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Assessment of myofiber microstructure changes due to atrophy and recovery with time-dependent diffusion MRI

Lemberskiy, Gregory; Feiweier, Thorsten; Gyftopoulos, Soterios; Axel, Leon; Novikov, Dmitry S; Fieremans, Els
Current clinical MRI evaluation of musculature largely focuses on nonquantitative assessments (including T1-, T2- and PD-weighted images), which may vary greatly between imaging systems and readers. This work aims to determine the efficacy of a quantitative approach to study the microstructure of muscles at the cellular level with the random permeable barrier model (RPBM) applied to time-dependent diffusion tensor imaging (DTI) for varying diffusion time. Patients (N = 15, eight males and seven females) with atrophied calf muscles due to immobilization of one leg in a nonweight-bearing cast, were enrolled after providing informed consent. Their calf muscles were imaged with stimulated echo diffusion for DTI, T1-mapping and RPBM modeling. Specifically, After cast removal, both calf muscles (atrophied and contralateral control leg) were imaged with MRI for all patients, with follow-up scans to monitor recovery of the atrophied leg for six patients after 4 and 8 weeks. We compare RPBM-derived microstructural metrics: myofiber diameter, a, and sarcolemma permeability, κ, along with macroscopic anatomical parameters (muscle cross-sectional area, fiber orientation, <θ>, and T1 relaxation). ROC analysis was used to compare parameters between control and atrophied muscle, while the Friedman test was used to evaluate the atrophied muscle longitudinally. We found that the RPBM framework enables measurement of microstructural parameters from diffusion time-dependent DTI, of which the myofiber diameter is a stronger predictor of intramuscular morphological changes than either macroscopic (anatomical) measurements or empirical diffusion parameters. This work demonstrates the potential of RPBM to assess pathological changes in musculature that seem undetectable with standard diffusion and anatomical MRI.
PMID: 34002901
ISSN: 1099-1492
CID: 4876922

Imaging-based patient-reported outcomes (PROs) database: How we do it

Gyftopoulos, Soterios; Jacobs, Adam; Samim, Mohammad
Patient-reported outcomes (PROs) provide an essential understanding of the impact a condition or treatment has on a patient, while complementing other, more traditional outcomes information like survival and time to symptom resolution. PROs have become increasingly important in medicine with the push toward patient-centered care. The creation of a PROs database within an institution or practice provides a way to collect, understand, and use this kind of patient feedback to inform quality improvement and develop the evidence base for medical decision-making and on a larger scale could potentially help determine national standards of care and treatment guidelines. This paper provides a first-hand account of our experience setting up an imaging-based PROs database at our institution and is organized into steps the reader can follow for creating a PROs database of their own. Given the limited use of PROs within both diagnostic and interventional radiology, we hope our paper stimulates a new interest among radiologists who may have never considered outcomes work in the past.
PMID: 32945932
ISSN: 1432-2161
CID: 4593502

Applying Business Strategy Principles to Radiology: Weight/Variance Principle [Editorial]

Gyftopoulos, Soterios; Ciavarra, Gina
PMID: 32741658
ISSN: 1878-4046
CID: 4553612

ACR Appropriateness Criteria® Chronic Foot Pain

Tafur, Monica; Bencardino, Jenny T; Roberts, Catherine C; Appel, Marc; Bell, Angela M; Gyftopoulos, Soterios; Metter, Darlene F; Mintz, Douglas N; Morrison, William B; Small, Kirstin M S; Subhas, Naveen; Weissman, Barbara N; Yu, Joseph S; Kransdorf, Mark J
Chronic foot pain is a frequent clinical complaint, which can significantly impact the quality of live in some individuals. These guidelines define best practices with regards to requisition of imaging studies based on specific clinical scenarios, which have been grouped into different variants. Each variant is accompanied by a brief description of the usefulness, advantages, and limitations of different imaging modalities. The present narrative is the result of an exhaustive assessment of the available literature and a thorough review process by a panel of experts on Musculoskeletal Imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
PMID: 33153552
ISSN: 1558-349x
CID: 4664342

MRI of superior capsular reconstruction graft and associated short-term clinical outcomes in patients with massive irreparable rotator cuff tears

