David Jamadar - Academia.edu (original) (raw)

Papers by David Jamadar

We have found in our practice that the normal extensor retinaculum of the wrist may appear hypoec... more We have found in our practice that the normal extensor retinaculum of the wrist may appear hypoechoic on sonography and, because it is closely applied to the extensor tendons, may simulate tenosynovitis. This study prospectively evaluates the extensor retinaculum in 50 healthy adult volunteers, characterizing its sonographic appearance. The extensor retinaculum has a characteristic appearance on sonography. A hypoechoic appearance from anisotropy should not be confused with tenosynovitis.

OBJECTIVE. This article evaluates the utility of performing a focused musculoskeletal sonography ... more OBJECTIVE. This article evaluates the utility of performing a focused musculoskeletal sonography examination on the basis of patients' presenting complaints. MATERIALS AND METHODS. Six hundred two patients evaluated over 6 months were scanned using a routine protocol. At the completion of the routine examination, each patient was asked to indicate a focal point of discomfort and, if present, was rescanned

The purpose of this article is to describe the anatomy of the inguinal region in a way that is us... more The purpose of this article is to describe the anatomy of the inguinal region in a way that is useful for sonographic diagnosis of inguinal region hernias, and to illustrate the sonographic appearance of this anatomy. We show sonographic techniques for evaluating inguinal, femoral, and spigelian hernias and include surgically proven examples. Understanding healthy inguinal anatomy is essential for diagnosing inguinal region hernias. Sonography can diagnose and differentiate between various inguinal region hernias.

Photons Plus Ultrasound: Imaging and Sensing 2008: The Ninth Conference on Biomedical Thermoacoustics, Optoacoustics, and Acousto-optics, 2008

ABSTRACT As an emerging imaging technology that combines the merits of both light and ultrasound,... more ABSTRACT As an emerging imaging technology that combines the merits of both light and ultrasound, photoacoustic tomography (PAT) holds promise for screening and diagnosis of inflammatory joint diseases such as rheumatoid arthritis. In this study, the feasibility of PAT in imaging small-animal joints and human peripheral joints in a noninvasive manner was explored. Ex vivo rat tail and fresh cadaveric human finger joints were imaged. Based on the intrinsic optical contrast, intra- and extra-articular tissue structures in the joints were visualized successfully. Using light in the near-infrared region, the imaging depth of PAT is sufficient for cross-sectional imaging of a human peripheral joint as a whole organ. PAT, as a novel imaging modality with unique advantages, may contribute significantly to the early diagnosis of inflammatory joint disorders and accurate monitoring of disease progression and response to therapy.

The purpose of our study was to determine which wrist fractures are not prospectively diagnosed a... more The purpose of our study was to determine which wrist fractures are not prospectively diagnosed at radiography using CT as a gold standard and to identify specific fracture patterns. Through a search of radiology records from January 1 to December 31, 2005, 103 consecutive patients were identified as having radiographic and CT examinations of the wrist. After excluding incomplete or nondiagnostic examinations and those with a greater than 6-week interval between imaging studies, the final study group consisted of 61 wrist examinations in 60 patients. Two musculoskeletal radiologists and one emergency radiologist blindly reviewed CT examinations, and each bone (scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate, metacarpals, distal radius, distal ulna) was categorized as normal or fractured, with agreement reached by consensus. Each prospective radiographic report was categorized as either normal or fracture/equivocal for each osseous structure. Results were compared using the chi-square and Fisher's exact tests. In the proximal carpal row, lunate and triquetrum fractures were often radiographically occult (0% and 20%, respectively, detected at radiography); whereas in the distal carpal row, trapezoid, capitate, and hamate fractures were often occult (0%, 0%, and 40% detected at radiography, respectively). Hamate fractures were significantly associated with metacarpal fractures, and distal radius fractures were associated with scaphoid and ulna fractures. Thirty percent of wrist fractures were not prospectively diagnosed on radiography, suggesting that CT should be considered after a negative radiographic finding if clinically warranted. The location of a dorsal scaphoid avulsion fracture emphasizes the need for specific radiographic views or cross-sectional imaging for diagnosis.

