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3D-MRI versus 3D-CT in the evaluation of glenoid deformity in glenohumeral arthritis using Dixon 3D FLASH sequence

Rosenthal, Yoav; Samim, Mohammad; Gyftopoulos, Soterios; Kolade, Oluwadamilola O; Kwon, Young W; Zuckerman, Joseph D; Virk, Mandeep S
OBJECTIVE:To compare MRI with 3D reconstructions and 3D-CT with respect to assessment of glenoid wear in osteoarthritic shoulders. METHODS:3D reconstructions were generated for CT and MR (utilizing the Dixon technique) imaging performed on 29 osteoarthritic shoulders. Two reviewers independently performed glenoid morphometric measurements and evaluated glenoid erosion. Mean differences between the two modalities were calculated. Inter-observer agreement was calculated using kappa coefficient. RESULTS:The combined mean absolute difference (bias) in glenoid version between 3D-CT and 3D-MRI was 2.7° ± 1.6° (range 0.15-7.85, P value = 0.7). The combined mean absolute difference in glenoid inclination between 3D-CT and 3D-MRI was 6.8° ± 4.1° (range 0.8°-15.75°, P value = 0.17). No significant inter-reader variation in glenoid version and inclination measurements on 3D-CT and 3D-MRI was found (P > 0.05). The inter-reader reliability for both CT and MRI was high for Walch grading of glenoid bone loss (κ = 1, κ = 0.81, respectively). CONCLUSIONS:3D-MRI is comparable to 3D-CT with respect to axial glenoid bone loss, as measured by glenoid version. However, for coronal bone loss estimation, measured by glenoid inclination, 3D-CT remains the gold standard. Thus, 3D-MR can be used as an alternative for preoperative assessment of glenoid version in arthritic shoulders.
PMID: 35737085
ISSN: 1432-2161
CID: 5282062

Does Sacrococcygeal Skeletal Morphology and Morphometry Influence Pressure Injury Formation in Adults?

Delmore, Barbara; Sprigle, Stephen; Samim, Mohammad; Alfonso, Allyson R; Lin, Lawrence; Chiu, Ernest
GENERAL PURPOSE/OBJECTIVE:To present a study that investigated sacrococcygeal skeletal structure as a possible nonmodifiable intrinsic risk factor for pressure injury and identify possible issues caused by its morphology. TARGET AUDIENCE/BACKGROUND:This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES/OBJECTIVE:After participating in this educational activity, the participant will:1. Recognize the background information the authors considered when planning and conducting their study of sacrococcygeal skeletal structure as a possible pressure injury risk factor.2. Identify the characteristics of the two groups of study participants.3. Choose the results of the study clinicians may consider when implementing evidence-based practice.
PMID: 36264750
ISSN: 1538-8654
CID: 5391362

Postoperative MRI of Shoulder Instability

Samim, Mohammad; Gyftopoulos, Soterios
Following anterior shoulder instability surgery, patients may present with new or recurrent symptoms. Postoperative imaging, including MR imaging, may be obtained for these patients to assess the integrity of the repaired tissues and orthopedic fixation hardware or grafts. Familiarity with different operative techniques and their expected normal appearances and complications helps in the appropriate interpretation of these imaging studies. This article provides an overview of the current treatment guidelines and surgery options for patients with anterior shoulder instability and reviews the normal and abnormal postoperative imaging appearances of the shoulder joint after treatment with the most common surgical stabilization techniques.
PMID: 36243507
ISSN: 1557-9786
CID: 5352262

Imaging features and biopsy yield of soft tissue metastatic lesions: 10-year single tertiary center experience

Ilag, Marisa; Burke, Christopher; Walter, William R; Samim, Mohammad
OBJECTIVE:To evaluate imaging features of soft tissue metastases, technical factors associated with diagnostic yield of image-guided biopsy, and clinical impact of biopsy results on patient outcomes. MATERIALS AND METHODS/METHODS:A total of 1605 image-guided soft tissue biopsies were retrospectively identified from December 2010 to December 2020. Included lesions were histologically proven musculoskeletal soft tissue metastases. Lesions were excluded if intraabdominal, intrathoracic, retroperitoneal, associated with osseous lesions or surgical scar implants or arising from skin or lymph nodes. Image guidance modality, needle size, number of cores, and lesion location, size, and depth from skin were recorded. Patient demographics, malignancy history, biopsy-driven changes in management, and survival rate after biopsy were collected. RESULTS:Forty-six patients met the inclusion criteria with a biopsy diagnostic yield of 44/46 (95.7%). Metastases were most commonly located truncal (82.6%, p < 0.001) and intramuscular (78.3%, p < 0.001). A total of 37/46 (80.4%) biopsies were US-guided. And 9/46 (19.6%) were CT-guided. There was no significant difference in the number of cores or mean needle gauge between diagnostic and nondiagnostic biopsies. At time of review, 23 (50%) patients were deceased, with a mean survival of 13.5 months after biopsy. The majority (71.7%) of patients had a known primary malignancy at time of biopsy, most commonly lung (24.2%) and breast (24.2%). Overall survival showed no association with anatomic location (p > 0.83) or tissue type (p > 0.34). The most common biopsy-driven outcome was initiation of chemotherapy, immunotherapy, and/or radiotherapy (52.2%). CONCLUSION/CONCLUSIONS:Image-guided biopsy for soft tissue metastases has high diagnostic yield and commonly influences clinical management. Metastases were most commonly intramuscular in the trunk and are associated with poor prognosis.
PMID: 36202920
ISSN: 1432-2161
CID: 5351682

