Radiology study guide

Topics: Rheumatoid arthritis, Arthritis, Knee Pages: 11 (3234 words) Published: November 1, 2014

6267450-292100Test #1
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Arthritides and Arthropathies
To provide a method to logically exercise approach the radiographic findings in arthritis Categories of Bone Disease- common abbreviation is CATBITES
C: Congenital (Normal finding) – achondroplasia, dwarfism, etc A: Arthritides – arthritis, spondylitis, etc
T: Trauma – fractures, etc
B: Hematological (blood) – osteonocrosis, sickle cell, thallesemia I: Infection – pyogenic infection, TB, staph, etc
T: Tumors - malignancies
E: Endocrine, metabolic, nutritional – osteoporosis, hyper parathyroidism, rickets, scurvy, etc S: Soft tissue – catch all, lymphomas, etc
Degenerative Disorders: characterized by osteophytes- degenerative bone OA, EOA, DISH, Neurotrophic Arthropathy, OPLL
Inflammatory Disorders: characterized by erosion and peri-articular osteopenia Rheumatoid Types – RA and JRA
Connective Tissue Arthropathies – SLE and Scleroderma
Rheumatoid Variants (Serum Negative RH Factor Group)
HLAB27 test Positive
Presence of sacraliliatis
Ankylosing Spondylitis
Enteropathic Arthropathy
Psoriatic Arthropathy (Psoriasis)
Reiter’s Syndrome
Endocrine and Metabolic Related Disorders (Crystal Deposition Joint Diseases) Gout -(Sodium Urea Crystals), CPDD, HADD, Ochronosis
Primary Synovial Disorders
Synoviochondrometaplasia (SVCM)(Joint Mouse)
Pigmented Villonodular Synovitis (PVN’s)
Infectious Arthritis
Pyogenic (puss forming) Arthritis – Staph Infection
Non pyogenic Arthritis – TB, Fungal infections

Miscellaneous Disorders
Osteitis Condensans Ilii (OCI) – bilateral triangular shaped sclerosis of the ileum or medial clavicle Osteitis Pubis – erosion and sclerosis of pubic symphysis Hypertophic Osteoarthropathy (HPO) – periostitis with double stripe sign – digital clubbing Classification of Articulations

Motion Based Classification – Synarthrosis, Ampiarthrosis, Diarthrosis Histological Based Classification
Fibrous Joints – Syndesmosis, Sutures, Interossi
Cartilaginous Joints – IVD, Pubic Symphysis, SC, SM
Synovial Joint – Ball and Socket, Hinge, Saddle, Mortise
Important to know that synovium is in direct contact with the bone—known as the “Bare Area” Imaging Considerations
Conventional Radiography
Most Common and best imaging for visualizing arthritides
Alignment, Bone, Cartilage space, Distribution ’soft tissue Norgaard Projection
Use with RA – semi-supinated to see pisiform, 2nd, and 3rd MC heads Magnification Radiography
Soft tissue swelling and small erosions
Conventional Tomography
Demonstrates the degree of joint destruction
Computed Tomography
Mainly used for SI problems – degeneration or inflammatory changes Arthrography
Contrast injected into joint – use with CT
Bone Scintigraphy (Bone Scan)
Shows distribution of the arthritis (hot spots) – differentiate active disease from arthritis in remission Extremely sensitive, but not specific!
Magnetic Resonance Imaging (MRI)
Excellent contrast between soft tissue and bone (Axial skeleton) Good for identifying increased amounts of fluid, not good for differentiating inflammatory from non inflammatory fluid T1 image is fat image and T2 image is water image

Clinical Information
Clinical findings such as:
Joint swelling, dereased ROM, Soft tissue masses, Symptoms related to physical activity Gout
Soft tissue masses tend to be non-uniform when surrounding joint White spots – calcified tophi – sodium urate
Psoriatic Arthritis “sausage digits”
Pitted Nail, Silver Scales and they occur in extensors
Laboratory information
Auto Antibodies – Rheumatoid factor and ANA
Histocompatibility Antigens – Rheumatoid Variants: Sero-negative – HLA-B27 (SI), HLA-DR4 (RA), HLA-B8 (DISH) Joint Aspiration (Crystal deposition) – Gout and Pagets
Uric Acid – Gout and Tumor
ESR – Sedimentation Rate (high if inflammation)
C Reactive Protein (high if inflammation)
Radiographic Diagnosis
Radiographic Presentations
Site of initial insult
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