Clinical Medicine 216 - Imaging (final)
_________ uses X-ray examination of the breasts for detection of tumours.
Mammography takes around _________ minutes.
30 to 45
Powder, lotion, perfume, or deodorant can produce _________ on the mammogram.
_________ is typically used for further evaluation of masses found on mammography or palpable masses not seen on mammograms.
_________ is useful to evaluate questionable findings and for pre-surgical evaluation in patients with known breast cancer to detect additional lesions that might change the surgical approach. For example, breast-conserving lumpectomy to mastectomy.
Screening mammography is not routinely recommended for women under age ________ , it may have a role for selected individuals in the high risk category.
Where there is a family history of a first degree relative with pre-menopausal breast cancer, referral for mammography may be advised at an age _________ years younger than the age of the relative’s diagnosis.
5 to 10
_________ are involved in the performance, supervision, and interpretation of mammography.
Under the supervision of the radiologist, the __________ will have the responsibility for image acquisition and day to day quality control.
Medical radiation technologist
_________ takes the responsibility for the initial testing, and for conducting and overseeing quality control testing of the mammographic unit such as collimation assessment, focal spot size, resolution measurements, and beam quality assessment.
_________ responsibilities include ensuring confidentiality, understanding policies and the requirements for an information systems quality assurance program.
Information systems specialist
Elective mammography should not be performed during _________ because of increased sensitivity to radiation damage in the proliferating breast.
Pregnancy or lactation
_________ is not recommended for use in pregnancy, therefore, enhanced MRI should not be performed in pregnancy unless assessment with MRI is critical to acute patient care and cannot be avoided.
MRI can be performed for suspected malignancy during _________ .
It is not necessary to suspend ________ after iodinated contrast or gadolinium administration.
Females under the age of __________ with a palpable abnormality or significant symptoms should undergo targeted ultrasound. Thereafter, mammography should be performed if there is suspicion of malignancy.
Mammography has high sensitivity in this type of breast:
The sensitivity of mammography in this type of breast is limited:
Extremely dense breast
Radiologists look for ________ ?
Skin thickening, micro-calcifications, and dominant masses
Always ________ suspicious calcifications.
_________ of all malignant tumours are discovered by mammography because of the presence of suspicious calcifications.
Short-term follow-up of less than ________ months is almost never useful.
For women with very dense breasts, some breast tumors may be difficult to detect with mammography, with ________ percent being false negative .
An estimated _________ percent of cancers are missed by mammography.
10 to 30
Treatment options for _________ include mastectomy, lumpectomy with breast irradiation, or, for patients with small lesions (<1-2 cm) of low-grade DCIS, lumpectomy alone.
Ductal carcinoma in situ (DCIS)
_________ is a new kind of test. It takes multiple x-rays in an ark of each breast from many angles. It uses less pressure, and takes 11 images in 7-seconds. (aka. 3D mammography)
Digital tomosynthesis ________ .
Improves dense breast imaging
The radiation dose for digital tomosynthesis is ________ than that of a single conventional mammography image.
Ultrasonography (US) in breast imaging is used to differentiate _________ lesions. Also US cannot detect most small calcifications.
Solid from cystic
Abscess and hematoma may mimic a ________ .
Ultrasonography (US) of a markedly hypoechoic (appears dark) mass of the breast is suggestive of ________ .
MRI in breast imaging is _________ sensitive to small abnormalities. It is used to image implants and ruptures, and it is also effective for dense breast imaging.
An MRI takes around ________ minutes, and requires the use of injected contrast, and often cannot distinguish between cancerous and noncancerous tumours.
30 to 60
_________ is offered as a for-profit service, using a heat-sensitive infrared camera to take images of the body and detect blood flow pattern, and some breast thermography clinics claim the service they provide can detect breast cancer.
The gold standard for diagnosis of endometriosis is direct visualization by ________ and histologic study.
