Di Imaging Exam 3

What hormones and nutrients stimulate bone production?

GH

Thyroid

Calcitonin

Vit D and C

What hormones inhibit bone pdt?

PTH

Cortisol

An allencompassing definition for increased radiolucency of bone is ?

osteopenia

What is the MC etiology of osteopenia?

osteoporosis

What % change of bone is needed to show osteopenia?

30-50%

After what age does bone mass decrease?

35 years of age

What happens to hip fracture occurance in women after 60?

risk of fractures double every 5 years

What are the primary causes of osteopenia?

senile

postmenopausal

Endocrine causes of decreased bone are called ?

osteopenia

What is the appearance of old compression fractures on MRI?

white

A gradual loss of skeletal mass seen with advancing age is known as ?

senile osteoporosis

Increased bone loss seen in women following menopause is known as ?

postmenopausal osteoporosis

What decade of life does the gradual loss of skeletal mass begin in women?

fourth decade

What are some signs of osteoporosis?

pain

loss of height/ compression fractures

accentuated kyphosis

What are the risk factors for osteoporosis?

female

>70

caucasian or asian

early onset of menopause

inactivity

What are modifiable risk factors for osteoporosis?

smoking

alcohol abuse

excessive caffeine

excessive dietary protein

lack of calcium

lack of sunlight

What are radiographic features of osteopenia?

pencil-thin cortices

resorption of trabeculae

accentuated vertical struts

altered vertebral shape

What are 3 causes of patholgical fracture? 1 additional for child?

osteoporosis/penia

lytic mets

multiple myeloma

EG-child

What is the appearnace of a compression fractured vertebra?

fish vertebrae

If you see one vertebra with decreased trabeculation, you would call this a ?

hemangioma

An excentuated kyphosis due to compression fractures is known as ?

Dowager's hump

When is a CT needed for compression fractures?

if compression exceeds 30% of the original body height

A fracture of the vertebra where the posterior body is convex is called ?

burst fracture

What happens to the peduncular distance with a burst fracture?

widens

A flat vertebra is called?

vertebra plana

What do steroids do to bone?

decrease bone leading to osteopenia

A fracture of ? or ? vertebra is stable

anterior or posterior

What type of vertebral fracture is unstable?

middle or multiple sections

What is the appearance of osteoporosis in an extremity?

thinned cortices

endosteal scalloping

loss of trabeculae

risk of fractures

How can you look for osteopenia in the hip?

Ward's triangle

What is the pattern of loss for WArd's triangle?

loss from medial to lateral

What are the lesions of multiple myeloma?

punch out

How does T-score correlate to fracture risk?

every -1 SD = double the fracture risk

-1 SD= what % bone lost

10%

What is the T score for osteopenia?

2.5 to 1

What is the T score for osteoporosis?

2.5

What are the recs for osteopenia?

exercise

calcium, protein, Vit C

No smoking

No drinking

What can cause regional osteoporosis?

immobilization and disuse

reflex sympathetic dystrophy

What is reflex sympathetic dystrophy syndrome?

acute pain, regional osteoporosis following trivial trauma

>50

trophic skin changes

Who is transient osteoporosis of the hip seen in?

young to middle aged adults (maybe pregnancy)

MC in males

Which hip is involved in transient osteoporosis of the hip in men? women?

Men- bilateral

women- left

What is needed to make the diagnosis of transient osteoporosis of the hip?

MRI

What are the 2 main causes of osteomalacia?

Vitamin D metabolism

renal tubular phosphate loss

What is the name for childhood osteomalacia?

Rickets

What are the radiographic features of osteomalacia?

osteopenia

coearsened trabeculation

Looser zones

deformities

basilar invagination

acetabular protrusion

Which side of the bone are Looser lines found on?

concave side

What are the radiographic features of Rickets?

widened, bulky physeal plates and irregularity

splaying of the metaphysis and physis

Bowing

rachitic rosary

paintbrush metaphysis

What causes scurvy?

long term deficiency of Vitamin C

What are the manifestations of scurvy?

petechiae, bleeding gums, hematuria

low serum ascorbic acid levels

osteopenic bones

What are the radiological features of scurvy?

osteopenia

dense zone of provisional calcification

beak-like metaphyseal outgrowths

radiodense sclerosis around epiphysis

scorbutic zone

corner sign

Ring epiphysis of scurvy is called?

