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MSK-Derm by Minnie > SM 226a - MSK Imaging > Flashcards

SM 226a - MSK Imaging Flashcards

1
Q

Which imaging modality is most commonly used during musculoskeletal procedures?

Which kinds of procedures?

A

Fluoroscopy

Used when injecting contrast (for arthrography), or steroids

Used to guide synovial fluid sampling

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2
Q

What are the imaging recommendations for evaluating neck pain?

A
  • Plain x-ray series
  • Consider MRI if x-rays are normal but there signfiicant pain or other symptoms
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3
Q

What is the role of ultrasound in the evaluation of musculoskeletal pathologies?

A

Evaluation of superficial soft tissues

Tendons, ligaments, nerves

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4
Q

Relative or absolute contraindication to MRI?

Aneurysm clips

A

Relative

(Consider postponement or other imaging modalities if posisble)

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5
Q

Describe the scoring system for Dual X-ray absorptiometry

A
  • T-score: Difference between bone mineral density of patient and the standard young adult population
    • <1 SD from the mean = normal
    • 1-2.4 SD from the mean = osteopenia
    • >2.5 SD from mean = osteoporosis
    • >2.5 SD from mean + one or mor low-trauma fractures = severe osteoporosis
  • Z-score: Difference between bone mineral density of patient and the standard for patients that age (same ranges)
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6
Q

Relative or absolute contraindication to MRI?

Stimulator

A

Absolute

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7
Q

Which imaging modality usually guides soft-tissue procedures?

A

Ultrasound

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8
Q

What information can we learn from PET imaging?

A

Identify areas of increased metabolic activity

Useful in finding and evaluating cancer metastasis

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9
Q

What are the uses of image-guided biopsy?

A

Evaluate a known lesion of unknon etiology

Confirm a diagnosis

Staging of disease

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10
Q

Relative or absolute contraindication to MRI?

Patient’s weight exceeds the weight limit

A

Absolute

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11
Q

What are the advantages of bone scintigraphy?

What are the disadvantages?

A
  • Advantages
    • Sensitive
    • Provides physiologic information about bone homeostasis
    • Localize areas of high bone turnover/deposition
      • Identify sites fo tumor or metastasis
    • Can do whole-body imaging
  • Disadvantages
    • Not specific
    • Time-intensive (4-6 hours)
    • Exposure to ionizing radiation
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12
Q

What imaging modality will uncover areas of rapid bone turnover?

A

Bone scintigraphy

(A type of nuclear medicine)

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13
Q

What is a myelogram used for?

What can we learn?

A

Contrast is introduced into the thecal (dural) sac; contrast injection is guided by CT or fluorscopy

CT evaluates where the contrast has gone

This helps us see if there is a bone or soft tissue pathology that is affecting where the contrast goes after it is injected

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14
Q

What are the contraindications to arthrography?

A

Contrast allergy

Same as contraindications to MRI

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15
Q

What are the advantages of fluoroscopy?

What are the disadvantages?

A
  • Advantages
    • Dynamic imaging
  • Limitations
    • Radiation exposure to patient and operator
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16
Q

What is bone scintigraphy?

What is it used for?

A

A whole-body bone scan

  • Normal result = normal bone
  • Abnormal result indicates an area of the body with high bone turnover, but does not reveal the specific pathology
    • Provides physiologic information
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17
Q

Relative or absolute contraindication to MRI?

Pacemaker

A

Absolute

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18
Q

What are the imaging recommendations for evaluating a neoplasm

A
  • Plain x-ray
  • MRI with contrast
    • If osseous, must image joint to joint
      • Ex: if concerned about femur, get knee through hip
    • Contrast helps us see if there is active blood flow (necrosis or hemorrhage)
  • CT
  • Nuclear medicine study
    • Bone scintigraphy or PET CT to identify osseous metastasis
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19
Q

What are the imaging recommendations for evaluating osteomyelitis in a non-diabetic patient?

A
  • Plain radiograph
  • MRI with contrast
20
Q

What are the relative contraindications for MRI?

A

Aneurysm clips

Metal

21
Q

Which imaging modality usually guides bone biopsy?

A

CT

22
Q

What are the imaging recommendations for evaluating osteomyelitis in a diabetic patient?

A
  • Plain x-ray
  • MRI
    • No contrast due to impaired renal function
  • Nuclear medicine study
23
Q

What conditions could result in a positive bone scan (bone scintigraphy)?

A

Anything that leads to increased bone deposition and blood flow

  • Fracture healing
  • Infection
  • Biastic metastases
  • Tumor
24
Q

What are the advantages of ultrasound in the evaluation of musculoskeletal pathologies?

What are the disadvantages?

A
  • Advantages
    • Patient friendly
      • No radiation or contrast
    • Dynamic imaging
      • Some pathologies are only evident when the patient is moving
    • Inexpensive
  • Limitations
    • User-dependent
    • Not great for looking at bone
25
Q

What is the role of nuclear medicine in the evaluation of musculoskeletal pathologies?

