destruction look like?
^opacity involving larger portions of skeletal structure
34
What pattern of destruction is involved in osteopetrosis?
diffuse
35
What is a zone of transition?
interface between normal bone and diseased bone
36
A zone of transition can be ____ or ____
long (wide) or short (narrow)
37
A ____ zone of transition is considered aggressive
long/wide
38
A ____ zone of transition is generally considered non-aggressive
short/narrow
39
Permeative and motheaten destruction typically have a ____ zone of transition
long/wide
40
Geographic lytic destruction typically has a ____ zone of transition
short/narrow
41
What is a long/wide zone of transition?
No sharp demarcation between healthy and diseased bone
42
What is a short/narrow zone of transition?
Sharp demarcation between healthy & diseased bone (can tell exactly where it stops)
43
What is referred to as the "skin" of bone?
periosteum
44
What is reactive bone formation?
intramembranous bone formed in response to stress (lifting of periosteum) on bone or soft tissue
45
Reactive bone formation is also called _____
periosteal reaction
46
What are the types of periosteal reaction?
- solid - laminated - spiculated - codman's triangle
47
Which type of periosteal reaction is the least aggressive?
solid
48
A ____ periosteal reaction is described as a focal, cortical thickening
solid
49
What is a solid periosteal reaction?
as periosteum is lifted slowly, it has time to fill in completely
50
What are potential causes of solid periosteal reaction?
- bone hemorrhage (eg. fatigue Fx) - benign bone tumors (eg. osteoid osteoma)
51
A ____ periosteal reaction is described as an "onion skin" appearance
laminated
52
What is a laminated periosteal reaction?
- lifts periosteum, stops, repeats - lays down bone during rest phase
53
A ____ periosteal reaction is described as a "hair on end" or "sunburst" appearance
spiculated
54
What is a spiculated periosteal reaction?
periosteum is lifted rapidly, and bone growth occurs along Sharpey fibers
55
What is a Codman's triangle periosteal reaction?
process extending beyond bone rapidly, stripping periosteum away from adjacent *uninvolved* bone, creating a "triangle" appearance
56
What do aggressive types of periosteal reaction have in common?
there is a soft tissue mass extending beyond the bone
57
What are the patterns of matrix calcifcation?
- no calcification - target calcification - stippled calcification - blastic lesion - ground glass
58
What does matrix calcification tell us about a tumor?
what it's made of
59
What type of matrix calcification occurs in purely lytic lesions?
none (can't tell matrix)
60
What type of matrix calcification occurs with fatty tissue?
target calcification/sequestrum
61
What type of matrix calcification occurs with cartilaginous tissue?
stippled calcification
62
What type of matrix calcification occurs with osseous tissue?
blastic lesion
63
What type of matrix calcification occurs with fibrous tissue?
ground glass
64
What is target calcification/sequestrum?
central calcification of fat in bone
65
What is stippled calcification?
macrocalcification of cartilage appearing as individual white dots (looks like ice cube)
66
What is ground glass appearance?
microcalcification of fibrous tissue creating an opaque "frosted glass" appearance
67
What 2 factors indicate a soft tissue mass extending beyond the bone?
- aggressive periosteal Rxn - displacement of fascial planes
68
Soft tissue mass is typically only seen in ____ bone tumors
primary (not metastatic)
69
If a tumor metastasizes to bone, will there be a soft tissue mass extending beyond the bone?
NO (rarely)
70
____ do not cross joints, while ____ will readily cross joints.
- tumors - infections
71
A radiograph shows a lytic lesion with a narrow zone of transition, a "soap-bubble" appearance, and a laminated periosteal reaction. Is this lesion aggressive or non-aggressive?
aggressive (1 aggressive characteristic = aggressive)
72
If your differential diagnosis includes tumor or infection, what follow-up imaging is required?
MRI with contrast
73
What distinguishes the epiphysis of a bone from the metaphysis?
physeal scar
74
What acronym is used for differential diagnoses of geographic lytic lesions?
FEGNOMASHIC
75
What acronym is used for differential diagnoses of aggressive lesions in older adults?
MML
76
What is the radiographic latent period for periosteal reactions?
10-21 days
77
What is the acronym for differential diagnoses of lesions with a cartilage matrix?
ICE

NYCC Bone & Joint (71 decks)

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