Mohammad Samim - Academia.edu (original) (raw)
Papers by Mohammad Samim
Skeletal Radiology, Sep 18, 2020
Patient-reported outcomes (PROs) provide an essential understanding of the impact a condition or ... more Patient-reported outcomes (PROs) provide an essential understanding of the impact a condition or treatment has on a patient, while complementing other, more traditional outcomes information like survival and time to symptom resolution. PROs have become increasingly important in medicine with the push toward patient-centered care. The creation of a PROs database within an institution or practice provides a way to collect, understand, and use this kind of patient feedback to inform quality improvement and develop the evidence base for medical decision-making and on a larger scale could potentially help determine national standards of care and treatment guidelines. This paper provides a first-hand account of our experience setting up an imagingbased PROs database at our institution and is organized into steps the reader can follow for creating a PROs database of their own. Given the limited use of PROs within both diagnostic and interventional radiology, we hope our paper stimulates a new interest among radiologists who may have never considered outcomes work in the past.
Skeletal Radiology, Jun 23, 2022
Magnetic Resonance Imaging Clinics of North America, Nov 1, 2022
International Journal of Surgery, Dec 1, 2008
Surgical clips may incorporate into the duodenal ulcer after laparoscopic cholecystectomy leading... more Surgical clips may incorporate into the duodenal ulcer after laparoscopic cholecystectomy leading to a rare complication. Case report: A 70-year-old woman, 15 years after laparoscopic cholecystectomy, developed weight loss, anemia and gastric outlet obstruction secondary to a chronic duodenal ulcer. Gastroscopy showed a clip in the ulcer bed. At surgery she was found to have gastric outlet obstruction and mobilization of the duodenum revealed a large ulcer with a migrated clip from the cystic duct in its base. The ulcer was excluded and the clip was removed. She was perfectly well at the follow-up after 2 months. Conclusions: Migration of endo-surgical clips is a rare complication after laparoscopic surgery. Surgeons, gastroenterologists and radiologists should be aware of this late complication of laparoscopic cholecystectomy in cases of acute abdominal symptoms.
Radiology, Nov 1, 2019
Background The MRI manifestations of subspine impingement (SSI) other than morphologic features o... more Background The MRI manifestations of subspine impingement (SSI) other than morphologic features of anterior inferior iliac spine (AIIS) have not been extensively explored and validated. Purpose To determine the MRI findings associated with SSI, including AIIS morphologic features, femoral distal cam, and associated soft-tissue injuries. Materials and Methods This is a retrospective study of symptomatic patients who underwent arthroscopic treatment for femoroacetabular impingement between December 2014 and March 2017, with preoperative MRI within 6 months before surgery. The SSI group included patients with clinical and intraoperative findings of SSI; the remaining patients comprised the non-SSI group. Preoperative MRI findings were independently assessed by two radiologists who were blinded to clinical information. Interreader agreement was assessed, and multivariable logistic regression was also used. Results A total of 62 patients (mean age ± standard deviation, 42.1 years ± 11.9; 38 women) were included. SSI was diagnosed in 20 of the 62 patients (32%) (mean age, 43 years ± 12); 42 patients (68%) did not have SSI (mean age, 41 years ± 10). Reader 1 detected distal cam in 16 of the 20 patients with SSI (80%) and eight of the 42 patients without SSI (19%), and reader 2 detected distal cam in 15 of the 20 patients with SSI (75%) and eight of the 42 patients without SSI (19%) (P < .001 for both). Reader 1 detected signs of impingement on the distal femoral neck (IDFN) in 18 of the 20 patients with SSI (90%) and seven of the 42 patients without SSI (16%), and reader 2 detected signs of IDFN in 13 of the 20 patients with SSI (65%) and nine of the 42 patients without SSI (21%) (P < .001 and P = .001, respectively). Reader 1 detected superior capsular edema in 15 of 20 patients with SSI (75%) and three of 42 patients without SSI (7%), and reader 2 detected superior capsular edema in 17 of 20 patients with SSI (85%) and 22 of 42 patients without SSI (52%) (P < .001 and P = .02, respectively). Distal cam was a predictor of SSI after adjustment for IDFN. Interreader agreement was substantial for distal cam (κ = 0.80) and moderate for IDFN (κ = 0.50). Conclusion Soft-tissue injuries and osseous findings other than morphologic features of the anterior inferior iliac spine were associated with subspine impingement. © RSNA, 2019 See also the editorial by Guermazi in this issue.
