Faculty Bibliography

OBJECTIVE:The open access movement has pushed for greater access to scientific knowledge by expanding access to scientific journal articles. There is limited information about the extent to which open access policies have been adopted by radiology journals. We performed a systematic analysis to ascertain the proportion of radiology journals with open access options. MATERIALS AND METHODS:A search was performed with the assistance of a clinical informationist. Full and mixed English-language diagnostic and interventional radiology Web of Science journals (impact factors > 1.0) were included. Nuclear medicine, radiation oncology, physics, and solicitation-only journals were excluded. Primary outcome was open access option (yes or no) with additional outcomes including presence or absence of embargo, complete or partial copyright transfer, publication fees, and self-archiving policies. Secondary outcomes included journal citations, journal impact factors, immediacy, Eigenfactor, and article influence scores. Independent double readings were performed with differences resolved by consensus, supplemented by contacting editorial staff at each journal. RESULTS:In all, 125 journals were identified; review yielded 49 journals (39%, mean impact factor of 2.61). Thirty-six of the journals had open access options (73.4%), and four journals were exclusively open access (8.2%). Twelve-month embargoes were most commonly cited (90.6%) with 28.6% of journals stating that they did not require a complete transfer of copyright. Prices for open access options ranged from $750 to $4,000 (median $3,000). No statistically significant differences were found in journal impact measures comparing journals with open access options to journals without open access options. CONCLUSIONS:Diagnostic and interventional radiology journals have widely adopted open access options with a few radiology journals being exclusively open access.

Minimally invasive procedures play a crucial role in the diagnosis and treatment of many pediatric musculoskeletal conditions. Although computed tomography and fluoroscopy are commonly used for image guidance, the associated exposure to ionizing radiation is especially concerning in pediatric patients. Ultrasonography may be used successfully in a subset of interventions, but it is often not useful for complex, deep, and osseous targets. Interventional magnetic resonance imaging (iMRI) facilitates targeting and treatment of musculoskeletal lesions at many locations with high accuracy due to its excellent tissue contrast. Furthermore, MRI provides imaging guidance without the use of ionizing radiation and as such complies with the ALARA practice mandate in a formidable fashion. MRI guidance is our method of choice for lesion that are not visible by other modalities or when other techniques and modalities failed. MRI guidance is especially useful for selective targeting of complex lesions, intra-articular lesions, cyst aspirations in difficult locations of the body, and lesions that are located adjacent to surgical hardware. Tumor-related diagnostic sampling is more frequently performed under MRI; however, MRI guidance is also exquisitely well suited for a variety of therapeutic percutaneous osseous or articular conditions, such as osteoid osteoma, epiphyseal bone bridging, osteochondritis dissecans lesions, and aneurysmal bone cysts. In this article, we will describe the technical aspects and clinical indications of a variety of MRI-guided pediatric procedures in the musculoskeletal system.

Low-flow vascular malformations are congenital lesions that can occur throughout the body. Treatment of these lesions is indicated to ameliorate pain, cosmetic disfigurement, and functional impairment. The first-line treatment of low-flow vascular malformations is percutaneous sclerotherapy. Traditionally, sclerotherapy is performed with a combination of ultrasound and fluoroscopy. However, malformations that are deep in the abdomen and pelvis or are obscured by overlying fascia or scar may be difficult to be visualized with ultrasound and fluoroscopy. MR-guided sclerotherapy has emerged as an alternative modality that can be used to needle guidance and sclerosant monitoring. In this review, we discuss the historical and current use of MR-guided sclerotherapy for the treatment of low-flow vascular malformations.

Purpose To determine the diagnostic performance of three-dimensional (3D) MRI for the depiction and characterization of cartilage defects within the knee joint by using arthroscopy and/or open surgery as the standard of reference. Materials and Methods A systematic literature search was performed to extract diagnostic studies published between January 1985 and October 2017. Two independent investigators assessed the methodologic quality of each study by using Quality Assessment of Diagnostic Accuracy Studies 2. Bivariate random-effects model was used to compare the diagnostic odds ratio (DOR) of 3D and two-dimensional (2D) MRI for helping to detect knee cartilage defects and to assess the effect of relevant covariates on diagnostic performance of 3D MRI. Meta-regression analysis was performed to assess DOR of 3D MRI during the last 3 decades. Results Twenty-seven studies (composed of 1710 MRI examinations) were included. Of those, 16 (59%) studies compared the diagnostic performance of 3D and 2D MRI. The diagnostic performance of 3D MRI statistically significantly improved over the last 3 decades (P = .003). Three-dimensional MRI obtained by using 3.0-T field strength had higher DOR relative to 1.5-T or lower field strength (relative DOR, 4.05; P = .01). Three-dimensional multiplanar reformation was associated with higher specificity (P = .001) compared with conventional axial, sagittal, and coronal 2D MRI planes. Three-dimensional fast-spin-echo sequences provided higher sensitivity and specificity (P < .05) than did 2D MRI. Conclusion Three-dimensional MRI currently provides comparable diagnostic performance to two-dimensional MRI, with improvement in diagnostic performance achieved by using 3.0-T field strength, three-dimensional fast-spin-echo sequences, and multiplanar reformation. © RSNA, 2018 Online supplemental material is available for this article.

