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Download Part 1 - Radiology
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Transcript
M-2 MUSCULOSKELETAL IMAGING-2013 DR. F. NEUFFER RADIOLOGY SPINE AND EXTREMITY • • • • TRAUMA - DEGENERATIVE INFECTIOUS - INFLAMMATORY NEOPLASTIC cardiovascular • • • • • 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.
