Lynne Steinbach | University of California, San Francisco (original) (raw)

Papers by Lynne Steinbach

European Journal of Pediatrics, 2013

European radiology, Jan 4, 2016

To evaluate the ability of different MRI sequences to detect chondrocalcinosis within knee cartil... more To evaluate the ability of different MRI sequences to detect chondrocalcinosis within knee cartilage and menisci, and to analyze the association with joint degeneration. Subjects with radiographic knee chondrocalcinosis (n = 90, age 67.7 ± 7.3 years, 50 women) were selected from the Osteoarthritis Initiative and matched to controls without radiographic chondrocalcinosis (n = 90). Visualization of calcium-containing crystals (CaC) was compared between 3D T1-weighted gradient-echo (T1GE), 3D dual echo steady-state (DESS), 2D intermediate-weighted (IW), and proton density (PD)-weighted fast spin-echo (FSE) sequences obtained with 3T MRI and correlated with a semiquantitative CaC score obtained from radiographs. Structural abnormalities were assessed using Whole-Organ MRI Score (WORMS) and logistic regression models were used to compare cartilage compartments with and without CaC. Correlations between CaC counts of MRI sequences and degree of radiographic calcifications were highest for...

Clinical Orthopaedics and Related Research, Mar 1, 1997

ABSTRACT PURPOSE Focal ulnar nerve dysfunction at the elbow is a frequent clinical problem, and e... more ABSTRACT PURPOSE Focal ulnar nerve dysfunction at the elbow is a frequent clinical problem, and early diagnosis with clinical examination and electrophysiological studies is limited. Magnetic resonance (MR) neurography is an imaging study tailored to examine peripheral nerves and is a potentially useful new diagnostic tool in the evaluation of ulnar neuropathy at the elbow. The current study assessed the value of MR neurography as a diagnostic test for ulnar neuropathy at the elbow. METHOD AND MATERIALS MR neurograms of the ulnar nerve at the elbow were performed on 21 patients with signs and symptoms of ulnar nerve dysfunction as evaluated by a neurologist. These findings were compared with MR neurograms of the elbow of 10 normal volunteers. Symptomatic and normal elbows were imaged in the supine position in a small extremity coil on one of three 1.5 T MR units. The sensitivity, specificity, and accuracy of MR neurography in detecting ulnar nerve abnormality were determined. RESULTS For average ulnar nerve size, median latencies in the symptomatic and normal groups were 0.11 cm2 and 0.06 cm2 respectively; the distributions in the two groups differed with high statistical significance (Mann–Whitney U = 190.5, n1 = 21, n2 = 10, P < 0.001 two-tailed). For relative signal intensity, median latencies in the symptomatic and normal groups were 2.2 and 1.4 respectively; the distributions in the two groups differed significantly (Mann–Whitney U = 167, n1 = 21, n2 = 10, P < 0.01 two-tailed). When using a size cutoff of 0.08 cm2 for a positive test, sensitivity was 95%, specificity was 80%, and accuracy was 90%. At this size, MR neurography demonstrated a positive correlation with EMG results in eleven of thirteen symptomatic patients. CONCLUSION Ulnar nerve size and relative signal intensity were greater in patients with symptoms of ulnar nerve dysfunction than in the normal volunteers. MR neurography of the elbow correlates well with symptoms and EMG findings related to ulnar neuropathy in the elbow region. It is a useful diagnostic test for evaluation of ulnar nerve dysfunction at the elbow. CLINICAL RELEVANCE/APPLICATION MR neurography of the elbow is a sensitive and specific diagnostic test for ulnar neuropathy in the elbow and is recommended as a complement to current diagnostic modalities in difficult cases.