Campbell, Abigail L; Baron, Samuel L; Pham, Hien; Gyftopoulos, Soterios; Meislin, Robert; Samim, Mohammad
OBJECTIVE:To assess MRI appearance of the dermal allograft and its correlation with clinical outcome following superior capsular reconstruction (SCR). MATERIALS AND METHODS/METHODS:This is a retrospective study of patients who underwent SCR between 2015 and 2018. Patients with postoperative MRI and clinical follow-up were included. Exclusion criteria were preoperative shoulder instability, advanced glenohumeral arthritis, and lack of postoperative MRI or clinical follow-up. Radiographs and MRIs were evaluated for graft integrity and position, acromiohumeral interval, superior subluxation distance (SSD), and glenohumeral cartilage loss. Correlation between imaging and clinical outcome measures were assessed. RESULTS:24 shoulders (23 patients) met the inclusion criteria at a mean clinical and MRI follow-up of 9.1 months. There were 12 intact grafts (50%) and 12 torn grafts (50%), most commonly at the glenoid attachment (8/12). Patients with graft tear had greater SSD (mean 10.5 ± 6.1 mm) than those without tear (mean 6.1 ± 3.8 mm) (p = 0.028). SSD > 7.9 mm had a 79% sensitivity and 91% specificity for graft tear. The intact grafts were more commonly covering the superior humeral head (91.7%) compared with the torn grafts (41.7%) (p = 0.027). There was improvement of clinical outcome measures including American Shoulder and Elbow Surgeons score (p = 0.005) and forward elevation (p = 0.021) although there was no correlation between clinical outcome and integrity of the graft. CONCLUSION/CONCLUSIONS:SCR results in significant short-term clinical improvement even in the presence of graft tear on postoperative MRIs on current study. Gap between graft and the anchors, non-superior position of the graft, and humeral head superior subluxation can be associated with tear.
PMID: 33129183
ISSN: 1873-4499
CID: 4655792

Comparison between radiography and magnetic resonance imaging for the detection of sacroiliitis in the initial diagnosis of axial spondyloarthritis: a cost-effectiveness study

Gorelik, Natalia; Tamizuddin, Farah; Rodrigues, Tatiane Cantarelli; Beltran, Luis; Malik, Fardina; Reddy, Soumya; Koo, James; Subhas, Naveen; Gyftopoulos, Soterios
OBJECTIVE:The purpose of our study was to determine the cost-effectiveness of radiography and MRI-based imaging strategies for the initial diagnosis of sacroiliitis in a hypothetical population with suspected axial spondyloarthritis. MATERIALS AND METHODS/METHODS:A decision analytic model from the health care system perspective for patients with inflammatory back pain suggestive of axial spondyloarthritis was used to evaluate the incremental cost-effectiveness of 3 imaging strategies for the sacroiliac joints over a 3-year horizon: radiography, MRI, and radiography followed by MRI. Comprehensive literature search and expert opinion provided input data on cost, probability, and utility estimates. The primary effectiveness outcome was quality-adjusted life-years (QALYs), with a willingness-to-pay threshold set to $100,000/QALY gained (2018 American dollars). RESULTS:Radiography was the least costly strategy ($46,220). Radiography followed by MRI was the most effective strategy over a 3-year course (2.64 QALYs). Radiography was the most cost-effective strategy. MRI-based and radiography followed by MRI-based strategies were not found to be cost-effective imaging options for this patient population. Radiography remained the most cost-effective strategy over all willingness-to-pay thresholds up to $100,000. CONCLUSION/CONCLUSIONS:Radiography is the most cost-effective imaging strategy for the initial diagnosis of sacroiliitis in patients with inflammatory back pain suspicious for axial spondyloarthritis.
PMID: 32382977
ISSN: 1432-2161
CID: 4430602

Analysis of Different Levels of Structured Reporting in Knee Magnetic Resonance Imaging: Commentary [Editorial]

Burke, Christopher J; Gyftopoulos, Soterios
PMID: 32336648
ISSN: 1878-4046
CID: 4411772

Three-dimensional MRI Bone Models of the Glenohumeral Joint Using Deep Learning: Evaluation of Normal Anatomy and Glenoid Bone Loss

