T2: CSF = black

T1: CSF = white

Increased parynchyma, decreased suclci, increased entricles (loss of parynchyma/atrophy)

Scattered high signal areas (1/decade, use MRI)

Decreased atten, wedge shape

MCA

Can have mass push midline over

INcrease signal, wedge shaped

Edema b/c infarct

Old cerebral infarct

Leaves area of exvacuo (area of healing, low attenuation (blacker))

Caroitids

Other A

Risk of CV accident

High freq US = freq shift of sound returning

For blood flow (even in small vessels)

Blue away from brain, red towards

L to R shunt in heart issues

Turbulence = aneurysm or artherosclerosis

Dilated post-stenotic vessels and degree of stenosis

MR: Arteries

Doppler: Blood flow

Typical change: white cortical rim @ vert margins

Trabecula: scant (loss of densities) and course

Qunatity decreases, composition is normal

X ray (only hand in known cases) AND

Dual Photon Scanning

ID who need tx (compare age matched and to 30 year old of similar race/ethnic)

SD's from mean via T score

Porosis = <-2.5

Penia = b/w -2.5 and -1.0

Norm = >-1.0

Widespread or just local joint

Loss joint space b/c dehydration/degeneration

Subchondral eburnation (sclerosis, subchondral cysts_

Osteophytes (sharp points, spurs)

Heberden's Nodes (big knuckles)

Large joints usually involved

Reactive sclerosis (errosions?)

Systemic Disturbance

Loss of Joint Space: Pannus (eats articular cartilage)

See osteoperosis next to joint (juxta arthricular, may be one of 1st signs of RA)

Diffuse soft tissue swelling

Marginal erosisions (osteoarthritis starts in the middle)

Any synovial joint

More extensive changes (more juxtarticular osteoperosis)

Ulnar dislocation

Metabolic Issue

Deposition of Urate Crystals in nearby soft tissue and bony structures causes bone destruction

Loss of joint space

Lump soft tissue swelling (esp great toe, metatarsal phalangeal joint)

Can get calcified tophus in center of bony leucencies

Cardiac Catheratization

Radionucleide Study (Technicium and thalium isotopes for perfusion)

PET scanning (perfusion and metabolism)

MRI (non-invasive, non-contrast)

CT

X Ray will be normal (may show enlarged heart)

Coronary Angiogram

Use ROA for imaging L coronary and R coronary

Helpful to eval myocardium (including A)

CT scoring: non invasive for Ca+2 loading in walls of A

Amount of Ca+2 is proporitional to amount of soft plaque

Use: ID increased risk for MI and significant stenosis

Thalium and Sestamibi to ID perfusion

Thalium = K+ analog, use @ time of injection b/c not strongly attached

ID: ischemic areas (take up K+)

Sest = snapshot of time of injection, can eval hours later

Look for homogenous uptake

3 planes (donut one and two long axis): stress vs rest to ID stress induced ischemia (will resolve on rest)

Need cyclotron for radionuc N-13

Higher quality

Less artifacts

Can get 3D images

For physiology of heart

Morphology and function

Don't need contrast (esp. important in pts w/renal issues)

Motion pictures

X ray: interstitial pulmonary edema

Thickened interstitial marks due to fluid deposition

Big heart

Redistribute blood flow from bottom to top w/distension in upper pulmonary A's

Indistinct hilar margins

Blurring of pulmonary vessels

Kerly B lines @ costophrenic angle

Increased Central interstital markings

Interstital and alveolar pulmonary edema

Large upper lobe vessesl

Hilar blurring

Prominant Intersitital markings

Peri-hilar fluffy infiltrates

Pathenemonic for Congestive Heart Failure

Due to fluid in intraseptal spaces

Perpendicular lines from plural surface

Short and horizontal

Close to lateral walls

Thickened interlobular septa b/c fluid accumulates outside of pulmonary vessels

Gestation Sac: 4.5 - 5 wks

Yolk Sac: 5 wks

Embryo (own structure): 5-6 wks

Placenta (relation to cervical os): 8 wks

Anechoic structure

Echogenic Rim (descidual rxn: body reaction to fetus implanting itself)

Gestational Sac (internal echos)

