Anatomical
Area of
Complaint |
Presenting
Symptoms |
|
Imaging Modalities
Indicated |
HEAD |
|
acoustic neuroma, multiple sclerosis, temporal lobe lesion, tumor, or stroke, sub or epidural hematoma, cyst
|
MRI: the most sensitive for suspected pathology listed
CT: less expensive than MRI but not as sensitive
|
HEAD |
|
temporal lobe lesion, tumor, or stroke, multiple sclerosis, cerebrovascular accident, cyst
|
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
|
HEAD |
localized pain or headaches
|
tumor, abcess, arteriovenous malformation, trauma, cyst
|
MRI: most sensitive
CT: less expensive and less
sensitive
Exception: CT is more
specific for calcified tumors
|
HEAD |
|
tumor or other space occupying lesion, mastoiditis, sinusitis, hydrocephalus, cyst
|
MRI: most sensitive
CT: less expensive not sensitive
|
HEAD |
|
tumor or other space occupying lesion, cerebrovascular accident (CVA), cyst or multiple sclerosis
|
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)
|
HEAD |
|
subdural or epidural hematoma, or other hemorrhage, infection, abcess
|
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
abcess
CT: most sensitive for
hemorrhage in acute stage 1st 3 days post hemorrhage
|
HEAD |
|
acoustic neuroma, occipital lobe lesion,
optic nerve lesion, meningioma, cyst, olefactory nerve lesion
|
MRI: most sensitive
CT: less expensive but less sensitive
Exception: CT is more specificfor calcifying lesions
|
HEAD |
|
|
MRI: most sensitive
CT: less sensitive except for calcifying lesions
|
HEAD |
|
prolactinoma or other pituitary tumor
|
MRI: most sensitive
CT: less sensitivity due to scatter artifact from sellaturcicia
|
CERVICAL |
unilateral or bilateral symptomatology of neck or upper extremities
|
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)
|
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
|
CERVICAL |
history post trauma or surgery
|
HNP, recurrent HNP versus scar tissue, ligamentous tearing, non-displaced fracture, syringomylia, infection, recurrent cord tumor
|
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
|
CERVICAL |
loss of range of motion or excessive motion of individual motor units
|
ligamentous tearing or laxity, muscle spasm
|
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
|
CERVICAL |
history of cancer or systemic
disease affecting bone
(Pagets, Lupus, etc.)
|
metastasis to spinal cord or bony structures, marrow
changes secondary to
systemic disease, pathological fracture from
metastasis
|
MRI: the most sensitive for
evaluation of metastasis or
marrow changes a known area
CT: sensitive for bony detail
|
THORACIC |
unilateral or bilateral
symptomatology of trunk or
lower extremeties
|
arthritic hypertrophy, HNP,
bulging anulus, cord tumor,
syringomyelia, stenosis of
canal or foraminal openings,
compression fracture
|
MRI: the most sensitive for
various soft tissue
structures-discs, canal contents, tumors,
syringomyelia
CT: most sensitive for bony
structures
|
THORACIC |
history post trauma or surgery
|
compression fracture,
syringmyelia, recurrent HNP versus scar tissue, recurrent cord tumor, infection
|
MRI: most sensitive for
evaluating soft tissue
strutures
CT: best for bony details
|
THORACIC |
history post cancer or
systemic disease affecting
bone (Pagets, Lupus, ect.)
|
metastasis to spinal cord or
bony structures, marrow
changes secondary to systemic disease,
pathological fracture
|
MRI: most sensitive for
evaluating soft tissue
strutures and marrow
CT: best for bony details
|
LUMBAR |
unilateral or bilateral
symptomatology of lower back, pelvis, lower
extremeties, or
incontinence
|
arthritic hypertrophy, HNP,
bulging anulus, conus or
cauda equina tumor
stenosis of canal or foraminal openings, compression fracture, abdominal aortic aneurysm, tethered cord
|
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
|
LUMBAR |
history post trauma or surgery
|
compression fracture, neural canal or foraminal stenosis, infection, recurrent HNP versus scar tissue, recurrent conus or cauda equina tumor
|
MRI: most sensitive for soft
tissue evaluation post
surgery or trauma
CT: best for bony detail
|
LUMBAR |
history of cancer or systemic
disease affecting bone
(Pagets, Lupus, etc.)
|
metastasis to spinal cord or
bony structures, pathological
fracture, marrow changes
secondary to systemic disease
|
MRI: most sensitive for
evaluating soft tissue
structures, best for follow-up evaluation of
known mets or marrow abnormalities
|
SHOULDER |
|
glenoid labrum tear,
degenerative joint disease
|
MRI: most accurately depicts glenoid labrum
glenoid fossa
|
SHOULDER |
pain and weakness, decreased
range of motion, history of
arthritis or trauma
|
full or partial thickness
rotator cuff tear, impingement syndrome,
fracture, synovial cysts,
neoplasm, effusion, infection
|
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
|
HIP |
history of cancer or systemic
disease affecting bone
(Pagets, Lupus, etc.)
|
metastatic tumor, occult
fracture, marrow changes to
secondary systemic disease
|
MRI: highly sensitive to
metastatic lesions and
marrow changes, can
evaluate fractures in multiple planes
CT: more sensitive for bony
detail
|
HIP |
unilateral or bilateral pain,
decreased range of motion,
history of trauma or surgery
|
avascular necrosis, tumor,
degenerative joint disease,
occult fracture
|
MRI: the most sensitive
imaging modality for
detecting in schemic
necrosis in bone, only
modality that images hyaline
cartilage
NOTE: Hip prothesis patients are safe to scan by MRI degradation of images may or may not occur
depending on content of prothesis
CT: good bony detail,
sensitive for occult fractures
|
KNEE |
pain, decreased range of
motion, history of trauma or
prior surgery, history of
arthritis
|
meniscal tear, cruciate
ligament tear effusion,
chondromalacia patellae,
subchondral fracture,
osteochondritis dessicans,
avascular necrosis, collateral
ligament tear, neoplasm,
infection
|
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
|
WRIST, ELBOW, ANKLE & FOOT |
pain, decreased range of
motion, history of trauma
or prior surgery, history
of arthritis
|
avascular necrosis, intra-
articular loose bodies, transchondral fracture,
cyst formation, tendon or
ligament tearing, soft tissue
or bony tumor, fracture
non-unions
|
MRI: the most sensitive for
soft tissue evaluation and
chronic fractures, multiplanar evaluation
advantages
X-RAY: best for bony detail
and morphology
|
CHEST:
LUNG & HEART |
history of cancer or
Hodgkin's disease
|
metastasis, lymphatic
involvement
|
MRI: less sensitive than CT,
but good for follow-up if CT is equivocal, images
substernal
lymphadenopothy 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 very
high resolution imaging of
small lesions, good initial
screen if small lesions are
suspected
|
ABDOMEN:
LIVER, SPLEEN,
PANCREAS AND KIDNEYS
|
history of cancer
diminished function or
loss of function, chronic or acute localized or non-localized abdominal
pain
|
primary or metastatic, tumor
involvement, benign cyst,
hemochromatosis, infection
|
MRI: equivalent to or less
sensitive than CT, and more
expensive, 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
small lesions, good initial
screen if small lesions are
suspected
|
PELVIS:
BLADDER, UTERUS,
OVARIES, PROSTATE
|
history of benign masses
or cancer, chronic or
acute localized or non-
localized pelvic pain
|
primary or metastatic, tumor involvement, benign
tumor or cyst, infection
|
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
|
