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Acosta Julbe JI, Gottreich JR, Ermann J, Isaac Z, DeFilipp M, Andrew MN, Chang Y, Zampini JM, Katz JN, Mandell JC. Reporting of Facet Joint Inflammation in Lumbar Spine MRI Studies in Patients With Low Back Pain. Spine (Phila Pa 1976) 2024; 49:733-740. [PMID: 38229507 DOI: 10.1097/brs.0000000000004923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
STUDY DESIGN Retrospective. OBJECTIVE We aimed to assess the frequency of facet joint inflammatory features noted in routine radiology reports of lumbar spine magnetic resonance imaging (MRI) studies among patients with chronic low back pain. SUMMARY OF BACKGROUND DATA Facet joint arthropathy is one of the most common causes of chronic low back pain. It may encompass various inflammatory imaging characteristics, such as facet joint effusion, bone marrow edema, and soft tissue edema. The extent to which radiology reports mention inflammatory features of the lumbar facet joints and the accuracy of these reports have not been investigated. MATERIALS AND METHODS The authors performed a chart review on 49 subjects with previous facet-related interventions ( i.e . medial branch blocks or intra-articular facet joint injection) and MRI available in the medical record. One senior musculoskeletal radiologist and a musculoskeletal radiology fellow graded the inflammatory features using a published facet joint inflammation grading system [Gold Standard (GS)]. The authors identified the inflammatory markers mentioned in the radiology reports and calculated the sensitivity and positive predictive value of the radiology reports compared with GS readings. RESULTS Compared with the GS, the sensitivity of radiology reports for facet joint effusion, bone marrow, and soft tissue edema ranged from 6% to 22%, and the positive predictive value ranged from 25% to 100%. L4/5 had the highest number of cases with inflammatory features noted on the reports. CONCLUSION Inflammatory findings, such as facet joint effusion, bone marrow edema, and soft tissue edema, are not commonly identified in radiology reports. Further investigations are needed to determine the clinical importance of MRI-detected lumbar facet joint inflammatory features as a potential mechanism of nociception and as a predictor of outcomes following injections or other therapies.
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Affiliation(s)
- José I Acosta Julbe
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Julia R Gottreich
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Joerg Ermann
- Harvard Medical School, Boston, MA
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA
| | - Zacharia Isaac
- Harvard Medical School, Boston, MA
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, MA
| | - Miriam DeFilipp
- Harvard Medical School, Boston, MA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Michael N Andrew
- Harvard Medical School, Boston, MA
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, MA
| | - Yuchiao Chang
- Harvard Medical School, Boston, MA
- Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Jay M Zampini
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jeffrey N Katz
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA
| | - Jacob C Mandell
- Harvard Medical School, Boston, MA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
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Acosta JI, Ermann J, Isaac Z, DeFilipp M, Gottreich JR, Andrew MN, Chang Y, Zampini JM, Katz JN, Mandell JC. Comprehensive Grading System of Inflammatory Features of the Lumbar Facet Joints on Magnetic Resonance Imaging. Spine (Phila Pa 1976) 2024; 49:332-340. [PMID: 37798843 PMCID: PMC10922347 DOI: 10.1097/brs.0000000000004846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Abstract
STUDY DESIGN Retrospective. OBJECTIVE We aimed to describe a magnetic resonance imaging (MRI)-based grading system of inflammatory features of the lumbar facet joints using an atlas and assess its reliability. SUMMARY OF BACKGROUND DATA Chronic low back pain is often caused by facet joint arthropathy. Inflammatory features are often evident on MRI. While several grading systems of facet arthropathy have been described, there is scant data on the reliability of these systems, and none focus exclusively on inflammatory features. MATERIALS AND METHODS We describe a grading system that assesses facet joint effusion, bone marrow edema, and soft tissue edema. Each feature was graded from 0 to 3 (facet edema) or 0 to 2 (bone marrow edema intensity and extent, soft tissue edema intensity and extent). Four spine experts graded MRIs of 50 subjects at the bilateral L3/4, L4/5, and L5/S1 levels. All subjects had symptomatic facet arthropathy and received therapeutic facet joint injections. We assessed the intra-reader and inter-reader reliability of each feature at each joint and summarized across all six joints. RESULTS The mean age of subjects was 56 years (SD = 17), and 48% were female. The injections occurred at the L3/4 level in 12% of cases, at L4/5 in 88%, and at L5/S1 in 80% of cases. The intra-reader reliability kappa's for each feature ranged from 0.42 to 0.81. In contrast, the inter-reader reliability kappa values for each feature ranged from 0.37 to 0.54. CONCLUSION MRI inflammatory features of the lumbar facet joints are often noted in patients with low back pain. The proposed grading system is reliable and could serve as a research tool for studies assessing the clinical relevance and prognostic value of these features.
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Affiliation(s)
- José I. Acosta
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Joerg Ermann
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Zacharia Isaac
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Miriam DeFilipp
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Julia R. Gottreich
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Michael N. Andrew
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Yuchiao Chang
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jay M. Zampini
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jacob C. Mandell
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Ma Y, Pan I, Kim SY, Wieschhoff GG, Andriole KP, Mandell JC. Deep learning discrimination of rheumatoid arthritis from osteoarthritis on hand radiography. Skeletal Radiol 2024; 53:377-383. [PMID: 37530866 DOI: 10.1007/s00256-023-04408-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE To develop a deep learning model to distinguish rheumatoid arthritis (RA) from osteoarthritis (OA) using hand radiographs and to evaluate the effects of changing pretraining and training parameters on model performance. MATERIALS AND METHODS A convolutional neural network was retrospectively trained on 9714 hand radiograph exams from 8387 patients obtained from 2017 to 2021 at seven hospitals within an integrated healthcare network. Performance was assessed using an independent test set of 250 exams from 146 patients. Binary discriminatory capacity (no arthritis versus arthritis; RA versus not RA) and three-way classification (no arthritis versus OA versus RA) were evaluated. The effects of additional pretraining using musculoskeletal radiographs, using all views as opposed to only the posteroanterior view, and varying image resolution on model performance were also investigated. Area under the receiver operating characteristic curve (AUC) and Cohen's kappa coefficient were used to evaluate diagnostic performance. RESULTS For no arthritis versus arthritis, the model achieved an AUC of 0.975 (95% CI: 0.957, 0.989). For RA versus not RA, the model achieved an AUC of 0.955 (95% CI: 0.919, 0.983). For three-way classification, the model achieved a kappa of 0.806 (95% CI: 0.742, 0.866) and accuracy of 87.2% (95% CI: 83.2%, 91.2%) on the test set. Increasing image resolution increased performance up to 1024 × 1024 pixels. Additional pretraining on musculoskeletal radiographs and using all views did not significantly affect performance. CONCLUSION A deep learning model can be used to distinguish no arthritis, OA, and RA on hand radiographs with high performance.
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Affiliation(s)
- Yuntong Ma
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Ian Pan
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Stanley Y Kim
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Ged G Wieschhoff
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Katherine P Andriole
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- MGH & BWH Center for Clinical Data Science, Suite 1303, 100 Cambridge St, Boston, MA, 02114, USA
| | - Jacob C Mandell
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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Acosta Julbe JI, Mandell JC, Ermann J, Isaac Z, Gottreich JR, Zampini JM, DeFilipp M, Andrew MN, Katz JN. Predictors of Outcomes After Lumbar Intra-Articular Facet Joint Injections and Medial Branch Blocks: A Scoping Review. Spine (Phila Pa 1976) 2023; 48:1455-1463. [PMID: 37470372 PMCID: PMC10528906 DOI: 10.1097/brs.0000000000004776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/26/2023] [Indexed: 07/21/2023]
Abstract
STUDY DESIGN A scoping review. OBJECTIVE We aimed to identify and describe the factors associated with the patient-reported response after lumbar intra-articular facet joint (FJ) injections or medial branch blocks (MBBs). SUMMARY OF BACKGROUND DATA FJ osteoarthritis is among the most common causes of chronic low back pain. Management often includes FJ intra-articular injection and MBBs (which may be followed by radiofrequency ablation of the nerves innervating these joints). However, the success of these approaches is variable, prompting interest in identifying patient characteristics (imaging features, clinical signs, and among others) associated with response to these types of facet injections. MATERIALS AND METHODS We performed a literature search on factors associated with patient-reported outcomes after lumbar FJ intra-articular injections or MBBs for patients with low back pain published in English or Spanish between 2000 and 2023. We excluded duplicate papers that did not describe factors associated with outcomes or those describing other interventions. We collected data on the association of these factors with patient-reported outcomes. RESULTS Thirty-seven studies met the inclusion criteria and were analyzed. These studies evaluated factors, such as age, depression, and single photon emission computed tomography (SPECT), and among variables. Age and imaging findings of facet arthropathy were the most frequently described factors. Imaging findings of FJ arthropathy and positive SPECT were often associated with positive results after intra-articular FJ injections or MBBs. In contrast, younger age and smoking were frequently associated with less favorable clinical outcomes. CONCLUSION Numerous factors were considered in the 37 studies included in this review. Imaging findings of facet arthropathy, duration of pain, and positive SPECT were consistently associated with favorable results after facet interventions.
