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Musculoskeletal abscopal effect: a review of the important imaging findings and their clinical relevance
Farzaneh, Hana; Jardon, Meghan; Gyftopoulos, Soterios; Samim, Mohammad
The abscopal effect is a rare but important phenomenon in which targeted therapy of the primary tumor, mainly radiation therapy, leads to the regression of malignant cells at distant sites from the primary tumor and outside the field of treatment. Radioembolization is a developing area of interventional oncology, typically involving microscopic radioactive spheres loaded with yttrium-90. The abscopal effect on distant bone metastases has been previously reported in patients following palliative radiotherapy; however, it has also been observed with more targeted radiation treatments, such as yttrium-90, primarily outside the musculoskeletal system. Musculoskeletal radiologists should be familiar with the abscopal effect, as the indications for radiation therapy are on the rise, and recent advancements in immune therapy have resulted in the induction of the abscopal effect. Herein, we present a case of the abscopal effect in musculoskeletal metastatic disease following targeted radioembolization. We also review the literature on the abscopal effect involving metastatic bone lesions resulting from different types of cancer therapy. Finally, we present recent advancements in cancer treatment with the aim of utilizing this effect.
PMID: 40374773
ISSN: 1432-2161
CID: 5844662
Reliability of pre-operative symptoms, radiographs, and MRI for the assessment of cartilage loss in patients with femoroacetabular impingement syndrome with intra-operative correlation
Jardon, Meghan; Burke, Christopher; Li, Zachary; Lin, Charles; Li, Xiaochun; Goldberg, Judith D; Youm, Thomas; Samim, Mohammad
OBJECTIVE:To assess the correlation of pre-operative symptoms, pre-operative diagnostic imaging for cartilage loss, and intra-operative cartilage findings in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome. MATERIALS AND METHODS/METHODS:Three radiologists performed retrospective independent reviews of pre-operative MRIs in 96 hips for acetabular/femoral cartilage loss utilizing a simplified "high-low" classification and the International Cartilage Repair Society grading system. Severity of supra-foveal central femoral head cartilage loss was separately noted. Pre-operative radiographs were graded using the Tonnis and Kellgren-Lawrence systems and for central joint space narrowing. Pre-operative patient symptoms were prospectively gathered utilizing the Nonarthritic Hip Score and the modified Harris Hip Score. Intra-operatively, cartilage loss was recorded using the Outerbridge system. RESULTS: CONCLUSION/CONCLUSIONS:Despite MRI underestimation of cartilage loss, the very weak-to-weak correlation of clinical symptoms with pre-operative imaging and intra-operative findings emphasizes the importance of MRI in pre-operative evaluation.
PMID: 40312549
ISSN: 1432-2161
CID: 5834262
Diagnostic Workup of Ulnar Neuropathy at the Elbow: A Cost-effectiveness Study
Jardon, Meghan; Subhas, Naveen; Sneag, Darryl B; Li, Zachary I; Jazrawi, Laith M; Paksima, Nader; Chang, Connie Y; Cardoso, Madalena Da Silva; Gyftopoulos, Soterios
RATIONALE AND OBJECTIVES/OBJECTIVE:Multiple modalities exist for diagnosing ulnar neuropathy at the elbow (UNE), including electrodiagnostic testing (EDX), ultrasound (US), and magnetic resonance imaging (MRI), with no consensus on the optimal strategy. This study's objective was to determine the most cost-effective diagnostic strategy in patients with suspected UNE. MATERIALS AND METHODS/METHODS:We developed a decision analytic model from the U.S. healthcare perspective over a 1-year time horizon. Our hypothetical population comprised 56-year-old males with medial elbow pain and/or paresthesias radiating to the hand, without weakness. We compared incremental cost-effectiveness and total net monetary benefit (NMB) of single-modality strategies (EDX, US, MRI) and multimodality strategies (combinations of US/MRI, EDX/US, EDX/MRI). Input probabilities and utility values were obtained from the literature, and costs from Centers for Medicaid & Medicare Services and institutional data. The primary outcome was quality-adjusted life years (QALYs). Willingness-to-pay threshold was $100,000. RESULTS:The diagnostic strategy utilizing US first, followed by MRI, was favored with the highest total QALYs, .935, and total NMB, $92,667. EDX and US single-modality strategies were less favorable, with lower total QALYs, .894 and .906, respectively, and lower total NMB, $88,866 and $90,022. Other diagnostic strategies were excluded by absolute or extended dominance. One-way sensitivity analyses found model results sensitive to the utility of UNE recovery, but otherwise robust over a range of costs/probabilities. CONCLUSION/CONCLUSIONS:Our cost-effectiveness analysis suggests an initial US, then MRI is the most cost-effective strategy in the workup of patients with suspected UNE.