OBJECTIVES:The aim of this study was to test the hypothesis that magnetic resonance imaging (MRI) of the knee with 10-minute 3-dimensional (3D) controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) sampling perfection with application optimized contrast using different flip angle evolutions (SPACE) turbo spin echo (TSE) protocols can replace 20-minute 2-dimensional (2D) TSE standard-of-reference protocols for the diagnosis of internal derangement. MATERIALS AND METHODS:After internal review board approval and prospective informed consent, 100 symptomatic subjects underwent MRI of the knee at 3 T and 50 symptomatic subjects at 1.5 T, consisting of 10-minute 3D CAIPIRINHA SPACE TSE and 20-minute standard-of-reference 2D TSE protocols. Two fellowship-trained musculoskeletal radiologists assessed the studies in an anonymized and randomized fashion for structural abnormalities. Descriptive statistics, interreader reliability, intermethod concordance, diagnostic definitiveness, and interchangeability tests were applied. P values equal to or smaller than 0.01 were considered significant. RESULTS:The interchangeability analysis showed that the 3D MRI can replace the 2D MRI protocols, whereas a superiority of 3D MRI was suggested statistically for the detection of medial and lateral meniscal tears, cartilage defects, and bone marrow edema by significantly higher common pair exact match proportions of readers (P < 0.01, respectively).The overall interreader reliabilities were 89% of exact matches for 2D TSE (κ, 0.842) and 96% of exact matches for 3D TSE (κ, 0.941) (P < 0.01). There was good intermethod concordance (κ, 0.736; range, 0.579-1.000). The interreader reliability (2D TSE: κ, 0.748 [0.603-1.000]; 3D TSE: κ, 0.901 [0.797-1.000]) and diagnostic definitiveness were significantly higher for the 3D than 2D MRI (P < 0.01). CONCLUSIONS:10-minute 3D CAIPIRINHA SPACE TSE MRI protocols can replace 20-minute 2D TSE standard-of-reference MRI protocols for the evaluation of internal derangement of the knee by producing similar results in individual patient diagnoses, whereas interpretations of 3D CAIPIRINHA SPACE TSE MRI examinations resulted in an overall higher interreader reliability, intermethod concordance, and reader definitiveness.

Purpose To test the hypothesis that synthetic MRI of the knee generates accurate and repeatable quantitative maps and produces morphologic MR images with similar quality and detection rates of structural abnormalities than does conventional MRI. Materials and Methods Data were collected prospectively between January 2017 and April 2018 and were retrospectively analyzed. An International Society for Magnetic Resonance in Medicine-National Institute of Standards and Technology phantom was used to determine the accuracy of T1, T2, and proton density (PD) quantification. Statistical models were applied for correction. Fifty-four participants (24 men, 30 women; mean age, 40 years; range, 18-62 years) underwent synthetic and conventional 3-T MRI twice on the same day. Fifteen of 54 participants (28%) repeated the protocol within 9 days. The intra- and interday agreements of quantitative cartilage measurements were assessed. Contrast-to-noise (CNR) ratios, image quality, and structural abnormalities were assessed on corresponding synthetic and conventional images. Statistical analyses included the Wilcoxon test, χ² test, and Cohen Kappa. P values less than or equal to .01 were considered to indicate a statistically significant difference. Results Synthetic MRI quantification of T1, T2, and PD values had an overall model-corrected error margin of 0.8%. The synthetic MRI interday repeatability of articular cartilage quantification had native and model-corrected error margins of 3.3% and 3.5%, respectively. The cartilage-to-fluid CNR and menisci-to-fluid CNR was higher on synthetic than conventional MR images (P ≤ .001, respectively). Synthetic MRI improved short-tau inversion recovery fat suppression (P Ë‚ .01). Intermethod agreements of structural abnormalities were good (kappa, 0.621-0.739). Conclusion Synthetic MRI of the knee is accurate for T1, T2, and proton density quantification, and simultaneously generated morphologic MR images have detection rates of structural abnormalities similar to those of conventional MR images, with similar acquisition time. © RSNA, 2018.