Ultrasonography is the ________ investigational tool for suspected endometriosis. It allows detection of ovarian cysts and other pelvic disorders such as uterine fibroids.
Ultrasound is predominantly used to evaluate the ovaries and to assess the pelvis in the workup for _________.
Pelvic pain or infertility
Ultrasound is most commonly used imaging of the uterus, and either ________ .
Transvaginal or transabdominal
MRI has a greater specificity for the diagnosis of ________ than the other non-invasive imaging techniques.
What is the condition in which the endometrium breaks through the myometrium? It may present with menorrhagia and dysmenorrhoea. Ultrasound and MRI are imaging modalities that may show characteristic findings.
________ is usually the first and often the only imaging modality employed to investigate menorrhagia and dysmenorrhoea.
A type of x-ray taken of a woman's reproductive tract after a dye is injected, and is part of a basic fertility evaluation. May result in a 'fill and spill' phenomenon.
Hysterosalpingography (HSG) is usually performed under ________ and takes about 15-20 minutes.
What are the contraindications to a Hysterosalpingogram?
The presence of an infection of the genital tract; recent or active bleeding; suspected intrauterine pregnancy; and allergy to iodinated contrast material.
CT is unable to diagnose adenomyosis, but may suggest its presence when uterine ________ is present.
_________ is the modality of choice to diagnose and characterize adenomyosis.
_________ are caused by endometriosis, pelvic inflammatory disease, neoplasms, and surgical trauma.
Ultrasound often only demonstrates ________ in the peritoneal cavity or non-specific thickening and increased vascularity of the endometrium.
________ usually arises as a complication of Chlamydia or Gonorrhoeae infection that rises from the vagina or cervix to the fallopian tubes.
Tubo-ovarian abscess (TOA)
A corpus luteum may seal and fill with fluid or blood, forming a corpus luteum cyst. The characteristic circular Doppler appearance is called the _________ ?
Ring of fire
When a Graafian follicle or follicular cyst bleeds, a ________ is formed.
Complex hemorrhagic ovarian cyst (HOC)
The Poly-Cystic Ovary Syndrome (PCOS) is also known as Stein-Leventhal syndrome, with 10 or more peripheral simple cysts usually characteristic __________ appearance.
Residual ovary syndrome or ovarian remnant syndrome is a condition that occurs when ovarian tissue is left behind following _________ , causing development of a pelvic mass, pelvic pain, and occasionally dyspareunia.
__________ is a condition that results from retrograde flow through incompetent valves in ovarian veins. The diagnosis is established by the demonstration of multiple dilated, tortuous parauterine veins.
Pelvic congestion syndrome
What is the most common benign neoplasm of the uterus arising from smooth muscle, often with no symptoms? Ultrasound is the usual diagnostic tool.
Fibroids on x-ray are only visualized if ________. X-ray is NOT the modality to use to diagnose fibroids.
Ultrasonography has been used to image the developing fetus for decades without any concrete evidence of ________ . Because MRI is so new, a thorough investigation of its biologic effects on the developing fetus has not been done.
The most common cause of ________ is urinary tract infection.
The most common cause of recurring urinary tract infection in men is chronic _________ .
Imaging of the _________ uses CT urography: for evaluation of structural abnormalities and possible abscess formation; MRI could be considered if the patient has an allergy to contrast.
Lower urinary tract
Imaging of the _________ uses CT abdomen with contrast (or without); and MRI abdomen: for patients with contrast allergies and pregnant patients.
Upper urinary tract
CT is the most sensitive modality for diagnosis and assessment of _________ complications, but it does have a significant radiation exposure and should be used sparingly, especially in young patients.
Pyelonephritis and renal abscess can mimic ________ .
In acute pyelonephritis, _________ shows areas of decreased uptake in the upper and lower poles of the right kidney, consistent with pyelonephritis.