PMID: 39915180
ISSN: 1878-4046
CID: 5784322
Approach to imaging modalities in the setting of suspected infection
Jardon, Meghan; Alaia, Erin F
Imaging plays an important role in the workup of musculoskeletal infection, in conjunction with clinical history and physical exam. There are multiple imaging modalities that can be of clinical utility in the setting of suspected infection, each with their own benefits and limitations. Radiography is a low-cost, accessible modality providing a broad osseous overview, but can be insensitive for early osteomyelitis. Ultrasound plays a more limited role in the workup of musculoskeletal infection, but can be useful in the pediatric population or for real-time guidance for joint and soft tissue aspirations. Computed tomography (CT) plays an important role in the timely and accurate diagnosis of critically ill patients in the emergency setting. Its superior soft tissue characterization allows for diagnosis of abscesses, and it can help confirm the clinical diagnosis of necrotizing fasciitis when soft tissue gas is present. Magnetic resonance imaging (MRI) is often the modality of choice in the diagnosis of infection, as its superior contrast resolution allows for clear delineation of the presence and extent of both soft tissue infection and osteomyelitis. Additionally, the use of intravenous contrast and advanced imaging sequences such as diffusion weighted imaging (DWI) further increases the diagnostic utility of MRI in the assessment for infection. Familiarity with the diagnostic utility of each imaging modality will allow the radiologist to appropriately guide imaging workup in the setting of clinically suspected infection.
PMID: 37857751
ISSN: 1432-2161
CID: 5650862
Imaging approach to prosthetic joint infection
Jardon, Meghan; Fritz, Jan; Samim, Mohammad
The diagnosis of prosthetic joint infection (PJI) remains challenging, despite multiple available laboratory tests for both serum and synovial fluid analysis. The clinical symptoms of PJI are not always characteristic, particularly in the chronic phase, and there is often significant overlap in symptoms with non-infectious forms of arthroplasty failure. Further exacerbating this challenge is lack of a universally accepted definition for PJI, with publications from multiple professional societies citing different diagnostic criteria. While not included in many of the major societies' guidelines for diagnosis of PJI, diagnostic imaging can play an important role in the workup of suspected PJI. In this article, we will review an approach to diagnostic imaging modalities (radiography, ultrasound, CT, MRI) in the workup of suspected PJI, with special attention to the limitations and benefits of each modality. We will also discuss the role that image-guided interventions play in the workup of these patients, through ultrasound and fluoroscopically guided joint aspirations. While there is no standard imaging algorithm that can universally applied to all patients with suspected PJI, we will discuss a general approach to diagnostic imaging and image-guided intervention in this clinical scenario.
PMID: 38133670
ISSN: 1432-2161
CID: 5612252
Utilization of shear wave elastography to quantify and predict response to upper extremity botulinum toxin injections in patients with cerebral palsy: A pilot study
Jardon, Meghan; Nguyen, Joseph; Casaletto, Emily; Ko, Lydia; Wolff, Aviva; Daluiski, Aaron; Nwawka, O Kenechi
OBJECTIVE:Shear wave elastography (SWE) was used to quantify change in upper extremity muscle stiffness in patients with unilateral spastic cerebral palsy (USCP) following botulinum toxin A (BTX-A) therapy. We hypothesized that SWE measures would decrease following ultrasound-guided BTX-A injection, and correlate with functional improvement. METHODS:SWE measures of BTX-A treated muscles were recorded immediately pre-injection, and at 1-, 3- and 6-months post-injection. At the same timepoints, functional assessment was performed using the Modified Ashworth Scale (MAS), and passive and active range of motion (PROM and AROM) measures. Correlation of SWE with MAS, PROM and AROM, as well as the relationship between change in SWE and change in MAS, PROM and AROM was determined using Spearman's rank correlation coefficient and generalized estimating equation modeling. RESULTS:16 muscles were injected and longitudinally assessed. SWE and MAS scores decreased following BTX-A injection (p = 0.030 and 0.004, respectively), reflecting decreased quantitative and qualitative muscle stiffness. Decreased SWE reached statistical significance at 1- and 3-months, and 1-, 3- and 6-months for MAS. When comparing relative change in SWE to relative change in AROM, larger change in SWE strongly correlated with positive change in AROM (p-value range:<0.001-0.057). BTX-A responders also demonstrated lower baseline SWE (1.4 m/s) vs. non-responders (1.9 m/s), p = 0.035. CONCLUSION/CONCLUSIONS:Ultrasound-guided BTX-A injections in patients with USCP resulted in decreased quantitative and qualitative muscle stiffness. Strong correlation between change in SWE and AROM, as well as the significant difference in baseline SWE for BTX-A responders and non-responders, suggests SWE may provide a useful tool to predict and monitor BTX-A response.