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2004

To understand a linear artifact that projects deep to reflective structures that move rapidly whi... more To understand a linear artifact that projects deep to reflective structures that move rapidly while using tissue harmonic imaging with pulse inversion (PI) sonography. We hypothesize that this artifact is due to a cancellation error between firings in PI imaging, and it is, therefore, similar in generation to the twinkling artifact in color Doppler sonography. This artifact could be studied with the use of surfaces of different roughness to represent different rates of motion, in which roughness corresponds to spatial fluctuations in surface height. Given very slight variations in beam focusing as occurs with sonographic imaging arrays, these spatial fluctuations translate into temporal fluctuations in the received signal as would occur with tissue motion. We scanned 4 different sandpaper grits and a smooth surface through a water path using fundamental and PI mode, 1- and 2-pulse techniques, respectively. The sandpaper and the smooth surface were scanned through a water path at mec...

Emergency radiology, 2002

We present a case of traumatic bamboo foreign body penetration through the posterior thigh extend... more We present a case of traumatic bamboo foreign body penetration through the posterior thigh extending cephalad into the pelvis sustained during skiing. The unsuspected bamboo foreign body was missed prospectively on the initial portable trauma radiograph of the pelvis, but was retrospectively quite apparent as a linear 12 x 2-cm radiolucent region overlying the left pelvis and hip region. On CT examination, the bamboo stick appeared as a round cylindrical air-filled structure of high density compared to soft tissue - the typical appearance of bamboo. Bamboo foreign bodies can be recognized radiographically by this typical appearance, since it is one of the few wood products that causes high attenuation relative to soft tissue on CT.

Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society, 2003

To assess whether the presence of subchondral bone marrow abnormalities (bone marrow edema (BME))... more To assess whether the presence of subchondral bone marrow abnormalities (bone marrow edema (BME)) and cartilage defects, determined by magnetic resonance imaging (MRI), would explain the difference between painful osteoarthritis of the knee (OAK) compared with painless OAK or pain without OAK. Four groups of women (30 per group), aged 35-55 years, were recruited from the southeast Michigan Osteoarthritis cohort (group 1: painful OAK; group 2: painless OAK; group 3: knee pain without OAK; and group 4: no OAK or knee pain). OAK was defined by a Kellgren-Lawrence score of 2 or greater, while pain was based on self-report. BME and cartilage defects were identified from MRI. BME lesions were identified in 56% of all knees. BME lesions were four times (95% CI=1.7, 8.7) more likely to occur in the painless OAK group as compared with the group with pain, but no OAK. BME lesions >1cm were more frequent (OR=5.0; 95% CI=1.4, 10.5) in the painful OAK group than all other groups. While the fr...

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2003

Radiology, 2005

To prospectively compare magnetic resonance (MR) imaging-defined abnormalities of osteoarthritis ... more To prospectively compare magnetic resonance (MR) imaging-defined abnormalities of osteoarthritis (OA) of the knee with radiographic severity measurements of OA of the knee and self-reported pain. This study was approved by the institutional review board of University of Michigan. Informed consent was obtained for this HIPAA-compliant study. Knee MR imaging was performed in 117 women (mean age, 46 years; range, 32-56 years) from a community-based arthritis study (n = 1053) with 30 women in each of four categories: (a) no pain and no OA of the knee, (b) no pain and OA of the knee, (c) pain and no OA of the knee, and (d) pain and OA of the knee. OA of the knee was defined from radiographs. Two hundred thirty-two eligible knees had Kellgren-Lawrence scores for OA of the knee as follows: grade 0, 115 (49.6%); grade 1, 33 (14.2%); grade 2, 66 (28.4%); grade 3, 17 (7.3%); and grade 4, one (0.4%). MR images were assessed for location and severity of defects of cartilage, bone marrow edema (BME), osteophytes, subchondral cysts, sclerosis, meniscal and/or ligamentous tears, joint effusion, synovial cysts, and synovitis. MR imaging findings were compared with radiographic severity of OA of the knee (Kellgren-Lawrence scale) and self-reported pain with analysis of variance, t tests, and contingency table analyses. Defects of cartilage (higher than grade IIA) were found in 75% of knees; BME was found in 57% of knees (<1 cm, 41%; >1 cm, 16%). Large BME lesions were common in the pain and OA of the knee group (P = .001); this group was significantly more likely to have defects of cartilage (P = .001); meniscal tears (P = .001); and osteophytes, subchondral cysts, sclerosis, joint effusion, and synovitis (P < .001). Defects of cartilage, osteophytes, sclerosis, meniscal or ligamentous tears, joint effusion, and synovitis were strongly related to increasing Kellgren-Lawrence grade (P < .001). In middle-aged women, there were significant associations between pain, radiographic severity of OA of the knee, and seven MR imaging-identified parameters.

