1
|
Gimber LH, Montgomery EA, Morris CD, Krupinski EA, Fayad LM. MRI characteristics associated with high-grade myxoid liposarcoma. Clin Radiol 2017; 72:613.e1-613.e6. [PMID: 28256200 DOI: 10.1016/j.crad.2017.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 11/28/2016] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
Abstract
AIM To identify magnetic resonance imaging (MRI) features differentiating high-grade (>5% round-cell component) from low-grade myxoid liposarcomas (LPS) (≤5% round-cell component). MATERIALS AND METHODS Informed consent was waived. Patients with myxoid LPS and MRI before biopsy, neoadjuvant therapy, and surgery were included retrospectively. High-grade components were recorded from histological specimens by a pathologist (24 years of experience). Images were evaluated by a senior radiologist (>12 years of experience) for tumour size, location, tissue layer, and MRI features (signal intensity, heterogeneity, margin, and perilesional characteristics). Descriptive statistics, Fisher's exact test to identify associations with a round-cell component, and multivariate logistic regression to identify independent predictors of high-grade tumours were used. RESULTS Thirty-one patients (16 women [mean 51.1 years; range 19-79 years] and 15 men [mean 45.5 years; range 18-95 years]) with myxoid LPS (23 low-grade, eight high-grade) were included. All high-grade lesions had lipid signal, a peritumoural capsule and peritumoural contrast enhancement, and more commonly exhibited heterogeneous signal; however, the average size of ≥10 cm was the strongest independent indicator of high-grade status (odds ratio [OR], 14.6; 95% confidence interval [CI]: 1.6, 131). CONCLUSION Size ≥10 cm is most strongly associated with high-grade myxoid LPS (round-cell component >5%). Other features possibly differentiating high-grade from low-grade status include lesion margin, lipid signal, and perilesional characteristics.
Collapse
Affiliation(s)
- L H Gimber
- Department of Medical Imaging, The University of Arizona, College of Medicine, Banner - University Medical Center, 1501 N Campbell Ave., P.O. Box 245067, Tucson, AZ 85724, USA.
| | - E A Montgomery
- Department of Pathology, The Johns Hopkins University, Weinberg Bldg, Rm. 2242, 401 North Broadway, Baltimore, MD 21231, USA
| | - C D Morris
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, 601 N Caroline St, Baltimore, MD 21287, USA
| | - E A Krupinski
- Department of Radiology & Imaging Sciences, Emory University, 1364 Clifton Rd NE D107, Atlanta, GA 30322, USA
| | - L M Fayad
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins University School of Medicine, 601 North Wolfe Street, Baltimore, MD 21287, USA
| |
Collapse
|
2
|
Ahlawat S, Corl FM, LaPorte DM, Fishman EK, Fayad LM. MDCT of hand and wrist infections: emphasis on compartmental anatomy. Clin Radiol 2017; 72:338.e1-338.e9. [PMID: 28065641 DOI: 10.1016/j.crad.2016.11.020] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 11/14/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
Abstract
Hand and wrist infections can present with a spectrum of manifestations ranging from cellulitis to deep-space collections. The various infectious processes can be categorised as superficial or deep infections based on their respective locations relative to the tendons. Superficial hand infections are located superficial to the tendons and are comprised of cellulitis, lymphangitis, paronychia, pulp-space infections, herpetic whitlow, and include volar as well as dorsal subcutaneous abscesses. Deep hand infections are located deep to the tendon sheaths and include synovial space infections, such as infectious tenosynovitis, deep fascial space infections, septic arthritis, necrotising fasciitis, and osteomyelitis. Knowledge of hand and wrist compartmental anatomy is essential for the accurate diagnosis and management of hand infections. Although early and superficial infections of the hand may respond to non-surgical management, most hand infections are surgical emergencies. Multidetector computed tomography (MDCT), with its muliplanar reformation (MPR) and three-dimensional (3D) capabilities, is a powerful tool in the emergency setting for the evaluation of acute hand and wrist pathology. The clinical and imaging features of hand and wrist infections as evident on MDCT will be reviewed with emphasis on contiguous and closed synovial and deep fascial spaces. Knowledge of hand compartmental anatomy enables accurate characterisation of the infectious process and localise the extent of disease in the acute setting.