A

Detect osteoporosis and fracture risk

Example: Dual x-ray absorptiometry (DXA)

26
Q

What are the advantages of MRI in the evaluation of musculoskeletal pathologies?

What are the limitiations?

A
  • Advantages
    • Superior evaluation of joints, soft tissue, and cartilage
    • Superior contrast resolution
    • No rdiation exposure
  • Limitations
    • Not patient-friendly
      • Takes a long time
      • May induce claustrophobia
      • Obese patients
27
Q

What are the imaging recommendations for evaluating joint pain?

A
  • Plain x-ray
  • Consider MRI if you are looking for a soft tissue injury
  • Ultrasound may be used to evaluate superficial tendons
28
Q

What are the advantages of conventional radiography?

What are the limitations?

A
  • Advantages
    • Inexpensive
    • Reproducible; can follow a disease process over time within an institution or between different institiutions
    • Minimal radiation
  • Limitations
    • Occult fractures; may be hidden if structures overlap
    • Limited evaluation of soft tissue
    • Must have at least 2 views
29
Q

Which imaging modality will help us determine a patinet’s risk fo osteoporosis and fracture?

A

Dual x-ray absorptiometry

(A type of nuclear medicine)

30
Q

What procedures require image guidance?

A
  • Biopsy
  • Arthrography
  • Myelogram
  • Therapy
    • Corticosteroid injection
    • Calcific tendinitis lavage
    • Vertebroplasty
    • Thermal ablation
31
Q

Relative or absolute contraindication to MRI?

Metal in the orbit

A

Absolute

32
Q

What are the advantages of a myelogram?

What are the limitations?

A
  • Advantages
    • Can be used if MRI is contraindicated
    • Evaluation of the bone
    • Dynamic imaging is possible
  • Disadvantages
    • Contraindicated for patients with contrast allergies
    • Exposure to ionizing radiation
    • Invasive procedure; potential injury to nerve roots
    • Not as good as MRI for soft tissue evaluation
33
Q

What are the imaging recommendations for evaluating chronic back pain in an adult?

A
  • Plain x-ray
  • MRI for follow-up or if indicated by x-ray findings
34
Q

List three types of nuclear medicine commonly used in musculoskeletal medicne.

What is each one used for?

A
  • Dual x-ray absorptiometry
    • Evaluates bone density to evaluate risk of ostoporosis and fracture
  • Bone scintigraphy
    • A “bone scan”
    • Uncovers areas of rapid bone turnover
    • Sensitive but not specific
  • PET scan
    • Identify areas of increased metabolism
    • Useful in identifying and evaluating metastases
35
Q

What is dual x-ray absorptiometry (DXA)?

A

A type of nuclear medicine that helps to detect osteoporosis and evaluate fracture risk

  • Low resolution x-ray images of the lumbar spine and proximal femer
  • This helps determine if the patien thas a loss in bone mineral density that would increase their risk of osteoporosis and fracture
36
Q

What are the indications for x-ray?

A

Evaluation of…

  • Trauma
  • Infection
  • Arthritis
  • Mechanism of injury
  • Need for MRI
37
Q

What are the imaging recommendations for evaluating occult fractures?

A
  • Plain x-ray (at least 2 views)

If x-ray is normal but there is concern for injury, consider CT, MRI, nuclear medicine study

38
Q

Describe the advantages and disadvantages of CT imaging

A
  • Advantages
    • ​Superior spatial resolution
    • Multi-planar images possible
    • Widely available
    • Fast
  • Disadvantages
    • More expensive than x-ray
    • More ionizing radiation
    • Artifact with metal - may degrade the quality of the image
39
Q

What are the imaging recommendations for evaluating acute back pain?

A
  • Plain x-ray
  • Consider CT if related to direct trauma
  • MRI if there is suspicion of soft-tissue injury
40
Q

What is arthrography?

What is it used for?

A

Arthrography introduces contrast into the joint so that we can evaluate the joints

Usually in conjunction with MRI; “MRI with contrast”

Used to evaluate:

  • Labrum (potential tears)
  • Cartilage
  • Rotator cuff tendons
  • Intrinsic ligaments
41
Q

List the absolute contraindications to MRI

A
  • Cardiac devices; pacemakers or stimulaors
  • Metal in the orbit
  • Patient’s weight exceeds weight limit
42
Q

If MRI is contraindicated, which alternative imaging can be used?

A

Myelogram

(Introduce contrast to the dural sac, use CT to see where it goes)

43
Q

What are the imaging recommendations for evaluating chronic back pain in a child?

A
  • Plain x-ray
    • will catch most pathologies in adolescents
  • Nuclear medicine exam
  • MRI only if previous tests are inconclusive and there is suspicion that something is wrong
44
Q

Relative or absolute contraindication to MRI?

Recently-placed metal in the body

A

Relative - may migrate or heat up

Postpone imaging or use other modality if possible

45
Q

What imaging modality is the mainstay for evaluation of bones?

A

Conventional radiography (x-ray)

MSK-Derm by Minnie (48 decks)

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