Ronald Adler - Academia.edu (original) (raw)

Papers by Ronald Adler

RadioGraphics, 2013

Tendon disorders along the plantar aspect of the foot may lead to significant symptoms but are of... more Tendon disorders along the plantar aspect of the foot may lead to significant symptoms but are often clinically misdiagnosed. Familiarity with the normal anatomy of the plantar tendons and its appearance at magnetic resonance (MR) imaging and ultrasonography (US) is essential for recognizing plantar tendon disorders. At MR imaging, the course of the plantar tendons is optimally visualized with dedicated imaging of the midfoot and forefoot. This imaging should include short-axis images obtained perpendicular to the long axis of the metatarsal shafts, which allows true cross-sectional evaluation of the plantar tendons. Normal plantar tendons appear as low-signal-intensity structures with all MR sequences. At US, accurate evaluation of the tendons requires that the ultrasound beam be perpendicular to the tendon. The normal tendon appears as a compact linear band of echogenic tissue that contains a fine, mixed hypoechoic and hyperechoic internal fibrillar pattern. Tendon injuries can be grouped into six major categories: tendinosis, peritendinosis, tenosynovitis, entrapment, rupture, and instability (subluxation or dislocation) and can be well assessed with both MR imaging and US. The radiologist plays an important role in the diagnosis of plantar tendon disorders, and recognizing their imaging appearances at MR imaging and US is essential.

Journal of the American College of Radiology, 2014

Substantial cost, morbidity, and mortality are associated with acute proximal femoral fracture an... more Substantial cost, morbidity, and mortality are associated with acute proximal femoral fracture and may be reduced through an optimized diagnostic imaging workup. Radiography represents the primary diagnostic test of choice for the evaluation of acute hip pain. In middle aged and elderly patients with negative radiographs, the evidence indicates MRI to be the next diagnostic imaging study to exclude a proximal femoral fracture. CT, because of its relative decreased sensitivity, is only indicated in patients with MRI contraindications. Bone densitometry (DXA) should be obtained in patients with fragility fractures. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

American Journal of Roentgenology, 1998

The user has requested enhancement of the downloaded file.

American Journal of Roentgenology, 2000

OBJECTIVE. The objective of this study was to describe the sonographic appearance of tears of the... more OBJECTIVE. The objective of this study was to describe the sonographic appearance of tears of the distal biceps brachii tendon. CONCLUSION. Sonography can reveal complete and partial tears of the distal biceps tendon, thus providing an alternative technique to MR imaging.

American Journal of Roentgenology, 2012

Characterization of the distribution and imaging characteristics of platelet-rich plasma (PRP) an... more Characterization of the distribution and imaging characteristics of platelet-rich plasma (PRP) and autologous blood after injection is currently limited despite the growing use. We sought to improve understanding of the distribution of PRP or autologous blood after it has been injected into a tendon to evaluate whether injected materials truly stayed within the local region of injection. Fifty ultrasound-guided PRP or autologous blood injections performed for tendinopathy were retrospectively reviewed. Consensus review of the imaging data was performed by two radiologists to characterize the distribution of the injectate (i.e., within the tendon, along the tendon sheath, along the paratenon, or leakage into the adjacent joint or surrounding soft tissues). The presence of fluid and microbubbles from the injectate served as an indicator of material distribution. Image review verified the injectate within the tendon in 100% of cases. In 98% of reviewed cases, injected PRP or autologous blood dissected beyond the local injection site (defined as >2 cm from the site of injection) and was identified in adjacent soft tissues in 51% of cases. Visualization of injectate along a paratenon or tendon sheath (when applicable) was seen in 86% and 100% of cases respectively; however, intraarticular extension was uncommon (8%). Our study showed that postinjection imaging may be of value in assessing the anatomic distribution of injectate after intratendinous therapy. Furthermore, our initial review found that in the majority of cases injected blood products tended to distribute beyond the local area of injection.