Collapse
Affiliation(s)
- S Ahlawat
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins University School of Medicine, 601 North Wolfe Street, Baltimore, MD 21287, USA.
| | - F M Corl
- Department of Radiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55902, USA
| | - D M LaPorte
- Johns Hopkins Outpatient Center, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - E K Fishman
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins University School of Medicine, 601 North Wolfe Street, Baltimore, MD 21287, USA
| | - L M Fayad
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins University School of Medicine, 601 North Wolfe Street, Baltimore, MD 21287, USA
| |
Collapse
|
3
|
Guo J, Glass JO, McCarville MB, Shulkin BL, Daryani VM, Stewart CF, Wu J, Mao S, Dwek JR, Fayad LM, Madewell JE, Navid F, Daw NC, Reddick WE. Assessing vascular effects of adding bevacizumab to neoadjuvant chemotherapy in osteosarcoma using DCE-MRI. Br J Cancer 2015; 113:1282-8. [PMID: 26461056 PMCID: PMC4815789 DOI: 10.1038/bjc.2015.351] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/21/2015] [Accepted: 09/10/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the impact of bevacizumab alone and in combination with cytotoxic therapy on tumour vasculature in osteosarcoma (OS) using DCE-MRI. METHODS Six DCE-MRI and three (18)F-FDG PET examinations were scheduled in 42 subjects with newly diagnosed OS to monitor the response to antiangiogenic therapy alone and in combination with cytotoxic therapy before definitive surgery (week 10). Serial DCE-MRI parameters (K(trans), v(p), and v(e)) were examined for correlation with FDG-PET (SUV(max)) and association with drug exposure, and evaluated with clinical outcome. RESULTS K(trans) (P=0.041) and v(p) (P=0.001) significantly dropped from baseline at 24 h after the first dose of bevacizumab alone, but returned to baseline by 72 h. Greater exposure to bevacizumab was correlated with larger decreases in v(p) at day 5 (P=0.04) and week 10 (P=0.02). A lower K(trans) at week 10 was associated with greater percent necrosis (P=0.024) and longer event-free survival (P=0.034). CONCLUSIONS This is the first study to demonstrate significant changes of the plasma volume fraction and vascular leakage in OS with bevacizumab alone. The combination of demonstrated associations between drug exposure and imaging metrics, and imaging metrics and patient survival during neoadjuvant therapy, provides a compelling rationale for larger studies using DCE-MRI to assess vascular effects of therapy in OS.
Collapse
Affiliation(s)
- J Guo
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN 38105-3678, USA
| | - J O Glass
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN 38105-3678, USA
| | - M B McCarville
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN 38105-3678, USA
| | - B L Shulkin
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN 38105-3678, USA
| | - V M Daryani
- Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - C F Stewart
- Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - J Wu
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - S Mao
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - J R Dwek
- Department of Radiology, Rady Children's Hospital, San Diego, CA 92123, USA
| | - L M Fayad
- The Musculoskeletal Tumor Program, The Johns Hopkins University, Baltimore, MD 21287, USA
| | - J E Madewell
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - F Navid
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - N C Daw
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - W E Reddick
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN 38105-3678, USA
| |
Collapse
|
4
|
Kwee RM, Ahlawat S, Kompel AJ, Morelli JN, Fayad LM, Zikria BA, Demehri S. Association of mucoid degeneration of anterior cruciate ligament with knee meniscal and cartilage damage. Osteoarthritis Cartilage 2015; 23:1543-50. [PMID: 25907861 DOI: 10.1016/j.joca.2015.04.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 11/11/2014] [Revised: 04/06/2015] [Accepted: 04/14/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the prevalence of anterior cruciate ligament (ACL) mucoid degeneration in patients referred for routine knee magnetic resonance (MR) imaging, and its association with age and structural joint damage. METHOD Four independent radiologists assessed 413 consecutive knee MR examinations for the presence of a normal or ruptured ACL, or ACL mucoid degeneration. Knees with ACL mucoid degeneration were frequency matched by age, sex, and MR field strength with consecutive control knees with a normal ACL (1:2 ratio). Differences in meniscal and cartilage damage of the tibiofemoral compartments, as determined by the Whole-Organ MR Imaging Score (WORMS) system, were compared by Mann-Whitney U tests. Multivariable logistic regression analysis identified the association of ACL mucoid degeneration with severe MTFC cartilage damage (WORMS≥5). RESULTS Patients with ACL mucoid degeneration (n = 36; 36% males; median age 55.5 years, range: 26-81) were older than patients with a normal (P < 0.001) or ruptured ACL (P < 0.001), without sex predilection (P = 0.76), and were more frequently diagnosed at 3 T (12%) compared to 1.5 T (2%). Knees with ACL mucoid degeneration had statistically significantly more medial meniscal (P < 0.001) and central and posterior medial tibiofemoral compartment (MTFC) cartilage (P < 0.001) damage compared with control knees (n = 72), but there were no differences in patients ≤50 years (P = 0.09 and 0.32, respectively). In multivariable logistic regression, severe MTFC cartilage damage (WORMS≥5) was significantly associated with ACL mucoid degeneration (odds ratio 4.09, 95% confidence interval 1.29-12.94, P = 0.016). CONCLUSION There is a strong association between ACL mucoid degeneration and cartilage damage in the central and posterior MTFC, especially in patients >50 years.