Wimberger sign

What are the primary causes of HPT?

parathyroid gland adenoma

What is the MC cause of hypercalcemia?

HPT

Secondary HPT is a complication of ?

chronic renal disease

Teritary HPT is seen in ?

dialysis pt

Who MC has HPT?

30-50 yr women

What is the saying for HPT?

stones, bones, abdominal groans, psychiatric moans

What are the radiologic features of HPT?

osteopenia

subperiosteal resorption

distal tuft resorption

accentuated trabeculation

brown tumors

soft tissue calcification

What is the most definitive radiographic sign of HPT?

subperiosteal resorption

What are the joints MC affected by subperiosteal resorption of HPT?

radial margins of middle and proximal phalanges of 2nd and 3rd digits

What are the diff di for resorption of the distal clavicle?

HPT

RA

osteolytis

AS

Scleroderma

What doe HPT of the spine look like?

rugger jersey spine

What does HPT of the skull look like?

salt-and-pepper

Which disorder do we see Rugger jersey spine with?

HPT

T/F wide SI are also seen with HPT

true

A bone disorder occurring when the kidneys fail to maintain proper levels of calcium and phosphorus in the blood affecting patients on dialysis is known as ?

renal osteodystrophy

Your patient has sacroilitis with rugger jersey spine and has had a kidney transplant. What would the diagnosis be?

renal osteodystrophy

? account for 10% of neoplasms within cranium

pituitary tumors

What are the symptoms of pituitary tumors?

headaches

visual disturbances

discomfort in extremities

What are the measurements of an enlarged sella?

16 x 12

What is the significance of an enlarged sella?

empty

tumor

normal

aneurysm

In an adult oversecretion of GH is known as ?

acromegaly

What is the appearance of someone with acromegaly?

large hands and feet

What is the name for someone with excess growth hormone as a child?

gigitism

What are those with GH disorders predisposed to?

DJD

What are the signs of acromegaly?

soft tissue thickening

coarse facial features

enlarged jaw, hands, feet, head

spreading teeth

macroglossia

prominent forehead

enlarged sella

What are radiographic features of acromegaly?

spade=like distal tufts

hooking osteophytes of distal tuffs

What should the measurement of heel pad thickness be?

<23mm

A disease caused by increased production of cortisol is called ?

hypercortisolism

What cause hypercortisolism?

MC exogenous corticosteroid admin

Cushings

What are signs and symptoms of cushing?

obesity

moon face

accelerated hair growth

buffalo hump

purple striae

vert and rib fx

What are radiographic features of cushing?

osteopenia

compression fx

AVN

atherosclerotic plaquing

What is the MC congenital dwarfing skeletal dysplasia?

achondroplasia

T/F achondroplasia is associated with a normal life expectancy

true

What is the appearance of the hands in someone with achondroplasia?

trident hands

What can happen to the spinal canal in someone with achondroplasia?

narrowing

What is the look of the pelvis in someone with achondroplasia?

narrow pelvic inlet aka champagne glass

What happens to the bone metaphysis in someone with achondroplasia?

metaphyseal cupping

What does a trident hand appearance mean?

fingers are of approximately equal length and diverge from one another in 2 pairs

What are some radiographic features of the spine of someone that has achondroplasia?

posterior body scalloping

short pedicles decreasing caudally

bullet vertebrae

horizontal sacrum

What are the features of the skull in someone with achondroplasia?

macrocephaly

frontal bossing

foramen magnum stenosis

arnold-chiari malformation

What type of gait does someone with achonroplasia havve?

waddling

You take images of your patient and see hypoplasia of the clavicles and an increased number of wormian bones. What is the diagnosis?

cleidocranial dysplasia

Along with absent clavicles, what may happen with cleidocranial dysplasia?

widened pubic symphysis and other midline deficits

What is the appearance of someone with Marfans?

tall, arachnodactyly

What are some major concerns that could affect someone with Marfan's?

heart valve defects, aortic aneurysm, lens dislocation

What is the test to do if you suspect your patient might have Marfans?

positive thumb sign

positive wrist sign

What may the chest look like in someone with Marfans?

pectus excavatum

What are the 4 major clinical criteria of oseogenesis imperfecta?

skeletal fragility

blue sclera

abnormal dentition

premature otosclerosis

What are the radiographic findings associated with osteogenesis imperfecta?

osteopenia

bowed long bones

thin cortex

multiple fractures