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Affiliation(s)
- José I. Acosta Julbe
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jacob C. Mandell
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Joerg Ermann
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Zacharia Isaac
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Julia R. Gottreich
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jay M. Zampini
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Miriam DeFilipp
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Michael N. Andrew
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Koh S, Epelboym Y, Mandell JC, Burch E. Awareness of interventional radiology and image guided musculoskeletal interventions among orthopaedic surgeons, rheumatologists, and physiatrists: A multi-site analysis. Clin Imaging 2023; 102:26-30. [PMID: 37473557 DOI: 10.1016/j.clinimag.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE Evaluate physicians who treat musculoskeletal (MSK) disorders in their knowledge of image-guided MSK interventions, and identify areas that could benefit from education. MATERIALS AND METHODS A 17-question survey was distributed to orthopaedic surgeons, physiatrists, and rheumatologists in the 14-hospital health system. It inquired about demographics, practice environment, awareness of interventional radiology (IR) and MSK radiology (MSKR) training, referral patterns, and knowledge of image-guided MSK interventions. RESULTS In total, 59 of 303 physicians completed the survey (41% orthopaedists, 35% physiatrists, and 24% rheumatologists). Most (93%) were attendings and 41% were female. A minority of survey respondents (17%) recognized the designation of IR as a distinct specialty of medicine per the American Board of Medical Specialties, in contrast to MSKR, which is not designated as a distinct specialty. When queried about IR procedures not under investigation, 24% selected genicular artery embolization and 31% selected embolization for adhesive capsulitis. Barriers to referral were as follows: 21% of specialists performed the procedure, 17% listed electronic medical record challenges, 14% reported scheduling difficulty, 13% reported no barriers, 11% reported difficulty consulting, 11% referred to another specialty, 10% did not have enough knowledge of image guided procedures, and 3% reported the procedure is not performed by IR or MSKR. CONCLUSIONS Survey data reveal a knowledge gap among surveyed physicians regarding IR as a specialty as well as areas of IR research in MSK disorders. Findings suggest areas where referring physicians can be educated and identify barriers to referral.
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Affiliation(s)
- Sukjin Koh
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
| | - Yan Epelboym
- Division of Angiography and Interventional Radiology, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
| | - Jacob C Mandell
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - Ezra Burch
- Division of Angiography and Interventional Radiology, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Acosta JI, Mandell JC, Ermann J, Isaac Z, Zampini JM, DeFilipp M, Gottreich JR, Andrew M, Katz JN. Grading Systems of Lumbar Facet Joint Inflammatory Changes on Magnetic Resonance Imaging: A Scoping Review. Spine (Phila Pa 1976) 2023; 48:636-644. [PMID: 36856452 PMCID: PMC10101880 DOI: 10.1097/brs.0000000000004609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/13/2023] [Indexed: 03/02/2023]
Abstract
STUDY DESIGN A scoping review. OBJECTIVE We aimed to identify and characterize grading systems of the inflammatory features of the lumbar facet joints (FJs) noted on magnetic resonance imaging and summarize their reliability. SUMMARY OF BACKGROUND DATA Chronic low back pain is one of the most common causes of disability worldwide and is frequently accompanied by FJ osteoarthritis. Inflammatory changes in the lumbar FJs are commonly noted in imaging studies of patients with FJ osteoarthritis and low back pain. Several grading systems for these inflammatory changes have been developed. However, these grading system's features and reliability have yet to be reviewed. MATERIALS AND METHODS We performed a literature search of studies reporting grading systems for FJ inflammatory changes published in English or Spanish between 1985 and 2022. We collected data on reported interreader reliability measures of each grading system. Finally, we compared the features of inflammation described by each system. RESULTS Six studies met the inclusion criteria and were used in our analysis. Features commonly graded in these systems are the hyperintensity signal noted within the FJ, bone marrow edema, and the extent of the soft-tissue edema surrounding the FJs. We found that the interreader reliability measures ranged from 0.56 to 0.96. CONCLUSIONS Only 6 studies have reported methods for documenting inflammation in the FJs. Studies varied in the precise tissues and phenomena included in the grading systems. However, the systems were generally reliable. Future studies should document the reliability of these methods when independent investigators are not involved in developing the classification schemes. Further work might combine one or more of these measures to establish a standard and reliable grading system for inflammatory changes in the FJs, including signal intensity within the joint, bone marrow edema, and soft-tissue inflammation.
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Affiliation(s)
- José I. Acosta
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jacob C. Mandell
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Joerg Ermann
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Zacharia Isaac
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jay M. Zampini
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Miriam DeFilipp
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Julia R. Gottreich
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Michael Andrew
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Epelboym Y, Mandell JC, Collins JE, Burch E, Shiang T, Killoran T, Macfarlane L, Guermazi A. Genicular Artery Embolization as a Treatment for Osteoarthritis Related Knee Pain: A Systematic Review and Meta-analysis. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03422-0. [PMID: 36991094 DOI: 10.1007/s00270-023-03422-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/13/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE Genicular artery embolization (GAE) is a minimally invasive therapy for symptomatic osteoarthritis (OA) in patients with knee pain refractory to conservative management. The purpose of this study was to evaluate evidence on the effectiveness of GAE for OA related knee pain as part of a systematic review and meta-analysis. MATERIALS AND METHODS Using Embase, PubMed, and Web of Science, a systematic review was performed to identify studies evaluating treatment of knee OA with GAE. The primary outcome measure was change in pain scale score at 6 months. A Hedge's g was computed as a measure of effect size, selecting Visual Analog Scale (VAS) first if available and Knee Injury and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Osteoarthritis Index if VAS was not available. RESULTS After screening titles, abstracts, and the full text, 10 studies met inclusion criteria. A total of 351 treated knees were included. Patients who underwent GAE demonstrated declines in VAS pain scores at 1 month {- 34 points [95% CI (- 43.8, - 24.6)], 3 months {- 30 points [95% CI (- 41.7, - 19.2)], 6 months {- 41 points [95% CI (- 54.0, - 27.2)], and 12 months {- 37 points [95% CI (- 55.0, - 18.1)]. Hedges' g from baseline to 1, 3, 6, and 12 months, was {- 1.3 [95% CI (- 1.6, - 0.97)]}, {- 1.2 [95% CI (- 1.54, - 0.84)]}, {- 1.4 [95% CI (- 2.1, - 0.8)]}, and {- 1.25 [95% CI (- 2.0, - 0.6)]}, respectively. CONCLUSION GAE provides durable reductions in pain scores for patients suffering with mild, moderate, and severe OA.
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Affiliation(s)
- Yan Epelboym
- Division of Angiography and Interventional Radiology, Department of Radiology, Brigham and Women's Hospital, Boston, MA, 02115, USA.
| | - Jacob C Mandell
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jamie E Collins
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ezra Burch
- Division of Angiography and Interventional Radiology, Department of Radiology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Tina Shiang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy Killoran
- Division of Angiography and Interventional Radiology, Department of Radiology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Lindsey Macfarlane
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA, 02118, USA
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Jen A, Kochkodan-Self J, Mandell JC. A Retrospective Analysis of Sternal Lesions Detected on Breast MRI in Patients Without History of Cancer. J Breast Imaging 2023; 5:48-55. [PMID: 38416958 DOI: 10.1093/jbi/wbac078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To determine the imaging characteristics and stability over time of sternal lesions identified on breast MRI in patients without history of cancer. METHODS An IRB-approved retrospective analysis of all breast MRIs performed at our institution from September 1, 2017 to December 1, 2021 that included one of several key words related to the sternum. Studies with history of non-dermatologic malignancy including breast cancer, absence of a true sternal lesion, or presence of symptoms during the examination were excluded. Imaging was reviewed for size, distribution, signal characteristics, and presence of contrast enhancement, perilesional edema, periosteal edema, or intralesional fat. Available comparison imaging, clinical history, and follow-up recommendations were reviewed. Descriptive statistics were used to summarize lesion data. RESULTS Of 60 lesions included from 60 patients, 40 lesions with more than two years of comparison imaging were either stable or decreased in size and none demonstrated change in signal characteristics. The majority of these presumed benign lesions demonstrated hypointense signal on T1-weighted sequences (21/40, 52.5%), hyperintense signal on fluid-sensitive sequences (33/40, 82.5%), contrast enhancement (32/40, 80.0%), and absence of clear intralesional fat (29/40, 72.5%). One patient who did not have comparison imaging was diagnosed with malignancy (multiple myeloma) eight months following their MRI. This lesion demonstrated uniquely diffuse and heterogeneous enhancement but did not undergo biopsy. CONCLUSION Sternal lesions in women without history of non-dermatologic malignancy have a very low likelihood of malignancy. Common imaging characteristics of the presumed benign lesions can inform imaging recommendations when incidental sternal lesions are discovered.