American Journal of Roentgenology, 2003

We investigated the ability of sonography to reveal the polyethylene liner used in total knee art... more We investigated the ability of sonography to reveal the polyethylene liner used in total knee arthroplasty with the hopes of establishing a possible relationship between the sonographic measurement of the actual thickness of the polyethylene liner and the estimated thickness based on conventional radiography. Twenty-four consecutive patients who were referred for Doppler screening for deep venous thrombosis after total knee arthroplasty were evaluated. The polyethylene liner was identified on sonography, and three measurements were obtained from four locations: anteromedial joint line (just medial to the midline incision), along the medial joint line, anterolateral joint line (just lateral to the midline incision), and along the lateral joint line. These sonographic measurements were compared with radiographic measurements of the radiolucent polyethylene liner and with the manufacturers' stated size of the polyethylene liner. Linear regression analyses were then performed. The polyethylene liner is seen on sonography as a strong linear echogenic interface with posterior acoustic shadowing. Linear regression analyses showed a high correlation (r = 0.8) between the sonographic measurements and the radiographic measurements. A relatively poor correlation (r = 0.2) was noted between the manufacturers' stated size of the liner and the sonographic measurements. We found that the polyethylene liner used in total knee arthroplasty can be clearly identified during sonographic evaluation of the knee. We also found a high correlation between the longitudinal measurement of the polyethylene liner with the thickness of the radiolucent polyethylene as measured on conventional radiographs. We propose that sonography could potentially be a useful noninvasive imaging modality to screen for subtle cases of polyethylene wear.

American Journal of Roentgenology, 2003

The objective of our study was to review our experience using sonography to evaluate the rotator ... more The objective of our study was to review our experience using sonography to evaluate the rotator cuff after arthroplasty. Diagnostic reliability, with respect to surgical findings, as well as subjective assessment of the examinations, including the usefulness of applications such as extended field-of-view imaging, photopic imaging, and tissue harmonic imaging, were reviewed. We found sonography to be a useful method of imaging the rotator cuff after arthroplasty. Extended field-of-view imaging and tissue harmonic imaging aided in diagnosis by improving visualization of regional anatomic landmarks and increasing conspicuity of small tendon tears.

American Journal of Roentgenology, 2005

Our objective was to review our experience performing sonography-guided iliopsoas bursal/peritend... more Our objective was to review our experience performing sonography-guided iliopsoas bursal/peritendinous injections as a diagnostic and therapeutic tool in the workup and treatment of patients with hip pain. Sonography-guided iliopsoas bursal/peritendinous injections are useful in determining the cause of hip pain. They can provide relief to most patients with iliopsoas tendinosis/bursitis after hip replacement. The results of injection alone are not as successful in cases of idiopathic iliopsoas tendinosis/bursitis, but the technique can help determine which patients may benefit from a surgical tendon release.

American Journal of Roentgenology, 2004

The purpose of our study was to describe the sonographic appearance of cubital bursitis in three ... more The purpose of our study was to describe the sonographic appearance of cubital bursitis in three patients and to illustrate the use of sonographic guidance for therapeutic injections. Cubital bursitis, a rare but painful condition of the elbow, can be diagnosed with sonography. Cubital bursitis is seen as distention of the bicipitoradial bursa in the proximal forearm, occasionally with fluid or complex synovial debris in more severe cases. Power Doppler imaging can aid in providing information about active inflammation. Two patients in our series were treated using sonographically guided decompression of the bursa and steroid injection with good clinical results.

American Journal of Roentgenology, 1991

American Journal of Roentgenology, 1999

American Journal of Roentgenology, 1996

American Journal of Roentgenology, 1997

American Journal of Physical Medicine & Rehabilitation, 2005

Grant Cooper, MD, Gregory E. Lutz, MD Ronald S. Adler, MD From the Department of Physical Medicin... more Grant Cooper, MD, Gregory E. Lutz, MD Ronald S. Adler, MD From the Department of Physical Medicine and Rehabilitation, New York-Presbyterian University Hospitals of Columbia and Cornell, New York, New York (GC); and the Departments of Physical Medicine and ...

OBJECTIVE. Power Doppler sonography is a new technique that offers extended dynamic range over th... more OBJECTIVE. Power Doppler sonography is a new technique that offers extended dynamic range over that provided by conventional color Doppler imaging, thereby facilitating measurement of tissue perfusion. We evaluated the efficacy of power Dop- pier sonography in depicting soft-tissue hyperemia in musculoskeletal inflammatory conditions. SUBJECTS AND METHODS. Twenty-three patients with predominantly unifocal musculoskeletal symptoms were evaluated with conventional gray-scale imaging and power Doppler sonography. The shoulder was evaluated in 14 patients, the elbow in three, and various other sites in six. For comparison purposes, the contralateral asymptomatic joint or site was examined in 17 cases. Fluid collections were aspirated in seven patients. RESULTS. Soft-tissue hyperemia was seen on power Doppler sonograms at the symptomatic site(s) in 22 of 23 cases studied, with an appearance ranging from frank tissue blush to large, isolated peritendinous/peribursal vessels. Findings asso...

