Transcript Part 1 - Radiology

M-2
MUSCULOSKELETAL
IMAGING-2013
DR. F. NEUFFER
RADIOLOGY
SPINE AND EXTREMITY
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TRAUMA - DEGENERATIVE
INFECTIOUS - INFLAMMATORY
NEOPLASTIC
cardiovascular
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X-RAY PLAIN FILM
CT
MR
NUCLEAR MEDICINE
ultrasound
MODALITY CHOICES
PLAIN FILMS - TRAUMA- FRACTURES
CT - BONE DETAIL –TRAUMA
MR - SOFT TISSUE
JOINTS - LIGAMENTS - DISCS- MARROW
NM - BONE DENSITY- OSTEOPOROSIS-
SCANS-MALIGNANCY / INFECTION
US - EFFUSIONS - TENDONS
LATERAL LUMBAR SPINE
POSTERIOR
ANTERIOR
TRANSVERSE OR AXIAL
PROJECTION
ANTERIOR
HISTORY OF CHRONIC NECK PAIN
• PLAIN FILM
• SCREEN
• BONY ANATOMY
• ALIGNMENT
DEGENERATIVE
DISC DISEASE
NORMAL
HX OF PAIN -- POST FALL
CT GIVES MORE DETAIL OF
FINDINGS ON PLAIN X-RAYS
COMPRESSION FRACTURE
RECONSTRUCTION SAGITTAL CT
Teardrop fracture
The MR also shows the edema in the spinal cord from trauma.
NUCLEAR MEDICINE
DEXA SCAN
ASSESSES CALCIUM AND FRACTURE RISK
NEW COMPRESSION FRACTURE?
NUCLEAR BONE SCAN
Increased activity on bone scan supports recent event.
HX OF RADIATING PAIN TO
RIGHT LEG -Rt S1 Root
MR FOR NEUROLOGICAL
FINDINGS
ANKYLOSING
SPONDYLITIS
Chronic inflammatory disease primarily of spine
Age-young adults 15-35 years
Mostly Caucasian Male
Clinical findings
Insidious onset of back pain and stiffness
Poor chest expansion
Stiffness dorsal kyphosis
HLA-B 27 positive in >90%
Location
Axial skeleton
Sacroiliac joint Hallmark of disease
Normal for comparison
ANKYLOSING
SPONDYLITIS
BAMBOO SPINE
SI JOINT- ANKYLOSIS
Bilateral osteophytes are seen bridging the disc spaces at multiple levels. This is a so-called
bamboo spine and is classic for ankylosing spondylitis.
THE NARROWED CENTRAL
CANAL CAN PRESENT WITH
NEUROGENIC CLAUDICATION.
LEG PAIN WITH WALKING
RELIEVED BY SITTING AND
BENDING FORWARD.
METASTATIC DISEASE CAN IMPINGE ON
SPINAL CORD AND NERVE ROOTS
AND REQUIRE EMERGENCY SURGERY
NORMAL BONE SCAN
METASTATIC BONE
DISEASE
OBLIQUE LUMBAR SPINE
SPONDYLOLYSIS
SPONDYLOLISTHESIS
Bony defect in spinal ring (Spondylosis) can
lead to subluxation (Spondylolisthesis)
ABNORMAL FINDINGS AT C1-2
ON X-RAY AND CT
THE PATIENT IS SEEN IN A GERIATRIC CLINIC
AS PART OF HEALTH SCREEN. SHE HAS THESE
XRAYS AND SCAN BUT IS NOT CONVERSANT.
YOU TALK WITH DAUGHTER ABOUT HISTORY OF
Rheumatoid erosions can affect the transverse
ligament at C1-2 and allow subluxation. This could
lead to cord compromise chronically or acutely.