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MBBS II MSS > L05 – Introduction to Radiology of the Musculoskeletal System > Flashcards

L05 – Introduction to Radiology of the Musculoskeletal System Flashcards

1
Q

What are the soft tissues in a typical joint?

A

Muscle
Tendon
Ligament
Bursa

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2
Q

What are the advantages of radiography?

A

Readily available
Cheap and fast
Good bone and joint details especially for appendicular skeleton

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3
Q

What are the disadvantages of radiography?

A

Ionizing radiation
Limited soft tissue visualisation and differentiation
Not so good for complex anatomy or pathology

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4
Q

What are the applications of radiographic visualization in MSS?

A

1) Fracture
2) Bone tumors: Classification and diagnosis
3) Infection or inflammation i.e. osteomyelitis
4) Spinal column pathology: gross morphology i.e. degenerative scoliosis

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5
Q

Explain how CT scans work?

A

Combines continuous gantry rotation with table motion
» path of X-ray beam around patient follows a helical path
» Data acquired in single slice / single volume

Multi-slice helical scans produce a set of interleaved helices for reconstruction

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6
Q

Difference between helical CT scanning and Multi-slice helical reconstruction?

A

Helical scanning = one source, one detector

Multi-slice = increased detail and resolution using multiple sources and detectors

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7
Q

What are the advances in CT technology?

A

Faster scanning time for faster anatomical coverage

Higher resolution and finer detail

Software advances to improve image quality and 3D reconstruction

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8
Q

Advantages of CT in viewing MSS?

A
  • Excellent for complex bone details
  • Detects subtle soft tissue calcification
  • Allow reconstruction into different planes (e.g. saggital, coronal)
  • guide aspiration/ biopsy in deep tissue
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9
Q

Disadvantages of CT in viewing MSS?

A

Ionizing radiation higher
Quite expensive
Not as good as MRI and ultrasound for soft tissues differentiation

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10
Q

When is CT used to view MSS?

A
  • Trauma with complex anatomy (i.e. pelvus, foot)
  • Fast investigation in severe trauma with widespread damage
  • High definition of bony details and calcification in tumours
  • Deep seated abscess due to infection
  • Guide nerve root block
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11
Q

What is HRUS used for visualizing?

A

High Resolution Ultrasound(HRUS)

For viewing superficial soft tissue details

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12
Q

Advantages of HRUS?

A
  • No ionizing radiation
  • Inexpensive
  • Good for soft tissue details in superficial structures, masses
  • Excellent spatial resolution particularly in superficial joints
  • Real-time examination
  • Available (+++), convenient
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13
Q

Disadvantages of HRUS?

A
  • Operator dependent
  • Long learning curve
  • Limited depth of penetration of sound beam = poor delineation of large or deep masses/ cannot see through bone
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14
Q

When is HRUS used?

A

Confirm mass

superficial soft tissue pathology

Real-time examination of joints and tendons

Real-time guidance for aspiration or biopsy

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15
Q

What superficial soft tissue pathologies can HRUS help delineate?

A
  • Cystic (hypoechoic/dark) or Non- cystic (hyperechoic/ light) masses
  • Effusion vs Synovial thickening
  • Dx of neurogenic tumour, lipoma
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16
Q

What is the imaging sequences of MRI?

A

1) T1- weighted: view Bone and Fat
2) Proton-density with fat suppression: view Cartilage and ligament
3) T2- weighted with fat suppression: view fluid retention/ edema, malignancies

17
Q

Advantages of MRI in viewing MSS?

A 
NO radiation 
multiplanar capability 
excellent soft tissue differentiation 
sensitive to bone marrow changes (similar to nuclear scan) 
 spinal and epidural lesions
18
Q

Disadvantages of MRI in viewing MSS?

A

Not readily available
Very expensive
Contraindicated in patient with pacemaker or electronic devices

19
Q

What type of trauma needs MRI for viewing?

A

spinal and epidural lesions***

soft tissue or ligamentous injuries e.g. knee, shoulder, ankle***

trabecular fracture

20
Q

Why is MRI needed for viewing tumors?

A

staging (not for diagnosis, cannot differentiate subtypes)

choosing biopsy site (MRI should be performed before biopsy)

21
Q

Give examples of MSS infections that MRI can visualize?

A

osteomyelitis, myositis, arthritis (also seen with HRUS), tenosynovitis (also seen with HRUS), cellulitis

22
Q

Give examples of spinal column and canal pathologies viewed by MRI.

A

Modality of choice for spinal and epidural lesions:

 Intervertebral disc protrusion
 Spondylodiscitis (paraspinal soft tissues)
 Spinal cord / nerve (root) compression (e.g. metastasis from thyroid cancer)

23
Q

Give an example of a radionuclide or nuclear scan?

A

PET

Positron emission tomography

24
Q

When is radionuclide or nuclear scan used in viewing MSS?

A
  • BONE METASTASIS scan: very sensitive for marrow changes but not specific (i.e. tumour and fracture may look similar)
  • Specaliszed scans (e.g. WBC / gallium scan) for LOCALIZE ABSCESS/ INFECTION e.g. Acute Osteomyelitis)
25
Q

Advantages of Nuclear scans in viewing MSS?

A
  • Gives FUNCTIONAL INFORMATION
  • EARLY DETECTION of disease e.g. tumour, infection
  • Specific radionuclide for diseases e.g. abscess
26
Q

Disadvantages of Nuclear scans for viewing MSS?

A
  • Poor STRUCTURAL info.
  • Not specific i.e. tumour, infection and fracture may look similar on bone scan
  • EXPENSIVE
  • IONIZING RADIATION
27
Q

Choose the appropriate radiography method for: Simple fracture?

A

Xray

28
Q

Choose the appropriate radiography method for: Patient with severe trauma and widespread damage?

A

CT

  • Minimal mobilization of patient
  • Fast and one-stop images for multiple system
  • Prioritize management e.g. vascular injury
29
Q

Choose the appropriate radiography method for: complex fracture of the foot?

A

CT

For regions having complex anatomy

30
Q

Choose the appropriate radiography method for: cervical spine injury?

A

CT

Excellent for excluding cervical spine injury especially when radiographs are equivocal or inadequate

31
Q

Choose the appropriate radiography method for: injured ligaments and soft tissue?

A

MRI

32
Q

Choose the appropriate radiography method for: Spinal trauma with cord or neural damage?

A

MRI

33
Q

Choose the appropriate radiography method for: Marrow edema?

A

MRI

34
Q

Choose the appropriate radiography method for: vertebral anomaly in scoliosis?

A

CT

35
Q

Choose the appropriate radiography method for: herniated intervertebral disc?

A

MRI

36
Q

Choose the appropriate radiography method for: Paraspinal soft tissue damage?

A

MRI

37
Q

Choose the appropriate radiography method for: effusion, synovial thickening, masses?

A

Ultrasound

38
Q

Choose the appropriate radiography method for: deep soft tissue and intra-articular tissue damage?

A

MRI

39
Q

What are the scans used to Dx and used when treating Rheumatoid arthritis?

A

Dx = X-ray

Guide injection of steroids into joint to treat inflammation = Ultrasound

MBBS II MSS (31 decks)

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