Physician’s Guide

Anatomical Area
of Complaint

  • Head
  • Head
  • Head
  • Head
  • Head
  • Head
  • Head
  • Head
  • Head
  • Cervical
  • Cervical
  • Cervical
  • Cervical
  • Thoracic
  • Thoracic
  • Thoracic
  • Lumbar
  • Lumbar
  • Lumbar
  • Shoulder
  • Shoulder
  • Hip
  • Hip
  • Knee
  • Wrist, Elbow, Ankle, and Foot
  • Chest: Lungs and Heart
  • Abdomen: Liver, Spleen, Pancreas, and Kidneys
  • Pelvis: Bladder, Uterus, Ovaries, Prostate

Presenting
Symptoms

  • dizziness
  • seizures
  • localized pain or headaches
  • non-localized headache
  • behavioral changes
  • post trauma or surgery
  • sensory changes
  • history of cancer
  • amenorrhea or lactation
  • unilateral or bilateral symptomology of neck or upper extremities
  • history post trauma or surgery
  • loss of range of motion or excessive motion of individual motor units
  • history of cancer or systemic disease affecting bone (Pagets, Lupus, etc.)
  • unilateral or bilateral symptomology of trunk or lower extremities
  • history post trauma or surgery
  • history post cancer or systemic disease affecting bone (Pagets, Lupus, ect.)
  • unilateral or bilateral symptomology of lower back, pelvis, lower extremities, or incontinence
  • history post trauma or surgery
  • history of cancer or systemic disease affecting bone (Pagets, Lupus, etc.)
  • chronic dislocation
  • pain and weakness, decreased range of motion, history of arthritis or trauma
  • history of cancer or systemic disease affecting bone (Pagets, Lupus, etc.)
  • unilateral or bilateral pain, decreased range of motion, history of trauma or surgery
  • pain, decreased range of motion, history of trauma or prior surgery, history of arthritis
  • pain, decreased range of motion, history of trauma or prior surgery, history of arthritis
  • history of cancer or Hodgkin’s disease
  • history of cancer, loss of function, chronic or acute, localized or non-localized abdominal pain
  • history of benign masses or cancer, chronic or acute localized or non- localized pelvic pain

Suspected
Pathology

  • acoustic neuroma, multiple sclerosis, temporal lobe lesion, tumor, or stroke, sub or epidural hematoma, cyst
  • temporal lobe lesion, tumor, or stroke, multiple sclerosis, cerebrovascular accident, cyst
  • tumor, abscess, arteriovenous malformation, trauma, cyst
  • tumor or other space occupying lesion, mastoiditis, sinusitis, hydrocephalus, cyst
  • tumor or other space occupying lesion, cerebrovascular accident (CVA), cyst or multiple sclerosis
  • subdural or epidural hematoma, or other hemorrhage, infection, abscess
  • acoustic neuroma, occipital lobe lesion, optic chiasm or optic nerve lesion, meningioma, cyst, olefactory nerve lesion
  • metastasis
  • prolactinoma or other pituitary tumor
  • arthritic hypertrophy, herniated nucleus pulposus (HNP), bulging anulus fibrosus, cord tumor, syringomylia, stenosis of spinal canal of foraminal openings, non-displaced fracture, multiple sclerosis (MS)
  • HNP, recurrent HNP versus scar tissue, ligamentous tearing, non-displaced fracture, syringomylia, infection, recurrent cord tumor
  • ligamentous tearing or laxity, muscle spasm
  • metastasis to spinal cord or bony structures, marrow changes secondary to systemic disease, pathological fracture from metastasis
  • arthritic hypertrophy, HNP, bulging anulus, cord tumor, syringomyelia, stenosis of canal or foraminal openings, compression fracture
  • compression fracture, syringmyelia, recurrent HNP versus scar tissue, recurrent cord tumor, infection
  • metastasis to spinal cord or bony structures, marrow changes secondary to systemic disease, pathological fractur
  • arthritic hypertrophy, HNP, bulging anulus, conus or cauda equina tumor, stenosis of canal or foraminal openings, compression fracture, abdominal aortic aneurysm, tethered cord
  • compression fracture, neural canal or foraminal stenosis, infection, recurrent HNP versus scar tissue, recurrent conus or cauda equina tumor
  • metastasis to spinal cord or bony structures, pathological fracture, marrow changes secondary to systemic disease
  • glenoid labrum tear, degenerative joint disease
  • full or partial thickness rotator cuff tear, impingement syndrome, fracture, synovial cysts, neoplasm, effusion, infection
  • metastatic tumor, occult fracture, marrow changes to secondary systemic disease
  • avascular necrosis, tumor, degenerative joint disease, occult fracture
  • miniscal tear, cruciate ligament tear effusion, chondromalacia patellae, subchondral fracture, osteochondritis dessicans, avascular necrosis, collateral ligament tear, neoplasm, infection
  • avascular necrosis, intra-articular loose bodies, transchondral fracture, cyst formation, tendon or ligament tearing, soft tissue or bony tumor, fracture non-unions
  • metastasis, lymphatic involvement
  • primary or metastatic, tumor involvement, benign cyst, hemochromatosis, infection
  • primary or metastatic, tumor involvement, benign tumor or cyst, infection