Cervix

Can only tell there's something there: may or may not see heart

Endovag scan (camera goes fishing into fornicies = can ID and measure embryo to guess @ delivery time and age of embryo (own structure))

More detail, more resolution, w/color can check heart

Can seeL gestational sac, embryo and yolk sac (small echogenic ring w/dark center)

Amniotic membrane shows up as own membrane prior to fusion w/chorionic membrane (will fuse)

Use Doppler w/motion (color) to see if fetus is alive

Funny line thing = M mode for heart rate, one plane, to ID heart rate

Fetal Head

Placental There

Also see materal myometrium

See mieralization of bone

See umbilical cord

Can see head, 3rd vent (hypechoic, low atten) and choroid plexus (echogenic, white)

Greay echogenic area = parynchyma

Outer echo rim = calvariums

Are important parts of brain there? Are choiroid plexus ok?

Four chamber view = cross section

Prenatally ID cardiac anomalies

Can ID aortic and pulmonary structures

Bowl in chest = congenital diaphragmatic hernia

3 foci on vert are normal (posterior part and transverse processes not fused yet = triangle)

Hydronephrosis or Agenesis of Kidneys 

 Menigiomyeloceal (sac-like cysts: brain tissue, CSF and meninges, protrude thru congenital defectin skull) and myeloceals (bulge w/nerve in it, like spinal bifida): defects of post central line of spine: look for disruption of white dots along post line of vert also for collections of fluid there

Can use length of femur to do something cool

Umbilical cord: 2 A and Veins: is it where you want?

Can have weird insertions and anterior abdominal defect

Brain: Anencephaly (upper part doesn't develop, above brainstem, parynchyma doesn't develop), hyrdocehalus (blockage of interventricular circulation), Chiari Deformities (posterior fossa of spine), Encephaloceal (protrusino of brain content, neural content outside of skull)

Spina bifida Cystica (diruption of posterior elements, bulging sac outside), Myelomeningeoceal (Nerve roots extending out into sac)

Renal: Hydronephrosis (dilitation of ureter, chonic leads to loss of function, can intervene)), Renal Agenesis (absence of kidneys)

Cardiac: Chambers, Orientation (dextrocardia on R, esp during embryonic development)

General: Abdominal wall defects (diaphragmatic hernia cna lead to lungs not developing), Lung Abnormalities

Omphalaceal

Abdominal Wall Defects

Gastrochesis

Midgut Malrotation (go out 90 degs, back in 180 more)

Focal Intestinal Atresia

9 wks: hernaition out, 90 rote

12 wks: 180 more as moves back in

Around SMA

Midline defect

Has covering membrane (abnorminal wall)

Contents: organs (liver, stomach, etc...), bowel, umb cord @ apex

Has significance that may be other congential anomalies that co-exist

Curvilinear echogenic line = midline defect w/GI stuff, enclosed by membraine

Paramedian defect (NOT midline),

defect of anterior wall (lateral to umbilicus), bowel loops float FREE, cord is seperate

NO covering membrane

Surgically repair @ birth, very few other anomalies (unlike w/omphal has lots of other anomalies)

SI on L, Colon on R

Problem: attachments are not appropriate: tendencies to rotate on self: valvulus, also: cecum on wrong side so appendicitis won't present normally (diagnostic difficulties)

Do: plain film upright abdoment (plain radiography)

"Double Bubble" sign: air distended in stomach (one bubble) and proximal duodenum (second bubble)

Atresia involved 2nd part of duodenum

Hard to see on US b/c fetal abdomen: all fluid, bowels all fluid, hard to see echos, but radiograph once born can swallow air and check out anomalies

Diaphysis ossified @ birth (shaft of long bone), epiphysis radioluscent (cart) @ birth except distal femoral epiphysis (develop epiphyseal ossification centers (EOC) later in life b/c bones keep growing as life goes on)

See shafts but not lots @ joint

Physis: cart plate b/c EOC and metaphysis: does bone growth in lenght, when closes: longitudinal bone growth stops, "growth plates", weak point in bone

Metaphysis: active bone formation location, next to physis = get osteoid formation and calcification for growth

Achondroplasia: cart growth deficiency @ growth plate: short limb dwarf, trunks normal w/short limbs

Osteogenesis Imperfecta: ossification growth deficiency: don't ossify, soft bones, intrauteral fracture, curves in utero, lots of fractures

Hypophosphatasia: metabolic defect (abnormalities, charachterstic apperances)

Congenital Heart Disease:

Intra-cardial septal defect (ASD/VSD): US prenatal, MRI/US post birth

Patent Ductus Arteriosus: US w/Doppler for flow

Tetrology of Fallot

Endocardial Cushion Defect: Chambers come together @ cushion, no separation of chambers of heart

Pulmonary Stenosis

Congenital Vessel Anomalies:

Coarctrition of Aorta: constriction

Double Aorta: have two!