American Journal of Roentgenology, Jul 1, 2018
The aim of this article is to review the postoperative MRI appearances of irreparable massive rot... more The aim of this article is to review the postoperative MRI appearances of irreparable massive rotator cuff tears (RCTs) after surgery was performed using newer techniques, including patch repair, muscle tendon transfer, superior capsular reconstruction, and subacromial balloon implantation. Newer surgical techniques are emerging for the management of massive RCTs. As radiologists become increasingly likely to encounter postoperative imaging studies of RCTs repaired using these techniques, familiarity with the normal postoperative appearances and complications associated with these techniques becomes important.
American Journal of Roentgenology, Jun 1, 2018
The purpose of this study was to determine whether adding DWI to conventional MRI of the sacroili... more The purpose of this study was to determine whether adding DWI to conventional MRI of the sacroiliac joints improves the diagnostic performance of MRI readers in the detection of sacroiliitis. MR images of the sacroiliac joints of 63 patients with lower back pain obtained between January 2016 and December 2016 were analyzed retrospectively. Three readers reviewed the MRI studies for bone marrow edema lesions around the sacroiliac joints as a marker of active sacroiliitis and gave a diagnostic confidence score of 0-4 using MRI without DWI and MRI with DWI in separate sessions. The normalized apparent diffusion coefficient mean (nADC) was measured. Clinical and radiologic data using the Assessment of Spondyloarthritis International Society criteria were the reference for the diagnosis of sacroiliitis. Diagnostic performance, confidence scores, and interreader agreement for the MRI methods were compared. The nADC values of patients with and those without sacroiliitis were compared. The accuracy, sensitivity, and specificity of MRI without DWI were 68.3%, 69.0%, and 67.6% and for MRI with DWI were 74.6%, 69.0%, and 79.4% (accuracy and sensitivity, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.100; specificity, p = 0.039). The mean confidence score for MRI without DWI was 3.60 and for MRI with DWI was 3.67 (p = 0.270). The kappa coefficient for MRI without DWI was 0.28 and for MRI with DWI was 0.46 (p = 0.041). The nADC in patients with sacroiliitis was 3.86 and in patients without sacroiliitis was 1.6 (p ≤ 0.001). The nADC AUC was 0.758 (95% CI, 0.67-0.83). The addition of DWI to conventional MRI does not significantly improve overall diagnostic performance in terms of accuracy, sensitivity, or confidence in the detection of inflammatory sacroiliitis, but it does have increased specificity and interobserver agreement. ADC threshold values can be used as predictors of sacroiliitis but give no added advantage over MRI with DWI.
Radiographics, Jul 1, 2016
■ Identify and diagnose VBD by using imaging diagnostic criteria. ■ Describe CT, MR imaging, and ... more ■ Identify and diagnose VBD by using imaging diagnostic criteria. ■ Describe CT, MR imaging, and digital subtraction angiographic findings of VBD, potential complications, and imaging pitfalls. ■ Discuss the main underlying pathophysiology and various clinical presentations of VBD.
Magnetic Resonance Imaging Clinics of North America, May 1, 2023
Skeletal Radiology, Oct 6, 2022
Skeletal Radiology, Feb 13, 2018
Arthroscopy, sports medicine, and rehabilitation, Jun 1, 2021
Purpose: To explore the relationship between generalized joint hypermobility and hip labrum width... more Purpose: To explore the relationship between generalized joint hypermobility and hip labrum width. Methods: A retrospective review was performed of a single-surgeon database containing patients who underwent hip arthroscopy between 2014 and 2017. Patients were assessed for generalized laxity via Beighton Test Scoring (BTS), which tests for hyperextension of the fifth metacarpophalangeal joint, thumb apposition, elbow hyperextension, knee hyperextension, and trunk flexion on a 9-point scale. Patients were stratified into a "high BTS cohort" with a BTS !4, and a control cohort with BTS <4. Magnetic resonance imaging measurements of labral width for each patient were conducted by 2 blinded, musculoskeletal fellowshipetrained radiologists at standardized "clockface" locations using a previously validated technique. Statistical analyses used to determine associations between BTS and labral width included ManneWhitney U and Fisher exact testing as well as linear regression. Results: Thirty-four patients met inclusion criteria (17 cases, 17 controls). Both groups were composed exclusively of female patients. There was no significant difference between cases or controls in terms of age (33.3 AE 10.4 years vs 35.2 AE 8.3 years, P ¼ .57) or body mass index (26.1 AE 9.3 vs 23.6 AE 3.4, P ¼ .36). The high Beighton score cohort had significantly thinner labrae at the indirect rectus (5.35 AE 1.2 mm vs 7.1 AE 1.1 mm, P < .001) and anterosuperior position (5.53 AE 1.4 mm vs 7.27 AE 1.6 mm, P ¼ .003). There was no statistical difference between the high Beighton score cohort and controls at the psoas U position (6.47 AE 1.6 mm vs 7.43 AE 1.7 mm, P ¼ .112). Linear regression analysis demonstrated Beighton score was significantly negatively associated with labrum width at the indirect rectus position (R 2 ¼ 0.33, P < .001) and the anterosuperior position (R 2 ¼ 0.25, P ¼ .004). Conclusions: Patients with a BTS !4 were found to have significantly thinner labra than those with a BTS of <4. Level of Evidence: III, retrospective comparative trial.