Imaging Modalities
Indicated

  • MRI: the most sensitive for suspected pathology listed
    CT: less expensive than MRI but not as sensitive
  • MRI: the most sensitive for suspected pathology listed CT: less expensive than MRI but not as sensitive Exception: CT is more sensitive in acute stage (1st 3 days) post cerebral hemorrhage
  • MRI: most sensitive CT: less expensive and less sensitive Exception: CT is more specific for calcified tumors
  • MRI: most sensitive CT: less expensive not sensitive
  • MRI: the most sensitive for tumor or multiple sclerosis CT: less sensitive for tumor, more sensitive for acute stage CVA (1st 3 days post trauma)
  • MRI: most sensitive for hemorrhage in sub-acute stage (4 to10 days post trauma) or chronic stage (10 days or more post trauma), for infection or abscess CT: most sensitive for hemorrhage in acute stage 1st 3 days post hemorrhage
  • MRI: most sensitive CT: less expensive but less sensitive Exception: CT is more specific for calcifying lesions
  • MRI: most sensitive CT: less sensitive except for calcifying lesions
  • MRI: most sensitive CT: less sensitivity due to scatter artifact from sella turcica
  • MRI: most sensitive for various soft tisssue structures-discs, canal contents, tumors or MS CT: more sensitive for bony structures or for non-displaced fracture
  • MRI: most sensitive for syringomyelia, HNP, or post surgery evaluation CT: more sensitive for non- displaced fracture VIDEO FLOUROSCOPY: most sensitive for joint motion abnormalities post trauma
  • MRI: most sensitive for soft tissue structures, inflammatory reactions CT: most sensitive for bone pathology VIDEO FLOUROSCOPY: most sensitive for join motion abnormalities related to ligamentous injury
  • MRI: the most sensitive for evaluation of metastasis or marrow changes a known area CT: sensitive for bony detail NUCLEAR MEDICINE: offers whole body coverage for initial localization of metastasis to bone, best for initial screening
  • MRI: the most sensitive for various soft tissue structures-discs, canal contents, tumors, syringomyelia CT: most sensitive for bony structures
  • MRI: most sensitive for evaluating soft tissue structures CT: best for bony details
  • MRI: most sensitive for evaluating soft tissue structures and marrow CT: best for bony details NUCLEAR MEDICINE: offers whole body coverage for initial localization of metastasis disease in bone
  • MRI: the most sensitive for soft tissue structures, easily identifies aneurysms CT: best for bony details (bulging anulus versus osteopathic growth) also visualizes aneurysms well
  • MRI: most sensitive for soft tissue evaluation post surgery or trauma CT: best for bony detail
  • MRI: most sensitive for evaluating soft tissue structures, best for follow-up evaluation of known mets or marrow abnormalities NUCLEAR MEDICINE: offers whole body coverage, best for initial screening CT: best for bony detail
  • MRI: most accurately depicts glenoid labrum glenoid fossa
  • MRI: most sensitive for partial thickness tears, same sensitivity as arthrography for full thickness tears, most sensitive for synovial cysts, impingement syndrome, neoplasm, effusion, infection Arthrography: equal sensitivity with MRI for full thickness tears, less sensitive for partial thickness tears
  • MRI: highly sensitive to metastatic lesions and marrow changes, can evaluate fractures in multiple planes CT: more sensitive for bony detail NUCLEAR MEDICINE: offers whole body coverage best for initial localization of metastatic disease in bone
  • MRI: the most sensitive imaging modality for detecting in schemic necrosis in bone, only modality that images hyaline cartilage NOTE: Hip prosthesis patients are safe to scan by MRI degradation of images may or may not occur depending on content of prosthesis CT: good bony detail, sensitive for occult fractures
  • MRI: most comprehensive and most sensitive imaging modality for non-surgical evaluation of the knee Arthrography: sensitive for cruciate ligament tears, and meniscal tears which go to an articular surface
  • MRI: the most sensitive for soft tissue evaluation and chronic fractures, multiplanar evaluation advantages X-RAY: best for bony detail and morphology
  • MRI: less sensitive than CT, but good for follow-up if CT is equivocal, images substernal lymphadenopathy well – no scatter artifact CT: equivalent to or more sensitive than MRI, less affected by peristaltic, respiratory and pulsatile motion, best for initial screen ULTRASOUND: offers high resolution imaging of lesions, good initial screen if small lesions are suspected
  • MRI: equivalent to or less sensitive than CT, good for follow-up when CT is equivocal, best for hemochromatosis CT: equivalent to or more sensitive than MRI, less affected by peristaltic, respiratory pulsatile motion, best for initial screen ULTRASOUND: offers very high resolution imaging of lesions, good initial screen if small lesions are suspected
  • MRI: best at evaluating wall invasion by tumor growth best for follow-up after tumor sites have been localized with CT CT: good for initial screening and localization of gross tumors ULTRASOUND: best for initial screening of pelvic lesions, real time imaging offers best structure identification, very high resolution capabilities