Transposition of Great Vessels

Upper R = SVC and Ascending Aorta

Lower R = R Atria

Upper L: Aortic Arch

Aortic Pulmonary Window b/w Aortic arch and main pulmonary A(see lymph nodes from metastatic here) 

Mid L: Main pulmonary A

Mid L: L Atra

Lower L: L Ventricle

Anterior: Upper: Aortic Arch (may not see)

Mid: Pulmonary Artery (general area, A may not stand alone)

Lower: R Ventricle

Posterior: Upper: Left Atrium (just below hilum (increased atten))

Lower: Left ventricle and IVC (little curvy @ bottom)

Increased pulmonary vascularity (L to R shunt)

Small aortic Arch (blood diverted away from here)

Large main pulmonary A (shunt causes them to take in more)

R atrial and Ventricular Hypert (b/c accomodating higher pressure)

"Boot-shaped" heart

1. Pulmonic stenosis (infundibulum)

2. VSD

3. R ventricle hypertrophy

4. Overidding aorta

Causes: decrease in pulmonary circulation

Abnormal size/form: Horshoe kidney (joined @ pole, inferior more common)

Abnormal posistion: Malrotate (sit angled off), ectopia (in pelvis, sit where normally put kidney transplant)

Abnormal structure: polystsitc (normal parynchyma replaced by cysts, black holes, lobular, not smooth)

Abnormal drianage: duplication of kidneys, ureters (can insert below sphincter = chronic wetting, hydronephrosis = dark areas b/c of dilation, hypoechoic, thinning of cortex w/chronic)

Use: Intravenous urogram for normal imaging

Can do CT or US for lots of these things

Direct Sx: Solitary mass, unilateral hilar mass

Indirect: atelectasis (collapsed lung), slowly resolving pneumonia (non-resolved inflamm, can block airway), pleural effusion, abscess

Adenopathy: widened mediastinum, SVC syndrome (swell upper extreme = blood can't return thru SVC), tracheal compression (displacement on radiograph, stridor on clinical eval), Naerve Paralysisis (recurrent larynegeal = hoarse, phrenic = lack of motion of diaphragm)

Metastatic tumor!

Varying size of nodes

Associated atenlectasis of LUL = greyness

Shift of midline, R expands to compensate

Infiltrating bronchogenic cancer in hilum or anywhere

Use Hx to Dx nodule first or abnormality in hilum

Multiple nodes

Vary in size

Esp in lower lung

Eval Metabolic activity

(Once see nodes do PET)

Combo CT and PET = anatomy and physiology (metabolism)

Filling Defect

Do barium meal: masses, constrictions, ulcers

Lower GI tumors: polyploid masses, annular constrictions

Esophageal: narrow w/irregular mucosa

Stomach: filling defect into column (space occupying)

Linitis Plastica: narrowing of prox stomach, diffuse infiltration of lymphoma into wall of stomach w/no motion on fluosc (tummy won't squish on palpation)

Polyposis: multiple small filling defect = polyps (can have hereditary polyposis syndrome)

Colon Carcinoma: "Apple Core" in advanced

Hepatic Mets: low atten areas, lesions in both, can have mets from colon cancer

Benign: sharp, well defined, cortical "expansion" (bigger where tumor grows, pushes cortex away but still intact), narrow zone of transition, preserved cortical or trabecular patters (whispies)

Malig: irreg outline, broad zone of transition, break thru cortex (that outer denser region), periosteal (coats outside of cortex, get onion skin layers w/chronic periosteal reactions = lamellar apperance as opposed to smooth w/one trauma event, can have sunburst/hair on end look too w/rapid neoplastic growth) elevation, soft tissue mass (can be infiltrative), mets