Clinical Orthopaedics and Related Research, May 1, 1997

Arthritis and Rheumatism, Feb 1, 2002

Clinical Orthopaedics and Related Research, Mar 1, 1996

ABSTRACT

Journal of Pediatric Orthopedics, 2004

Bone marrow transplantation (BMT) is effective in ameliorating many of the clinical manifestation... more Bone marrow transplantation (BMT) is effective in ameliorating many of the clinical manifestations of Hurler syndrome. However, long-term data on the natural history of the musculoskeletal disorders of Hurler syndrome after BMT are limited. The authors report the orthopaedic outcomes in seven patients with Hurler syndrome who were successfully engrafted between 1990 and 1999, and have been followed for a mean of 7.6 years since transplantation. Medical records, clinical examinations, and imaging studies were reviewed to assess the development and management of hip dysplasia, genu valgum, spine abnormalities, hand abnormalities, and joint range of motion. BMT does not appear to alter the natural history of the musculoskeletal disorders in Hurler syndrome, although there may be a beneficial effect on upper extremity joint mobility.

The Radiologic Clinics of North America, Mar 1, 1994

Numerous recent technical innovations in magnetic resonance imaging have dramatically improved th... more Numerous recent technical innovations in magnetic resonance imaging have dramatically improved the imaging evaluation of musculoskeletal disease; however, with the introduction of new techniques comes the risk of inappropriate applications and unanticipated pitfalls in interpretation. Some of the practical and theoretical implications of these recent innovations as well as potential caveats associated with their use are highlighted in the following discussion.

American Journal of Roentgenology, Nov 23, 2012

The objective of our study was to determine the imaging appearances of a pseudotumor of the upper... more The objective of our study was to determine the imaging appearances of a pseudotumor of the upper limb, latissimus dorsi tendinosis and tear, in five patients and to correlate those imaging findings with clinical history and histopathology. Tears or reactive tendinosis of the latissimus dorsi tendon at its insertion on the proximal humerus may present as a pseudotumor. Awareness of the imaging findings may allow accurate diagnosis and conservative management.

ABSTRACT PURPOSE To describe the MR imaging findings of disuse osteopenia (DO) in the knee joints... more ABSTRACT PURPOSE To describe the MR imaging findings of disuse osteopenia (DO) in the knee joints of patients that were immobilized for the last 4-12 weeks. METHOD AND MATERIALS MRI knee examinations in 53 patients (24 men, 29 women, aged 18-65 years) were performed following 4 to 12 weeks of ipsilateral lower extremity immobilization therapy for ACL injuries (28), ankle/foot fractures (15), ankle tendon injuries (7) and metatarsal osteotomies (3). Using fat-suppressed, fluid sensitive, intermediate-weighted sequences, bone marrow signal abnormalities were analyzed by 2 radiologists and scored according to 1) severity of signal abnormalities, 2) signal intensity relative to cartilage, 3) morphology, and 4) degree of increased intraosseous focal signal in the distal femur and proximal tibia epiphysis and metaphysis as well as the patella. In addition to Pearson’s chi-square test, Spearman rank correlation test and Kendall’s tau comparing individual scores using a p<0.05 level of confidence, Cohen’s Kappa values were calculated for intraobserver and interobserver agreement. RESULTS All 53 patients presented abnormal bone marrow findings in the femur epiphysis. T2 hyperintense signal abnormalities were significantly more severe in the subchondral and intramedullary compartments of the femoral epiphysis and in the patellar intracortical compartments, than in other compartments (Pearson’s chi-square test; p=0.0024). High scores of severity were associated with confluent and patchy signal patterns (Spearman rank correlation and Kendall’s tau; p<0.0001). Increased focal signal abnormalities suggestive of increased vascularity were noted in the intracortical compartments of the femoral and the tibial metaphyses and patella in 33% of the cases. Weighted Cohen’s Kappa values for intraobserver and interobserver agreement of the scoring system were 0.79 and 0.68, respectively. CONCLUSION DO manifestations in the knee on fat-suppressed fluid sensitive sequences were most prevalent and severe in the distal femoral epiphysis where both confluent and patchy hyperintense patterns predominated. In addition findings suggestive of increased intracortical vascularity were observed in the patella. CLINICAL RELEVANCE/APPLICATION Radiologists need to be familiar with the specific MRI pattern associated with DO to differentiate this from other bone marrow abnormalities.