British Journal of Radiology, 1994

Korean journal of radiology : official journal of the Korean Radiological Society

MR imaging appearances of different types of reconstructive muscle flaps following reconstructive... more MR imaging appearances of different types of reconstructive muscle flaps following reconstructive surgery of the lower extremity with associated post-surgical changes due to altered anatomy, radiation, and potential complications, can be challenging. A multidisciplinary therapeutic approach to tumors allows for limb salvage therapy in a majority of the patients. Decision-making for specific types of soft tissue reconstruction is based on the body region affected, as well as the size and complexity of the defect. Hematomas and infections are early complications that can jeopardize flap viability. The local recurrence of a tumor within six months after a complete resection with confirmed tumor-free margins and adjuvant radiation therapy is rare. Identification of a new lesion similar to the initial tumor favors a finding of tumor recurrence.

Academic Radiology, 2015

Publishing is critical for academic medicine career advancement. Rejection of manuscripts can be ... more Publishing is critical for academic medicine career advancement. Rejection of manuscripts can be demoralizing. Obstacles faced by clinical faculty may include lack of time, confidence, and optimal writing practices. This study describes the development and evaluation of a peer-writing group, informed by theory and research on faculty development and writing. Five clinical-track radiology faculty members formed a "Writers' Circle" to promote scholarly productivity and reflection on writing practices. Members decided to work with previously rejected manuscripts. After members' initial meeting, interactions were informal, face to face during clinical work, and online. After the first 6 months, an anonymous survey asked members about the status of articles and evaluations of the writing group. Ten previously rejected articles, at least one from each member, were submitted to the Circle. In 6 months, four manuscripts were accepted for publication, five were in active revision, and one was withdrawn. All participants (100%) characterized the program as worth their time, increasing their motivation to write, their opportunities to support scholarly productivity of colleagues, and their confidence in generating scholarship. Peer-support writing groups can facilitate the pooling of expertise and the exchange of recommended writing practices. Our peer-support group increased scholarly productivity and provided a collegial approach to academic writing.

Osteoarthritis and Cartilage, 2002

We assessed the probability that mid-aged women with a Kellgren and Lawrence (K-L) score of 1 are... more We assessed the probability that mid-aged women with a Kellgren and Lawrence (K-L) score of 1 are likely to progress to a score of 2 or regress to a score of zero at a second time point, 2-3 years later. Osteoarthritis (OA) of measurements (weight-bearing X-rays and interviews) were undertaken in women from the Southeast Michigan population who were > or =40 years of age, and who participated in both the 1995 and 1998 measurements (N=679). Of the 17.1 % of women with a 1995 K-L score of 1 in their right knee, 37.1% had a K-L score of 1 in 1998 while 32.8 % had a score of > or =2 and 30.2% had a score of zero. For 26.0% of women, the score progressed by at least one unit over the 2.5 year period whereas scores for only 7.0% of women regressed in the same time period. Women who had a K-L score of 1 in the right knee in 1995 were 2.5 times more likely to have a K-L score of 1 in 1998 (95% CI=1.6-3.8); and were 2.2 times more likely to have a K-L score of 2 or greater (95% CI=1.4-3.5) in 1998 compared with other scores. These women were 74% less likely to have a score of zero in 1998 (95% CI=0.2-0.4). Further, other risk factors, specifically age and BMI were predictors of increasing K-L grade in 1998. These findings suggest that a score of 1 is part of the advancement to emergent OAK; and suggest the following criteria to characterize individuals who are at an intervenable stage on the pathway toward OAK: age > or =40, BMI > or =30, and K-L score of > or =1. From the perspective of both the individual and the examiner, these assessment characteristics are relatively simple to assess clinically.