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Affiliation(s)
- Aaron Jen
- Brigham and Women's Hospital and Harvard Medical School, Department of Radiology, Boston, MA, USA
| | - Jeanne Kochkodan-Self
- Brigham and Women's Hospital and Harvard Medical School, Department of Radiology, Boston, MA, USA
| | - Jacob C Mandell
- Brigham and Women's Hospital and Harvard Medical School, Department of Radiology, Boston, MA, USA
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Jhala K, Mandell JC, Klein S, Qureshi T, DiPiro P, Giess CS, Khorasani R. When the Virtually Impossible is Virtually Possible: Optimal Workflows and Consultation Types for Virtual Radiology Reading Rooms. J Am Coll Radiol 2023; 20:105-111. [PMID: 36494061 DOI: 10.1016/j.jacr.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Khushboo Jhala
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Jacob C Mandell
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sabrina Klein
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Taj Qureshi
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pamela DiPiro
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Catherine S Giess
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ramin Khorasani
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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10
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Ma Y, Mandell JC, Rocha T, Mendicuti MAD, Weaver MJ, Khurana B. Diagnostic accuracy of pelvic radiographs for the detection of traumatic pelvic fractures in the elderly. Emerg Radiol 2022; 29:1009-1018. [PMID: 36190583 DOI: 10.1007/s10140-022-02090-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 09/22/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE Prompt identification of traumatic pelvic fractures in the elderly is critical to guide clinical management; however, the accuracy of pelvic radiographs is often compromised by multiple factors. The purpose of this study is to examine the diagnostic accuracy of radiographs for the detection of pelvic fractures, with CT as the standard of reference. METHODS A retrospective review was performed of patients ≥ 65 years with traumatic pelvic fractures evaluated with both pelvic radiography and computed tomography (CT) from May 2016 to October 2019. Pelvic fractures were classified into fractures of the pubis, ilium, ischium, sacrum, and acetabulum. All pelvic radiographs were independently reviewed by two emergency radiologists. Original CT reports were utilized for the reference standard. RESULTS 177 patients were included, with a total of 555 fractures. The mean age was 81 years and 68% were female. The most common mechanism of injury was fall (62%), followed by motor vehicle accidents (18%). The most fractured bone was the pubis (314/555 fractures). Global pooled sensitivity for pelvic radiographs in detecting pelvic fractures compared to CT was 48%, with a specificity of 93%. Sensitivity for the detection of pelvic fractures is classified by the following types: pubis 61%, acetabulum 60%, ilium 41%, sacrum 20%, and ischium 17%. Eighteen patients (10%) required surgical fixation. Mortality was 8%. CONCLUSION Pelvic radiographs have low sensitivity in detecting traumatic pelvic fractures. These radiographically occult fractures may be clinically significant as a cause of long-term pain and may require orthopedic consultation and possible surgical management.
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Affiliation(s)
- Yuntong Ma
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Jacob C Mandell
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Tatiana Rocha
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Maria ADuran Mendicuti
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Michael J Weaver
- Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Bharti Khurana
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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11
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Mandell JC, Khurana B. Musculoskeletal Trauma and Infection. Magn Reson Imaging Clin N Am 2022; 30:441-454. [PMID: 35995472 DOI: 10.1016/j.mric.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
MR is often the most definitive imaging for assessment of musculoskeletal trauma and infection. Although it is not possible to address all the intricacies of these complex topics in a single article, this review will attempt to provide a useful toolbox of skills by discussing several common clinical scenarios faced by emergency radiologists in interpretation of adult trauma and infection. These scenarios include MR assessment of hip and pelvic fracture, traumatic soft tissue injuries, septic arthritis, soft tissue infection, and osteomyelitis.
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Affiliation(s)
- Jacob C Mandell
- Musculoskeletal Imaging and Intervention, Division of Musculoskeletal Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Bharti Khurana
- Division of Emergency Radiology, Brigham and Women's Hospital, Trauma Imaging Research and Innovation Center, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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12
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Czuczman GJ, Mandell JC, Wessell DE, Lenchik L, Ahlawat S, Baker JC, Cassidy RC, Demertzis JL, Garner HW, Klitzke A, Maynard JR, Pierce JL, Reitman C, Thiele R, Yost WJ, Beaman FD. ACR Appropriateness Criteria® Inflammatory Back Pain: Known or Suspected Axial Spondyloarthritis: 2021 Update. J Am Coll Radiol 2021; 18:S340-S360. [PMID: 34794593 DOI: 10.1016/j.jacr.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 02/07/2023]
Abstract
Inflammatory back pain is a hallmark feature of axial spondyloarthritis, a heterogeneous group of inflammatory disorders which affects the sacroiliac joints and spine. Imaging plays a key role in diagnosis of this disease and in facilitating appropriate treatment. This document provides evidence-based recommendations on the appropriate use of imaging studies during multiple stages of the clinical evaluation of patients with suspected or known axial spondyloarthritis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Jacob C Mandell
- Research Author, Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts
| | | | - Leon Lenchik
- Panel Vice-Chair, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Shivani Ahlawat
- Musculoskeletal Fellowship Director; and Chair, REiNS Whole Body MRI Committee, Johns Hopkins Hospital, Baltimore, Maryland
| | - Jonathan C Baker
- Mallinckrodt Institute of Radiology Washington University School of Medicine, Saint Louis, Missouri
| | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; Executive Board, Kentucky Orthopaedic Society; and American Academy of Orthopaedic Surgeons
| | | | | | - Alan Klitzke
- Roswell Park Comprehensive Cancer Center, Buffalo, New York; Board of Directors, American College of Nuclear Medicine; Board of Directors, SNMMI Correlative Imaging Council; and Delegate, American Medical Association House of Delegates
| | - Jennifer R Maynard
- Program Director Sports Medicine Fellowship, Mayo Clinic Florida, Jacksonville, Florida; Primary care physician; Medical Advisor Women's Tennis Association; Vice-Chair, Jacksonville Sports Medicine Program Executive Board; Chair, Florida High School Athletic Association Sports; and Medicine Advisory Committee
| | | | - Charles Reitman
- Medical University of South Carolina, Charleston, South Carolina; and Board of Directors, North American Spine Society
| | - Ralf Thiele
- University of Rochester School of Medicine and Dentistry, Rochester, New York, American College of Rheumatology
| | - William J Yost
- UnityPoint Health, Des Moines, Iowa, American College of Physicians
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13
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Miskin N, Gaviola GC, Huang RY, Kim CJ, Lee TC, Small KM, Wieschhoff GG, Mandell JC. Standardized Classification of Lumbar Spine Degeneration on Magnetic Resonance Imaging Reduces Intra- and Inter-subspecialty Variability. Curr Probl Diagn Radiol 2021; 51:491-496. [PMID: 34556373 DOI: 10.1067/j.cpradiol.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND PURPOSE To determine the efficacy of standardized definitions of degenerative change in reducing variability in interpretation of lumbar spine magnetic resonance imaging within and between groups of subspecialty-trained neuroradiologists (NR) and musculoskeletal radiologists (MSK). MATERIALS AND METHODS Six radiologists, three from both NR and MSK groups were trained on a standardized classification system of degenerative change. After an 11-month washout period, they independently re-interpreted fifty exams at the L4-L5 and L5-S1 levels. Responses were converted to a six-point ordinal scale for the assessment of neural foraminal stenosis and spinal canal stenosis (SCS), three-point scale for lateral recess stenosis, and four-point scale for facet osteoarthritis (FO). Intra-subspecialty and inter-subspecialty analysis was performed using the weighted Cohen's kappa with a binary matrix of all reader pairs. RESULTS Inter-subspecialty agreement improved from k=0.527 (moderate) to k=0.602 (substantial) for neural foraminal stenosis, from k=0.540 (moderate) to k=0.652 (substantial) for SCS, from k=0.0818 (slight) to k=0.337 (fair) for lateral recess stenosis, and from k=0.176 (slight) to k=0.495 (moderate) for FO. The NR group demonstrated improved intra-subspecialty agreement for the assessment of SCS, from k=0.368 (fair) to k=0.638 (substantial). The MSK group demonstrated improved intra-subspecialty agreement for the assessment of FO, from k=0.134 (slight) to k=0.413 (moderate). Intra-subspecialty agreement was similar for other parameters before and after training. CONCLUSIONS As result of the standardized definitions training, the NR and MSK groups each improved in one of the four parameters, while inter-subspecialty variability improved in all four parameters. These definitions may be useful in clinical practice across radiology subspecialties.
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Affiliation(s)
- Nityanand Miskin
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Glenn C Gaviola
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christine J Kim
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Thomas C Lee
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kirstin M Small
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ged G Wieschhoff
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jacob C Mandell
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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14
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Miskin N, Isaac Z, Lu Y, Makhni MC, Sarno DL, Smith TR, Zampini JM, Mandell JC. Simplified Universal Grading of Lumbar Spine MRI Degenerative Findings: Inter-Reader Agreement of Non-Radiologist Spine Experts. Pain Med 2021; 22:1485-1495. [PMID: 33713135 DOI: 10.1093/pm/pnab098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/23/2021] [Accepted: 03/09/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE 1) To describe a simplified multidisciplinary grading system for the most clinically relevant lumbar spine degenerative changes. 2) To measure the inter-reader variability among non-radiologist spine experts in their use of the classification system for interpretation of a consecutive series of lumbar spine magnetic resonance imaging (MRI) examinations. METHODS ATS multidisciplinary and collaborative standardized grading of spinal stenosis, foraminal stenosis, lateral recess stenosis, and facet arthropathy was developed. Our institution's picture archiving and communication system was searched for 50 consecutive patients who underwent non-contrast MRI of the lumbar spine for chronic back pain, radiculopathy, or symptoms of spinal stenosis. Three fellowship-trained spine subspecialists from neurosurgery, orthopedic surgery, and physiatry interpreted the 50 exams using the classification at the L4-L5 and L5-S1 levels. Inter-reader agreement was assessed with Cohen's kappa coefficient. RESULTS For spinal stenosis, the readers demonstrated substantial agreement (κ = 0.702). For foraminal stenosis and facet arthropathy, the three readers demonstrated moderate agreement (κ = 0.544, and 0.557, respectively). For lateral recess stenosis, there was fair agreement (κ = 0.323). CONCLUSIONS A simplified universal grading system of lumbar spine MRI degenerative findings is newly described. Use of this multidisciplinary grading system in the assessment of clinically relevant degenerative changes revealed moderate to substantial agreement among non-radiologist spine physicians. This standardized grading system could serve as a foundation for interdisciplinary communication.
