Musculoskeletal Radiology Overview

Study Notes

Musculoskeletal Radiology

Radiology diagnoses bone, joint, and soft tissue issues using various imaging techniques. It identifies fractures, tumours, infections, degeneration, and soft tissue abnormalities.

Imaging Modalities

X-ray (Plain Radiography):
- Uses ionizing radiation to image tissue density.
- Initial imaging for fractures, dislocations, osteoarthritis, and initial tumour assessment.
- Advantages: Fast, affordable, readily available.
- Disadvantages: Limited soft tissue detail, radiation exposure.
- Views: AP, lateral, oblique.
Computed Tomography (CT):
- Uses X-rays and computers to create cross-sectional images.
- Evaluates complex fractures, bone lesions, spinal issues, 3D reconstruction.
- Advantages: High-resolution images, detailed bony anatomy, good for complex fractures.
- Disadvantages: Higher radiation dose than X-ray, expensive, less soft tissue detail than MRI.
Magnetic Resonance Imaging (MRI):
- Uses magnetic fields and radio waves for detailed soft tissue imaging.
- Gold standard for soft tissue injuries (ligaments, tendons), bone marrow issues, joint disorders, and tumour characterisation.
- Advantages: Excellent soft tissue contrast, no radiation.
- Disadvantages: Expensive, longer scan time, contraindicated with metal implants.
Ultrasound:
- Uses high-frequency sound waves for real-time images.
- Evaluates soft tissue (muscles, tendons, ligaments), joint effusions, and guided injections.
- Advantages: No radiation, portable, real-time.
- Disadvantages: Operator dependent, limited for deep structures and bones.
Nuclear Medicine (Bone Scintigraphy):
- Uses radiotracers to detect increased bone turnover.
- Detects bone metastases, infections, and fractures not visible on X-ray.
- Advantages: Sensitive for bone pathology detection.
- Disadvantages: Limited specificity, radiation exposure.

Indications for Musculoskeletal Radiology

Trauma (fractures, dislocations, soft tissue injuries)
Degenerative diseases (osteoarthritis, disc degeneration)
Inflammatory diseases (rheumatoid arthritis, osteomyelitis)
Tumours (primary bone tumours, metastases)
Congenital anomalies (developmental dysplasia of the hip, scoliosis)
Metabolic bone diseases (osteoporosis, rickets)

Common Radiological Findings

Fractures:
- Types: transverse, oblique, spiral, comminuted, greenstick.
- X-ray appearance: Bone cortex discontinuity, with or without displacement.
- Pathological fractures: In weakened bones (e.g., tumors, osteoporosis).
- Healing: Callus formation. Follow-up needed.
Osteoarthritis (OA):
- Primary modality: X-ray
- Findings: joint space narrowing, subchondral sclerosis, osteophyte formation, subchondral cysts.
- Utility of MRI: Assesses early cartilage damage and soft tissues.
Rheumatoid Arthritis (RA):
- Modalities: X-ray, MRI (early disease)
- Findings: Periarticular osteopenia, joint space narrowing, marginal erosions, soft tissue swelling.
- Advanced Imaging: MRI shows synovial hypertrophy and pannus formation.
Osteomyelitis:
- Modalities: X-ray, MRI, bone scan.
- Findings: X-ray: bone destruction, periosteal reaction. MRI: Early marrow edema, soft tissue involvement, abscesses. Bone scan: Early detection, localization.
Bone Tumors:
- Primary: osteosarcoma, chondrosarcoma, Ewing's sarcoma
- Metastatic: From breast, prostate, lung cancers
- Modalities: X-ray, CT, MRI
- Findings: Lytic or sclerotic lesions, periosteal reactions (like sunburst). MRI: Soft tissue invasion, margins. Bone scan: Metastasis detection
Soft Tissue Pathologies:
- Ligament/Tendon injuries: Best assessed with MRI (tears, sprains, tendonitis)
- Muscle tears/contusions: MRI (muscle edema, hemorrhage, tears)
- Bursitis: Ultrasound or MRI (bursal fluid)

Special Techniques

DEXA (Dual-Energy X-ray Absorptiometry): Measures bone mineral density, for osteoporosis assessment. Used to determine fracture risk.
Arthrography: Contrast-enhanced study of joint spaces (detects labral/ligamentous injuries, often combined with MRI).
CT Arthrography: Provides detailed joint space and cartilage images, useful in complex joint issues (especially when MRI is not feasible).

Description

This quiz covers the fundamentals of musculoskeletal radiology, focusing on various imaging techniques used to diagnose bone, joint, and soft tissue conditions. Learn about the advantages and disadvantages of X-ray, CT, and MRI imaging modalities, as well as their applications in identifying fractures and other abnormalities.