Ultrasound in Medicine & Biology, 2003

Ultrasound in Medicine & Biology, 2003

the superior ability of the human eye to distinguish bright colors, as opposed to dark grays. The... more the superior ability of the human eye to distinguish bright colors, as opposed to dark grays. The purpose of this study was compare photopic imaging with conventional sonography in low contrast settings in musculoskeletal sonography. Methods: 49 patients underwent sonography to evaluate the foot, using a 7.5-MHz linear transducer on a Siemans Sonoline Elegra ultrasound unit. 39 patients were evaluated for plantar nerve neuromas, whereas the other 10 patients underwent evaluation of their plantar fascia. 83 image pairs were obtained. Images in each pair depicted the same structure, with and without photopic imaging, for a total of 166 images. These images were then presented on a computer monitor in random order to two radiologists experienced in musculoskeletal sonography. Using a five-point scale, the radiologists independently rated each image for overall image contrast, tissue boundaries, deep tissue boundaries, and how well internal characteristics of lesions were depicted. Results: Three-way analysis of variance revealed photopic imaging improved overall image contrast, definition of tissue boundaries, and depiction of internal characteristics of lesions (pϽ0.005 for all parameters). Mean scores for overall image contrast, definition of tissue boundaries, definition of deep tissue boundaries, and depiction of internal lesion characteristics were 3.95, 3.56, 3.10, and 3.26, respectively, for photopic imaging and 3.32, 2.98, 2.57, and 2.71, respectively, for conventional imaging. Conclusions: Photopic imaging significantly improves image contrast and may be particularly useful in musculoskeletal applications, such as evaluation for neuromas and plantar fasciitis where lesion contrast is low.

Thyroid, 1998

Our purpose was to determine if micronodular lung metastases from papillary thyroid cancer had di... more Our purpose was to determine if micronodular lung metastases from papillary thyroid cancer had diameters that were less than 1 mm and therefore of a size for which irradiation by radioiodine (131I) is inefficient. In five patients, lung metastases seen on computed tomography (CT) were enumerated and sized in the entire right lung and right upper lung giving volumes of measurable, ie, more than 1 mm diameter, tumors. Concentrations of diagnostic 131I were quantified scintigraphically in the same regions. Fractions of administered 131I per milliliter of tumor and the absorbed radiation from the subsequent treatments were calculated to see if the 131I levels in lungs were greater than expected for the visible tumor volumes. Two other patients manifesting similar findings had lung biopsies that were reviewed for size of metastases. The calculated fractions of administered activity per milliliter of tumor and the absorbed radiations from the treatments with 131I were exceptionally high. Biopsies revealed numerous tumors below the resolution of CT. We conclude that the fractions of administered activity and absorbed radiations of 131I in tumors were high because the measured tumor volumes underestimated the total tumor volumes. Many lung metastases were less than 1 mm in diameter.

Surgical and Radiologic Anatomy, 2014

The purpose of this study was to establish normative data for the CT appearance of inguinal lymph... more The purpose of this study was to establish normative data for the CT appearance of inguinal lymph nodes. After Institutional Review Board approval, search of the radiology information system identified 500 consecutive CT examinations of the pelvis. Patients were included if no lower extremity or perineum pathology, or history of malignancy at the time of CT examination, and a clinical note documenting no tumor at least 2 years after the CT. The final study group was 77 patients. CT examinations were retrospectively reviewed and bilateral inguinal lymph nodes were characterized by size (short axis and largest size in general), number, and presence of fat attenuation. The mean short-axis inguinal lymph node size was 5.4 mm (range 2.1-13.6 mm), measured at 8.8 mm two standard deviations above the mean. The mean number of superficial and deep inguinal lymph nodes was 10.7 (range 3-18) and 1.2 per patient (range 1-2), respectively. Superficial and deep inguinal nodes showed internal fat attenuation in 85 and 78% of nodes, and were oval in shape in 95 and 78%, respectively. Inguinal lymph nodes in asymptomatic patients have a mean short axis of 5.4 mm, a short axis of 8.8 mm at two standard deviations above the mean, and are multiple and symmetric in size and number (4-20 per patient). Normal inguinal lymph nodes were commonly oval in shape and contained fat, although such findings may be absent in smaller lymph nodes.