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Affiliation(s)
- Nityanand Miskin
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zacharia Isaac
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yi Lu
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Melvin C Makhni
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Danielle L Sarno
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy R Smith
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jay M Zampini
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob C Mandell
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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15
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Fennessy FM, Mandell JC, Boland GW, Seltzer SE, Giess CS. Strategies to Increase Resilience, Team Building, and Productivity Among Radiologists During the COVID-19 Era. J Am Coll Radiol 2021; 18:675-678. [DOI: 10.1016/j.jacr.2020.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 11/30/2022]
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16
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Dianat S, Small KM, Shah N, Lattermann C, Mandell JC. Imaging of meniscal allograft transplantation: what the radiologist needs to know. Skeletal Radiol 2021; 50:615-627. [PMID: 33011872 DOI: 10.1007/s00256-020-03631-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 02/02/2023]
Abstract
Meniscal allograft transplantation is an emerging surgical option for younger patients with symptomatic meniscal deficiency, which aims to restore anatomic biomechanics and load distribution in the knee joint, and by so doing to potentially delay accelerated osteoarthritis. In this review article, we summarize the structure and biomechanics of the native meniscus, describe indications and procedure technique for meniscal allograft transplantation, and demonstrate the spectrum of expected postoperative imaging and role of imaging to identify potential complications.
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Affiliation(s)
- Saeed Dianat
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Division of Musculoskeletal Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Kirstin M Small
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nehal Shah
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christian Lattermann
- Department of Orthopedic Surgery, Center for Cartilage Repair and Sports Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jacob C Mandell
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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17
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Levin ES, Mandell JC, Smith SE. Do non-weight-bearing knee radiographs for chronic knee pain result in increased follow-up imaging? Skeletal Radiol 2021; 50:515-519. [PMID: 32820346 DOI: 10.1007/s00256-020-03585-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE While weight-bearing radiographs are considered the optimal method for evaluation of joint spaces in osteoarthritis, non-weight-bearing radiographs are often performed. The purpose of this study is to evaluate the rate of follow-up radiographs in patients receiving non-weight-bearing radiographs for chronic knee pain in the outpatient setting, compared with patients receiving weight-bearing radiographs. MATERIALS AND METHODS Consecutive patients who received non-weight-bearing knee radiographs for chronic knee pain between January 1, 2018, and June 15, 2019, were included. Exclusion criteria included trauma, concern for infection or tumor, and post-surgical radiographs. An age- and sex-matched control group of 100 patients who received weight-bearing knee radiographs was compiled. The proportion of follow-up radiographs within 1 year was compared between the study and control groups with chi-squared tests. RESULTS Four hundred non-weight-bearing knee radiographic examinations were included. There were 74/400 (18.5%) follow-up radiographs within 12 months. All follow-up radiographs were weight-bearing. In the control group, 4/100 (4%) had follow-up weight-bearing radiographs within 1 year (p < 0.001). CONCLUSION Outpatients who underwent non-weight-bearing knee radiographs for chronic pain had a higher frequency of repeat imaging than those who initially underwent weight-bearing knee radiographs. These results suggest that non-weight-bearing knee radiographs are of lower clinical utility compared with weight-bearing radiographs.
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Affiliation(s)
- Elizabeth S Levin
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
| | - Jacob C Mandell
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Stacy E Smith
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.,The Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA, USA
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18
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Sun EX, Mandell JC, Weaver MJ, Kimbrell V, Harris MB, Khurana B. Clinical utility of a focused hip MRI for assessing suspected hip fracture in the emergency department. Emerg Radiol 2020; 28:317-325. [PMID: 33175269 DOI: 10.1007/s10140-020-01870-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE A focused hip MRI (FHMR) for the detection of radiographically occult hip fractures was implemented in our emergency department (ED) in 2013. The goal of this study was to assess the clinical utility of this protocol. METHODS We retrospectively reviewed radiology reports of 262 unique patients who underwent 263 FHMR (coronal T1, coronal STIR, axial T2 fat saturated) for suspected hip fracture in the ED from October 2013 to March 2020. Electronic medical records were reviewed for the ED course, follow-up imaging, and clinical management within 90 days. RESULTS Seventy-one patients had one or more fractures identified by FHMR: one-third had proximal femoral fractures; two-third had pelvic fractures. Of these 71 patients, 53 (74%) had radiographically occult fractures, including 14 (20%) with occult proximal femoral fractures; 4 patients had fractures occult on CT. Nineteen patients with a suspected fracture on radiography were found to have no fracture on FHMR. Four fractures not reported on FHMR were later seen on follow-up imaging: these included 1 isolated greater trochanter, 1 additional ischial tuberosity, 1 additional superior pubic ramus, and 1 additional sacrum. All four fractures were treated non-operatively. Muscle/tendon injury was the most common type of injury, seen in 50% (130/262) patients with the most commonly torn tendons being the hamstring (44%; 15/34) followed by gluteus medius tendon (18%; 6/34). A full-hip or pelvis MRI was done after FHMR in only 5 patients, primarily for the purpose of better characterizing findings already identified on FHMR (2 for fracture, 2 for tendon injury, 1 for soft tissue metastasis). Only one of these five studies provided new information: ruling out a previously questioned fracture. Clinical management of the vast majority of patients was based solely on findings from the FHMR. CONCLUSIONS FHMR offers reliable identification of radiographically occult hip fractures and muscle/tendon injuries. The protocol is well trusted in guiding patient management in our ED.
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Affiliation(s)
- Ellen X Sun
- Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02215, USA.
| | - Jacob C Mandell
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02215, USA
| | - Michael J Weaver
- Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02215, USA
| | - Vera Kimbrell
- Department of Radiology, Duke University Hospital, 2301 Erwin Rd, Durham, NC, 27710, USA.,Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02215, USA
| | - Mitchel B Harris
- Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Bharti Khurana
- Trauma Imaging Research and Innovation Center, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02215, USA
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19
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Casadaban LC, Mandell JC, Epelboym Y. Genicular Artery Embolization for Osteoarthritis Related Knee Pain: A Systematic Review and Qualitative Analysis of Clinical Outcomes. Cardiovasc Intervent Radiol 2020; 44:1-9. [PMID: 33135117 DOI: 10.1007/s00270-020-02687-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/13/2020] [Indexed: 01/15/2023]
Abstract
Objective To systematically review the published literature on genicular artery embolization (GAE) for osteoarthritis (OA) related knee pain. Materials and Methods Using three databases, a systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Outcome measures included the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results Three single-arm studies were included from an initial search yielding 305 results. One hundred and eighty-six knees in 133 patients with either mild-to-moderate (174/186, 94%) or severe (12/186, 6%) OA underwent embolization with either imipenem/cilastatin sodium (159/186, 85%) or embozene (27/186, 15%). Technical success was 100%. Average VAS improved from baseline at 1 day, 1 week, 1 month, 3 months, 4 months, 6 months, 1 year and 2 years (66.5 at baseline vs 33.5, 32.7, 33.8, 28.9, 29.0, 22.3, 14.8 and 14.0, respectively). Average WOMAC scores improved from baseline at 1, 3, 4, 6, 12 and 24 months (45.7 at baseline vs 24.0, 31.0, 14.8, 14.6, 8.2 and 6.2). Severe OA in 12 cases showed initially improved VAS, but was not sustained. Minor adverse events such as erythema in the region of embolization (21/186, 11%), puncture-site hematoma (18/186, 10%), paresthesia (2/186, 1%) and fever (1/186, 0.5%) were reported. Conclusion Limited single-arm studies report GAE is promising for treating OA-related pain. Most treatments performed for mild-to-moderate OA demonstrated durable clinical responses from 6 months to 4 years. Limited data for severe OA suggest a non-durable response. Future studies should be standardized to facilitate comparison and control for placebo effect.
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Affiliation(s)
- Leigh C Casadaban
- Division of Angiography and Interventional Radiology, Department of Radiology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Jacob C Mandell
- Division of Angiography and Interventional Radiology, Department of Radiology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Yan Epelboym
- Division of Angiography and Interventional Radiology, Department of Radiology, Brigham and Women's Hospital, Boston, MA, 02115, USA.
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20
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Affiliation(s)
- Junzi Shi
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (J.S., J.C.M., L.S.B.); and Department of Radiology, Division of Musculoskeletal Imaging and Intervention, NYU Langone Health, New York, NY (C.J.B., R.S.A.)
| | - Jacob C Mandell
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (J.S., J.C.M., L.S.B.); and Department of Radiology, Division of Musculoskeletal Imaging and Intervention, NYU Langone Health, New York, NY (C.J.B., R.S.A.)
| | - Christopher J Burke
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (J.S., J.C.M., L.S.B.); and Department of Radiology, Division of Musculoskeletal Imaging and Intervention, NYU Langone Health, New York, NY (C.J.B., R.S.A.)
| | - Ronald S Adler
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (J.S., J.C.M., L.S.B.); and Department of Radiology, Division of Musculoskeletal Imaging and Intervention, NYU Langone Health, New York, NY (C.J.B., R.S.A.)
| | - Luis S Beltran
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (J.S., J.C.M., L.S.B.); and Department of Radiology, Division of Musculoskeletal Imaging and Intervention, NYU Langone Health, New York, NY (C.J.B., R.S.A.)