Collapse
Affiliation(s)
- R M Kwee
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S Ahlawat
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - A J Kompel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - J N Morelli
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - L M Fayad
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - B A Zikria
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - S Demehri
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| |
Collapse
|
5
|
Thompson JM, Carrino JA, Skolasky RL, Chhabra A, Fayad LM, Machado A, Soldatos T, Morrison WB, McFarland EG. Glenoid notch MRI findings do not predict normal variants of the anterior and superior labrum. Clin Radiol 2015; 70:e90-6. [PMID: 26050070 DOI: 10.1016/j.crad.2015.04.016] [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: 09/02/2014] [Revised: 02/25/2015] [Accepted: 04/28/2015] [Indexed: 11/28/2022]
Abstract
AIM To determine (1) the relationship of a glenoid notch to the presence of a normal labral variant in the anterior-superior glenoid labrum; (2) the inter- and intra-observer reliability of recognising a glenoid notch; and (3) whether magnetic resonance arthrography (MRA) is more reliable than non-contrast magnetic resonance imaging (MRI) in visualising a glenoid notch. MATERIALS AND METHODS From 1995 through 2010, 104 patients underwent MRI or MRA before diagnostic shoulder arthroscopy by the senior author. Five blinded musculoskeletal radiologists independently read the images twice to evaluate for the presence or absence of a glenoid notch. Fifty-nine (57%) patients had normal anterior-superior labral variants. The authors calculated the relationship of the readings to the arthroscopically determined presence or absence of a normal labral variant and the reading's diagnostic performance and rater reliability. RESULTS On average, 38% (range 9-65%) of the glenoid scans were read as notched. The sensitivity, specificity, positive predictive value, and negative predictive value of the notch relative to the presence of a normal variant were 43.1%, 71.2%, 70.2%, and 48% versus 44.3%, 77.5%, 79.4%, and 56.1% for MRI and MRA, respectively. The overall average intra-observer κ-values were 0.438 (range 0.203-0.555) and 0.346 (range -0.102 to 0.570) for MRI and MRA, respectively. The average interobserver intra-class correlation coefficient reliability values were 0.730 (range 0.693-0.760) and 0.614 (range 0.566-0.662) for MRI and MRA, respectively. CONCLUSIONS A notched glenoid on MRI lacks sufficient diagnostic performance and rater reliability for the clinical detection and prediction of normal anterior-superior labral variants.