________ is a type of infection of the bladder wall by gas-forming bacteria or fungi. The most frequent offending organism is E. coli, X-ray and CT usually is diagnostic with gas in the bladder wall.
________ reveals a segment of irregular, beaded narrowing in the distal bulbous urethra in Gonococcal urethral stricture.
Contrast-enhanced CT is the best imaging tool if abscess suspected and will demonstrate a diffusely enlarged, edematous gland in _________ .
Infection of the testicle and epididymis is called _________. Ultrasound is the gold standard of diagnosis, and it classically appears as hypoechoic enlargement of the testicle and epididymis with increased flow on doppler colour imaging.
Benign prostatic hyperplasia is the most common cause of urinary complaints in men, and ultrasound remains the _________ for diagnosis and staging.
Dysuria may be the earliest symptom of the irritative changes caused by _________ of the bladder.
Carcinoma in situ
For renal cell cancer, ________ is frequently used to both diagnose and stage renal cell carcinomas.
__________ is the most common primary neoplasm of the urinary bladder, and also the entire urinary system. MRI is superior to other modalities in locally staging the tumour.
Transitional cell carcinoma (TCC)
A ________ is an X-ray test that takes pictures of your bladder and urethra while your bladder is full and while you are urinating. Contrast material is injected into your bladder through your urethra.
_________ is the gold standard imaging modality for stones in the urinary system.
With a CT, almost all stones are opaque but vary considerably in density. ________ of renal tract calculi are visible on a non-contrast CT. One of the commonest sites for a stone to become lodged is at the vesicoureteric junction.
An infection ________ an obstructing stone is often an emergency. The body has difficulty clearing these infections and because antibiotics often cannot reach adequate levels due to the decreased blood supply and urine flow that occurs whenever a stone causes obstruction.
The normal epidermis head is _________ and the epidydimal body and tail is _______ to the testis.
________ is a surgical emergency, and can result in cutting of the blood supply to the spermatic cord.
In testicular torsion, ________ diagnosis and surgical management are critical if the testis is to be salvaged. Doppler ultrasound has become widely accepted as a sole modality for diagnosis.
________ identifies the absence of blood flow typically found in a twisted testicle, which distinguishes the condition from epididymitis. Epididymitis shows increased flow.
Color Doppler sonography
The ________ sign of the spermatic cord on imaging may indicate acute torsion.
Torsion of the appendix testis is the most common cause of an acute painful _________ a child
Ultrasound is used to distinguish between intratesticular masses, which are more commonly malignant, and extratesticular masses, which are more commonly benign in _________ .
Imaging of testicular cancers
Ultrasound can also be used to accurately differentiate intratesticular solid masses, which are often _________ , from cystic lesions, which are usually ________ .
MRI imaging showed a 100% sensitivity and an 88% specificity for differentiation of benign from malignant intratesticular lesions. The initial staging workup usually includes CT or MR imaging of the ________ .
Chest, abdomen, and pelvis
The most common sites of solid organ metastatic disease are the __________. Testicular metastases to bone may also occur.
Lungs, liver, and brain
In ________ , ultrasound is the gold standard investigation. Characteristic findings include: hypoechogenicity, hypervascularity, swelling and scrotal wall thickening.
MRI is the best cross-sectional modality to assess ________ replacing CT.
Cryptorchidism (absence of a testis in the scrotal sac)
_________ happens when part of the large or small intestine becomes stuck in the groin or scrotum and cannot go back into the abdomen.
Incarcerated inguinal hernia
_________ is a sac filled with fluid that forms around a testicle and most common in babies.
Ultrasound is the first modality usually used to evaluate hydrocele. It presents as a simple fluid collection. It is ________ on Doppler evaluation. It may contain septations, calcifications or cholesterol.
________ is the dilatation of the plexus of veins, found in the spermatic cord, where ultrasound is the diagnostic modality of choice.