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21
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Shi J, Mandell JC, Burke CJ, Adler RS, Beltran LS. Review of Interventional Musculoskeletal US. Radiographics 2020. [DOI: 10.1148/rg.2020200036.pres] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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22
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Gosangi B, Mandell JC, Weaver MJ, Uyeda JW, Smith SE, Sodickson AD, Khurana B. Bone Marrow Edema at Dual-Energy CT: A Game Changer in the Emergency Department. Radiographics 2020; 40:859-874. [DOI: 10.1148/rg.2020190173] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Babina Gosangi
- From the Departments of Radiology (B.G., J.C.M., J.W.U., S.E.S., A.D.S., B.K.) and Orthopedic Surgery (M.J.W.), Brigham and Women’s Hospital Emergency Radiology Division, 75 Francis St, Boston, MA 02115
| | - Jacob C. Mandell
- From the Departments of Radiology (B.G., J.C.M., J.W.U., S.E.S., A.D.S., B.K.) and Orthopedic Surgery (M.J.W.), Brigham and Women’s Hospital Emergency Radiology Division, 75 Francis St, Boston, MA 02115
| | - Michael J. Weaver
- From the Departments of Radiology (B.G., J.C.M., J.W.U., S.E.S., A.D.S., B.K.) and Orthopedic Surgery (M.J.W.), Brigham and Women’s Hospital Emergency Radiology Division, 75 Francis St, Boston, MA 02115
| | - Jennifer W. Uyeda
- From the Departments of Radiology (B.G., J.C.M., J.W.U., S.E.S., A.D.S., B.K.) and Orthopedic Surgery (M.J.W.), Brigham and Women’s Hospital Emergency Radiology Division, 75 Francis St, Boston, MA 02115
| | - Stacy E. Smith
- From the Departments of Radiology (B.G., J.C.M., J.W.U., S.E.S., A.D.S., B.K.) and Orthopedic Surgery (M.J.W.), Brigham and Women’s Hospital Emergency Radiology Division, 75 Francis St, Boston, MA 02115
| | - Aaron D. Sodickson
- From the Departments of Radiology (B.G., J.C.M., J.W.U., S.E.S., A.D.S., B.K.) and Orthopedic Surgery (M.J.W.), Brigham and Women’s Hospital Emergency Radiology Division, 75 Francis St, Boston, MA 02115
| | - Bharti Khurana
- From the Departments of Radiology (B.G., J.C.M., J.W.U., S.E.S., A.D.S., B.K.) and Orthopedic Surgery (M.J.W.), Brigham and Women’s Hospital Emergency Radiology Division, 75 Francis St, Boston, MA 02115
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Affiliation(s)
- Olga Laur
- From the Departments of Emergency Radiology (O.L., B.K.), Musculoskeletal Radiology (J.C.M., S.E.S.), and Neuroradiology (C.C.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; and Department of Radiology, Shields Health Care, Brockton, Mass (D.S.T.)
| | - Jacob C Mandell
- From the Departments of Emergency Radiology (O.L., B.K.), Musculoskeletal Radiology (J.C.M., S.E.S.), and Neuroradiology (C.C.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; and Department of Radiology, Shields Health Care, Brockton, Mass (D.S.T.)
| | - David S Titelbaum
- From the Departments of Emergency Radiology (O.L., B.K.), Musculoskeletal Radiology (J.C.M., S.E.S.), and Neuroradiology (C.C.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; and Department of Radiology, Shields Health Care, Brockton, Mass (D.S.T.)
| | - Charles Cho
- From the Departments of Emergency Radiology (O.L., B.K.), Musculoskeletal Radiology (J.C.M., S.E.S.), and Neuroradiology (C.C.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; and Department of Radiology, Shields Health Care, Brockton, Mass (D.S.T.)
| | - Stacy E Smith
- From the Departments of Emergency Radiology (O.L., B.K.), Musculoskeletal Radiology (J.C.M., S.E.S.), and Neuroradiology (C.C.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; and Department of Radiology, Shields Health Care, Brockton, Mass (D.S.T.)
| | - Bharti Khurana
- From the Departments of Emergency Radiology (O.L., B.K.), Musculoskeletal Radiology (J.C.M., S.E.S.), and Neuroradiology (C.C.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; and Department of Radiology, Shields Health Care, Brockton, Mass (D.S.T.)
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Ratanaprasatporn L, Mandell JC. Clinical utility of a postprocedural CT scan in CT-guided musculoskeletal biopsies. Skeletal Radiol 2020; 49:257-262. [PMID: 31327022 DOI: 10.1007/s00256-019-03279-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study is first to determine the clinical utility of the postprocedure scan in detecting postinterventional complications after CT-guided musculoskeletal biopsies, and second to evaluate the contribution to the radiation dose of the postprocedural CT scan. MATERIALS AND METHODS Retrospective analysis of 500 consecutive CT-guided musculoskeletal biopsies over an 18-month period from 29 March 2017 to 28 September 2018, where spiral postprocedure scans were obtained in every case. To assess the clinical utility of postinterventional CT scans, it was determined whether immediate post-procedural complications were detected on the postprocedural scans only or were also seen on the procedural images. To evaluate the relative radiation exposure of postprocedural scans, a ratio was obtained of the dose-length product (DLP) of the postprocedural scan compared with the total DLP of each case. RESULTS A total of 397 bone biopsies and 103 soft-tissue biopsies were performed in 471 patients. The immediate postprocedural complication rate was 0.4% (2 out of 500) in all procedures. Both complications were minor (small hematomas) and detected only on postinterventional CT scans. The average total DLP for the procedures was 383.5 mGy*cm. The average DLP of the postprocedural scan was 64.0 mGy*cm. The average radiation dose contribution of the postprocedural CT scans toward the total DLP was 17.4%. CONCLUSION Immediate postprocedural complications in CT-guided musculoskeletal interventions are rare. When complications do occur, they are usually minor. To substantially reduce radiation dose, postinterventional CT scans should not be performed routinely.
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Affiliation(s)
- Lisa Ratanaprasatporn
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Jacob C Mandell
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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Chea P, Mandell JC. Current applications and future directions of deep learning in musculoskeletal radiology. Skeletal Radiol 2020; 49:183-197. [PMID: 31377836 DOI: 10.1007/s00256-019-03284-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 02/02/2023]
Abstract
Deep learning with convolutional neural networks (CNN) is a rapidly advancing subset of artificial intelligence that is ideally suited to solving image-based problems. There are an increasing number of musculoskeletal applications of deep learning, which can be conceptually divided into the categories of lesion detection, classification, segmentation, and non-interpretive tasks. Numerous examples of deep learning achieving expert-level performance in specific tasks in all four categories have been demonstrated in the past few years, although comprehensive interpretation of imaging examinations has not yet been achieved. It is important for the practicing musculoskeletal radiologist to understand the current scope of deep learning as it relates to musculoskeletal radiology. Interest in deep learning from researchers, radiology leadership, and industry continues to increase, and it is likely that these developments will impact the daily practice of musculoskeletal radiology in the near future.
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Affiliation(s)
- Pauley Chea
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Jacob C Mandell
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Shi J, Ermann J, Weissman BN, Smith SE, Mandell JC. Thinking beyond pannus: a review of retro-odontoid pseudotumor due to rheumatoid and non-rheumatoid etiologies. Skeletal Radiol 2019; 48:1511-1523. [PMID: 30868232 DOI: 10.1007/s00256-019-03187-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/10/2019] [Accepted: 02/11/2019] [Indexed: 02/02/2023]
Abstract
Retro-odontoid pseudotumor, or mass-like retro-odontoid soft tissue thickening, is an uncommon but important imaging finding that may be associated with rheumatoid arthritis, crystal deposition diseases, as well as non-inflammatory conditions such as cervical degenerative changes and mechanical alterations. Retro-odontoid pseudotumor is commonly associated with atlantoaxial microinstability or subluxation. MRI and CT have an important role in the detection and diagnosis of retro-odontoid pseudotumor. However, due to a wide range of imaging characteristics and ambiguous etiology, it is a frequently misunderstood entity. The purpose of this article is to review relevant anatomy of the craniocervical junction; describe various imaging appearances, pathophysiology and histology in both rheumatoid and non-rheumatoid etiologies; and discuss differential diagnosis of retro-odontoid pseudotumor in order to help guide clinical management.
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Affiliation(s)
- Junzi Shi
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
| | - Joerg Ermann
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Barbara N Weissman
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Stacy E Smith
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Jacob C Mandell
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
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Marshall RA, Mandell JC, Weaver MJ, Ferrone M, Sodickson A, Khurana B. Imaging Features and Management of Stress, Atypical, and Pathologic Fractures. Radiographics 2019; 38:2173-2192. [PMID: 30422769 DOI: 10.1148/rg.2018180073] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Traumatic and atraumatic fractures are entities with distinct but often overlapping clinical manifestations, imaging findings, and management protocols. This article is a review of terminology, etiology, and key imaging features that affect management of atraumatic fractures including stress fractures, atypical femoral fractures, and pathologic fractures. The terminology of atraumatic fractures is reviewed, with an emphasis on the distinctions and similarities of stress, atypical, and pathologic fractures. The basic biomechanics of normal bone is described, with an emphasis on the bone remodeling pathway. This framework is used to better convey the shared etiologies, key differences, and important imaging findings of these types of fractures. Next, the characteristic imaging findings of this diverse family of fractures is discussed. For each type of fracture, the most clinically relevant imaging features that guide management by the multidisciplinary treatment team, including orthopedic surgeons, are reviewed. In addition, imaging features are reviewed to help discriminate stress fractures from pathologic fractures in patients with challenging cases. Finally, imaging criteria to risk stratify an impending pathologic fracture at the site of an osseous neoplasm are discussed. Special attention is paid to fractures occurring in the proximal femur because the osseous macrostructure and mix of trabecular and cortical bone of the proximal femur can function as a convenient framework to understanding atraumatic fractures throughout the skeleton. Atraumatic fractures elsewhere in the body also are used to illustrate key imaging features and treatment concepts. ©RSNA, 2018.