Skeletal Radiology, Oct 17, 2018
Objective A major factor that impacts the long-term outcome and complication rates of total shoul... more Objective A major factor that impacts the long-term outcome and complication rates of total shoulder arthroplasty is the preoperative posterior glenoid bone loss quantified by glenoid retroversion. The purpose of this study was to assess if glenoid retroversion varies significantly at different glenoid heights in Walch B2 and B3 glenoids. Materials and methods Patients with B2 and B3 glenoid types were included following retrospective review of 386 consecutive CT shoulder studies performed for arthroplasty preoperative planning. True axial CT reconstructions were created using a validated technique. Two readers independently measured the glenoid retroversion angles according to the Friedman method using the Bintermediate^glenoid at three glenoid heights: 75% (upper), 50% (equator), and 25% (lower). The variances between the three levels for a given patient were calculated. Results Twenty-nine B2 and 8 B3 glenoid types were included. There was no significant difference in variance of glenoid version among the three levels in B2 or B3 groups. The mean variance in retroversion degree between equator-lower, upper-equator, and upper-lower glenoid was − 0.4, 0.3, and − 0.2 for B2; and − 0.2, 1.9, and 1.9 for B3 glenoid, respectively. The level of inter-reader agreement was fair to good for variance at equator-lower, and good to excellent for upper-equator and upper-lower glenoid. Conclusions Glenoid version can be accurately measured at any level between 25 and 75% of glenoid height for Walch B2 and B3. We recommend that the glenoid equator be used as the reference to assure consistent and reliable version measurements in this group of patients.
Journal of Shoulder and Elbow Surgery, Aug 1, 2018
Background: The goal of the Latarjet procedure is restoration of shoulder stability enabled by ac... more Background: The goal of the Latarjet procedure is restoration of shoulder stability enabled by accurate graft positioning and union. This study aimed to establish a reproducible method of quantitatively assessing coracoid graft osseous union percentage (OUP) using computed tomography (CT) scans and to determine the effect of other factors on the OUP. Materials and methods: Postoperative CT scans of 41 consecutive patients treated with the open Latarjet procedure (37% primary, 63% revision) for anterior glenohumeral instability were analyzed for the OUP, position of the graft, and screw type and angle. Two musculoskeletal radiologists independently examined the images 2 times, and intraobserver and interobserver reliability was calculated using intraclass correlation coefficient (ICC). Results: Mean OUP was 66% (range, 0%-94%) using quantitate methods, with good intraobserver reliability (ICC = 0.795) and interobserver reliability (ICC = 0.797). Nonunion and significant graft resorption was found in 2 patients. No significant difference was found in the mean OUP in the primary (63%) vs. revision Latarjet procedure (67%). Grafts were flush in 39%, medial in 36%, and lateral in 8%. The medial and neutral graft position was associated with slightly higher OUP (72% and 69%) compared with lateral (65%). OUP was higher when the superior screw angle was less than 17°and the inferior screw angle was less than 24°. This difference did not reach statistical significance. Screw type was not associated with significant difference in OUP. Conclusion: Quantitative assessment of osseous union of the graft using a reproducible method that we introduced showed similar OUP in the primary and revision Latarjet procedure.