Collapse
Affiliation(s)
- J M Thompson
- The Johns Hopkins School of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - J A Carrino
- Department of Radiology and Imaging, Weill Medical College of Cornell University, Hospital for Special Surgery, New York, NY, USA
| | - R L Skolasky
- Spine Outcomes Center, The Johns Hopkins University, Baltimore, MD, USA
| | - A Chhabra
- Musculoskeletal Section, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University, Baltimore, MD, USA
| | - L M Fayad
- Musculoskeletal Section, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University, Baltimore, MD, USA
| | - A Machado
- Musculoskeletal Section, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University, Baltimore, MD, USA
| | - T Soldatos
- Musculoskeletal Section, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University, Baltimore, MD, USA
| | - W B Morrison
- Musculoskeletal Imaging Division, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - E G McFarland
- Division of Shoulder Surgery, The Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
6
|
Demehri S, Muhit A, Zbijewski W, Stayman JW, Yorkston J, Packard N, Senn R, Yang D, Foos D, Thawait GK, Fayad LM, Chhabra A, Carrino JA, Siewerdsen JH. Assessment of image quality in soft tissue and bone visualization tasks for a dedicated extremity cone-beam CT system. Eur Radiol 2015; 25:1742-51. [PMID: 25599933 DOI: 10.1007/s00330-014-3546-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 11/21/2014] [Accepted: 12/01/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess visualization tasks using cone-beam CT (CBCT) compared to multi-detector CT (MDCT) for musculoskeletal extremity imaging. METHODS Ten cadaveric hands and ten knees were examined using a dedicated CBCT prototype and a clinical multi-detector CT using nominal protocols (80 kVp-108mAs for CBCT; 120 kVp- 300 mAs for MDCT). Soft tissue and bone visualization tasks were assessed by four radiologists using five-point satisfaction (for CBCT and MDCT individually) and five-point preference (side-by-side CBCT versus MDCT image quality comparison) rating tests. Ratings were analyzed using Kruskal-Wallis and Wilcoxon signed-rank tests, and observer agreement was assessed using the Kappa-statistic. RESULTS Knee CBCT images were rated "excellent" or "good" (median scores 5 and 4) for "bone" and "soft tissue" visualization tasks. Hand CBCT images were rated "excellent" or "adequate" (median scores 5 and 3) for "bone" and "soft tissue" visualization tasks. Preference tests rated CBCT equivalent or superior to MDCT for bone visualization and favoured the MDCT for soft tissue visualization tasks. Intraobserver agreement for CBCT satisfaction tests was fair to almost perfect (κ ~ 0.26-0.92), and interobserver agreement was fair to moderate (κ ~ 0.27-0.54). CONCLUSION CBCT provided excellent image quality for bone visualization and adequate image quality for soft tissue visualization tasks. KEY POINTS • CBCT provided adequate image quality for diagnostic tasks in extremity imaging. • CBCT images were "excellent" for "bone" and "good/adequate" for "soft tissue" visualization tasks. • CBCT image quality was equivalent/superior to MDCT for bone visualization tasks.
Collapse
Affiliation(s)
- S Demehri
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, 21287, USA,
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Demehri S, Belzberg A, Blakeley J, Fayad LM. Conventional and functional MR imaging of peripheral nerve sheath tumors: initial experience. AJNR Am J Neuroradiol 2014; 35:1615-20. [PMID: 24763412 DOI: 10.3174/ajnr.a3910] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Differentiating benign from malignant peripheral nerve sheath tumors can be very challenging using conventional MR imaging. Our aim was to test the hypothesis that conventional and functional MR imaging can accurately diagnose malignancy in patients with indeterminate peripheral nerve sheath tumors. MATERIALS AND METHODS This institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study retrospectively reviewed 61 consecutive patients with 80 indeterminate peripheral nerve sheath tumors. Of these, 31 histologically proved peripheral nerve sheath tumors imaged with conventional (unenhanced T1, fluid-sensitive, contrast-enhanced T1-weighted sequences) and functional MR imaging (DWI/apparent diffusion coefficient mapping, dynamic contrast-enhanced MR imaging) were included. Two observers independently assessed anatomic (size, morphology, signal) and functional (ADC values, early arterial enhancement by dynamic contrast-enhanced MR) features to determine interobserver agreement. The accuracy of MR imaging for differentiating malignant from benign was also determined by receiver operating characteristic analysis. RESULTS Of 31 peripheral nerve sheath tumors, there were 9 malignant (9%) and 22 benign ones (81%). With anatomic sequences, average tumor diameter (6.3 ± 1.8 versus 3.9 ± 2.3 mm, P = .009), ill-defined/infiltrative margins (77% versus 32%; P = .04), and the presence of peritumoral edema (66% versus 23%, P = .01) were different for malignant peripheral nerve sheath tumors and benign peripheral nerve sheath tumors. With functional sequences, minimum ADC (0.47 ± 0.32 × 10(-3) mm(2)/s versus 1.08 ± 0.26 × 10(-3) mm(2)/s; P < .0001) and the presence of early arterial enhancement (50% versus 11%; P = .03) were different for malignant peripheral nerve sheath tumors and benign peripheral nerve sheath tumors. The minimum ADC (area under receiver operating characteristic curve was 0.89; 95% confidence interval, 0.73-0.97) and the average tumor diameter (area under the curve = 0.8; 95% CI, 0.66-0.94) were accurate in differentiating malignant peripheral nerve sheath tumors from benign peripheral nerve sheath tumors. With threshold values for minimum ADC ≤ 1.0 × 10(-3) mm(2)/s and an average diameter of ≥4.2 cm, malignancy could be diagnosed with 100% sensitivity (95% CI, 66.4%-100%). CONCLUSIONS Average tumor diameter and minimum ADC values are potentially important parameters that may be used to distinguish malignant peripheral nerve sheath tumors from benign peripheral nerve sheath tumors.
