Mss 05: Musculoskeletal Imaging

Front 1

What are the different methods for musculoskeletal imaging?

Back 1

- Radiographs (plain films)
- Fluroscopy
- Ultrasound
- Computed Tomography (CT)
- Magnetic Resonance Imaging (MRI)
- Nuclear Medicine

Front 2

What things need to be considered when deciding on the appropriate imaging modality?

Back 2

- Body part of interest
- Differential diagnosis consideration
- Age of patient
- Patient history
- Cost of exam
- Radiation dose
- Availability

Front 3

What guidelines should be used to choose the appropriate imaging modality?

Back 3

1. What is the clinical question?
2. What test is most likely to answer this question (what tests are available to you)?
3. If more than one test will work, consider safety and cost of the procedure

Front 4

How should you approach an imaging study?

Back 4

- Develop a consistent search pattern
- E.g., hardware, joint(s), bones, soft tissues

Front 5

What is shown in this image?

Back 5

Pancoast tumor - lung apices don't look the same - tumor is causing shoulder pain

Front 6

When you see one injury / fracture, what should your search pattern be next?

Back 6

Look for another injury (often two)
E.g., Notice fractured radius, look at other angle to notice displaced ulna

Front 7

What is shown in this image?

Back 7

Vascular Channel - not a fracture, tend to always be in same place so once you've seen them you should be able to recognize it again

Front 8

What is a Sesamoid bone?

Back 8

Bone embedded in a tendon where the tendon passes over a joint

Front 9

What is the largest Sesamoid bone?

Back 9

Patella

Front 10

What is the name of the accessory bone that is occasionally seen in the posterior knee?

Back 10

Fabella

Front 11

What is shown in this image?

Back 11

Lunotriquetral Coalition - 7 instead of 8 wrist bones
(developmental abnormality)

Front 12

What is shown in this image?

Back 12

Sacral Agenesis (born without a sacrum)

Front 13

What is shown in this image?

Back 13

Marfan's Syndrome (tall and lanky w/ long fingers)

Front 14

What is shown in this image (look at the corners of the vertebrae)?

Back 14

Limbus Vertebral Bodies (not a fracture, this is normal for them)

Front 15

When looking at an image, what differential diagnoses should you consider?

Back 15

VINDICATE:
- Vascular
- Infection
- Neoplasm
- Drugs
- Inflammatory / Idiopathic
- Congenital
- Autoimmune
- Trauma
- Endocrine / Metabolic

Front 16

What is shown in this image?

Back 16

- Tooth in pelvis = Teratoma or got punched in face and swallowed tooth
- Fibrous Dysplasia (benign tumor) - caused lesion and a fracture through lesion

Front 17

What is shown in this image?

Back 17

Osteosarcoma = malignant (not well defined)

Front 18

What is shown in these separate images?

Back 18

- Benign on left (more well-defined)
- Malignant on right (not well-defined)

Front 19

What is shown in this image?

Back 19

Calcific Tendonitis

Front 20

What is shown in this image?

Back 20

Crest Syndrome - calcifications in soft tissue

Front 21

What is shown in this image?

Back 21

Soft Tissue Hemangiomas (abnormal calcification)

Front 22

In what joints are effusions most easily diagnosed?

Back 22

- Knee
- Elbow
- Ankle
- Wrist
- Fingers

Front 23

What is shown in this image?

Back 23

Effusion around knee (140 cc was removed)

Front 24

How should you describe a fracture?

Back 24

- Location
- Orientation
- Displacement
- Apposition
- Angulation
- Intraarticular involvement
- Communication
- Open vs. Closed
- Associated injuries

Front 25

What is shown in this image?

Back 25

Jones fracture (a fracture of the diaphysis of the fifth metatarsal of the foot)

Front 26

What is shown in this image?

Back 26

Rolando Fracture (intra-articular fracture through the base of the first metacarpal bone - the bone located just proximal to the thumb)

Front 27

What is shown in this image?

Back 27

Intra-trochanteric Fracture - oblique fracture, very common, needs to be repaired

Front 28

What happens in an avulsion fracture?

Back 28

Fracture which causes the tendon or ligament to pull off of bone

Front 29

What is the pattern on images for Osteoarthritis?

Back 29

- Osteophytes
- Asymmetric joint loss

Front 30

What is shown in this image?

Back 30

Gout

Front 31

What is shown in this image?

Back 31

CPPD (Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease)

Front 32

What are the most common images taken in radiology?

Back 32

Radiographs (x-rays)

Front 33

What are the pros and cons of Radiographs (xrays)?

Back 33

Pros:
- Cheap
- Readily available
- Many different views and techniques
- Often a good initial test

Cons:
- Radiation dose
- Limited sensitivity
- Does not work in all areas equally

Front 34

What is Fluoroscopy used for?

Back 34

- Real time evaluation of structures
- Can be used intra-operatively
- Used to set fractures and guid procedures
- Interventional radiology, GI and GU radiology, lumbar punctures, joint injections, and biopsies

Front 35

What are the pros and cons of Fluoroscopy?

Back 35

Pros:
- Real time evaluation of structures
- Procedural guidance
- Placement of needles, tubes, stents, and catheters

Cons:
- Radiation exposure
- Image quality limited

Front 36

What is Ultrasound used for?

Back 36

- Evaluate musculoskeletal system
- Guid procedures: biopsies, aspirations, and joint injections
- Evaluate tendons and ligaments
- Evaluate cortical surface of bone for erosions in diseases such as RA

Front 37

What are the pros and cons of Ultrasound?

Back 37

Pros:
- No radiation
- Portable machines / take up little space
- No special room preparation

Cons:
- User dependent
- Not all structures can be evaluated

Front 38

What is CT used for?

Back 38

- Evaluate and characterize osseous lesions and fractures
- Evaluate superficial and deep infections
- Evaluate post-traumatic and developmental deformities

Front 39

What are the pros and cons of CT?

Back 39

Pros:
- Fast and available
- Covers large anatomical area
- Great for procedures

Cons:
- Over-utilization
- Cost
- Metal artifacts (from implanted devices)
- Radiation dose

Front 40

What is MRI used for?

Back 40

- Gold standard for evaluation of muscles, tendons, ligaments, and joints
- Evaluates cortical bone and marrow
- Evaluate nearly every part of the body

Front 41

What are the pros and cons of MRI?

Back 41

Pros:
- Great soft tissue detail
- No radiation
- Can obtain images in any plane

Cons:
- Expensive
- Long exams
- Metal artifacts
- Claustrophobia

Front 42

What is Nuclear Medicine used for?

Back 42

- Evaluates "physiology" and "function"
- Studies a radioactive material that is injected into patient; subsequent imaging shows distribution of material in body
- A PET/CT scanner is a tool that combines radiology and Nuclear Medicine

Front 43

What are the pros and cons of Nuclear Medicine?

Back 43

Pros:
- Functional data
- Direct further radiology test
- High sensitivity

Cons:
- Poor anatomical detail
- Radiation dose
- Low specificity
- Expensive