Journal of The American College of Radiology, 2015
Purpose: This study aimed to determine the prevalence, importance, and types of incidental findin... more Purpose: This study aimed to determine the prevalence, importance, and types of incidental findings (IF) in non-enhanced CT scans performed for suspected renal colic, based on ACR white papers and other accepted radiographic recommendations. Methods: Retrospective review of 5,383 consecutive finalized reports of nonenhanced CT using renal colic protocol performed on adult patients at 2 emergency departments over a 5.5-year period. IF were defined as those unrelated to symptoms (as opposed to alternate causes of symptoms) and were categorized as "important" if follow-up was recommended based on recently published consensus recommendations. Subsets of reports of those with important IF were blindly re-reviewed to calculate inter-rater variability for presence and categorization of important IF. Results: Important IF were identified in 12.7% (95% confidence interval [CI]: 11.8%-13.6%) of scans. Prevalence of important IF increased with age: important IF in individuals age >80 years were 4 times more common than for those aged 18-30 years: 28.9% (95% CI: 22.4%-36.4%) versus 6.9% (95% CI: 5.5%-8.6%), respectively, P .05. Women had a higher prevalence of important IF compared with men: 13.4% (95% CI: 12.2%-14.7%) versus 11.9% (95% CI: 10.7%-13.2%), but the difference was not statically significant (P ¼ .09). There was substantial inter-rater agreement (kappa ! 0.69) regarding presence and classification of important IFs using published guidelines. Conclusions: Important IF occurred in 12.7% of non-enhanced CT scans performed for suspected renal colic in the emergency department and are more common in older individuals. Prospective studies that use radiographic recommendations to characterize IF and examine the outcome and cost of their workup are encouraged.
Skeletal Radiology, Mar 28, 2022
The purpose of this article is to present algorithms for the diagnostic management of solitary bo... more The purpose of this article is to present algorithms for the diagnostic management of solitary bone lesions incidentally encountered on computed tomography (CT) and magnetic resonance (MRI) in adults. Based on review of the current literature and expert opinion, the Practice Guidelines and Technical Standards Committee of the Society of Skeletal Radiology (SSR) proposes a bone reporting and data system (Bone-RADS) for incidentally encountered solitary bone lesions on CT and MRI with four possible diagnostic management recommendations (Bone-RADS1, leave alone; Bone-RADS2, perform different imaging modality; Bone-RADS3, perform follow-up imaging; Bone-RADS4, biopsy and/or oncologic referral). Two algorithms for CT based on lesion density (lucent or sclerotic/mixed) and two for MRI allow the user to arrive at a specific Bone-RADS management recommendation. Representative cases are provided to illustrate the usability of the algorithms.
Skeletal Radiology, Jan 29, 2014
Anterior knee pain is the most common knee complaint. It may be due to a variety of soft tissue o... more Anterior knee pain is the most common knee complaint. It may be due to a variety of soft tissue or osseous abnormalities. Knowledge of the radiologic appearance of the abnormalities allows more accurate diagnosis of the cause of the pain including chondral abnormalities, patellar instability and dislocation, femoral trochlear dysplasia, abnormal patellar location, bipartite patella, various tendinopathies, bursal inflammation, traction apophysitis in pediatric and adolescent patients, and miscellaneous diseases including mediopatellar plica syndrome and Hoffa&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease. Radiographs are often obtained to exclude acute osseous abnormalities, such as fractures. Magnetic resonance (MR) imaging offers superior soft tissue contrast resolution and allows for more accurate evaluation of the underlying etiology and therefore may improve treatment and possible surgical planning.
Magnetic Resonance Imaging Clinics of North America, May 1, 2020
MR imaging interpretation following rotator cuff repair can be challenging and requires familiari... more MR imaging interpretation following rotator cuff repair can be challenging and requires familiarity with various types of rotator cuff tear, their surgical treatments, normal postoperative MR imaging appearance, and complications. This article reviews the common surgical procedures for the reparable and nonreparable massive rotator cuff tears, their expected postoperative MR imaging findings, and imaging appearance of a range of complications.
Clinical Imaging, Nov 1, 2018
Hip MRI and arthroscopy have important roles for the evaluation of the patient with hip pain. An ... more Hip MRI and arthroscopy have important roles for the evaluation of the patient with hip pain. An understanding of what orthopedic surgeons want to know before and after hip arthroscopy as well as the limitations of arthroscopy would enable radiologists to improve their imaging interpretations and produce more clinically relevant, management guiding reports. The goal of this article is to review the basic principles of hip arthroscopy and MRI and compare their strengths and weaknesses. Normal clinically relevant hip anatomy, important pathologic conditions such as labral tears and cartilage injuries, femoroacetabular impingement specific findings like cam and pincer morphology, extra-articular conditions such as abductor and iliopsoas tendons pathology and common post-operative appearances are reviewed on MRI and arthroscopy.
