@article{pmid38351410,

title = {Phosphaturic mesenchymal tumor: management and outcomes of ten patients treated at a single institution},

author = {Marcos R Gonzalez and Neel Patel and Joseph J Connolly and Yin P Hung and Connie Y Chang and Santiago A Lozano-Calderon},

doi = {10.1007/s00256-024-04614-6},

issn = {1432-2161},

year  = {2024},

date = {2024-08-01},

journal = {Skeletal Radiol},

volume = {53},

number = {8},

pages = {1495--1506},

abstract = {BACKGROUND: Phosphaturic mesenchymal tumor (PMT) is a rare tumor that causes tumor-induced osteomalacia. Patients present with non-specific symptoms secondary to renal phosphate wasting and decreased bone mineralization. We sought to assess: (1) What are the common presenting features, laboratory and imaging findings, histologic findings of phosphaturic mesenchymal tumors? (2) What are the available treatment strategies for phosphaturic mesenchymal tumors and their long-term outcomes in terms of local recurrence and symptom control after treatment?nnMETHODS: We retrospectively identified patients with a histologic diagnosis of PMT located in the axial or appendicular skeleton, or surrounding soft tissues. A total of 10 patients were finally included in our study.nnRESULTS: Median tumor size was 1.9 cm (range, 1.1 to 6.1) and median time from symptom onset to diagnosis was 3 years (range, 0.5 to 15 years). All patients but one presented with hypophosphatemia (median 1.9 mg/dL, range 1.2 to 3.2). Pre-operative FGF-23 was elevated in all cases (median 423.5 RU/mL, range 235 to 8950). Six patients underwent surgical resection, three were treated percutaneously (radiofrequency ablation or cryoablation), and one refused treatment. Only one patient developed local recurrence and no patients developed metastatic disease. At last follow-up, nine patients showed no evidence of disease and one was alive with disease.nnCONCLUSION: Phosphaturic mesenchymal tumor is a rare tumor presenting with non-specific symptoms. Surgery is the standard treatment when negative margins can be achieved without significant morbidity. In patients with small tumors in surgically-inaccessible areas, radiofrequency ablation or cryoablation can be performed successfully.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38459983,

title = {Bone Density Screening Rates Among Medicare Beneficiaries: An Analysis with a focus on Asian Americans},

author = {Soterios Gyftopoulos and Casey E Pelzl and Madalena Da Silva Cardoso and Juliana Xie and Simona C Kwon and Connie Y Chang},

doi = {10.1007/s00256-024-04643-1},

issn = {1432-2161},

year  = {2024},

date = {2024-03-01},

journal = {Skeletal Radiol},

abstract = {PURPOSE: To report osteoporosis screening utilization rates among Asian American (AsA) populations in the USA.nnMETHODS: We retrospectively assessed the use of dual-energy X-ray absorptiometry (DXA) screening using the Medicare 5% Research Identifiable Files. Using Current Procedural Terminology (CPT) codes indicative of a DXA scan, we identified patients recommended for DXA screening according to the ACR-SPR-SSR Practice Parameters (females ≥ 65 years, males ≥ 70 years). Sociodemographic factors and their association with screening were evaluated using chi-square tests.nnRESULTS: There were 80,439 eligible AsA beneficiaries, and 12,102 (15.1%) received osteoporosis screening. DXA rate for women was approximately four times greater than the rate for men (19.8% vs. 5.0%; p < 0.001). AsA beneficiaries in zip codes with higher mean household income (MHI) were more likely to have DXA than those in lower MHI areas (17.6% vs. 14.3%, p < 0.001). AsA beneficiaries aged < 80 were more likely to receive DXA (15.5%) than those aged ≥ 80 (14.1%, p < 0.001). There were 2,979,801 eligible non-AsA beneficiaries, and 496,957 (16.7%) received osteoporosis screening during the study period. Non-Hispanic white beneficiaries had the highest overall screening rate (17.5%), followed by North American Native (13.0%), Black (11.8%), and Hispanic (11.1%) beneficiaries. Comparing AsA to non-AsA populations, there were significantly lower DXA rates among AsA beneficiaries when controlling for years of Medicare eligibility, patient age, sex, location, and mean income (p < 0.001).nnCONCLUSION: We found lower than expected DXA screening rates for AsA patients. A better understanding of the barriers and facilitators to AsA osteoporosis screening is needed to improve patient care.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38413401,