Cantarelli Rodrigues, Tatiane; Deniz, Cem M; Alaia, Erin F; Gorelik, Natalia; Babb, James S; Dublin, Jared; Gyftopoulos, Soterios
Purpose/UNASSIGNED:To use convolutional neural networks (CNNs) for fully automated MRI segmentation of the glenohumeral joint and evaluate the accuracy of three-dimensional (3D) MRI models created with this method. Materials and Methods/UNASSIGNED:Shoulder MR images of 100 patients (average age, 44 years; range, 14-80 years; 60 men) were retrospectively collected from September 2013 to August 2018. CNNs were used to develop a fully automated segmentation model for proton density-weighted images. Shoulder MR images from an additional 50 patients (mean age, 33 years; range, 16-65 years; 35 men) were retrospectively collected from May 2014 to April 2019 to create 3D MRI glenohumeral models by transfer learning using Dixon-based sequences. Two musculoskeletal radiologists performed measurements on fully and semiautomated segmented 3D MRI models to assess glenohumeral anatomy, glenoid bone loss (GBL), and their impact on treatment selection. Performance of the CNNs was evaluated using Dice similarity coefficient (DSC), sensitivity, precision, and surface-based distance measurements. Measurements were compared using matched-pairs Wilcoxon signed rank test. Results/UNASSIGNED:value range, .097-.99). Conclusion/UNASSIGNED:© RSNA, 2020.
PMID: 33033803
ISSN: 2638-6100
CID: 4627252

Applications of Artificial Intelligence in Musculoskeletal Imaging: From the Request to the Report

Gorelik, Natalia; Gyftopoulos, Soterios
Artificial intelligence (AI) will transform every step in the imaging value chain, including interpretive and noninterpretive components. Radiologists should familiarize themselves with AI developments to become leaders in their clinical implementation. This article explores the impact of AI through the entire imaging cycle of musculoskeletal radiology, from the placement of the requisition to the generation of the report, with an added Canadian perspective. Noninterpretive tasks which may be assisted by AI include the ordering of appropriate imaging tests, automatic exam protocoling, optimized scheduling, shorter magnetic resonance imaging acquisition time, computed tomography imaging with reduced artifact and radiation dose, and new methods of generation and utilization of radiology reports. Applications of AI for image interpretation consist of the determination of bone age, body composition measurements, screening for osteoporosis, identification of fractures, evaluation of segmental spine pathology, detection and temporal monitoring of osseous metastases, diagnosis of primary bone and soft tissue tumors, and grading of osteoarthritis.
PMID: 32809857
ISSN: 1488-2361
CID: 4566822

2019 musculoskeletal radiology fellowship match process: initial experiences and lessons learned

Gyftopoulos, Soterios; Demertzis, Jennifer L; Casagranda, Bethany
OBJECTIVE:To present the 2019 Musculoskeletal (MSK) fellowship Match information most useful to MSK fellowship programs and sections in hopes of optimizing the fellowship application and selection process for MSK fellowship applicants and training programs. MATERIALS/METHODS/METHODS:We performed a mixed method analysis to gain a better understanding of the 2019 MSK Fellowship Match process. First, we distributed a ten-question survey to the fellowship leadership from the 78 US fellowship programs registered with the Society of Skeletal Radiology. Second, we collected and reviewed NRMP Match data that were distributed on Match Day. RESULTS:We received completed surveys from 37 (45.7%) programs. Thirty-three (89.2%) of the responding programs identified themselves as academic, 3 (8.1%) as hybrid, and 1 (2.7%) as private practice. On average, programs interviewed 15.4 applicants over the interview session, with a range between 2 and 40. There was an average of 2.7 (range 1-8) open positions per fellowship and 1.2 (range 0-4) internal candidates per program. Each program interviewed 5.8 applicants per open position (range 1-24). There were a total of 81 certified MSK fellowship programs and 204 available positions in these programs. Twenty-four programs (29.6%) did not fill all positions resulting in a total of 36 unfilled positions (17.6%). The percentage of MSK unfilled programs, unfilled positions, and unmatched applicants were comparable to the Breast Imaging and Neuroradiology subspecialty matches. CONCLUSION/CONCLUSIONS:The MSK Fellowship Match was a success with high match rates for applicants and programs. Most importantly, the Match allowed programs to make more informed decisions on their fellowship training opportunities.
PMID: 32060623
ISSN: 1432-2161
CID: 4304682