Skeletal Radiology, Sep 18, 2020
Patient-reported outcomes (PROs) provide an essential understanding of the impact a condition or ... more Patient-reported outcomes (PROs) provide an essential understanding of the impact a condition or treatment has on a patient, while complementing other, more traditional outcomes information like survival and time to symptom resolution. PROs have become increasingly important in medicine with the push toward patient-centered care. The creation of a PROs database within an institution or practice provides a way to collect, understand, and use this kind of patient feedback to inform quality improvement and develop the evidence base for medical decision-making and on a larger scale could potentially help determine national standards of care and treatment guidelines. This paper provides a first-hand account of our experience setting up an imagingbased PROs database at our institution and is organized into steps the reader can follow for creating a PROs database of their own. Given the limited use of PROs within both diagnostic and interventional radiology, we hope our paper stimulates a new interest among radiologists who may have never considered outcomes work in the past.
Skeletal Radiology, Jun 23, 2022
Magnetic Resonance Imaging Clinics of North America, Nov 1, 2022
International Journal of Surgery, Dec 1, 2008
Surgical clips may incorporate into the duodenal ulcer after laparoscopic cholecystectomy leading... more Surgical clips may incorporate into the duodenal ulcer after laparoscopic cholecystectomy leading to a rare complication. Case report: A 70-year-old woman, 15 years after laparoscopic cholecystectomy, developed weight loss, anemia and gastric outlet obstruction secondary to a chronic duodenal ulcer. Gastroscopy showed a clip in the ulcer bed. At surgery she was found to have gastric outlet obstruction and mobilization of the duodenum revealed a large ulcer with a migrated clip from the cystic duct in its base. The ulcer was excluded and the clip was removed. She was perfectly well at the follow-up after 2 months. Conclusions: Migration of endo-surgical clips is a rare complication after laparoscopic surgery. Surgeons, gastroenterologists and radiologists should be aware of this late complication of laparoscopic cholecystectomy in cases of acute abdominal symptoms.
Radiology, Nov 1, 2019
Background The MRI manifestations of subspine impingement (SSI) other than morphologic features o... more Background The MRI manifestations of subspine impingement (SSI) other than morphologic features of anterior inferior iliac spine (AIIS) have not been extensively explored and validated. Purpose To determine the MRI findings associated with SSI, including AIIS morphologic features, femoral distal cam, and associated soft-tissue injuries. Materials and Methods This is a retrospective study of symptomatic patients who underwent arthroscopic treatment for femoroacetabular impingement between December 2014 and March 2017, with preoperative MRI within 6 months before surgery. The SSI group included patients with clinical and intraoperative findings of SSI; the remaining patients comprised the non-SSI group. Preoperative MRI findings were independently assessed by two radiologists who were blinded to clinical information. Interreader agreement was assessed, and multivariable logistic regression was also used. Results A total of 62 patients (mean age ± standard deviation, 42.1 years ± 11.9; 38 women) were included. SSI was diagnosed in 20 of the 62 patients (32%) (mean age, 43 years ± 12); 42 patients (68%) did not have SSI (mean age, 41 years ± 10). Reader 1 detected distal cam in 16 of the 20 patients with SSI (80%) and eight of the 42 patients without SSI (19%), and reader 2 detected distal cam in 15 of the 20 patients with SSI (75%) and eight of the 42 patients without SSI (19%) (P < .001 for both). Reader 1 detected signs of impingement on the distal femoral neck (IDFN) in 18 of the 20 patients with SSI (90%) and seven of the 42 patients without SSI (16%), and reader 2 detected signs of IDFN in 13 of the 20 patients with SSI (65%) and nine of the 42 patients without SSI (21%) (P < .001 and P = .001, respectively). Reader 1 detected superior capsular edema in 15 of 20 patients with SSI (75%) and three of 42 patients without SSI (7%), and reader 2 detected superior capsular edema in 17 of 20 patients with SSI (85%) and 22 of 42 patients without SSI (52%) (P < .001 and P = .02, respectively). Distal cam was a predictor of SSI after adjustment for IDFN. Interreader agreement was substantial for distal cam (κ = 0.80) and moderate for IDFN (κ = 0.50). Conclusion Soft-tissue injuries and osseous findings other than morphologic features of the anterior inferior iliac spine were associated with subspine impingement. © RSNA, 2019 See also the editorial by Guermazi in this issue.
