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MRI vs CT disc lesions
- MRI
- Unless CT has contrast
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What can a CT myelogram dx?
- Excellent pre-op
- Ruptured disc
- SC compression
- Stenosis
- Intervertebral tumor
- NR injury
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Common causes for stenosis
- 1. disc lesion
- 2. spondylolisthesis
- 3. osteophyte
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S/S of stenosis
- Neurogenic claudication
- LBP, leg pain when stand and walk (sometimes numbness, weakness, N+T)
- Okay in flexion
- If compress cord UMN signs below LOL
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CT advantages
- 1. Good for anatomy and pathology cross section (fx, stenosis, loose body, arthritis)
- 2. less time
- 3. less expensive
- 4. less claustrophobic
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CT disadvantages
- 1. radiation
- 2. bad for soft tissue
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CT search patterns
- A: Alignment
- B: Bone density
- C: cartilage, canal space
- S: soft tissue
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CT alignment
- 1. Congenital deformity
- 2. Fx
- 3. Spur
- 4. Sublux/dislocations
- 5. Supernumerary or absent bones
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CT bone density
- 1. loss of density
- 2. osteophytes
- 3. reactive sclerosis (certain CAs)
- 4. appearance of trabeculae – thin, coarsened, smudged
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CT Cartilage
- Joint space
- Subchondral bone (osteophytes)
- Epiphyseal plate fx
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Salter Harris Fx
- Shaft and head will be radio opaque
- Epiphyseal growth plate: radiotranslucent bc has cartilage in it
- Fx in growth plate
- May need surgery to prevent arrest of bone growth
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CT Soft tissue
- Periostium, bone CA
- Swollen tissue
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How does a bone scan work?
Takes advantage that injured one is trying to rebuild and contrast is absorbed at site of bone injury
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Bone scan indications
- 1. high risk CA pts (breast, lung, prostate, kidney)
- 2. after radiation
- 3. when other DI neg
- 4. Paget’s disease and other metabolic bone diseases (OM, rickets)
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