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Affiliation(s)
- Richard A Marshall
- From the Departments of Radiology (R.A.M., J.C.M., A.S., B.K.) and Orthopedic Surgery (M.J.W., M.F.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Jacob C Mandell
- From the Departments of Radiology (R.A.M., J.C.M., A.S., B.K.) and Orthopedic Surgery (M.J.W., M.F.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Michael J Weaver
- From the Departments of Radiology (R.A.M., J.C.M., A.S., B.K.) and Orthopedic Surgery (M.J.W., M.F.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Marco Ferrone
- From the Departments of Radiology (R.A.M., J.C.M., A.S., B.K.) and Orthopedic Surgery (M.J.W., M.F.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Aaron Sodickson
- From the Departments of Radiology (R.A.M., J.C.M., A.S., B.K.) and Orthopedic Surgery (M.J.W., M.F.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Bharti Khurana
- From the Departments of Radiology (R.A.M., J.C.M., A.S., B.K.) and Orthopedic Surgery (M.J.W., M.F.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
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Chang AL, Mandell JC. Syndesmotic Ligaments of the Ankle: Anatomy, Multimodality Imaging, and Patterns of Injury. Curr Probl Diagn Radiol 2019; 49:452-459. [PMID: 31668368 DOI: 10.1067/j.cpradiol.2019.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/13/2019] [Accepted: 09/03/2019] [Indexed: 12/17/2022]
Abstract
Injuries to the syndesmotic ligaments of the ankle or "high ankle sprains" are common in acute ankle trauma but can be difficult to diagnose both clinically and on imaging. Missed injuries to the syndesmosis can lead to chronic ankle instability, which can cause persistent pain and lead to early osteoarthritis. This review will illustrate the anatomy of the syndesmotic ligamentous complex, describe radiographic, CT, and MR imaging of the syndesmosis, demonstrate typical mechanisms of injuries and associated fracture patterns, and provide an overview of important management considerations.
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Affiliation(s)
- Andrew L Chang
- Long Beach Veteran Affairs, Imaging Service, Long Beach, CA.
| | - Jacob C Mandell
- Brigham and Women's Hospital, Division of Musculoskeletal radiology imaging and intervention, Boston, MA
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Miskin N, Gaviola GC, Huang RY, Kim CJ, Lee TC, Small KM, Wieschhoff GG, Mandell JC. Intra- and Intersubspecialty Variability in Lumbar Spine MRI Interpretation: A Multireader Study Comparing Musculoskeletal Radiologists and Neuroradiologists. Curr Probl Diagn Radiol 2019; 49:182-187. [PMID: 31133459 DOI: 10.1067/j.cpradiol.2019.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/09/2019] [Accepted: 05/07/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study is to assess the differences in degenerative spine MRI reporting between subspecialty-trained attending neuroradiologists and musculoskeletal radiologists (MSK) at a single institution, academic medical center. MATERIALS AND METHODS Fifty consecutive outpatient noncontrast lumbar spine examinations were selected from the Picture Archiving and Communication System. Three MSK and 3 neuroradiologists (NR) independently reviewed and interpreted the exams at the L4-L5 and L5-S1 levels in the same manner as in clinical practice. The assessment of neural foraminal stenosis (NFS) and spinal canal stenosis (SCS) was converted to a 5-point ordinal scale. The assessment of lateral recess stenosis (LRS) and facet osteoarthritis (FO) was recorded as present/absent. Intersubspecialty and intrasubspecialty analysis was performed using Cohen's kappa coefficient with a binary matrix of all reader pairs. RESULTS There was moderate intersubspecialty agreement (k = 0.527) for NFS and SCS (k = 0.540). Intersubspecialty agreement was slight for LRS (k = 0.0818) and FO (k = 0.176). The MSK group demonstrated greater intrasubspecialty agreement in assessment of NFS and SCS compared to the NR group, with nonoverlapping confidence intervals. The NR group demonstrated greater nominal intrasubspecialty agreement in the assessment of both LRS and FO, although with nonoverlapping confidence intervals. CONCLUSION There is moderate intersubspecialty agreement between MSK radiologists and neuroradiologists in reporting the severity of NFS and SCS, although MSK radiologists demonstrated greater intrasubspecialty agreement. There is slight intersubspecialty agreement for LRS and FO. The demonstration of differences in inter-reader agreement is a crucial first step to attempt to ameliorate these variabilities.
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Affiliation(s)
- Nityanand Miskin
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Glenn C Gaviola
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christine J Kim
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Thomas C Lee
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kirstin M Small
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ged G Wieschhoff
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jacob C Mandell
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Joyce AA, Williams JN, Shi J, Mandell JC, Isaac Z, Ermann J. Atlanto-axial Pannus in Patients with and without Rheumatoid Arthritis. J Rheumatol 2019; 46:1431-1437. [DOI: 10.3899/jrheum.181429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2019] [Indexed: 12/22/2022]
Abstract
Objective.Pannus formation in the atlanto-axial joint is a well-recognized complication of rheumatoid arthritis (RA). Occasionally, atlanto-axial pannus is reported when patients without a history of RA undergo magnetic resonance imaging (MRI) of the cervical spine. We sought to further characterize these patients.Methods.The Partners HealthCare Research Patient Data Registry was free-text searched for “atlanto-axial” AND “pannus” in cervical spine MRI reports from 2001 to 2015. Cases with MRI reports describing pannus were reviewed. Clinical data were extracted by chart review in cases with confirmed atlanto-axial pannus (n = 105).Results.Twenty-nine patients (27.6%) had RA, all of whom except one carried this diagnosis at the time of the MRI scan. Only 1 of 77 patients without a history of RA was subsequently diagnosed with RA (1.3%, 95% CI 0.1–7.0%, median followup 3.6 yrs). Non-RA patients were significantly older (median age 79 vs 63 yrs, p < 0.0001), less frequently female (55% vs 86%, p = 0.0032), and more likely to have undergone prior cervical spine surgery (18% vs 0%, p = 0.016) compared with RA patients. Thirty-four non-RA patients (44.7%) either had a clinical diagnosis of calcium pyrophosphate dihydrate disease (CPPD) or imaging evidence for tissue calcification. There were no significant differences in age or sex between the CPPD subgroup and other non-RA patients. Twenty-eight patients (26.7%) underwent cervical spine surgery.Conclusion.Patients without RA diagnosis and incidental atlanto-axial pannus on cervical spine MRI are unlikely to have previously unrecognized RA. Degenerative disease and tissue calcification may contribute to pannus formation in these patients.
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Laur O, Mandell JC, Titelbaum DS, Cho C, Smith SE, Khurana B. Acute Nontraumatic Back Pain: Infections and Mimics. Radiographics 2019. [DOI: 10.1148/rg.2019180077.pres] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Miskin N, Gaviola GC, Ghazikhanian V, Mandell JC. CT-guided transforaminal epidural steroid injections: do needle position and degree of foraminal stenosis affect the pattern of epidural flow? Skeletal Radiol 2018; 47:1615-1623. [PMID: 29915935 DOI: 10.1007/s00256-018-3002-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 05/28/2018] [Accepted: 06/03/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effect of needle position and foraminal stenosis on contrast flow directionality during CT-guided transforaminal epidural steroid injections (TFESI). MATERIALS AND METHODS One hundred five consecutive CT-guided injections were performed in 68 patients (mean age, 65.5 years) from January 1 to December 31 2017, all with preceding MRI. Two readers independently reviewed CT images to assess needle position and to determine direction of contrast flow, which was defined as central or peripheral. The MRIs were independently reviewed by the readers to determine the degree of foraminal stenosis. Inter-reader agreement for both was evaluated with the kappa statistic. Analyses were performed to determine effect of needle position, degree of foraminal stenosis, and volume of contrast injected with directionality of contrast flow, and association between contrast flow directionality with immediate post-procedural pain scores. RESULTS Central direction of contrast flow was demonstrated in 41/78 (52.6%) of cases with posterolateral needle position, and 20/27 (74.1%) with central or anteromedial needle position (p = 0.07). There was no difference in direction of contrast flow with high-grade versus absence of high-grade neuroforaminal narrowing, or with volume of contrast injected. There was no difference in immediate post-procedure pain scores regardless of contrast flow directionality. CONCLUSIONS Needle position is not significantly associated with contrast flow directionality during CT-guided TFESI, although there was a trend towards relatively decreased central flow with posterolateral positioning. Degree of foraminal stenosis and volume of injected contrast did not affect contrast flow directionality. There was no difference in immediate post-procedural pain scores with either direction of contrast flow.