American Journal of Roentgenology, Jul 1, 2018
The aim of this article is to review the postoperative MRI appearances of irreparable massive rot... more The aim of this article is to review the postoperative MRI appearances of irreparable massive rotator cuff tears (RCTs) after surgery was performed using newer techniques, including patch repair, muscle tendon transfer, superior capsular reconstruction, and subacromial balloon implantation. Newer surgical techniques are emerging for the management of massive RCTs. As radiologists become increasingly likely to encounter postoperative imaging studies of RCTs repaired using these techniques, familiarity with the normal postoperative appearances and complications associated with these techniques becomes important.
American Journal of Roentgenology, Jun 1, 2018
The purpose of this study was to determine whether adding DWI to conventional MRI of the sacroili... more The purpose of this study was to determine whether adding DWI to conventional MRI of the sacroiliac joints improves the diagnostic performance of MRI readers in the detection of sacroiliitis. MR images of the sacroiliac joints of 63 patients with lower back pain obtained between January 2016 and December 2016 were analyzed retrospectively. Three readers reviewed the MRI studies for bone marrow edema lesions around the sacroiliac joints as a marker of active sacroiliitis and gave a diagnostic confidence score of 0-4 using MRI without DWI and MRI with DWI in separate sessions. The normalized apparent diffusion coefficient mean (nADC) was measured. Clinical and radiologic data using the Assessment of Spondyloarthritis International Society criteria were the reference for the diagnosis of sacroiliitis. Diagnostic performance, confidence scores, and interreader agreement for the MRI methods were compared. The nADC values of patients with and those without sacroiliitis were compared. The accuracy, sensitivity, and specificity of MRI without DWI were 68.3%, 69.0%, and 67.6% and for MRI with DWI were 74.6%, 69.0%, and 79.4% (accuracy and sensitivity, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.100; specificity, p = 0.039). The mean confidence score for MRI without DWI was 3.60 and for MRI with DWI was 3.67 (p = 0.270). The kappa coefficient for MRI without DWI was 0.28 and for MRI with DWI was 0.46 (p = 0.041). The nADC in patients with sacroiliitis was 3.86 and in patients without sacroiliitis was 1.6 (p ≤ 0.001). The nADC AUC was 0.758 (95% CI, 0.67-0.83). The addition of DWI to conventional MRI does not significantly improve overall diagnostic performance in terms of accuracy, sensitivity, or confidence in the detection of inflammatory sacroiliitis, but it does have increased specificity and interobserver agreement. ADC threshold values can be used as predictors of sacroiliitis but give no added advantage over MRI with DWI.
Radiographics, Jul 1, 2016
■ Identify and diagnose VBD by using imaging diagnostic criteria. ■ Describe CT, MR imaging, and ... more ■ Identify and diagnose VBD by using imaging diagnostic criteria. ■ Describe CT, MR imaging, and digital subtraction angiographic findings of VBD, potential complications, and imaging pitfalls. ■ Discuss the main underlying pathophysiology and various clinical presentations of VBD.
Magnetic Resonance Imaging Clinics of North America, May 1, 2023
Skeletal Radiology, Oct 6, 2022
Skeletal Radiology, Feb 13, 2018
Arthroscopy, sports medicine, and rehabilitation, Jun 1, 2021
Purpose: To explore the relationship between generalized joint hypermobility and hip labrum width... more Purpose: To explore the relationship between generalized joint hypermobility and hip labrum width. Methods: A retrospective review was performed of a single-surgeon database containing patients who underwent hip arthroscopy between 2014 and 2017. Patients were assessed for generalized laxity via Beighton Test Scoring (BTS), which tests for hyperextension of the fifth metacarpophalangeal joint, thumb apposition, elbow hyperextension, knee hyperextension, and trunk flexion on a 9-point scale. Patients were stratified into a "high BTS cohort" with a BTS !4, and a control cohort with BTS <4. Magnetic resonance imaging measurements of labral width for each patient were conducted by 2 blinded, musculoskeletal fellowshipetrained radiologists at standardized "clockface" locations using a previously validated technique. Statistical analyses used to determine associations between BTS and labral width included ManneWhitney U and Fisher exact testing as well as linear regression. Results: Thirty-four patients met inclusion criteria (17 cases, 17 controls). Both groups were composed exclusively of female patients. There was no significant difference between cases or controls in terms of age (33.3 AE 10.4 years vs 35.2 AE 8.3 years, P ¼ .57) or body mass index (26.1 AE 9.3 vs 23.6 AE 3.4, P ¼ .36). The high Beighton score cohort had significantly thinner labrae at the indirect rectus (5.35 AE 1.2 mm vs 7.1 AE 1.1 mm, P < .001) and anterosuperior position (5.53 AE 1.4 mm vs 7.27 AE 1.6 mm, P ¼ .003). There was no statistical difference between the high Beighton score cohort and controls at the psoas U position (6.47 AE 1.6 mm vs 7.43 AE 1.7 mm, P ¼ .112). Linear regression analysis demonstrated Beighton score was significantly negatively associated with labrum width at the indirect rectus position (R 2 ¼ 0.33, P < .001) and the anterosuperior position (R 2 ¼ 0.25, P ¼ .004). Conclusions: Patients with a BTS !4 were found to have significantly thinner labra than those with a BTS of <4. Level of Evidence: III, retrospective comparative trial.
