Faculty Bibliography

OBJECTIVE:Knee osteoarthritis (KOA) causes pain and progressive disability, but pharmacologic treatments are limited. Colchicine inhibits inflammation that might modulate KOA, but efficacy trials have yielded mixed results. We tested whether colchicine, without concurrent NSAIDs, improved KOA pain, function, synovial effusion size, and OA-associated inflammatory serum biomarkers. METHODS:Participants with symptomatic KOA and radiographic Kellgren-Lawrence grades 2/3 were randomized to receive three months of daily colchicine or placebo in a double-blind manner, with no concurrent NSAID use. The primary outcome was between-group change in visual analog score (VAS) for index knee pain. Secondary outcomes included changes in Knee Osteoarthritis Outcome Scores (KOOS), size (depth in millimeters) of sonographically-identified effusions, acetaminophen use, and changes in OA-related serum biomarkers. RESULTS:, IL-1ra, IL-8, and VEGF (p < 0.16). CONCLUSION/CONCLUSIONS:This double-blind placebo-controlled trial of colchicine for KOA failed to demonstrate improvement in pain, function, or synovial effusion size in comparison to placebo at three months. Early improvement in OA-associated inflammatory biomarkers suggests a possible longer-term clinical benefit. Clinical Trials Registration No NCT03913442.

RATIONALE AND OBJECTIVES/OBJECTIVE:Radiology residency often fails to account for individual differences between residents or provide sufficient exposure to diverse pathologies. We sought to evaluate whether artificial intelligence (AI)-enabled "Precision Education" can accurately identify and address individual radiology resident pathology exposure gaps through supplemental personalized teaching cases. MATERIALS AND METHODS/METHODS:A curriculum outlined types and frequencies of important pathologies (IPs) residents should encounter during postgraduate years 2 through 4 (PGY-2 through PGY-4). Daily resident "live" clinical reports were analyzed by ChatGPT-4o prompts to detect IPs encountered. Each resident's live cases were then supplemented with curated anonymized teaching cases, with priority given to IPs encountered below curriculum-defined target thresholds to date. Volumes and IP exposure were compared between pre- (2022-2023) and postintervention (2024-2025) academic years. RESULTS:ChatGPT-4o demonstrated over 91% precision and recall in accurately identifying IPs. Unique IPs encountered by residents significantly increased postintervention from median 75-107 to 93.5-144 in abdominal, 43.5-70 to 73-99 in musculoskeletal, 32.5-38 to 64.5-79 in neuro-, 39.5-49 to 82-96.5 in pediatric, and 42.5-56 to 49.3-85.3 in thoracic imaging (all p < 0.05). Residents met significantly more curriculum-defined targets postintervention, increasing from a median 54-64 to 78.5-131.5 in abdominal, 21-49 to 51.5-75.5 in musculoskeletal, 3.5-9 to 21-38 in neuro-, 13.5-21 to 51.5-72 in pediatric, and 12.5-33 to 23-58 in thoracic imaging (all p < 0.05). Median live case interpretations were not significantly reduced by the intervention, aside from PGY-3 abdominal imaging cases (p = 0.0489). CONCLUSION/CONCLUSIONS:Personalized AI-enabled Precision Education accurately identified resident pathology exposure gaps, enhanced exposure to IPs, and maintained clinical training opportunities.

Chondromyxoid fibroma (CMF) is a rare benign bone neoplasm that typically occurs in young adults. Juxtacortical or surface-type CMF are rarer still and we present the case of a surface-type CMF in a 78-year-old woman, with only one other case described in a patient of a similar age previously. This patient was an otherwise healthy woman who presented for evaluation of a palpable lump in the anterior proximal tibia. Initial radiographs obtained demonstrated a focal soft tissue fullness immediately anterior to the anterior cortex of the proximal tibia, which contained faint chondroid-like matrix internally. There was associated scalloping of the anterior tibial cortex. MRI confirmed the presence of a juxtacortical, enhancing lesion. Subsequent excisional biopsy was performed and histopathology demonstrated features, which was consistent with surface-type CMF. At a 6-month follow-up the patient remained free of recurrence. In a patient of this age, paraosteal chondrosarcoma should be excluded. Surface-type CMF, although rare, has been described in older patients and while it is unlikely to feature in a list of differential considerations on initial imaging, awareness of the entity is important.