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Affiliation(s)
- Nityanand Miskin
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Glenn C Gaviola
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Varand Ghazikhanian
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jacob C Mandell
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Mandell JC, Wrobel WC, Laur O, Shah N, Robinson-Weiss C, Weaver MJ, Khurana B. A simplified classification of proximal femoral fractures improves accuracy, confidence, and inter-reader agreement of hip fracture classification by radiology residents. Emerg Radiol 2018; 26:179-187. [DOI: 10.1007/s10140-018-1660-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/15/2018] [Indexed: 11/30/2022]
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Czuczman GJ, Marrero DE, Huang AJ, Mandell JC, Ghazikhanian V, Simeone FJ. Diagnostic yield of repeat CT-guided biopsy for suspected infectious spondylodiscitis. Skeletal Radiol 2018; 47:1403-1410. [PMID: 29777259 DOI: 10.1007/s00256-018-2972-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 04/25/2018] [Accepted: 05/02/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the yield of repeat CT-guided biopsy in patients with suspected infectious spondylodiscitis following an initial biopsy with negative microbiology, and to identify factors associated with successful pathogen isolation. MATERIALS AND METHODS In this retrospective study, 21 patients (12 men, 9 women; mean age, 52, range, 12-84) were identified with clinically and radiologically suspected infectious spondylodiscitis who underwent repeat biopsy following negative cultures from an initial biopsy. The microbe yield as well as demographic, clinical, and laboratory findings were reviewed and statistical analysis was performed. RESULTS Repeat CT-guided biopsy isolated a causative microbe in 3/21 patients (14.3%). Younger age (p = 0.021) was significantly associated with successful microbe isolation. All three cases of successful microbe isolation occurred in patients not exposed to antibiotics (3/9 patients) whereas no successful microbe isolation occurred in patients who received antibiotics (0/12 patients); however, this difference did not reach statistical significance (p = 0.062). Gender, duration of symptoms, white blood cell count, biopsy interval, and biopsy site were not significantly associated with microbe isolation. CONCLUSIONS Overall microbiologic yield of repeat CT-guided biopsy for patients with suspected infectious spondylodiscitis was low at 14.3%; however, a higher yield was identified in patients who were younger in age and not exposed to pre-biopsy antibiotics.
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Affiliation(s)
| | | | - Ambrose J Huang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jacob C Mandell
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Varand Ghazikhanian
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - F Joseph Simeone
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Mandell JC, Wortman JR, Rocha TC, Folio LR, Andriole KP, Khurana B. Computed Tomography Window Blending: Feasibility in Thoracic Trauma. Acad Radiol 2018; 25:1190-1200. [PMID: 29428212 DOI: 10.1016/j.acra.2017.12.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 12/17/2017] [Accepted: 12/28/2017] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES This study aims to demonstrate the feasibility of processing computed tomography (CT) images with a custom window blending algorithm that combines soft-tissue, bone, and lung window settings into a single image; to compare the time for interpretation of chest CT for thoracic trauma with window blending and conventional window settings; and to assess diagnostic performance of both techniques. MATERIALS AND METHODS Adobe Photoshop was scripted to process axial DICOM images from retrospective contrast-enhanced chest CTs performed for trauma with a window-blending algorithm. Two emergency radiologists independently interpreted the axial images from 103 chest CTs with both blended and conventional windows. Interpretation time and diagnostic performance were compared with Wilcoxon signed-rank test and McNemar test, respectively. Agreement with Nexus CT Chest injury severity was assessed with the weighted kappa statistic. RESULTS A total of 13,295 images were processed without error. Interpretation was faster with window blending, resulting in a 20.3% time saving (P < .001), with no difference in diagnostic performance, within the power of the study to detect a difference in sensitivity of 5% as determined by post hoc power analysis. The sensitivity of the window-blended cases was 82.7%, compared to 81.6% for conventional windows. The specificity of the window-blended cases was 93.1%, compared to 90.5% for conventional windows. All injuries of major clinical significance (per Nexus CT Chest criteria) were correctly identified in all reading sessions, and all negative cases were correctly classified. All readers demonstrated near-perfect agreement with injury severity classification with both window settings. CONCLUSIONS In this pilot study utilizing retrospective data, window blending allows faster preliminary interpretation of axial chest CT performed for trauma, with no significant difference in diagnostic performance compared to conventional window settings. Future studies would be required to assess the utility of window blending in clinical practice.
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Mandell JC, Rocha TC, Duran-Mendicuti MA, Miskin NP, Shi J, Khurana B. Color postprocessing of conventional CT images: preliminary results in assessment of nondisplaced proximal femoral fractures. Emerg Radiol 2018; 25:639-645. [DOI: 10.1007/s10140-018-1626-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/06/2018] [Indexed: 11/28/2022]
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Tai R, Bolinske T, Ghazikhanian V, Mandell JC. The association of the medial joint vacuum phenomenon with ulnar collateral ligament injury in symptomatic elbows of younger athletes. Skeletal Radiol 2018; 47:795-803. [PMID: 29322208 DOI: 10.1007/s00256-017-2864-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/18/2017] [Accepted: 12/27/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the prevalence of intra-articular gas (IAG) on elbow radiography and evaluate variables, including IAG, as predictors of UCL injury. MATERIALS AND METHODS This IRB-approved retrospective study consisted of 241 consecutive elbow radiographic studies containing AP radiographs with valgus stress of both symptomatic and asymptomatic sides in 234 patients. The IAG, medial joint space (MJS), and MJS difference between the symptomatic and asymptomatic elbow (MJSD) were evaluated by two readers, as well as patient age, gender, sport played, and handedness. Primary outcomes included IAG on valgus stress radiographs and UCL injury, which was determined by intraoperative findings as the reference standard or MRI if surgery was not performed. Univariate analysis with Student's t, Fisher's exact, and chi-square tests were performed. RESULTS IAG only manifested with valgus stress and was demonstrated in 30/482 (6.2%) valgus stress radiographs in 27/234 (11.5%) patients. Overall, 21/241 (8.7%) valgus stress radiographs of the symptomatic elbow demonstrated IAG in 21 patients. A total of 128/241 (53.1%) elbow studies had evidence of UCL injury. MJS IAG (p = 0.0147) and increased MJSD (p = 0.0088) were significantly associated with UCL injury. Patient gender, age, handedness, laterality, sport played, and absolute MJS were not associated with UCL injury. MJS IAG with valgus stress demonstrates a sensitivity of 11.7% and specificity of 98.3% in detecting UCL injury for the symptomatic elbow. CONCLUSIONS MJS IAG infrequently manifests on valgus stress radiographs, but is specific for UCL injury in the symptomatic elbow of overhead throwing athletes. MJS IAG and increased MJSD are significantly associated with UCL injury.
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Affiliation(s)
- Ryan Tai
- Department of Radiology, UMass Memorial Medical Center, 55 Lake Ave North, Worcester, MA, 01655, USA.
| | - Tyson Bolinske
- Department of Radiology, Radiology Associates of Durango, 1010 Three Springs Avenue, Durango, CO, 81301, USA
| | - Varand Ghazikhanian
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jacob C Mandell
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Hostetter J, Khanna N, Mandell JC. Integration of a Zero-footprint Cloud-based Picture Archiving and Communication System with Customizable Forms for Radiology Research and Education. Acad Radiol 2018; 25:811-818. [PMID: 29555567 DOI: 10.1016/j.acra.2018.01.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/16/2017] [Accepted: 01/15/2018] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to integrate web-based forms with a zero-footprint cloud-based Picture Archiving and Communication Systems (PACS) to create a tool of potential benefit to radiology research and education. MATERIALS AND METHODS Web-based forms were created with a front-end and back-end architecture utilizing common programming languages including Vue.js, Node.js and MongoDB, and integrated into an existing zero-footprint cloud-based PACS. RESULTS The web-based forms application can be accessed in any modern internet browser on desktop or mobile devices and allows the creation of customizable forms consisting of a variety of questions types. Each form can be linked to an individual DICOM examination or a collection of DICOM examinations. CONCLUSIONS Several uses are demonstrated through a series of case studies, including implementation of a research platform for multi-reader multi-case (MRMC) studies and other imaging research, and creation of an online Objective Structure Clinical Examination (OSCE) and an educational case file.