We have found in our practice that the normal extensor retinaculum of the wrist may appear hypoec... more We have found in our practice that the normal extensor retinaculum of the wrist may appear hypoechoic on sonography and, because it is closely applied to the extensor tendons, may simulate tenosynovitis. This study prospectively evaluates the extensor retinaculum in 50 healthy adult volunteers, characterizing its sonographic appearance. The extensor retinaculum has a characteristic appearance on sonography. A hypoechoic appearance from anisotropy should not be confused with tenosynovitis.

OBJECTIVE. This article evaluates the utility of performing a focused musculoskeletal sonography ... more OBJECTIVE. This article evaluates the utility of performing a focused musculoskeletal sonography examination on the basis of patients' presenting complaints. MATERIALS AND METHODS. Six hundred two patients evaluated over 6 months were scanned using a routine protocol. At the completion of the routine examination, each patient was asked to indicate a focal point of discomfort and, if present, was rescanned

The purpose of this article is to describe the anatomy of the inguinal region in a way that is us... more The purpose of this article is to describe the anatomy of the inguinal region in a way that is useful for sonographic diagnosis of inguinal region hernias, and to illustrate the sonographic appearance of this anatomy. We show sonographic techniques for evaluating inguinal, femoral, and spigelian hernias and include surgically proven examples. Understanding healthy inguinal anatomy is essential for diagnosing inguinal region hernias. Sonography can diagnose and differentiate between various inguinal region hernias.

Photons Plus Ultrasound: Imaging and Sensing 2008: The Ninth Conference on Biomedical Thermoacoustics, Optoacoustics, and Acousto-optics, 2008

ABSTRACT As an emerging imaging technology that combines the merits of both light and ultrasound,... more ABSTRACT As an emerging imaging technology that combines the merits of both light and ultrasound, photoacoustic tomography (PAT) holds promise for screening and diagnosis of inflammatory joint diseases such as rheumatoid arthritis. In this study, the feasibility of PAT in imaging small-animal joints and human peripheral joints in a noninvasive manner was explored. Ex vivo rat tail and fresh cadaveric human finger joints were imaged. Based on the intrinsic optical contrast, intra- and extra-articular tissue structures in the joints were visualized successfully. Using light in the near-infrared region, the imaging depth of PAT is sufficient for cross-sectional imaging of a human peripheral joint as a whole organ. PAT, as a novel imaging modality with unique advantages, may contribute significantly to the early diagnosis of inflammatory joint disorders and accurate monitoring of disease progression and response to therapy.

The purpose of our study was to determine which wrist fractures are not prospectively diagnosed a... more The purpose of our study was to determine which wrist fractures are not prospectively diagnosed at radiography using CT as a gold standard and to identify specific fracture patterns. Through a search of radiology records from January 1 to December 31, 2005, 103 consecutive patients were identified as having radiographic and CT examinations of the wrist. After excluding incomplete or nondiagnostic examinations and those with a greater than 6-week interval between imaging studies, the final study group consisted of 61 wrist examinations in 60 patients. Two musculoskeletal radiologists and one emergency radiologist blindly reviewed CT examinations, and each bone (scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate, metacarpals, distal radius, distal ulna) was categorized as normal or fractured, with agreement reached by consensus. Each prospective radiographic report was categorized as either normal or fracture/equivocal for each osseous structure. Results were compared using the chi-square and Fisher's exact tests. In the proximal carpal row, lunate and triquetrum fractures were often radiographically occult (0% and 20%, respectively, detected at radiography); whereas in the distal carpal row, trapezoid, capitate, and hamate fractures were often occult (0%, 0%, and 40% detected at radiography, respectively). Hamate fractures were significantly associated with metacarpal fractures, and distal radius fractures were associated with scaphoid and ulna fractures. Thirty percent of wrist fractures were not prospectively diagnosed on radiography, suggesting that CT should be considered after a negative radiographic finding if clinically warranted. The location of a dorsal scaphoid avulsion fracture emphasizes the need for specific radiographic views or cross-sectional imaging for diagnosis.

