Principles of Imaging/Radiology Flashcards

1
Q

what are the most common types of arthritis?

A

rheumatoid arthritis

osteoarthritis

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2
Q

what joints are usually affected in OA?

A

weight bearing joints as due to wear and tear (spine, hip, knee, thumb base)
often asymmetrical

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3
Q

what are the radiological features of OA?

A
asymmetrical loss of joint space
subchondral sclerosis
subchondral cysts
osteophyte formation
gross joint deformity
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4
Q

what causes subchondral sclerosis in OA?

A

increased subchondral bone cellularity and vascularity excited bone turnover

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5
Q

what causes osteophytes formation?

A

periosteal formation

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6
Q

describe joint involvement in RA?

A
only affects synovial joints
symmetrical
commonly
- MCP, MTP
- PIP
- wrists, hips, knees, shoulders
- C1/C2
DIP sparing
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7
Q

what happens in the synovium in RA?

A

increased proliferation and vascularisation in synovium

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8
Q

what are the radiographic features of RA?

A
soft tissue swelling 
periarticular osteoporosis (darkening of bone on X ray due to loss of bone density)
destruction of joint margin by inflammatory pannus (later throughout the joint)
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9
Q

what causes soft tissue swelling in RA?

A

synovial proliferation and reactive joint effusion

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10
Q

what causes osteoporosis in RA?

A

hyperaemia causes bone demineralisation

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11
Q

how can deformity occur in RA?

A

capsular and ligamentous softening allow joint subluxation and deformity

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12
Q

what can happen to eroded bone in RA?

A

eroded bone ends may fuse (ankylosis)

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13
Q

what are the common characteristics of sero-negative arthritis?

A

sacro-iliac joint and spine involvement
ill defined periarticular bone formation
tendency to joint ankylosis

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14
Q

describe new bone formation in RA vs OA?

A

RA = more fuzzy and ill defined

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15
Q

why are fractures more unstable in RA?

A

bc all bones and ligaments etc are ossified so no soft tissue to stabilise the fracture

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16
Q

name 3 types of sero-negative arthritis?

A

psoriatic arhtitis
ankylosing spondylitis
reiter’s syndrome (reactive arthritis)

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17
Q

what are the shared features of each sero-negative arthritis?

A

sacroiliac joint and spine involvement
ill defined periarticular bone formation
tendency to joint ankylosis

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18
Q

what do radiographic features indicate in arthritis?

A

indicate that bone and joint damage that has already occurred, therefore patients might have missed the opportunity to have their disease modified

19
Q

what early features of arthritis can be shown by other imaging tests and may indicate that its not too late to modify the disease?

A
increased joint vascularity
inflamed synovium 
bone marrow oedema
subtle early bone erosion
- e.g bone scan, doppler US, MRI, MR
20
Q

what can be seen on imaging of the spine?

A
bones
ligaments
IV discs
Spinal cord and nerves
blood vessels
21
Q

what is the most detailed imaging?

A

X ray = bone outline
CT = detailed bone outline and some soft tissues
MRI = bone outline, bone marrow, discs, ligaments, spinal cord and nerves (all soft tissue)

22
Q

describe normal curvature of the spine

A

smooth

loss of normal alignment spells trouble

23
Q

what are the common features of all vertebrae from C3-L5?

A
vertebral body
posterior arch containing
- 2 pedicles
- 2 laminae
- 1 spinous process
- 2 transverse processes
24
Q

where is the neural foramen in vertebrae?

A

lies inferior to the pedicle

25
Q

what forms the facet joints?

A

articular processes project superiorly and inferiorly between the pedicles and laminae forming the facet joints with adjacent vertebrae

26
Q

how can adjacent vertebrae indicate a problem?

A

consecutive vertebrae usually have similar size

variation can indicate problem

27
Q

describe C1

A

no vertebral body

anterior and posterior arch united by two large lateral masses

28
Q

describe C2

A

has an odontoid process which projects superiorly into C1 forming a joint with its anterior arch

29
Q

what is the best imaging to use for spinal fracture?

A

CT

30
Q

when is a CT used in spinal trauma?

A

if X ray shows fracture but more detail needed

if X ray normal but high clinical suspicion of fracture

31
Q

what provides stability to the spinal column?

A

surrounding ligaments

32
Q

how can you image spinal ligaments?

A

only MRI

but seeing normal alignment of the vertebrae on X ray or CT implies intact ligaments and a stable spine and vice versa

33
Q

what do normal/damaged ligaments look like on MRI?

A

normal = black
damaged = light
gap in black line shows where tear is in the ligament

34
Q

when is MRI used in spinal trauma?

A

to get detail of spinal ligaments

in patients with neurological deficit which is not explained by X ray or CT

35
Q

what soft tissue injuries can cause a neurological deficit?

A

acute prolapsed IV disc
epidural haematoma
spinal cord damage

36
Q

what does a bony tumour look like on X ray and CT?

A

bone destruction
vertebral collapse
bone sclerosis

37
Q

what does a bony tumour look like on MRI?

A
early = bone marrow infiltration
late = extradural mass and spinal cord compression
38
Q

what do bone metastases look like on MRI?

A

dark spots within the bone

39
Q

how are IV discs imaged?

A

discs are invisible on X rays (may show some disc space narrowing but correlates poorly with sciatica symptoms)
CT and MRI can show discs but MRI is best as it shows earlier disc dehydration

40
Q

how is the spinal cord imaged?

A

invisible on X ray and only poorly shown by CT

only adequately shown by MRI

41
Q

what can cause spinal cord disease?

A

trauma
demyelination
tumour
ischaemia

42
Q

describe the disease distribution in psoriatic arthritis

A

small joints of hands and feet
DIP joints
IP joint of big toe

43
Q

describe the disease distribution of ankylosing spondylitis

A

scattered lower limb large joints

44
Q

describe the disease distribution of reiters syndrome

A

scattered lower limb large joints

lower limb entheses