Magnetic Resonance Imaging, Feb 1, 1998

This study focuses on the spatial resolution required for cartilage imaging. The purposes of this... more This study focuses on the spatial resolution required for cartilage imaging. The purposes of this study were (I) to analyze the diagnostic performance in diagnosing artificially produced cartilage lesions in a small joint model using an optimized fat saturated three-dimensional gradient-echo sequence, (II) to relate the lesion size and depth as diagnosed in the magnetic resonance images with the corresponding pathologic findings and (III) to assess signal-to-noise (SNR) ratios for each of the protocols. Twenty-five artificial cartilage lesions were created in the knee joints of 10 rabbits. These specimens and seven specimens without lesions were imaged at 1.5 T using a three-dimensional gradient-echo sequence with varying slice thickness, field of view and matrix. A total of 404 corresponding images were selected, 50% with and 50% without cartilage lesions. Six radiologists scored all images according to five levels of confidence and receiver operating characteristic (ROC) analysis was performed. Lesion size and depth were compared to the corresponding pathological specimen sections. Additionally SNR ratios were calculated. ROC analysis of pooled data from all readers showed the highest area under the ROC curve for the sequence with the highest spatial resolution, while the diagnostic performance was significantly lower in the other sequences (p <0.01). Assessment of the lesion size and depth was correct in 45% and 40% respectively with the highest resolution and in 29% and 23% with the lowest resolution. SNR ratios decreased with increasing spatial resolution. In conclusion this study shows that increasing spatial resolution improves diagnostic performance in cartilage lesions, though SNR decreases substantially. Assessment of correct lesion size and depth still is limited.

Radiology, Feb 1, 2003

To determine whether knee pain, stiffness, and limited function in patients with different stages... more To determine whether knee pain, stiffness, and limited function in patients with different stages of osteoarthritis correlate with the degree of disease assessed on magnetic resonance (MR) images and radiographs. Radiographs in 50 patients with varying degrees of osteoarthritis of the knee were assessed by using the the Western Ontario and McMaster University (WOMAC) osteoarthritis index and the Kellgren-Lawrence (KL) scale. MR images were obtained and analyzed by two readers for cartilage lesions, bone marrow edema pattern, and ligamentous and meniscal lesions. Thirteen of 16 knees with a KL score of 4 showed full-thickness cartilage lesions and bone marrow edema pattern. Cruciate ligament tears were found in five of 12 knees with a KL score of 3 and in nine of 16 knees with a KL score of 4. While the KL score correlated significantly (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05) with the grade of cartilage lesions, and a substantially higher percentage of lesions with higher KL scores were found on MR images, the correlations between MR imaging findings and KL score versus clinical findings were not significant (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;.05). Significant differences between WOMAC scores were found only for the grades of cartilage lesions (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05). Cartilage lesions, bone marrow edema pattern, and meniscal and ligamentous lesions were frequently demonstrated on MR images in patients with advanced osteoarthritis. Clinical findings showed no significant correlations with KL score and extent of findings at MR imaging.

