Radiology Flashcards by Caitlin Nickens

What do you observe with Rheumatoid Arthritis on xray? (4)

erosions
joint space narrowing
osteopenia (periarticular)
soft tissue swelling (inflammation)

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What are the gross deformities of Rheumatoid Arthritis? (4)

swan neck
boutenierre
subluxations (ulnar MCP deviation and cervical vertebrae)
ankylosis

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Define ankylosis

rigid

consolidation of a joint

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Define pannus

abnormal layer of fibrovascular tissue or granulation tissue over a joint surface
grow in a tumor-like fashion, as in joints where it may erode articular cartilage and bone.

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psoriatic arthritis on xray

erosions= “pencil in cup” deformity of the phalanges

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reactive arthritis: what joints?

lower extremity: feet and SI joint

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define sclerosis

stiffening of a structure, usually caused by a replacement of the normal organ-specific tissue with connective tissue

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Define tophus, and name the associated disorder.

gout: A nodular mass of uric acid crystals
non-agressive erosions
overhanging edges
White, chalky gross appearance

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What is this the most common joint involved in gout?

first MTP

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Describe the appearance of CPPD deposition on xray.

chondrocalcinosis-cartilage calcification
looks like osteoarthritis but in unusual joints (nonweightbearing joints)
- classic is the shoulder or patellofemoral joint (normally the last area of the knee to get osteoarthritis)

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Define osteophytes

small abnormal bony outgrowth in response to increased joint reactive forces (buttressing)

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Define buttressing

developing thickened bone in response to increase in stress (often lateral growth where bone is not found normally)
osteophyte growth in response to increased joint reactive forces

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Use ultrasound for what in MSK? (5)

nerve blocks
fractures
tendon injury
foreign body
abscess vs cellulitis
The limit does not exist.

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ULTRASOUND TERMINOLOGY: Echogenicity

tissue’s relative ability to reflect or transmit ultrasound waves

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ULTRASOUND TERMINOLOGY: hyperechoic

(white on the screen)
hard/dense reflects virtually all ultrasound waves
nerves, fascia, cortex rim of bone, CT (tendon/ligament), epiderm/dermis

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ULTRASOUND TERMINOLOGY:

hypoechoic

(gray on the screen) Adipose tissue, cartilage, muscle

US can pass

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ULTRASOUND TERMINOLOGY:

anechoic

(black on the screen)
reflects virtually no ultrasound waves back to probe
vein, fluid

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How does a nerve appear on ultrasound?

(hyperechoic with stippled “honeycomb” structure)

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Explain the appearance of blood/fluid flow on ultrasound.

In Doppler mode, flow toward the probe appears red, while flow away from the probe appears blue.
*BART, i.e., Blue Away, Red Toward

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What are the uses of high frequency probes (10–15 MHz) in ultrasound?

better resolution but have less penetration.

US imaging of superficial structures

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What are the uses of a low frequency probe (2–5 MHz) in ultrasound?

deeper structures

quality of the image will be substantially poorer

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What ultrasound probe do you use for MSK?

linear transducer

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Describe the appearance of Necrotizing fasciitis on ultrasound.

thickened, distorted fascia with adjacent fluid and may have small echogenic foci of gas.

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How do cysts a appear on ultrasound?

anechoic with posterior acoustic shadowing

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How does cellulitis appear on ultrasound?

initially: generalized swelling and increased echogenicity of the skin and subcutaneous tissues worse case:cobblestone appearance: hyperechoic fat lobules become separated by hypechoic fluid-filled areas (edema)

check for wrist alignment on xray: 3 C's

radius-lunate-capitate

Define an "open fracture."

skin broken | infection risk

comminuted fracture

more than one fracture plane

intra-articular fracture

extends to joint surface no step off allowed osteoarthritis risk

XRAY: radiodense/ opaque

inhibit the passage of electromagnetic radiation opaque white appearance of dense materials (bone, tendons)

XRAY: radiolucent/ lucent

allow radiation to pass more freely darker appearance of less dense materials (fat)