Journal of the American College of Radiology : JACR, Jan 29, 2015

This ACR Appropriateness Criteria article offers imaging triage guidance for several variants of ... more This ACR Appropriateness Criteria article offers imaging triage guidance for several variants of patients presenting with acute foot trauma. Patients meeting inclusion criteria for the Ottawa Rules should undergo a 3-view radiographic series. Diabetic patients with peripheral neuropathy should undergo radiography, even though they do not meet the Ottawa Rules inclusion criteria. Patients with suspected midfoot and/or Lisfranc injury should undergo 3-view radiographs with weight bearing on at least the anterior-posterior view. Patients with suspected Lisfranc injury and normal radiographs should be considered for MRI and CT on a case-by-case basis. MRI or ultrasound could confirm cases of suspected acute tendon rupture. Radiography is the initial imaging modality for suspected plantar plate injury after metatarsal-phalangeal joint injury. Weight-bearing anterior-posterior, lateral, and sesamoid axial views may detect proximal migration of the hallux sesamoids. Ultrasound or MRI can d...

The majority of adults over the age of 65 y develop osteoarthritis (OA), a joint disease characte... more The majority of adults over the age of 65 y develop osteoarthritis (OA), a joint disease characterlz.ed by degeneration of artlcular cartilage and subchondral sclerosis. Early in the disease, the artlcular cartilage surface begins to change blstologically from a smooth to a rough or fibrillated appearance. A prerequisite for any chondroprotective pharmacological intervention is detection of OA in its preclllcal phase. Current diagnostic imaging modalities, such as radiographs or (nuclear) magnetic resonance ima&g, either cannot directly image the cartilage surface or lack sticient resolution to detect surface BbrlUatlons. We have developed an ultrasonic technique that can be used to characterize these surface fibrillations directly. We present our in vitro results with validation by laser-based confocal microscopic imaging. 0 1997 World Federation for Ultrasound in Medicine & Biology.

Journal of the American College of Radiology : JACR, 2015

Acute ankle injuries are frequently diagnosed and treated in emergency departments and outpatient... more Acute ankle injuries are frequently diagnosed and treated in emergency departments and outpatient clinics. Recent evidence-based clinical treatment guidelines and systematic review of economic analyses support the use of 3-view (anteroposterior, lateral, and mortise) radiographic evaluation of patients meeting the criteria of the Ottawa ankle rules. Cross-sectional imaging has a limited secondary role primarily as a tool for preoperative planning and as a problem-solving technique in patients with persistent symptoms and suspected of having occult fractures. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedu...

Seminars in Musculoskeletal Radiology, 1998

Power Doppler sonography (PDS) is a recently developed technique that depicts moving blood volume... more Power Doppler sonography (PDS) is a recently developed technique that depicts moving blood volume within tissues. The enhanced sensitivity of PDS makes it possible to depict soft tissue vascularity, facilitating its role in the evaluation of musculoskeletal inflammatory diseases. A broad range of new and potential applications of PDS in the musculoskeletal system will be described including its use in the setting of bursal, tendon, articular, and muscle diseases, and in the evaluation of fluid collections and soft tissue masses.

Ultrasound in Medicine & Biology, 1995

Imaging of blood flow perfusion is an area of significant medical interest. Recently, the advanta... more Imaging of blood flow perfusion is an area of significant medical interest. Recently, the advantages of using the total integrated Doppler power spectrum as the parameter that is encoded in color has been shown to result in an approximately threefold increase in flow sensitivity, a relative insensitivity to acquisition angle and lack of aliasing. We have taken this mode a step further and demonstrated the potential for quantifying blood flow using correlation-based algorithms applied to the power signal. We show that a( 7) = *(0)eeyr, T > 0, where a(~) is the two-time correlation of the fluctuation in the power signal, and Y is the speciiic flow (reciprocal of mean transit time). Scans of a dog's blood, pumped at a constant rate through gum rubber tubing, were obtained using a Diasonics Spectra lo-MHz linear array transducer at standard range-gated spectral mode (PRF = 1400 Hz, wall filter = 50 Hz, sample gate = 1.5 mm). A fixed Doppler angle of 68" was used. Five different flow rates were tested, and the velocities determined by power decorrelation were compared to the mean velocities calculated from the Doppler shifts by linear regression (R' = 0.987). We believe the results are very encouraging for using power decorrelation in perfusion evaluation.