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2004

To understand a linear artifact that projects deep to reflective structures that move rapidly whi... more To understand a linear artifact that projects deep to reflective structures that move rapidly while using tissue harmonic imaging with pulse inversion (PI) sonography. We hypothesize that this artifact is due to a cancellation error between firings in PI imaging, and it is, therefore, similar in generation to the twinkling artifact in color Doppler sonography. This artifact could be studied with the use of surfaces of different roughness to represent different rates of motion, in which roughness corresponds to spatial fluctuations in surface height. Given very slight variations in beam focusing as occurs with sonographic imaging arrays, these spatial fluctuations translate into temporal fluctuations in the received signal as would occur with tissue motion. We scanned 4 different sandpaper grits and a smooth surface through a water path using fundamental and PI mode, 1- and 2-pulse techniques, respectively. The sandpaper and the smooth surface were scanned through a water path at mec...

Emergency radiology, 2002

We present a case of traumatic bamboo foreign body penetration through the posterior thigh extend... more We present a case of traumatic bamboo foreign body penetration through the posterior thigh extending cephalad into the pelvis sustained during skiing. The unsuspected bamboo foreign body was missed prospectively on the initial portable trauma radiograph of the pelvis, but was retrospectively quite apparent as a linear 12 x 2-cm radiolucent region overlying the left pelvis and hip region. On CT examination, the bamboo stick appeared as a round cylindrical air-filled structure of high density compared to soft tissue - the typical appearance of bamboo. Bamboo foreign bodies can be recognized radiographically by this typical appearance, since it is one of the few wood products that causes high attenuation relative to soft tissue on CT.

Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society, 2003

To assess whether the presence of subchondral bone marrow abnormalities (bone marrow edema (BME))... more To assess whether the presence of subchondral bone marrow abnormalities (bone marrow edema (BME)) and cartilage defects, determined by magnetic resonance imaging (MRI), would explain the difference between painful osteoarthritis of the knee (OAK) compared with painless OAK or pain without OAK. Four groups of women (30 per group), aged 35-55 years, were recruited from the southeast Michigan Osteoarthritis cohort (group 1: painful OAK; group 2: painless OAK; group 3: knee pain without OAK; and group 4: no OAK or knee pain). OAK was defined by a Kellgren-Lawrence score of 2 or greater, while pain was based on self-report. BME and cartilage defects were identified from MRI. BME lesions were identified in 56% of all knees. BME lesions were four times (95% CI=1.7, 8.7) more likely to occur in the painless OAK group as compared with the group with pain, but no OAK. BME lesions >1cm were more frequent (OR=5.0; 95% CI=1.4, 10.5) in the painful OAK group than all other groups. While the fr...

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2003

Radiology, 2005

To prospectively compare magnetic resonance (MR) imaging-defined abnormalities of osteoarthritis ... more To prospectively compare magnetic resonance (MR) imaging-defined abnormalities of osteoarthritis (OA) of the knee with radiographic severity measurements of OA of the knee and self-reported pain. This study was approved by the institutional review board of University of Michigan. Informed consent was obtained for this HIPAA-compliant study. Knee MR imaging was performed in 117 women (mean age, 46 years; range, 32-56 years) from a community-based arthritis study (n = 1053) with 30 women in each of four categories: (a) no pain and no OA of the knee, (b) no pain and OA of the knee, (c) pain and no OA of the knee, and (d) pain and OA of the knee. OA of the knee was defined from radiographs. Two hundred thirty-two eligible knees had Kellgren-Lawrence scores for OA of the knee as follows: grade 0, 115 (49.6%); grade 1, 33 (14.2%); grade 2, 66 (28.4%); grade 3, 17 (7.3%); and grade 4, one (0.4%). MR images were assessed for location and severity of defects of cartilage, bone marrow edema (BME), osteophytes, subchondral cysts, sclerosis, meniscal and/or ligamentous tears, joint effusion, synovial cysts, and synovitis. MR imaging findings were compared with radiographic severity of OA of the knee (Kellgren-Lawrence scale) and self-reported pain with analysis of variance, t tests, and contingency table analyses. Defects of cartilage (higher than grade IIA) were found in 75% of knees; BME was found in 57% of knees (<1 cm, 41%; >1 cm, 16%). Large BME lesions were common in the pain and OA of the knee group (P = .001); this group was significantly more likely to have defects of cartilage (P = .001); meniscal tears (P = .001); and osteophytes, subchondral cysts, sclerosis, joint effusion, and synovitis (P < .001). Defects of cartilage, osteophytes, sclerosis, meniscal or ligamentous tears, joint effusion, and synovitis were strongly related to increasing Kellgren-Lawrence grade (P < .001). In middle-aged women, there were significant associations between pain, radiographic severity of OA of the knee, and seven MR imaging-identified parameters.