Collapse
Affiliation(s)
- S Demehri
- From The Russell H. Morgan Department of Radiology and Radiological Science (S.D., L.M.F.)
| | - A Belzberg
- Department of Neurosurgery (A.B.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - J Blakeley
- The Johns Hopkins Hospital Comprehensive Neurofibromatosis Center (J.B.), Department of Neurology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - L M Fayad
- From The Russell H. Morgan Department of Radiology and Radiological Science (S.D., L.M.F.)
| |
Collapse
|
8
|
Thakkar RS, Thakkar SC, Srikumaran U, McFarland EG, Fayad LM. Complications of rotator cuff surgery-the role of post-operative imaging in patient care. Br J Radiol 2014; 87:20130630. [PMID: 24734935 DOI: 10.1259/bjr.20130630] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
When pain or disability occurs after rotator cuff surgery, post-operative imaging is frequently performed. Post-operative complications and expected post-operative imaging findings in the shoulder are presented, with a focus on MRI, MR arthrography (MRA) and CT arthrography. MR and CT techniques are available to reduce image degradation secondary to surgical distortions of native anatomy and implant-related artefacts and to define complications after rotator cuff surgery. A useful approach to image the shoulder after surgery is the standard radiography, followed by MRI/MRA for patients with low "metal presence" and CT for patients who have a higher metal presence. However, for the assessment of patients who have undergone surgery for rotator cuff injuries, imaging findings should always be correlated with the clinical presentation because post-operative imaging abnormalities do not necessarily correlate with symptoms.
Collapse
Affiliation(s)
- R S Thakkar
- 1 The Russell H. Morgan Department of Radiology and Radiology Science, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | | | | | |
Collapse
|
9
|
Dreizin D, Ahlawat S, Del Grande F, Fayad LM. Gradient-echo in-phase and opposed-phase chemical shift imaging: role in evaluating bone marrow. Clin Radiol 2014; 69:648-57. [PMID: 24613580 DOI: 10.1016/j.crad.2014.01.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 01/31/2014] [Indexed: 12/16/2022]
Abstract
Chemical shift imaging (CSI) provides valuable information for assessing the bone marrow, while adding little to total examination time. In this article, we review the uses of CSI for evaluating bone marrow abnormalities. CSI can be used for differentiating marrow-replacing lesions from a range of non-marrow-replacing processes, although the sequence is associated with technical limitations and pitfalls. Particularly at 3 T, susceptibility artefacts are prevalent, and optimal technical parameters must be implemented with appropriate choices for echo times.
Collapse
Affiliation(s)
- D Dreizin
- Department of Radiology, John Hopkins Hospital, Baltimore, MD, USA
| | - S Ahlawat
- Department of Radiology, John Hopkins Hospital, Baltimore, MD, USA
| | - F Del Grande
- Department of Radiology, John Hopkins Hospital, Baltimore, MD, USA; Servizio di Radiologia, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - L M Fayad
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Hospital, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| |
Collapse
|
10
|
Fayad LM, Wang X, Blakeley JO, Durand DJ, Jacobs MA, Demehri S, Subhawong TK, Soldatos T, Barker PB. Characterization of peripheral nerve sheath tumors with 3T proton MR spectroscopy. AJNR Am J Neuroradiol 2013; 35:1035-41. [PMID: 24287094 DOI: 10.3174/ajnr.a3778] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND PURPOSE The characterization of peripheral nerve sheath tumors is challenging. The purpose here was to investigate the diagnostic value of quantitative proton MR spectroscopy at 3T for the characterization of peripheral nerve sheath tumors as benign or malignant, compared with PET. MATERIALS AND METHODS Twenty participants with 24 peripheral nerve sheath tumors underwent MR spectroscopy by use of a point-resolved sequence (TE, 135 ms). Six voxels were placed in 4 histologically proven malignant peripheral nerve