RadioGraphics, 2013

Tendon disorders along the plantar aspect of the foot may lead to significant symptoms but are of... more Tendon disorders along the plantar aspect of the foot may lead to significant symptoms but are often clinically misdiagnosed. Familiarity with the normal anatomy of the plantar tendons and its appearance at magnetic resonance (MR) imaging and ultrasonography (US) is essential for recognizing plantar tendon disorders. At MR imaging, the course of the plantar tendons is optimally visualized with dedicated imaging of the midfoot and forefoot. This imaging should include short-axis images obtained perpendicular to the long axis of the metatarsal shafts, which allows true cross-sectional evaluation of the plantar tendons. Normal plantar tendons appear as low-signal-intensity structures with all MR sequences. At US, accurate evaluation of the tendons requires that the ultrasound beam be perpendicular to the tendon. The normal tendon appears as a compact linear band of echogenic tissue that contains a fine, mixed hypoechoic and hyperechoic internal fibrillar pattern. Tendon injuries can be grouped into six major categories: tendinosis, peritendinosis, tenosynovitis, entrapment, rupture, and instability (subluxation or dislocation) and can be well assessed with both MR imaging and US. The radiologist plays an important role in the diagnosis of plantar tendon disorders, and recognizing their imaging appearances at MR imaging and US is essential.

Journal of the American College of Radiology, 2014

Substantial cost, morbidity, and mortality are associated with acute proximal femoral fracture an... more Substantial cost, morbidity, and mortality are associated with acute proximal femoral fracture and may be reduced through an optimized diagnostic imaging workup. Radiography represents the primary diagnostic test of choice for the evaluation of acute hip pain. In middle aged and elderly patients with negative radiographs, the evidence indicates MRI to be the next diagnostic imaging study to exclude a proximal femoral fracture. CT, because of its relative decreased sensitivity, is only indicated in patients with MRI contraindications. Bone densitometry (DXA) should be obtained in patients with fragility fractures. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

American Journal of Roentgenology, 1998

The user has requested enhancement of the downloaded file.

American Journal of Roentgenology, 2000

OBJECTIVE. The objective of this study was to describe the sonographic appearance of tears of the... more OBJECTIVE. The objective of this study was to describe the sonographic appearance of tears of the distal biceps brachii tendon. CONCLUSION. Sonography can reveal complete and partial tears of the distal biceps tendon, thus providing an alternative technique to MR imaging.

American Journal of Roentgenology, 2012

Characterization of the distribution and imaging characteristics of platelet-rich plasma (PRP) an... more Characterization of the distribution and imaging characteristics of platelet-rich plasma (PRP) and autologous blood after injection is currently limited despite the growing use. We sought to improve understanding of the distribution of PRP or autologous blood after it has been injected into a tendon to evaluate whether injected materials truly stayed within the local region of injection. Fifty ultrasound-guided PRP or autologous blood injections performed for tendinopathy were retrospectively reviewed. Consensus review of the imaging data was performed by two radiologists to characterize the distribution of the injectate (i.e., within the tendon, along the tendon sheath, along the paratenon, or leakage into the adjacent joint or surrounding soft tissues). The presence of fluid and microbubbles from the injectate served as an indicator of material distribution. Image review verified the injectate within the tendon in 100% of cases. In 98% of reviewed cases, injected PRP or autologous blood dissected beyond the local injection site (defined as >2 cm from the site of injection) and was identified in adjacent soft tissues in 51% of cases. Visualization of injectate along a paratenon or tendon sheath (when applicable) was seen in 86% and 100% of cases respectively; however, intraarticular extension was uncommon (8%). Our study showed that postinjection imaging may be of value in assessing the anatomic distribution of injectate after intratendinous therapy. Furthermore, our initial review found that in the majority of cases injected blood products tended to distribute beyond the local area of injection.