British Journal of Radiology, 1994

Korean journal of radiology : official journal of the Korean Radiological Society

MR imaging appearances of different types of reconstructive muscle flaps following reconstructive... more MR imaging appearances of different types of reconstructive muscle flaps following reconstructive surgery of the lower extremity with associated post-surgical changes due to altered anatomy, radiation, and potential complications, can be challenging. A multidisciplinary therapeutic approach to tumors allows for limb salvage therapy in a majority of the patients. Decision-making for specific types of soft tissue reconstruction is based on the body region affected, as well as the size and complexity of the defect. Hematomas and infections are early complications that can jeopardize flap viability. The local recurrence of a tumor within six months after a complete resection with confirmed tumor-free margins and adjuvant radiation therapy is rare. Identification of a new lesion similar to the initial tumor favors a finding of tumor recurrence.

Academic Radiology, 2015

Publishing is critical for academic medicine career advancement. Rejection of manuscripts can be ... more Publishing is critical for academic medicine career advancement. Rejection of manuscripts can be demoralizing. Obstacles faced by clinical faculty may include lack of time, confidence, and optimal writing practices. This study describes the development and evaluation of a peer-writing group, informed by theory and research on faculty development and writing. Five clinical-track radiology faculty members formed a "Writers' Circle" to promote scholarly productivity and reflection on writing practices. Members decided to work with previously rejected manuscripts. After members' initial meeting, interactions were informal, face to face during clinical work, and online. After the first 6 months, an anonymous survey asked members about the status of articles and evaluations of the writing group. Ten previously rejected articles, at least one from each member, were submitted to the Circle. In 6 months, four manuscripts were accepted for publication, five were in active revision, and one was withdrawn. All participants (100%) characterized the program as worth their time, increasing their motivation to write, their opportunities to support scholarly productivity of colleagues, and their confidence in generating scholarship. Peer-support writing groups can facilitate the pooling of expertise and the exchange of recommended writing practices. Our peer-support group increased scholarly productivity and provided a collegial approach to academic writing.

Osteoarthritis and Cartilage, 2002

We assessed the probability that mid-aged women with a Kellgren and Lawrence (K-L) score of 1 are... more We assessed the probability that mid-aged women with a Kellgren and Lawrence (K-L) score of 1 are likely to progress to a score of 2 or regress to a score of zero at a second time point, 2-3 years later. Osteoarthritis (OA) of measurements (weight-bearing X-rays and interviews) were undertaken in women from the Southeast Michigan population who were > or =40 years of age, and who participated in both the 1995 and 1998 measurements (N=679). Of the 17.1 % of women with a 1995 K-L score of 1 in their right knee, 37.1% had a K-L score of 1 in 1998 while 32.8 % had a score of > or =2 and 30.2% had a score of zero. For 26.0% of women, the score progressed by at least one unit over the 2.5 year period whereas scores for only 7.0% of women regressed in the same time period. Women who had a K-L score of 1 in the right knee in 1995 were 2.5 times more likely to have a K-L score of 1 in 1998 (95% CI=1.6-3.8); and were 2.2 times more likely to have a K-L score of 2 or greater (95% CI=1.4-3.5) in 1998 compared with other scores. These women were 74% less likely to have a score of zero in 1998 (95% CI=0.2-0.4). Further, other risk factors, specifically age and BMI were predictors of increasing K-L grade in 1998. These findings suggest that a score of 1 is part of the advancement to emergent OAK; and suggest the following criteria to characterize individuals who are at an intervenable stage on the pathway toward OAK: age > or =40, BMI > or =30, and K-L score of > or =1. From the perspective of both the individual and the examiner, these assessment characteristics are relatively simple to assess clinically.