sheath tumors and 22 voxels in 20 benign peripheral nerve sheath tumors (9 histologically proven, 11 with documented stability). The presence or absence of a trimethylamine signal was evaluated, the trimethylamine concentration estimated by use of phantom replacement methodology, and the trimethylamine fraction relative to Cr measured. MR spectroscopy results for benign and malignant peripheral nerve sheath tumors were compared by use of a Mann-Whitney test, and concordance or discordance with PET findings was recorded. RESULTS In all malignant tumors and in 9 of 18 benign peripheral nerve sheath tumors, a trimethylamine peak was detected, offering the presence of trimethylamine as a sensitive (100%), but not specific (50%), marker of malignant disease. Trimethylamine concentrations (2.2 ± 2.8 vs 6.6 ± 5.8 institutional units; P < .049) and the trimethylamine fraction (27 ± 42 vs 88 ± 22%; P < .012) were lower in benign than malignant peripheral nerve sheath tumors. A trimethylamine fraction threshold of 50% resulted in 100% sensitivity (95% CI, 58.0%-100%) and 72.2% (95% CI, 59.5%-75%) specificity for distinguishing benign from malignant disease. MR spectroscopy and PET results were concordant in 12 of 16 cases, (2 false-positive results for MR spectroscopy and PET each). CONCLUSIONS Quantitative measurement of trimethylamine concentration by use of MR spectroscopy is feasible in peripheral nerve sheath tumors and shows promise as a method for the differentiation of benign and malignant lesions. Trimethylamine presence within a peripheral nerve sheath tumor is a sensitive marker of malignant disease, but quantitative measurement of trimethylamine content is required to improve specificity.
Collapse
Affiliation(s)
- L M Fayad
- From The Russell H. Morgan Department of Radiology and Radiological Science (L.M.F., X.W., D.J.D., S.D., M.A.J., P.B.B.)Orthopedic Surgery (L.M.F.)Oncology (L.M.F., M.A.J.), The Johns Hopkins Hospital Comprehensive Neurofibromatosis Center
| | - X Wang
- From The Russell H. Morgan Department of Radiology and Radiological Science (L.M.F., X.W., D.J.D., S.D., M.A.J., P.B.B.)
| | - J O Blakeley
- Department of Neurology (J.O.B.), The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - D J Durand
- From The Russell H. Morgan Department of Radiology and Radiological Science (L.M.F., X.W., D.J.D., S.D., M.A.J., P.B.B.)
| | - M A Jacobs
- From The Russell H. Morgan Department of Radiology and Radiological Science (L.M.F., X.W., D.J.D., S.D., M.A.J., P.B.B.)Oncology (L.M.F., M.A.J.), The Johns Hopkins Hospital Comprehensive Neurofibromatosis Center
| | - S Demehri
- From The Russell H. Morgan Department of Radiology and Radiological Science (L.M.F., X.W., D.J.D., S.D., M.A.J., P.B.B.)
| | - T K Subhawong
- Department of Radiology (T.K.S.), University of Miami Miller School of Medicine, Miami, Florida
| | - T Soldatos
- Research Unit of Radiology and Medical Imaging (T.S.), National and Capodestrian University of Athens, Evgenidion Hospital, Athens, Greece
| | - P B Barker
- From The Russell H. Morgan Department of Radiology and Radiological Science (L.M.F., X.W., D.J.D., S.D., M.A.J., P.B.B.)
| |
Collapse
|
11
|
Abstract
BACKGROUND Magnetic resonance imaging (MRI) should be considered essential to the presurgical evaluation of pancreatic adenocarcinoma, to accurately detect resectable lesions and to spare patients with non-resectable tumors the morbidity, mortality, and expense of unnecessary surgery. This article is a review of the MRI characteristics of pancreatic adenocarcinoma, the features that determine its resectability, and the optimal MR sequences needed for its effective evaluation. The role of MRI imaging is contrasted with other imaging and invasive modalities for the diagnosis and staging of pancreatic adenocarcinoma.
Collapse
Affiliation(s)
- L M Fayad
- Division of Magnetic Resonance Imaging, Thomas Jefferson University Hospital, 132 South 10th Street, Suite 1096, Philadelphia, PA 19107, USA
| | | |
Collapse
|
12
|
Affiliation(s)
- L M Fayad
- Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY 10003, USA
| | | |
Collapse
|