American Journal of Roentgenology, 2003

We investigated the ability of sonography to reveal the polyethylene liner used in total knee art... more We investigated the ability of sonography to reveal the polyethylene liner used in total knee arthroplasty with the hopes of establishing a possible relationship between the sonographic measurement of the actual thickness of the polyethylene liner and the estimated thickness based on conventional radiography. Twenty-four consecutive patients who were referred for Doppler screening for deep venous thrombosis after total knee arthroplasty were evaluated. The polyethylene liner was identified on sonography, and three measurements were obtained from four locations: anteromedial joint line (just medial to the midline incision), along the medial joint line, anterolateral joint line (just lateral to the midline incision), and along the lateral joint line. These sonographic measurements were compared with radiographic measurements of the radiolucent polyethylene liner and with the manufacturers' stated size of the polyethylene liner. Linear regression analyses were then performed. The polyethylene liner is seen on sonography as a strong linear echogenic interface with posterior acoustic shadowing. Linear regression analyses showed a high correlation (r = 0.8) between the sonographic measurements and the radiographic measurements. A relatively poor correlation (r = 0.2) was noted between the manufacturers' stated size of the liner and the sonographic measurements. We found that the polyethylene liner used in total knee arthroplasty can be clearly identified during sonographic evaluation of the knee. We also found a high correlation between the longitudinal measurement of the polyethylene liner with the thickness of the radiolucent polyethylene as measured on conventional radiographs. We propose that sonography could potentially be a useful noninvasive imaging modality to screen for subtle cases of polyethylene wear.

American Journal of Roentgenology, 2003

The objective of our study was to review our experience using sonography to evaluate the rotator ... more The objective of our study was to review our experience using sonography to evaluate the rotator cuff after arthroplasty. Diagnostic reliability, with respect to surgical findings, as well as subjective assessment of the examinations, including the usefulness of applications such as extended field-of-view imaging, photopic imaging, and tissue harmonic imaging, were reviewed. We found sonography to be a useful method of imaging the rotator cuff after arthroplasty. Extended field-of-view imaging and tissue harmonic imaging aided in diagnosis by improving visualization of regional anatomic landmarks and increasing conspicuity of small tendon tears.

American Journal of Roentgenology, 2005

Our objective was to review our experience performing sonography-guided iliopsoas bursal/peritend... more Our objective was to review our experience performing sonography-guided iliopsoas bursal/peritendinous injections as a diagnostic and therapeutic tool in the workup and treatment of patients with hip pain. Sonography-guided iliopsoas bursal/peritendinous injections are useful in determining the cause of hip pain. They can provide relief to most patients with iliopsoas tendinosis/bursitis after hip replacement. The results of injection alone are not as successful in cases of idiopathic iliopsoas tendinosis/bursitis, but the technique can help determine which patients may benefit from a surgical tendon release.

American Journal of Roentgenology, 2004

The purpose of our study was to describe the sonographic appearance of cubital bursitis in three ... more The purpose of our study was to describe the sonographic appearance of cubital bursitis in three patients and to illustrate the use of sonographic guidance for therapeutic injections. Cubital bursitis, a rare but painful condition of the elbow, can be diagnosed with sonography. Cubital bursitis is seen as distention of the bicipitoradial bursa in the proximal forearm, occasionally with fluid or complex synovial debris in more severe cases. Power Doppler imaging can aid in providing information about active inflammation. Two patients in our series were treated using sonographically guided decompression of the bursa and steroid injection with good clinical results.

American Journal of Roentgenology, 1991

American Journal of Roentgenology, 1999

American Journal of Roentgenology, 1996

American Journal of Roentgenology, 1997

American Journal of Physical Medicine & Rehabilitation, 2005

Grant Cooper, MD, Gregory E. Lutz, MD Ronald S. Adler, MD From the Department of Physical Medicin... more Grant Cooper, MD, Gregory E. Lutz, MD Ronald S. Adler, MD From the Department of Physical Medicine and Rehabilitation, New York-Presbyterian University Hospitals of Columbia and Cornell, New York, New York (GC); and the Departments of Physical Medicine and ...

OBJECTIVE. Power Doppler sonography is a new technique that offers extended dynamic range over th... more OBJECTIVE. Power Doppler sonography is a new technique that offers extended dynamic range over that provided by conventional color Doppler imaging, thereby facilitating measurement of tissue perfusion. We evaluated the efficacy of power Dop- pier sonography in depicting soft-tissue hyperemia in musculoskeletal inflammatory conditions. SUBJECTS AND METHODS. Twenty-three patients with predominantly unifocal musculoskeletal symptoms were evaluated with conventional gray-scale imaging and power Doppler sonography. The shoulder was evaluated in 14 patients, the elbow in three, and various other sites in six. For comparison purposes, the contralateral asymptomatic joint or site was examined in 17 cases. Fluid collections were aspirated in seven patients. RESULTS. Soft-tissue hyperemia was seen on power Doppler sonograms at the symptomatic site(s) in 22 of 23 cases studied, with an appearance ranging from frank tissue blush to large, isolated peritendinous/peribursal vessels. Findings asso...