An MRI is effective at imaging bone and bone marrow disorders that can cause ________ . It can also help assess iron concentration in various organs such as the heart and liver
________ is a genetically determined disorders of hemoglobin synthesis with decreased production of polypeptide chains of hemoglobin molecules.
Radiographically, the skeletal response to marrow proliferation consists of ________ of the medulla, _______ of cortical bone, and ________ of cancellous bone, which results in a generalized loss of bone density.
Expansion; thinning; resorption
________ is a chronic hemoglobinopathy resulting from the presence of a mutated form of hemoglobin.
Sickle cell disease (SCD)
MRI is the best method for detecting early signs of changes in bone marrow due to acute and chronic _________ .
Bone marrow infarction, marrow hyperplasia, osteomyelitis, and osteonecrosis
________ may manifest with neurological features or megaloblastic anemia evident with MRI. Clinical signs of dorsal column involvement (loss of position and vibration sense and ataxia), lateral column involvement (spasticity, hyperreflexia and positive Babinski sign) and spinothalamic tracts involvement (sensory level).
Vitamin B12 deficiency
_________ is a cancer of plasma cells. Often, no symptoms are noticed initially. When advanced; bone pain, bleeding, frequent infections, and anemia may occur.
Multiple myeloma is the most common primary malignant ________ in adults.
_________ is a rare disease in which the bone marrow and the hematopoietic stem cells that reside there are damaged. This causes a deficiency of all three blood cell types (pancytopenia): red blood cells (anemia), white blood cells (leukopenia), and platelets (thrombocytopenia).
________ is characterized by recurrent upper airway obstruction occurring at the level of the pharynx during sleep. CT and magnetic resonance imaging are used.
Obstructive sleep apnea (OSA)
_________ Bone Forming Tumours; ________ Bone Destroying Tumours; ________ lytic & blastic pattern
Osteoblastic; osteolytic; mixed
Patterns of bone destruction: _________ Benign; _________ Malignant or Infection; _________ Aggressive Malignant.
Geographic; moth-eaten; permeative
________ loss of bone density is necessary before detectable on radiographs.
What type of pattern of bone destruction has separate chambers producing a soap bubble appearance?
What type of pattern of bone destruction is defined as an ill-defined zone of multiple small radiolucencies that may coalesce?
What type of pattern of bone destruction has numerous, tiny pinhole lesions, which are usually seen in the most rapidly aggressive malignant bone tumours.
On bone imaging, if the cortex is _______ it is usually a good sign; if the cortex is _________ it can either be benign or malignant; if the cortex is ________ it usually indicates an infection or a malignant tumour.
Intact; expanded or bulging; destroyed, eroded, or penetrated
There are three basic periosteal patterns of new bone formation:
Solid, lamellated, and spiculated
A _________ periosteal response is continuous layer of new bone that attaches to the outer cortical surface, and may create an elliptical appearance. It is typically benign due to a slow form of irritation such as a stress fracture or venous stasis.
On bone imaging an alternating layer pattern of lucent and opaque densities is know as ________ response.
What response gives a hair-on-end appearance in bone imaging that can be perpendicular, brushed whiskers, or sunburst, and is Indicative of an aggressive bone tumour, usually osteosarcoma?
________ of periosteal is new bone at the peripheral lesion-cortex junction as a result of the sub-periosteal extension of the lesion.
Margination or zone of transition is the _________ between a tumour and normal bone.
The ________ zone of transition is usually benign, and the margins of the lesion are sharp, definite, and sclerotic. Usually slow growing and commonly seen fibrous dysplasia and simple bone cysts.
The ________ zone of transition has imperceptible margination or hazy, ill-defined or a wide zone of transition, with no distinct line, and usually indicates aggressive bone destruction seen in malignant tumors and infections.
If the process began in the soft tissue; then the soft tissue destruction is greater than in the neighbouring bone (gout, soft tissue neoplasms). If the pathologic process began in bone then the boney destruction is usually greater than the soft tissue involvement
Outside-In vs. Inside-Out Principle
What is the dominant internal extracellular substance of a lesion?
