Adv Img

Ultrasound - Good for & NOT good for...

Sequestered disc:

disc fragmentation

Ionizing radiation:
Which forms of Imaging use it?

Management Annular tears?

spondylolytic (pars defect) or anterior spondylolisthesis:

Posterior limbus bone:

Two indications to refer for MRI

Vertebral artery aneurism/tortuosity:

Slurred speech:

Rovsings sign:

71 yr old white mail, sciatica for 2 mo, worse at nightprostate CA, clinical & ortho tests equivocal, no improvement after 3 wks of care all imaging done (-)

Cancer (CA) was Ruled Out (R/O) but disc lesion found does not correlate w/ level found on exam
Concerned cause may actually be Piriformis Syndrome
What test could help clarify discrepancy?

30 yr old asian male bartender, N & T in R hand, aggravated by work
(+) Phalen’s & Tinel’s

how to DDx b/w CTS & VSC?

Pt not improving, suspect disc lesion

How to R/O disc lesion?

29 yr old male w/ ankle pain & ↓ ROM
unresolved after inj. 4 wks prior,
X-Ray shows DJD & ossicles
suspect OCD, adjusted & rehab ongoing
what imaging do you use to R/O joint mice, insidious processes, see joint space & surfaces, & ligaments?

57 yr old male falls of 15’ ladder, strikes head, loses consciousness for <1 min., seekscare at your office 1st.
Pt is dizzy, sluggish, has a headache
which modality to quickly R/O fracture & internal bleeding?

35 yr old male “bad” hit in Rugby, dizziness, HA’s, vision changes, numbeness in Lshoulder, atrophy of L supraspinatus & fatigue
4 wks prior grade 2 A-C separation, X-Rays of C-Spine neg.,Concerned for brain inj.
To which MD do you refer & which tests are indicated?

35 yr old male “bad” hit in Rugby, dizziness, HA’s, vision changes, numbeness in Lshoulder, atrophy of L supraspinatus & fatigue
4 wks prior grade 2 A-C separation, X-Rays of C-Spine neg.,
Importance of asking the right questions: If atrophy of supraspinatus is of concern, which instrument would you use to determine if muscle is denervated?

27 yr old male cheerleader
(+) Lachman’s, Appley’s compression & Valgus Stress

Which modality would you use to image the meniscus, medial collateral & ACL?

38 yr old female w/ N & T in L forearm following MVAaggravated by computer wk, worsens w/ C-spine Rotation
(+) foraminal compression on the L, no weakness
X-ray – post. Spur & ↓ disc C5-C6
DDx? Modality to visualize IVF during motion?

Modality for neurological component of VSC especially during rotation?

Pt develops weakness in L hand during care

modality to R/O cervical herniation?

56 yr old female w/ neck pain & history of RA
X-rays show ↑ADI, which ligament is implicated?
During VF, which movement would show ↑ in ADI?

30 yr old male injured during Rugby, hyperflexion & “stinger” (head goes one way, bodygoes the other), numbeness lateral to aspect of both hands
Davis series- ↓ curve, mild IVF encroachment, mild DDS, multiple fixations, previoushistory of similar inj.
Which modality if symptoms persist & concern is radiculopathy?

Which modality if more concerned about myelopathy w/ disc herniation &/or cordcontusion?

12 yr old male Right elbow swollen & painful

history: fell out of tree

modality?

gold standard for spine & extremity trauma?

gold standard for disc ?

20 yr old female volleyball player, complains of shoulder pain w. overhead movement,such as serving or spike
(+) supraspiatus test, pain on Abduction
how do you evaluate for a partial rotator cuff tear, impingement, or bursitis?

42 yr old female, chronic thoracolumbar pain
(-) plain film x-ray, family history of CA & previous smoker
not resolving w/ care & want to R/O pathology
What is the starting point, cheapest, & gives evidence of ↑ metabolic activity?

48 yr old male, heel pain, limps into office after a 1 story fall.
Plain film equivocal
modality to R/O fracture?

Explain findings & recommendations
Pt. says “ I don’t know if this is important of not, but..."
Broke foot/ankle/lower leg 3 yrs before
Hip/pelvis/groin/femur head/buttock?
If NO new fractures, bone scan would most likely be (-) b/c?

54 yr old female, transient pt., parent of student
routine x-ray – portion of postior 7th rib is missing

Modality for extent of metastasis?

Breast 1° site of CA
Metastasis suspected to R kidney
Which imaging modality to image kidney, knowing the pt can not lay still for long?
Which modality to image kidney if pt is morbidly obese?

24 yr old female falls in grocery store 2 wks before & complains of LBP
compression fracture of L2 seen on film
pt has legal counsel & seems to be looking for a “free Lunch”
You suspect it's an old fracture, how do you age the break & why do you choose that modality?

Wellness practice wants to quanify components of VSC on a routine basis. How?

61 yr old female, severe LBP, progressive low extremity weakness, pain aggravated by neck flex
X-Ray – facet arthrosis, poss. Tropism & central canal stenosis.
Modality to evaluate these bony elements?

75 yr old male w/ LBP
x-rays look like young spine
ortho & neuro disc herniation
marked palpable abdominal pulse, large area of artherosclerosis on LL
Modality to R/O or R/I disc & aneurysm?

30 yr old female, LBP w/ L sciatica
(+) well leg raiser, SLR & valsalva’s
responds well but slowly, 50% in 3 wks
which modality?

42 yr old female, R leg pain to foot w/ N & T
unable to stand on Rt toes,
previous disc surgery w/ similar S & S, probable “failed back surgery”
Modality to DDx scar & recurrent disc?

21 yr old female, whiplash from MVA,
very slow progress over 3 wks
ROM improved but not the pain
Concern for occult fract./IVF encroachment.
Modality to R/O concerns?

68 yr old female w/ L shoulder pain,
fell on elbow,
shoulder ROM is ↓ & painful,
painful lock when attempting flexion
Plan of action?

43 yr old male w/ R hip pain, correlates w/ exercise,
already seen MD, extensive imaging already done,
care yields no improvement,
concern for underlying pathology, especially AVN.
Plan at this point?

Axial loading with nerve root compression

Cross sectional area of dural/thecal sac
canal open when pt is in flexion
Significance?

Transient synovitis

Dessication

T1 = CSF appears...

T2 = CSF appears...

Myelomalacia:

Ligamentum flavum hypertrophy (redundancy)

Microdisectomy:

Which motions open and close the IVF?

When do you order contrast w/ MRI?

Modic Endplate Changes

T1 weighted SE (spin echo) image =

Why do initial CT and not MRI with acute head trauma?

Why CT vs MRI for children?

Stork Test is evaluating for...

Active spondylolysis –

Technetium bone scan:

Stark Law

ACA & ICA guidelines on imaging:
full spine radiography

ACA & ICA guidelines on imaging:
Computer assisted mensuration

Discogram:

Stages of Disc Herniation

Disc Protrusion

Disc Extrusion

Disc Sequestration