Journal of the American College of Radiology : JACR, Jan 29, 2015

This ACR Appropriateness Criteria article offers imaging triage guidance for several variants of ... more This ACR Appropriateness Criteria article offers imaging triage guidance for several variants of patients presenting with acute foot trauma. Patients meeting inclusion criteria for the Ottawa Rules should undergo a 3-view radiographic series. Diabetic patients with peripheral neuropathy should undergo radiography, even though they do not meet the Ottawa Rules inclusion criteria. Patients with suspected midfoot and/or Lisfranc injury should undergo 3-view radiographs with weight bearing on at least the anterior-posterior view. Patients with suspected Lisfranc injury and normal radiographs should be considered for MRI and CT on a case-by-case basis. MRI or ultrasound could confirm cases of suspected acute tendon rupture. Radiography is the initial imaging modality for suspected plantar plate injury after metatarsal-phalangeal joint injury. Weight-bearing anterior-posterior, lateral, and sesamoid axial views may detect proximal migration of the hallux sesamoids. Ultrasound or MRI can d...

The majority of adults over the age of 65 y develop osteoarthritis (OA), a joint disease characte... more The majority of adults over the age of 65 y develop osteoarthritis (OA), a joint disease characterlz.ed by degeneration of artlcular cartilage and subchondral sclerosis. Early in the disease, the artlcular cartilage surface begins to change blstologically from a smooth to a rough or fibrillated appearance. A prerequisite for any chondroprotective pharmacological intervention is detection of OA in its preclllcal phase. Current diagnostic imaging modalities, such as radiographs or (nuclear) magnetic resonance ima&g, either cannot directly image the cartilage surface or lack sticient resolution to detect surface BbrlUatlons. We have developed an ultrasonic technique that can be used to characterize these surface fibrillations directly. We present our in vitro results with validation by laser-based confocal microscopic imaging. 0 1997 World Federation for Ultrasound in Medicine & Biology.

Journal of the American College of Radiology : JACR, 2015

Acute ankle injuries are frequently diagnosed and treated in emergency departments and outpatient... more Acute ankle injuries are frequently diagnosed and treated in emergency departments and outpatient clinics. Recent evidence-based clinical treatment guidelines and systematic review of economic analyses support the use of 3-view (anteroposterior, lateral, and mortise) radiographic evaluation of patients meeting the criteria of the Ottawa ankle rules. Cross-sectional imaging has a limited secondary role primarily as a tool for preoperative planning and as a problem-solving technique in patients with persistent symptoms and suspected of having occult fractures. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedu...

Seminars in Musculoskeletal Radiology, 1998

Power Doppler sonography (PDS) is a recently developed technique that depicts moving blood volume... more Power Doppler sonography (PDS) is a recently developed technique that depicts moving blood volume within tissues. The enhanced sensitivity of PDS makes it possible to depict soft tissue vascularity, facilitating its role in the evaluation of musculoskeletal inflammatory diseases. A broad range of new and potential applications of PDS in the musculoskeletal system will be described including its use in the setting of bursal, tendon, articular, and muscle diseases, and in the evaluation of fluid collections and soft tissue masses.

Ultrasound in Medicine & Biology, 1995

Imaging of blood flow perfusion is an area of significant medical interest. Recently, the advanta... more Imaging of blood flow perfusion is an area of significant medical interest. Recently, the advantages of using the total integrated Doppler power spectrum as the parameter that is encoded in color has been shown to result in an approximately threefold increase in flow sensitivity, a relative insensitivity to acquisition angle and lack of aliasing. We have taken this mode a step further and demonstrated the potential for quantifying blood flow using correlation-based algorithms applied to the power signal. We show that a( 7) = *(0)eeyr, T > 0, where a(~) is the two-time correlation of the fluctuation in the power signal, and Y is the speciiic flow (reciprocal of mean transit time). Scans of a dog's blood, pumped at a constant rate through gum rubber tubing, were obtained using a Diasonics Spectra lo-MHz linear array transducer at standard range-gated spectral mode (PRF = 1400 Hz, wall filter = 50 Hz, sample gate = 1.5 mm). A fixed Doppler angle of 68" was used. Five different flow rates were tested, and the velocities determined by power decorrelation were compared to the mean velocities calculated from the Doppler shifts by linear regression (R' = 0.987). We believe the results are very encouraging for using power decorrelation in perfusion evaluation.