PMID: 37236005
ISSN: 1872-6968
CID: 5487332
Diagnostic ultrasound and ultrasound-guided injections for peri-articular pain after knee replacement
Jardon, Meghan; Miller, Theodore T
OBJECTIVE:The purpose of this technical report is to review the sonographic spectrum of abnormalities accounting for peri-articular pain after knee replacement surgery, as well as to demonstrate the clinical utility of ultrasound in the diagnosis and treatment of this subset of patients. MATERIALS AND METHODS/METHODS:Utilizing an imaging report database, we performed a search for ultrasound examinations performed by a single radiologist for knee pain after knee arthroplasty at our institution over a 10-year period. The search yielded 63 patients, whom we have categorized by causative pathology, with representative diagnostic and procedural ultrasound images selected for inclusion. RESULTS:Our search yielded multiple causes of peri-articular knee pain after arthroplasty, including medial and lateral retinacular impingement and scarring, iliotibial band or conjoined tendon irritation, popliteus tendon impingement, medial collateral ligament impingement, pes anserine bursitis, and scarring of Hoffa's fat pad. CONCLUSION/CONCLUSIONS:While knee arthroplasty is an often-successful procedure, it can be complicated by post-operative peri-articular knee pain. Ultrasound provides a valuable tool for the diagnosis of painful peri-articular knee pathology, as it allows for both static and dynamic evaluation, as well as direct correlation with patient symptoms, and is not confounded by the metal components. In addition to its diagnostic utility, ultrasound can also guide diagnostic and/or therapeutic injections of anesthetic and corticosteroid. Given these advantages, ultrasound is an important tool in managing the painful post-arthroplasty knee.
PMID: 36136116
ISSN: 1432-2161
CID: 5422502
Deep-learning-reconstructed high-resolution 3D cervical spine MRI for foraminal stenosis evaluation
Jardon, Meghan; Tan, Ek T; Chazen, J Levi; Sahr, Meghan; Wen, Yan; Schneider, Brandon; Sneag, Darryl B
OBJECTIVE:To compare standard-of-care two-dimensional MRI acquisitions of the cervical spine with those from a single three-dimensional MRI acquisition, reconstructed using a deep-learning-based reconstruction algorithm. We hypothesized that the improved image quality provided by deep-learning-based reconstruction would result in improved inter-rater agreement for cervical spine foraminal stenosis compared to conventional two-dimensional acquisitions. MATERIALS AND METHODS/METHODS:Forty-one patients underwent routine cervical spine MRI with a conventional protocol comprising two-dimensional T2-weighted fast spin echo scans (2 axial planes, 1 sagittal plane), and an isotropic-resolution three-dimensional T2-weighted fast spin echo scan reconstructed over a 4-h time window with a deep-learning-based reconstruction algorithm. Three radiologists retrospectively assessed images for the degree to which motion artifact limited clinical assessment, and foraminal and central stenosis at each level. Inter-rater agreement was analyzed with weighted Fleiss's kappa (k) and comparisons between two-dimensional and three-dimensional sequences were performed with Wilcoxon signed-rank test. RESULTS:Inter-rater agreement for foraminal stenosis was "substantial" for two-dimensional sequences (k = 0.76) and "excellent" for the three-dimensional sequence (k = 0.81). Agreement was "excellent" for both sequences (k = 0.85 and 0.83) for central stenosis. The three-dimensional sequence had less perceptible motion artifact (p ≤ 0.001-0.036). Mean total scan time was 10.8 min for the two-dimensional sequences, and 7.3 min for the three-dimensional sequence. CONCLUSION/CONCLUSIONS:Three-dimensional MRI reconstructed with a deep-learning-based algorithm provided "excellent" inter-observer agreement for foraminal and central stenosis, which was at least equivalent to standard-of-care two-dimensional imaging. Three-dimensional MRI with deep-learning-based reconstruction was less prone to motion artifact, with overall scan time savings.