________: Cannot be suggested on plain films; ________: Frequently calcifies (Stippled, flocculent); ________: Demonstrate varying degrees of density from diffuse to hazy or dense/ivory (osteosarcoma); ________ :Smokey, hazy internal density, “ground glass” (fibrous dysplasia)
Fat; cartilage; osseous; Fibrous
Conditions of multiple tumours and tumour-like conditions:
Metastasis, multiple myeloma, Paget’s disease, fibrous dysplasia, haemophelia, Brown Tumours of hyperparathyroidism
________ almost always do not cross joints, but _________ do.
The two most common sources of joint contamination are ________ from a distant site and ________ . Secondary septic arthritis can be a complication of joint replacement therapy.
Bloodborne; traumatic implantation
Drug abusers are prone to infections of _________ joints.
Spine, sacroiliac, sternoclavicular, and symphysis pubis
For suppurative/pyogenic osteomyelitis ________ scans are the earliest means of diagnosis.
________ is usually a single joint involvement from hematogenous or direct implantation. The knee and hip are the most common sites.
Earliest signs are of a destructive lytic lesion of the anterior corner of the vertebral endplate with loss of disc space. Displaced paraspinal line on an AP view from abscess formation especially in T-spine (because of contrasting lung). May involve Psoas which can develop a snowflake type of calcification. Osteolytic vertebral body destruction with collapse causing a wedging of the vertebrae with angular kyphosis leading to a Gibbus deformity.
Radiologic features of TB
________ frequently progresses to abscess formation and thus often has a mass like appearance on MR images. The hallmark of muscle infection is fluid collections present inside the muscle.
In chronic muscular dystrophy, the muscle has been entirely replaced by _______ .
________ is a relatively common acquired chronic relapsing demyelinating disease involving the central nervous system. MRI is the preferred imaging modality for diagnosis and follow up.
Multiple sclerosis (MS)
This test should not be performed in women who are pregnant or breastfeeding. If you are hyperthyroid a hot nodule is seen that is producing excess thyroid hormone.If the uptake is very low because of hypothyroidism, nodules will appear “cold” as in thyroiditis (inflammation of the thyroid gland).
With radioactive iodine and if you are hyperthyroid, a ________nodule is seen that is producing excess thyroid hormone. If the uptake is very low because of hypothyroidism, nodules will appear ________ as in thyroiditis (inflammation of the thyroid gland).
________ is a generalized reduction in bone mass that is less severe than that resulting from osteoporosis, caused by the resorption of bone at a rate that exceeds bone synthesis.
_________ is a reduction in bone quantity, while _________ is a reduction in bone quality.
________ is the least sensitive method for assessing bone quantity and quality.
Plain Film Radiography
Subperiosteal bone resorption is a radiographic hallmark of ________ producing an irregular lace-like frayed appearance of the external/subperiosteal bone.
In the spine the effects of hyperparathyroidism can have a ________ pattern: alternating dense-lucent-dense pattern seen in vertebral bodies.
Rugger Jersey Spine
Hyperparathyroidism can present with ________ (osteoclastoma): distinct geographical radiolucenicies, may mimic a destructive neoplasm, and a ________ look with imaging of the skull.
Brown tumours; salt and pepper
For bone density assessment, _________ are diagnostic measure of choice for osteoporosis.
DEXA scans (Dual Energy X-ray Absorptiometry)
A _________ is the number of standard deviations away from the mean. The mean is derived from the age of peak bone mass (20 – 35 years). -2.5 or worse constitutes osteoporosis.
What body parts should be imaged when measuring bone density?
Hip, lumbar spine, calcaneus, and radius
__________ is a form of endometriosis characterized by the invasive, usually benign growth of tissue into smooth muscle such as the uterus.