Destrictive lesion

Permeative "broad zone of transition"

Extend into soft tissue

Zone of periosteal reaction (that sun burst thing)

Most common type of malignant bone cancer

Mix of lytic and blastic lesions

Can have amorphous calcifications in medial soft tissue

Common: astrocytoma: neoplasm of N cells OR meningeoma: benign but can be aggressive

On CT or MRI:

Mass, edema, enhancememtn (b/c breakdown of blood brain barrier)

From: Lung, breast, GI

Signs: CT/MRI: mass, edema, solid or ring shaped enhancement

MRI: T1 = gives better dx of size, T2 = shows edema, white on T2, use contrast enhance on T1, will look bigger than CT, use MRI for brain tumor

CT: Low atten lesions, isodense to gray, low grade surrounded by edema (black)

Slow growing

Minial mass effect

Intense enhancement

Do surge (that little tear drop shaped one near the midline)

Primary tumor of CNS, deals w/meninges, benign or malignant

Direct (primary): unilateral asymmetric mass, irregular shape and dense, invasive growth pattern (cysts are smooth)

Indirect or secondary: calcifications (micro Ca+2, irregular clusters), skin thickening/retraction, spiculations (fibrous like strandies along coopers lig)

Do US to ID morphology

US: Hypoechoic, irregular margins, echo shadowing posteriorly

Future:

Computer aided detection:

MRI: eval blood flow (see reds and oranges = abnormal = suggestive of neoplasm), increased blood flow and washout in breast tumors + ID other sites of neoplasm

PET: for staging of neoplasm, re-stage during and post redation or chemo, get black dotties

Out to in: Epiphysis

Epiphyseal Plate ("Physis", "Growth Plate")

Metaphysis

Diaphysis

Fracture line: lucent line, (can be dense w/overlap of frags)

Interruptions of bony trabec, can have bony shape or volume change

Bulging or buckling of cortex

Soft tissue swell

Joint effusion

Impacted = Compressed

Comminuted = piecies

Pathlogical = thru tumor

CLosed: w/in skin

Open = not

Avulsion = little piecie off tip

Dislocation: complete loss continuity

Subluxation: partial loss of continuity

Fracture-dislocation: one bone w/both

2 PROJECTIONS, include one end of joint and adjacent soft tissue

In kids do both sides

Special films: oblique, stress, flexion extension, and delayed

Check: displacement, angulation, shortening and rotation

Can do bone scan and MRI to help, or plain film x-ray

IN healing stress fracture: get periosteal reaction and resorption along fracture line, esp in early healing

Torus/buckling (bumpies on side)

Greenstick

Bowing

Epiphyseal (1 = Epiphys sep, 2 = Metaph frag, 3 = epi frag, 4 = vert thru all, 5 = crush)

Focal hematoma around end

Form granulation tissue

Bone callus (spindle-shape new bone formation): 2-4 wks

Remodle: 2-3 years

Cause: infection, distraction of fragment, poor blood supply, improper fixation, interposition of soft tissue b/w frags

Xray: widening of fracture line, no callus formation, smooth and sclerotic changes of frag ends

Ex: edema, hemorrhage, hematoma

Plain X-ray

CT

MRI

Angiography

US

Pulmonary contusion (density over lower spine)

Alveolar Hemorrahage and edema

Indist from other causes of consolidation

Linear low atten area in R lobe

Crescent of low atten beneath liver capsule

High dense area

Lens shaped

Confined to sutures

Think parietal

Balanced and T2

Band like high signal along right lateral brain surface

Crescentic shape

Represents methemoglobin from subdural bleed

Intraparynchymal Hematoma

No enhancement

Deep L pareital white matter

Oval high atten (blood) surrounding low atten (edema)

Mild mass effect

Epidural (poke in)

Subdural (sqeezed out)

Parynchemal (w/in)

T2

Focal high signal in tendon (white)

Irregular apperence to tendon

Tendons normally black (low signal)

High signal on fat supressed images

Deceleration Injury

Widened superior mediastinum

Exclude positional factors (laying down = widens out)

CT for ID blood

Angiogram to separate aortic injury from other vessel injury

Arch aortogram

X-Ray = bone

MRI = soft tissue extremity (muscle, tendon)

CT = organ damage (liver, spleen)