Likelihood of hip infection with image-guided hip aspiration dry tap: a 10-year retrospective study

Serfaty, Aline; Jacobs, Adam; Gyftopoulos, Soterios; Samim, Mohammad
OBJECTIVE:To determine the rate of infection in patients with suspected hip septic arthritis who underwent image-guided aspiration (IHA) resulting in dry-tap, diagnostic value of subsequent lavage and re-aspiration, and if pre-aspiration MRI can help prevent a dry tap. MATERIALS AND METHODS/METHODS:Retrospective review between 2010 to 2020 identified native hip (NH) and total hip arthroplasty (THA) patients who had a dry-tap following aspiration for suspected infection or periprosthetic joint infection (PJI). Serology tests, lavage/re-aspiration volumes, and aspirate cell-count/culture were assessed. On pre-aspiration MRI, presence/grade of joint effusion (JE), pseudocapsule dehiscence (PD), extraarticular fluid and sinus-tract were recorded. RESULTS:Out of 215 included dry-taps, 185 (86.0%) were non-infected and 30 (13.9%) infected. In subgroup analysis, 64/71(90.1%) NH and 121/144(84.0%) THA dry-taps were non-infected. Pre-aspiration MRI of THA group with dry-tap showed significant findings; PD with extraarticular fluid (8/12, 66.7%) and sinus tract (7/12, 58.3%) were higher in the infected compared to non-infected group (5/42, 11.9% and 0/42, 0.0%) (both p < 0.001). Among THA group, polymorphonuclear-leukocytes > 80% was present in 8/9 (88.9%) of infected versus 4/28 (14.3%) non-infected group (p < 0.001). Multivariable regression showed PD (p = 0.005) and JE (p = 0.042) being significant independent predictors of PJI, similarly the elevated CRP (p = 0.044) and JE (p = 0.017). CONCLUSION/CONCLUSIONS:Majority of patients suspected of hip joint infection with dry-tap were non-infected. Synovial PMN% following lavage maintains high sensitivity for detection of PJI. In patients with THA, PD and subsequent extraarticular collection can be associated with dry-tap therefore, pre-aspiration MRI can help determine their presence and plan the aspiration.
PMID: 35359220
ISSN: 1432-2161
CID: 5206042

Society of Skeletal Radiology- white paper. Guidelines for the diagnostic management of incidental solitary bone lesions on CT and MRI in adults: bone reporting and data system (Bone-RADS)

Chang, Connie Y; Garner, Hillary W; Ahlawat, Shivani; Amini, Behrang; Bucknor, Matthew D; Flug, Jonathan A; Khodarahmi, Iman; Mulligan, Michael E; Peterson, Jeffrey J; Riley, Geoffrey M; Samim, Mohammad; Lozano-Calderon, Santiago A; Wu, Jim S
The purpose of this article is to present algorithms for the diagnostic management of solitary bone lesions incidentally encountered on computed tomography (CT) and magnetic resonance (MRI) in adults. Based on review of the current literature and expert opinion, the Practice Guidelines and Technical Standards Committee of the Society of Skeletal Radiology (SSR) proposes a bone reporting and data system (Bone-RADS) for incidentally encountered solitary bone lesions on CT and MRI with four possible diagnostic management recommendations (Bone-RADS1, leave alone; Bone-RADS2, perform different imaging modality; Bone-RADS3, perform follow-up imaging; Bone-RADS4, biopsy and/or oncologic referral). Two algorithms for CT based on lesion density (lucent or sclerotic/mixed) and two for MRI allow the user to arrive at a specific Bone-RADS management recommendation. Representative cases are provided to illustrate the usability of the algorithms.
PMID: 35344076
ISSN: 1432-2161
CID: 5391352

Postoperative Musculoskeletal Imaging and Interventions Following Hip Preservation Surgery, Deformity Correction, and Hip Arthroplasty