PMID: 36269331
ISSN: 1432-2161
CID: 5422512
Imaging of Emerging Infectious Diseases
Jardon, Meghan; Mohammad, Shaden F; Jude, Cecilia M; Pahwa, Anokh
PURPOSE OF REVIEW/OBJECTIVE:Emerging infectious diseases have seen a record increase in prevalence, and understanding their management is critical in an increasingly global community. In this paper, we review current literature detailing the role of radiology in the diagnosis and treatment of the Ebola (EVD), Zika (ZVD), Chikungunya (CHIKF), H1N1, Middle East Respiratory (MERS), and Severe Acute Respiratory Syndrome (SARS) viruses. RECENT FINDINGS/RESULTS:Complex protocols are required to safely use portable imaging in EVD to prevent nosocomial spread of disease. In ZVD, antenatal ultrasound can detect fetal abnormalities early, allowing implementation of care and support to affected families. Imaging is useful in assessing the extent of involvement of chronic CHIKF and monitoring treatment effect. Chest radiography and CT play a more direct role in the diagnosis and monitoring of the viral infections with primarily respiratory manifestations (H1N1, MERS, and SARS). SUMMARY/CONCLUSIONS:Radiology plays a variable role in emerging infectious diseases, requiring an understanding of disease transmission and safe imaging practices, as well as imaging features that affect clinical management.
PMCID:7100865
PMID: 32226652
ISSN: 2167-4825
CID: 5192582
Outcomes of Preoperative MRI-Guided Needle Localization of Nonpalpable Mammographically Occult Breast Lesions
Gao, Yiming; Bagadiya, Neeti R; Jardon, Meghan L; Heller, Samantha L; Melsaether, Amy N; Toth, Hildegard B; Moy, Linda
OBJECTIVE: MRI-guided needle localization allows access to MRI-detected mammographically occult breast lesions that are not amenable to MRI-guided biopsy. The purpose of this study was to examine the safety and outcomes of MRI-guided needle localization. MATERIALS AND METHODS: Ninety-nine consecutive breast lesions that underwent preoperative MRI-guided needle localization were identified. Clinical indications for breast MRI, reasons for performing MRI-guided needle localization, and surgical pathology results were recorded. Lesion characteristics, procedure time, and complications were assessed. RESULTS: Of 99 lesions, 60 (60.6%) were in a location inaccessible for MRI biopsy, necessitating MRI-guided needle localization. Histologic evaluation revealed 38 (38.4%) carcinomas, 31 (31.3%) high-risk lesions, and 30 (30.3%) benign lesions. Carcinoma was more likely to be found in women with known cancer (31/61 [50.8%]; p = 0.003) than in women undergoing imaging for high-risk screening (2/18 [11.1%]) or problem solving (6/20 [30%]). Masses (p = 0.013) and foci (p < 0.001) were more likely to be malignant than were lesions with nonmass enhancement. Foci were significantly more often malignant compared with all other lesion types (9/10 [90%]; p < 0.001). The mean (+/- SD) procedure time was 32.9 +/- 9.39 minutes. All lesions were occult on specimen radiographs. There were no procedure-related complications. CONCLUSION: The positive predictive value of MRI-guided needle localization (38.4%) is comparable to that of mammography- and tomosynthesis-guided localizations and is highest in women with a known diagnosis of cancer. It is highly accurate in targeting small enhancing lesions, thereby improving surgical management. MRI-guided needle localization is a safe, accurate, and time-efficient procedure.
PMID: 27275652
ISSN: 1546-3141
CID: 2136442