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Mandell JC, Weaver MJ, Khurana B. Computed tomography for occult fractures of the proximal femur, pelvis, and sacrum in clinical practice: single institution, dual-site experience. Emerg Radiol 2018; 25:265-273. [DOI: 10.1007/s10140-018-1580-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/03/2018] [Indexed: 12/17/2022]
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Mandell JC, Marshall RA, Weaver MJ, Harris MB, Sodickson AD, Khurana B. Traumatic Hip Dislocation: What the Orthopedic Surgeon Wants to Know. Radiographics 2017; 37:2181-2201. [DOI: 10.1148/rg.2017170012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Jacob C. Mandell
- From the Department of Radiology (J.C.M., R.A.M., A.D.S., B.K.), Division of Musculoskeletal Imaging and Intervention (J.C.M.), Division of Emergency Radiology (A.D.S., B.K.), and Department of Orthopedic Surgery (M.J.W., M.B.H.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Richard A. Marshall
- From the Department of Radiology (J.C.M., R.A.M., A.D.S., B.K.), Division of Musculoskeletal Imaging and Intervention (J.C.M.), Division of Emergency Radiology (A.D.S., B.K.), and Department of Orthopedic Surgery (M.J.W., M.B.H.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Michael J. Weaver
- From the Department of Radiology (J.C.M., R.A.M., A.D.S., B.K.), Division of Musculoskeletal Imaging and Intervention (J.C.M.), Division of Emergency Radiology (A.D.S., B.K.), and Department of Orthopedic Surgery (M.J.W., M.B.H.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Mitchel B. Harris
- From the Department of Radiology (J.C.M., R.A.M., A.D.S., B.K.), Division of Musculoskeletal Imaging and Intervention (J.C.M.), Division of Emergency Radiology (A.D.S., B.K.), and Department of Orthopedic Surgery (M.J.W., M.B.H.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Aaron D. Sodickson
- From the Department of Radiology (J.C.M., R.A.M., A.D.S., B.K.), Division of Musculoskeletal Imaging and Intervention (J.C.M.), Division of Emergency Radiology (A.D.S., B.K.), and Department of Orthopedic Surgery (M.J.W., M.B.H.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Bharti Khurana
- From the Department of Radiology (J.C.M., R.A.M., A.D.S., B.K.), Division of Musculoskeletal Imaging and Intervention (J.C.M.), Division of Emergency Radiology (A.D.S., B.K.), and Department of Orthopedic Surgery (M.J.W., M.B.H.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
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Mandell JC, Rhodes JA, Shah N, Gaviola GC, Gomoll AH, Smith SE. Routine clinical knee MR reports: comparison of diagnostic performance at 1.5 T and 3.0 T for assessment of the articular cartilage. Skeletal Radiol 2017; 46:1487-1498. [PMID: 28717928 DOI: 10.1007/s00256-017-2714-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/28/2017] [Accepted: 07/03/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Accurate assessment of knee articular cartilage is clinically important. Although 3.0 Tesla (T) MRI is reported to offer improved diagnostic performance, literature regarding the clinical impact of MRI field strength is lacking. The purpose of this study is to compare the diagnostic performance of clinical MRI reports for assessment of cartilage at 1.5 and 3.0 T in comparison to arthroscopy. MATERIALS AND METHODS This IRB-approved retrospective study consisted of 300 consecutive knees in 297 patients who had routine clinical MRI and arthroscopy. Descriptions of cartilage from MRI reports of 165 knees at 1.5 T and 135 at 3.0 T were compared with arthroscopy. The sensitivity, specificity, percent of articular surfaces graded concordantly, and percent of articular surfaces graded within one grade of the arthroscopic grading were calculated for each articular surface at 1.5 and 3.0 T. Agreement between MRI and arthroscopy was calculated with the weighted-kappa statistic. Significance testing was performed utilizing the z-test after bootstrapping to obtain the standard error. RESULTS AND CONCLUSIONS The sensitivity, specificity, percent of articular surfaces graded concordantly, and percent of articular surfaces graded within one grade were 61.4%, 82.7%, 62.2%, and 77.5% at 1.5 T and 61.8%, 80.6%, 59.5%, and 75.6% at 3.0 T, respectively. The weighted kappa statistic was 0.56 at 1.5 T and 0.55 at 3.0 T. There was no statistically significant difference in any of these parameters between 1.5 and 3.0 T. Factors potentially contributing to the lack of diagnostic advantage of 3.0 T MRI are discussed.
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Affiliation(s)
- Jacob C Mandell
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
| | - Jeffrey A Rhodes
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Nehal Shah
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Glenn C Gaviola
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Andreas H Gomoll
- Cartilage Repair Center, Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Stacy E Smith
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
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Wieschhoff GG, Mandell JC, Czuczman GJ, Nikac V, Shah N, Smith SE. Acute non-contact anterior cruciate ligament tears are associated with relatively increased vastus medialis to semimembranosus cross-sectional area ratio: a case-control retrospective MR study. Skeletal Radiol 2017; 46:1469-1475. [PMID: 28710543 DOI: 10.1007/s00256-017-2709-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/02/2017] [Accepted: 06/20/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Hamstring muscle deficiency is increasingly recognized as a risk factor for anterior cruciate ligament (ACL) tears. The purpose of this study is to evaluate the vastus medialis to semimembranosus cross-sectional area (VM:SM CSA) ratio on magnetic resonance imaging (MRI) in patients with ACL tears compared to controls. MATERIALS AND METHODS One hundred knee MRIs of acute ACL tear patients and 100 age-, sex-, and side-matched controls were included. Mechanism of injury, contact versus non-contact, was determined for each ACL tear subject. The VM:SM CSA was measured on individual axial slices with a novel method using image-processing software. One reader measured all 200 knees and the second reader measured 50 knees at random to assess inter-reader variability. The intraclass correlation coefficient (ICC) was calculated to evaluate for correlation between readers. T-tests were performed to evaluate for differences in VM:SM CSA ratios between the ACL tear group and control group. RESULTS The ICC for agreement between the two readers was 0.991 (95% confidence interval 0.984-0.995). Acute ACL tear patients have an increased VM:SM CSA ratio compared to controls (1.44 vs. 1.28; p = 0.005). Non-contact acute ACL tear patients have an increased VM:SM CSA ratio compared to controls (1.48 vs. 1.20; p = 0.003), whereas contact acute ACL tear patients do not (1.23 vs. 1.26; p = 0.762). CONCLUSION Acute non-contact ACL tears are associated with increased VM:SM CSA ratios, which may imply a relative deficiency in hamstring strength. This study also demonstrates a novel method of measuring the relative CSA of muscles on MRI.
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Affiliation(s)
- Ged G Wieschhoff
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Jacob C Mandell
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Gregory J Czuczman
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Violeta Nikac
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Nehal Shah
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Stacy E Smith
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Mandell JC, Khurana B, Smith JT, Czuczman GJ, Ghazikhanian V, Smith SE. Osteomyelitis of the lower extremity: pathophysiology, imaging, and classification, with an emphasis on diabetic foot infection. Emerg Radiol 2017; 25:175-188. [DOI: 10.1007/s10140-017-1564-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 10/11/2017] [Indexed: 12/26/2022]
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Mandell JC, Khurana B, Smith SE. Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis. Skeletal Radiol 2017; 46:1165-1186. [PMID: 28343329 DOI: 10.1007/s00256-017-2632-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/22/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023]
Abstract
Stress fractures of the foot and ankle are a commonly encountered problem among athletes and individuals participating in a wide range of activities. This illustrated review, the second of two parts, discusses site-specific etiological factors, imaging appearances, treatment options, and differential considerations of stress fractures of the foot and ankle. The imaging and clinical management of stress fractures of the foot and ankle are highly dependent on the specific location of the fracture, mechanical forces acting upon the injured site, vascular supply of the injured bone, and the proportion of trabecular to cortical bone at the site of injury. The most common stress fractures of the foot and ankle are low risk and include the posteromedial tibia, the calcaneus, and the second and third metatarsals. The distal fibula is a less common location, and stress fractures of the cuboid and cuneiforms are very rare, but are also considered low risk. In contrast, high-risk stress fractures are more prone to delayed union or nonunion and include the anterior tibial cortex, medial malleolus, navicular, base of the second metatarsal, proximal fifth metatarsal, hallux sesamoids, and the talus. Of these high-risk types, stress fractures of the anterior tibial cortex, the navicular, and the proximal tibial cortex may be predisposed to poor healing because of the watershed blood supply in these locations. The radiographic differential diagnosis of stress fracture includes osteoid osteoma, malignancy, and chronic osteomyelitis.
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Affiliation(s)
- Jacob C Mandell
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
| | - Bharti Khurana
- Division of Emergency Radiology, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stacy E Smith
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
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Mandell JC, Khurana B, Folio LR, Hyun H, Smith SE, Dunne RM, Andriole KP. Clinical Applications of a CT Window Blending Algorithm: RADIO (Relative Attenuation-Dependent Image Overlay). J Digit Imaging 2017; 30:358-368. [PMID: 28097498 DOI: 10.1007/s10278-017-9941-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A methodology is described using Adobe Photoshop and Adobe Extendscript to process DICOM images with a Relative Attenuation-Dependent Image Overlay (RADIO) algorithm to visualize the full dynamic range of CT in one view, without requiring a change in window and level settings. The potential clinical uses for such an algorithm are described in a pictorial overview, including applications in emergency radiology, oncologic imaging, and nuclear medicine and molecular imaging.
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Affiliation(s)
- Jacob C Mandell
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
| | - Bharti Khurana
- Division of Emergency Radiology, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Les R Folio
- Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, USA
| | - Hyewon Hyun
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stacy E Smith
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ruth M Dunne
- Divisions of Thoracic Imaging and Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Katherine P Andriole
- Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Mackesy MM, Chick JFB, Chauhan NR, Mandell JC, Khurana B. Cesarean section scar ectopic pregnancy. J Emerg Med 2014; 46:685-6. [PMID: 24582642 DOI: 10.1016/j.jemermed.2013.11.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 10/11/2013] [Accepted: 11/17/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Meaghan Marie Mackesy
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Nikunj Rashmikant Chauhan
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jacob C Mandell
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bharti Khurana
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Chick JFB, Chauhan NR, Mandell JC, de Souza DAT, Bair RJ, Khurana B. Traffic jam in the duodenum: imaging and pathogenesis of Bouveret syndrome. J Emerg Med 2013; 45:e135-7. [PMID: 23880444 DOI: 10.1016/j.jemermed.2013.04.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/06/2013] [Accepted: 04/30/2013] [Indexed: 12/22/2022]
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Chick JFB, Mandell JC, de Souza DAT, Khurana B. Hand pain after fall. Dislocation of the fifth carpometacarpal. Ann Emerg Med 2013; 62:13, 27. [PMID: 23842050 DOI: 10.1016/j.annemergmed.2012.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 10/23/2012] [Accepted: 10/23/2012] [Indexed: 11/30/2022]
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Affiliation(s)
- Jeffrey Forris Beecham Chick
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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