XRAY: what does "sail sign" refer to

effusion | soft tissue swelling around bony fracture

how to name a bone displacement/angulation

named for location of distal bone relative to proximal: distal medial displacement

XRAY: distraction

bony fragments seperate

complications of fracture (5)

``` non/malunion avascular necrosis physeal arrest/fusion (growth) neurovascular injury early osteoarthritis ```

fractures in children (3)

torus (buckle fx), greenstick, physeal

salter harris fracture classification (5)

``` 1 physeal plate 2 physeal + metaphysis 3 physeal + epiphysis 4 metaphysis + physeal + epiphysis 5 crush of physeal plate ```

seenm on XRAY: 2-3 weeks after fx

increased vascularity wider fx line resorption of Ca2+ remodeling

XRAY: lytic

(low density - black)

XRAY: sclerotic

higher density - white

CT: based on differences in...

attenuation/density

CT: low attenuation

black | air

CT: high attenuation

white | bone

MRI: signal intensity= hyperintense= High

bright/white | liquid/fat

MRI: signal intensity= hypointense= low

dark/black | tendons/ligaments/bones

MRI: use for T1-weighted image

anatomy

MRI: use for T2-weighted image:

liquid//edema, tumor, infarction, inflammation, infection, fat suppression*** pathology

What is the gold standard for diagnosing bone tumors?

Conventional radiography

What is the term for "benign" bone tumors?

Indolent

What are the 3 locational divisions of bone on an axial plane?

Central: in the medulla Eccentric: off-center in the medulla Cortical: in the cortex (edge)

Describe an 1A margin, and its implications

- geographic - well-defined (can draw a clear line around it) - sclerotic around the edges (slow-growing enough that the bone can respond) - differential diagnoses are all benign

What are the features of a non-ossified fibroma

- benign - 1A margin - eccentric - very common in children and young

Describe a 1B margin

- geographic - Well-defined border - no sclerosis around the edges - Can be benign or malignant

Describe a 1C margin

- geographic - ill defined border - diagnosis usually malignant

Describe a II margin

moth-eaten - can tell the location but the extent is very unclear - diagnosis usually malignant

Describe a III margin

- permeative - hard to distinguish from moth-eaten, but tends to be even harder to locate specifically in bone - diagnosis usually malignant, except for osteomyelitis

What are the patterns of periosteal reactions with a nonaggressive tumor growth pattern? (4)

- solid - buttressing - expansion - septation

What are the patterns of periosteal reactions with an aggressive tumor growth pattern? (4)

- Codman triangle - laminated - hair on end - sunburst

best study for soft tissue and joints

MRI

best study for spinal cord and brain

MRI and CT

Myelography

combines dye with X-ray to evaluate problems with the spine that CT scans and an MRI might not be able to find. can see bones, spinal cord, and nerve roots (compression of masses)

indicators for imaging the spine/back

``` low back pain acute trauma neoplasms infections (abscess) MS vascular disease ```

best study for bones

xray

best study for reductions of fractures and guiding procedures

fluoroscpoy

best study for vessels and best contrast for bones

best study for functional or metabolic information

nuclear medicine

best study for soft tissue foreign body

Xray: pros

cheap rapid good resolution

xray: cons

need several views | radiation to pt

fluoroscopy: cons

high dose of radiation to pt

CT: pros

rapid good resolution can see behind structures

CT: cons

decreased soft tissue contrast (volume averaging artifact)

MRI: pros

great soft tissue contrast and internal joint derangement | no radiation to pt

MRI: cons

``` expensive long magnetic field (no metal) ```

nuclear medicine: cons

limited resolution | radiation to pt

US: cons

limited contrast | air and bone limit deep field imaging

used to study stress fractures, infection, and localizing tumors

nuclear medicine

Codman triangle

triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone

sequestrum

a piece of dead bone that has become separated during the process of necrosis from normal or sound bone. It is a complication of osteomyelitis

greenstick fx

common in flexible child bone | bone bends and cracks, instead of breaking completely into separate pieces.

Radiology Flashcards

(80 cards)