Skeletal Radiology, Oct 17, 2018
Objective A major factor that impacts the long-term outcome and complication rates of total shoul... more Objective A major factor that impacts the long-term outcome and complication rates of total shoulder arthroplasty is the preoperative posterior glenoid bone loss quantified by glenoid retroversion. The purpose of this study was to assess if glenoid retroversion varies significantly at different glenoid heights in Walch B2 and B3 glenoids. Materials and methods Patients with B2 and B3 glenoid types were included following retrospective review of 386 consecutive CT shoulder studies performed for arthroplasty preoperative planning. True axial CT reconstructions were created using a validated technique. Two readers independently measured the glenoid retroversion angles according to the Friedman method using the Bintermediate^glenoid at three glenoid heights: 75% (upper), 50% (equator), and 25% (lower). The variances between the three levels for a given patient were calculated. Results Twenty-nine B2 and 8 B3 glenoid types were included. There was no significant difference in variance of glenoid version among the three levels in B2 or B3 groups. The mean variance in retroversion degree between equator-lower, upper-equator, and upper-lower glenoid was − 0.4, 0.3, and − 0.2 for B2; and − 0.2, 1.9, and 1.9 for B3 glenoid, respectively. The level of inter-reader agreement was fair to good for variance at equator-lower, and good to excellent for upper-equator and upper-lower glenoid. Conclusions Glenoid version can be accurately measured at any level between 25 and 75% of glenoid height for Walch B2 and B3. We recommend that the glenoid equator be used as the reference to assure consistent and reliable version measurements in this group of patients.
Journal of Shoulder and Elbow Surgery, Aug 1, 2018
Background: The goal of the Latarjet procedure is restoration of shoulder stability enabled by ac... more Background: The goal of the Latarjet procedure is restoration of shoulder stability enabled by accurate graft positioning and union. This study aimed to establish a reproducible method of quantitatively assessing coracoid graft osseous union percentage (OUP) using computed tomography (CT) scans and to determine the effect of other factors on the OUP. Materials and methods: Postoperative CT scans of 41 consecutive patients treated with the open Latarjet procedure (37% primary, 63% revision) for anterior glenohumeral instability were analyzed for the OUP, position of the graft, and screw type and angle. Two musculoskeletal radiologists independently examined the images 2 times, and intraobserver and interobserver reliability was calculated using intraclass correlation coefficient (ICC). Results: Mean OUP was 66% (range, 0%-94%) using quantitate methods, with good intraobserver reliability (ICC = 0.795) and interobserver reliability (ICC = 0.797). Nonunion and significant graft resorption was found in 2 patients. No significant difference was found in the mean OUP in the primary (63%) vs. revision Latarjet procedure (67%). Grafts were flush in 39%, medial in 36%, and lateral in 8%. The medial and neutral graft position was associated with slightly higher OUP (72% and 69%) compared with lateral (65%). OUP was higher when the superior screw angle was less than 17°and the inferior screw angle was less than 24°. This difference did not reach statistical significance. Screw type was not associated with significant difference in OUP. Conclusion: Quantitative assessment of osseous union of the graft using a reproducible method that we introduced showed similar OUP in the primary and revision Latarjet procedure.