Background/Purpose: Obesity is a common risk factor for knee osteoarthritis (KOA). While it is intuitive that bariatric weight loss improves knee pain, it is not clear how much is due to decreased mechanical load vs metabolic changes. Methods: Patients were screened for knee pain prior to sleeve gastrectomy, gastric bypass, or laparoscopic gastric banding. We required pain for >15 days/month and VAS pain > 30, excluding lupus, inflammatory arthritis, crystal disease, psoriasis, and bilateral knee replacement. Enrolled patients took standing knee xrays for Kellgren-Lawrence (KL) grading. We measured BMI and used the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire at baseline and 1, 3, 6 and 12 months, calculating % excess weight loss (%EWL) and deltaKOOS. We collected blood at baseline and followup to study biomarkers for predicting KOOS scores. Results: Of 536 patients considering bariatric surgery, we found 308 with knee pain and enrolled 176 (91.5% female; BMI 43.6 kg/m2+/-7, 32-61; age 42 +/-11, 18-73) well distributed in xray severity (KL0-4). For the 150 patients who had surgery, knee improvement paralleled weight loss at the followups. At 1 year, %EWL correlated well with deltaKOOS pain (R = .262, n = 114, p = 0.005), similar to other intervals and to other KOOS measures. The sleeve and bypass (n=72 and 27) vs banding (n=15) resulted in higher deltaKOOS pain at 1 year: 32.9 +/-21.3 and 30.7 +/-22.6 vs 10.2 +/-21.4, p=0.001. Sleeve and bypass patients also achieved a higher % of their potential deltaKOOS pain improvement than did banding (65.2% and 60.1% vs 16.8% of remaining KOOS points to 100), and a higher % of patients improved to any degree (93.1% and 88.9% vs 66.7%). Radiographic severity did not predict deltaKOOS at 1 year, nor did the presence of key comorbidities. Patients lost weight in a near-linear fashion through 1 year (Fig. 1), but their KOOS improvements plateaued at 1 month. This held true in sleeve and bypass subgroups (with altered anatomy), while banding showed less consistent deltaKOOS despite a similar trend in %EWL. Baseline leptin levels in obese KOA were higher than non-obese KOA and non-obese/non-OA controls from other cohorts (100.2 +/-61.9 vs 26.2 +/-16.7 and 15.4+/-13.8, p<0.001). Similarly, IL-1Ra, a potential marker of OA progression, was much higher than non-obese KOA or controls (1123+/-940 vs 324.0+/-145.6 and 272+/-130.0, p<0.001). Within obese KOA, higher leptin levels predicted worse xrays (KL0/1 vs KL2/3/4, p = 0.037). After 1 year, mean leptin and IL1-Ra from obese KOA patients had decreased (p<0.001). Conclusion: Bariatric surgery improves knee OA symptoms proportionally to %EWL. Most relief occurs during the 1st month before much weight loss, suggesting a metabolic impact beyond mechanical load reduction on joints - at least with the sleeve and bypass that alter digestive anatomy. Leptin and IL-1Ra serum levels are elevated in obese KOA vs non-obese KOA and controls - and fall after bariatric surgery which could contribute to knee pain relief

Sirtuins participate in hormone imbalance, metabolism and aging, which are important processes for endometrial cancer (EC) development. Sirtuins mRNA expression (SIRT1 to 7) was determined in 76 ECs (63 Type I, 12 Type II and one mixed EC), and 30 non-neoplastic endometria (NNE) by quantitative real-time PCR. SIRT1 and SIRT7 protein expression was evaluated by immunohistochemistry using Allred score. Compared to NNE, ECs showed SIRT7 (p < 0.001) mRNA overexpression, whereas SIRT1 (p < 0.001), SIRT2 (p < 0.001), SIRT4 (p < 0.001) and SIRT5 (p < 0.001) were underexpressed. No significant differences were observed for SIRT3 and SIRT6. Type II ECs displayed lower SIRT1 (p = 0.032) and SIRT3 (p = 0.016) transcript levels than Type I ECs. Concerning protein expression, SIRT1 immunostaining median score was higher in ECs compared to NNE epithelium (EC = 5 vs. NNE = 2, p < 0.001), while SIRT7 was lower in ECs (EC = 6 vs. NNE = 7, p < 0.001). No significant associations were found between SIRT1/7 immunoexpression and histological subtype, grade, lymphovascular invasion or stage. Our data shows that sirtuins are deregulated in EC. The diversity of expression patterns observed suggests that sirtuins may have distinctive roles in endometrial cancer similarly to what has been described in other cancer models.

OBJECTIVE: To assess the relationship between knee alignment and subregional T1rho values of the femorotibial cartilage and menisci in patients with mild (Kellgren-Lawrence grade 1) to moderate (KL3) osteoarthritis (OA) at 3T. MATERIALS AND METHODS: 26 subjects with a clinical diagnosis of KL1-3 OA were included and subdivided into three subgroups: varus, valgus, and neutral. All subjects were evaluated on a 3T MR scanner. Mann-Whitney and Wilcoxon signed rank tests were performed to determine any statistically significant differences in subregional T1rho values of femorotibial cartilage and menisci among the three subgroups of KL1-3 OA patients. RESULTS: Medial femoral anterior cartilage subregion in varus group had significantly higher (p<0.05) T1rho values than all cartilage subregions in valgus group. Medial tibial central cartilage subregion had significantly higher T1rho values (p<0.05) than lateral tibial central cartilage subregion in varus group. The posterior horn of the medial meniscus in neutral group had significantly higher T1rho values (p<0.0029) than all meniscus subregions in valgus group. CONCLUSION: There exists some degree of association between knee alignment and subregional T1rho values of femorotibial cartilage and menisci in patients with clinical OA.