Samim, Mohammad; Khodarahmi, Iman; Burke, Christopher; Fritz, Jan
Total hip arthroplasty and hip preservation surgeries have substantially increased over the past few decades. Musculoskeletal imaging and interventions are cornerstones of comprehensive postoperative care and surveillance in patients undergoing established and more recently introduced hip surgeries. Hence the radiologist's role continues to evolve and expand. A strong understanding of hip joint anatomy and biomechanics, surgical procedures, expected normal postoperative imaging appearances, and postoperative complications ensures accurate imaging interpretation, intervention, and optimal patient care. This article presents surgical principles and procedural details pertinent to postoperative imaging evaluation strategies after common hip surgeries, such as radiography, ultrasonography, computed tomography, and magnetic resonance imaging. We review and illustrate the expected postoperative imaging appearances and complications following chondrolabral repair, acetabuloplasty, osteochondroplasty, periacetabular osteotomy, realigning and derotational femoral osteotomies, and hip arthroplasty.
PMID: 35654093
ISSN: 1098-898x
CID: 5283002

Bone Tumors: Imaging Features of the Most Common Primary Osseous Malignancies

Serfaty, Aline; Samim, Mohammad
Accurate interpretation and reporting of the imaging findings of primary bone tumors are crucial for timely and appropriate management. This article reviews multimodality imaging characteristics of the most common primary bone malignancies.
PMID: 35236590
ISSN: 1557-8275
CID: 5172742

Improved Functional Outcome Scores Associated with Greater Reduction in Cam Height Using the Femoroacetabular Impingement Resection Arc During Hip Arthroscopy

Kaplan, Daniel J; Matache, Bogdan A; Fried, Jordan; Burke, Christopher; Samim, Mohammad; Youm, Thomas
PURPOSE/OBJECTIVE:To evaluate the association between postoperative cam lesion measured by the "femoroacetabular impingement resection (FAIR) arc" and 2-year patient outcomes following hip arthroscopy. METHODS:A retrospective review of prospectively gathered data from 2013-2017 was performed. All patients who underwent hip arthroscopy for FAI with ≥ 2-year follow-up were included. Cam FAIR arc measurements were made pre and postoperatively on a 45° Dunn view radiograph. The clinical effect of postoperative cam maximal radial distance (MRD) was assessed using the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS). Patients were divided into subgroups based on relationship to the mean and standard deviations for cam MRD. One half standard deviation above the mean was found to be 3.15 mm. RESULTS:=0.004). Subgroup analysis demonstrated that patients in the cam MRD < 3.15 mm group had significantly higher mHHS (89.7 vs 70.0 p<0.001) and NAHS scores (90.5 vs 72.9, p<0.001) than those in the >3.15 mm group. Additionally, more patients in the <3.15 mm group reached the minimal clinically important difference (MCID) (95.2% vs 78.9%, p=0.048) and were above patient acceptable symptomatic state (PASS) (95.2% vs 52.6%, p<0.001) compared to the >3.15 mm group. CONCLUSION/CONCLUSIONS:Patients with a lower postoperative cam MRD relative to the FAIR arc demonstrated significantly improved outcomes as compared to those with higher postoperative MRD at two-year follow-up.
PMID: 34052374
ISSN: 1526-3231
CID: 4890722

Pediatric versus adult magnetic resonance imaging patterns in acute high ankle sprains

Walter, William R; Alaia, Erin F; Samim, Mohammad; Rosenberg, Zehava S
BACKGROUND:There is a paucity of literature describing MRI patterns of high ankle sprains in pediatric patients. Radiologists should understand MRI patterns of these injuries in both adults and children. OBJECTIVE:To describe normal MRI appearance of pediatric syndesmotic ligaments and compare MRI patterns of high ankle sprains in children versus adults. MATERIALS AND METHODS/METHODS:We reviewed consecutive ankle MRIs performed over 3 years and divided them into three cohorts: a normal pediatric (≤16 years) cohort, and pediatric and adult cohorts with acute/subacute ankle syndesmosis injuries. Our retrospective review assessed interobserver agreement (Cohen kappa coefficient) and normal pediatric syndesmotic anatomy. We compared patterns of high ankle sprains (Fisher exact test) including ligament tears, periosteal stripping, avulsions and fractures. RESULTS:Of the 582 ankle MRIs, we included 25 in the normal pediatric cohort, 20 in the pediatric injury cohort and 23 in the adult injury cohort. The anterior and posterior tibiofibular ligaments all attached to cortex or cartilaginous precursor, while the interosseous ligament/membrane complex attached to the fibrous periosteum in 22/25 (88%) normal pediatric cases. Tibial periosteal stripping at the interosseous ligament/membrane complex attachment occurred in 7/20 (35%) pediatric and 1/23 (4%) adult injury cases (P=0.02). No other statistically significant differences were found. Interobserver agreement ranged from kappa=0.46 to kappa=0.82 (ligament tears), 0.38 to 0.45 (avulsions) and 0.69 to 0.77 (periosteal stripping). CONCLUSION/CONCLUSIONS:The normal interosseous ligament/membrane complex typically attaches to fibrous periosteum rather than bony cortex. Tibial periosteal stripping, usually without tibial fracture, is significantly more common among pediatric high ankle sprains. MRI patterns of high ankle sprains are otherwise not significantly different between children and adults.
PMID: 34009406
ISSN: 1432-1998
CID: 4888742