Journal of The American College of Radiology, 2015
Purpose: This study aimed to determine the prevalence, importance, and types of incidental findin... more Purpose: This study aimed to determine the prevalence, importance, and types of incidental findings (IF) in non-enhanced CT scans performed for suspected renal colic, based on ACR white papers and other accepted radiographic recommendations. Methods: Retrospective review of 5,383 consecutive finalized reports of nonenhanced CT using renal colic protocol performed on adult patients at 2 emergency departments over a 5.5-year period. IF were defined as those unrelated to symptoms (as opposed to alternate causes of symptoms) and were categorized as "important" if follow-up was recommended based on recently published consensus recommendations. Subsets of reports of those with important IF were blindly re-reviewed to calculate inter-rater variability for presence and categorization of important IF. Results: Important IF were identified in 12.7% (95% confidence interval [CI]: 11.8%-13.6%) of scans. Prevalence of important IF increased with age: important IF in individuals age >80 years were 4 times more common than for those aged 18-30 years: 28.9% (95% CI: 22.4%-36.4%) versus 6.9% (95% CI: 5.5%-8.6%), respectively, P .05. Women had a higher prevalence of important IF compared with men: 13.4% (95% CI: 12.2%-14.7%) versus 11.9% (95% CI: 10.7%-13.2%), but the difference was not statically significant (P ¼ .09). There was substantial inter-rater agreement (kappa ! 0.69) regarding presence and classification of important IFs using published guidelines. Conclusions: Important IF occurred in 12.7% of non-enhanced CT scans performed for suspected renal colic in the emergency department and are more common in older individuals. Prospective studies that use radiographic recommendations to characterize IF and examine the outcome and cost of their workup are encouraged.
Skeletal Radiology, Mar 28, 2022
The purpose of this article is to present algorithms for the diagnostic management of solitary bo... more The purpose of this article is to present algorithms for the diagnostic management of solitary bone lesions incidentally encountered on computed tomography (CT) and magnetic resonance (MRI) in adults. Based on review of the current literature and expert opinion, the Practice Guidelines and Technical Standards Committee of the Society of Skeletal Radiology (SSR) proposes a bone reporting and data system (Bone-RADS) for incidentally encountered solitary bone lesions on CT and MRI with four possible diagnostic management recommendations (Bone-RADS1, leave alone; Bone-RADS2, perform different imaging modality; Bone-RADS3, perform follow-up imaging; Bone-RADS4, biopsy and/or oncologic referral). Two algorithms for CT based on lesion density (lucent or sclerotic/mixed) and two for MRI allow the user to arrive at a specific Bone-RADS management recommendation. Representative cases are provided to illustrate the usability of the algorithms.
Skeletal Radiology, Jan 29, 2014
Anterior knee pain is the most common knee complaint. It may be due to a variety of soft tissue o... more Anterior knee pain is the most common knee complaint. It may be due to a variety of soft tissue or osseous abnormalities. Knowledge of the radiologic appearance of the abnormalities allows more accurate diagnosis of the cause of the pain including chondral abnormalities, patellar instability and dislocation, femoral trochlear dysplasia, abnormal patellar location, bipartite patella, various tendinopathies, bursal inflammation, traction apophysitis in pediatric and adolescent patients, and miscellaneous diseases including mediopatellar plica syndrome and Hoffa&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease. Radiographs are often obtained to exclude acute osseous abnormalities, such as fractures. Magnetic resonance (MR) imaging offers superior soft tissue contrast resolution and allows for more accurate evaluation of the underlying etiology and therefore may improve treatment and possible surgical planning.
Magnetic Resonance Imaging Clinics of North America, May 1, 2020
MR imaging interpretation following rotator cuff repair can be challenging and requires familiari... more MR imaging interpretation following rotator cuff repair can be challenging and requires familiarity with various types of rotator cuff tear, their surgical treatments, normal postoperative MR imaging appearance, and complications. This article reviews the common surgical procedures for the reparable and nonreparable massive rotator cuff tears, their expected postoperative MR imaging findings, and imaging appearance of a range of complications.
Clinical Imaging, Nov 1, 2018
Hip MRI and arthroscopy have important roles for the evaluation of the patient with hip pain. An ... more Hip MRI and arthroscopy have important roles for the evaluation of the patient with hip pain. An understanding of what orthopedic surgeons want to know before and after hip arthroscopy as well as the limitations of arthroscopy would enable radiologists to improve their imaging interpretations and produce more clinically relevant, management guiding reports. The goal of this article is to review the basic principles of hip arthroscopy and MRI and compare their strengths and weaknesses. Normal clinically relevant hip anatomy, important pathologic conditions such as labral tears and cartilage injuries, femoroacetabular impingement specific findings like cam and pincer morphology, extra-articular conditions such as abductor and iliopsoas tendons pathology and common post-operative appearances are reviewed on MRI and arthroscopy.