Radiology, Jul 1, 2005

To compare 1.5- and 3.0-T magnetic resonance (MR) images of porcine knee specimens containing art... more To compare 1.5- and 3.0-T magnetic resonance (MR) images of porcine knee specimens containing artificial cartilage lesions in terms of accuracy of lesion depiction, image quality, and signal-to-noise ratio (SNR). This Health Insurance Portability and Accountability Act-compliant study had institutional review board approval, and informed consent was obtained from the human volunteers. Two fat-saturated cartilage MR imaging sequences (an intermediate-weighted fast spin-echo [SE] sequence and a spoiled gradient-echo [GRE] sequence) were optimized for imaging at 3.0 T in two human volunteers and then used to image 10 porcine knees in which 29 artificial cartilage lesions had been created. Corresponding sequences were used at 1.5 T for all specimens. Images were assessed by two radiologists in consensus, and diagnostic performance in lesion depiction was determined by using macroscopic findings in specimen slices as a reference standard. SNRs were also calculated. For statistical analysis, the McNemar test of discordant pairs was used with a level of significance of P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05. The best diagnostic performance for both the intermediate-weighted fast SE and the spoiled GRE sequences was achieved at 3.0 T. With use of corresponding fat-saturated intermediate-weighted fast SE sequences with an identical acquisition time (9 minutes 44 seconds), 26 (90%) of 29 lesions were detected at 3.0 T, while 18 (62%) were detected at 1.5 T. With use of fat-saturated spoiled GRE sequences, 24 (83%) of 29 lesions were detected at 3.0 T (acquisition time, 8 minutes 48 seconds), and 23 (79%) lesions were detected at 1.5 T (acquisition time, 11 minutes 14 seconds). The rate of correct lesion grade assessment was 65% (17 of 26 lesions) at 3.0 T and 61% (11 of 18 lesions) at 1.5 T with the intermediate-weighted fast SE sequences and 83% (20 of 24 lesions) at 3.0 T and 70% (16 of 23 lesions) at 1.5 T with the spoiled GRE sequences. Both subjective evaluation of image quality and SNR values were significantly higher at 3.0 T (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). In this animal model, MR imaging at 3.0 T increased the accuracy of cartilage lesion assessment when compared with imaging at 1.5 T. Image quality and SNR were highest at 3.0 T.

Data Revues 10649689 V11i2 S1064968903000229, Aug 28, 2011

American Journal of Roentgenology, Nov 20, 2012

The purpose of this study was to determine the incidence and severity of arthrographic pain after... more The purpose of this study was to determine the incidence and severity of arthrographic pain after intraarticular injection of a gadolinium mixture diluted in normal saline for direct MR arthrography. From March 2009 until January 2010, 155 consecutive patients underwent direct MR arthrography; 20 patients were lost to follow-up. Patients were contacted by telephone between 3 and 7 days after joint injection. Using an 11-point numeric pain rating scale, patients were asked to report if they had experienced joint pain that was different or more intense than their preinjection baseline, the severity of pain, the duration of pain, time to onset of pain, and eventual resolution of pain. The incidence of postarthrographic pain was 66% (89/135), with an average intensity of pain of 4.8 ± 2.4 (range, 1-10). Postarthrographic pain lasted an average of 44.4 ± 30.5 hours (range, 6-168 hours). The time to onset of pain after joint injection was on average 16.6 ± 13.1 hours (range, 4-72 hours). There was no significant difference regarding the severity or incidence of postarthrographic pain between groups on the basis of patient age (p = 0.20 and 0.26), patient sex (p = 0.20 and 0.86), contrast mixture contents (p = 0.83 and 0.49), or joint injected (p = 0.51 and 0.47). No patients experienced any other serious side effects. Sixty-six percent of patients who undergo direct MR arthrography will experience a fairly severe delayed onset of pain that completely resolves over the course of several days.

The Radiologic Clinics of North America, Mar 1, 1996

Para-articular cysts frequently are seen on routine imaging examinations. They may be clinically ... more Para-articular cysts frequently are seen on routine imaging examinations. They may be clinically asymptomatic or may cause pain, swelling, or impaired joint function. They often are associated with underlying joint disorders, such as trauma, degeneration, or inflammation. This article discusses the cause, symptoms, and appearance of para-articular cysts on various imaging examinations including arthrography, ultrasound, CT scan, and MR imaging. Specific attention is focused on those cystic masses appearing around the hip, knee, ankle and foot, shoulder, elbow, wrist and hand, spine, temporomandibular joints, and periosteum.