Ultrasound in Medicine & Biology, 2003

Ultrasound in Medicine & Biology, 2003

the superior ability of the human eye to distinguish bright colors, as opposed to dark grays. The... more the superior ability of the human eye to distinguish bright colors, as opposed to dark grays. The purpose of this study was compare photopic imaging with conventional sonography in low contrast settings in musculoskeletal sonography. Methods: 49 patients underwent sonography to evaluate the foot, using a 7.5-MHz linear transducer on a Siemans Sonoline Elegra ultrasound unit. 39 patients were evaluated for plantar nerve neuromas, whereas the other 10 patients underwent evaluation of their plantar fascia. 83 image pairs were obtained. Images in each pair depicted the same structure, with and without photopic imaging, for a total of 166 images. These images were then presented on a computer monitor in random order to two radiologists experienced in musculoskeletal sonography. Using a five-point scale, the radiologists independently rated each image for overall image contrast, tissue boundaries, deep tissue boundaries, and how well internal characteristics of lesions were depicted. Results: Three-way analysis of variance revealed photopic imaging improved overall image contrast, definition of tissue boundaries, and depiction of internal characteristics of lesions (pϽ0.005 for all parameters). Mean scores for overall image contrast, definition of tissue boundaries, definition of deep tissue boundaries, and depiction of internal lesion characteristics were 3.95, 3.56, 3.10, and 3.26, respectively, for photopic imaging and 3.32, 2.98, 2.57, and 2.71, respectively, for conventional imaging. Conclusions: Photopic imaging significantly improves image contrast and may be particularly useful in musculoskeletal applications, such as evaluation for neuromas and plantar fasciitis where lesion contrast is low.

Thyroid, 1998

Our purpose was to determine if micronodular lung metastases from papillary thyroid cancer had di... more Our purpose was to determine if micronodular lung metastases from papillary thyroid cancer had diameters that were less than 1 mm and therefore of a size for which irradiation by radioiodine (131I) is inefficient. In five patients, lung metastases seen on computed tomography (CT) were enumerated and sized in the entire right lung and right upper lung giving volumes of measurable, ie, more than 1 mm diameter, tumors. Concentrations of diagnostic 131I were quantified scintigraphically in the same regions. Fractions of administered 131I per milliliter of tumor and the absorbed radiation from the subsequent treatments were calculated to see if the 131I levels in lungs were greater than expected for the visible tumor volumes. Two other patients manifesting similar findings had lung biopsies that were reviewed for size of metastases. The calculated fractions of administered activity per milliliter of tumor and the absorbed radiations from the treatments with 131I were exceptionally high. Biopsies revealed numerous tumors below the resolution of CT. We conclude that the fractions of administered activity and absorbed radiations of 131I in tumors were high because the measured tumor volumes underestimated the total tumor volumes. Many lung metastases were less than 1 mm in diameter.

Surgical and Radiologic Anatomy, 2014

The purpose of this study was to establish normative data for the CT appearance of inguinal lymph... more The purpose of this study was to establish normative data for the CT appearance of inguinal lymph nodes. After Institutional Review Board approval, search of the radiology information system identified 500 consecutive CT examinations of the pelvis. Patients were included if no lower extremity or perineum pathology, or history of malignancy at the time of CT examination, and a clinical note documenting no tumor at least 2 years after the CT. The final study group was 77 patients. CT examinations were retrospectively reviewed and bilateral inguinal lymph nodes were characterized by size (short axis and largest size in general), number, and presence of fat attenuation. The mean short-axis inguinal lymph node size was 5.4 mm (range 2.1-13.6 mm), measured at 8.8 mm two standard deviations above the mean. The mean number of superficial and deep inguinal lymph nodes was 10.7 (range 3-18) and 1.2 per patient (range 1-2), respectively. Superficial and deep inguinal nodes showed internal fat attenuation in 85 and 78% of nodes, and were oval in shape in 95 and 78%, respectively. Inguinal lymph nodes in asymptomatic patients have a mean short axis of 5.4 mm, a short axis of 8.8 mm at two standard deviations above the mean, and are multiple and symmetric in size and number (4-20 per patient). Normal inguinal lymph nodes were commonly oval in shape and contained fat, although such findings may be absent in smaller lymph nodes.