title = {Can gas and infection coexist in the intervertebral disc? A retrospective analysis of percutaneously biopsied suspected discitis-osteomyelitis cases},

author = {Jad S Husseini and Arnau Hanly and Emre Omeroglu and Sandra B Nelson and Mary Kate Jesse and F Joseph Simeone and Connie Y Chang},

doi = {10.1007/s00256-024-04631-5},

issn = {1432-2161},

year  = {2024},

date = {2024-02-01},

journal = {Skeletal Radiol},

abstract = {OBJECTIVES: To retrospectively evaluate the correlation between intradiscal gas and infection in patients percutaneously biopsied for suspected discitis-osteomyelitis.nnMATERIALS AND METHODS: We retrospectively reviewed all CT-guided discitis-osteomyelitis biopsies performed between 2002 and 2022. Two independent trained musculoskeletal radiologists evaluated for presence of gas on CT and/or MRI within 1 week of the biopsy. Disagreements were resolved by a third musculoskeletal radiologist. CT was considered the gold standard for the detection of intradiscal gas. Pathology, microbiology, and imaging and clinical follow-up were used as the gold standard for presence of infection. Interrater agreement on CT and MRI, sensitivity, and positive predictive value were calculated, using the presence of gas as an indicator (test positive) for "no infection."nnRESULTS: There were 284 biopsies in 275 subjects (mean age 58 ± 1.0 (range 4-99) years; 101 (37%) females and 174 (63%) males). Of the biopsies, 12 (4%) were cervical, 80 (28%) were thoracic, 192 (68%) were lumbar, and 200 (70%) were considered true discitis-osteomyelitis based on pathology, imaging, and clinical follow-up. Interrater agreement was excellent for CT (kappa = 0.83) and poor for MRI (kappa =  - 0.021). The presence of gas had a 94% specificity and 76% negative predictive value for the absence of infection.nnCONCLUSION: CT is the preferred method for detecting intradiscal gas. The presence of gas means that discitis-osteomyelitis is unlikely. If intradiscal gas is present in the setting of discitis-osteomyelitis, the gas bubbles tend to be smaller and fewer in number.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38290886,

title = {Bone Marrow Biopsies: Is CT, Fluoroscopy, or no Imaging Guidance the Most Cost-Effective Strategy?},

author = {Soterios Gyftopoulos and Madalena Da Silva Cardoso and Jim S Wu and Naveen Subhas and Connie Y Chang},

doi = {10.1016/j.acra.2024.01.019},

issn = {1878-4046},

year  = {2024},

date = {2024-01-01},

journal = {Acad Radiol},

abstract = {RATIONALE AND OBJECTIVES: To determine the most cost-effective strategy for pelvic bone marrow biopsies.nnMATERIALS AND METHODS: A decision analytic model from the health care system perspective for patients with high clinical concern for multiple myeloma (MM) was used to evaluate the incremental cost-effectiveness of three bone marrow core biopsy techniques: computed tomography (CT) guided, and fluoroscopy guided, no-imaging (landmark-based). Model input data on utilities, costs, and probabilities were obtained from comprehensive literature review and expert opinion. Costs were estimated in 2023 U.S. dollars. Primary effectiveness outcome was quality adjusted life years (QALY). Willingness to pay threshold was $100,000 per QALY gained.nnRESULTS: No-imaging based biopsy was the most cost-effective strategy as it had the highest net monetary benefit ($4218) and lowest overall cost ($92.17). Fluoroscopy guided was excluded secondary to extended dominance. CT guided biopsies were less preferred as it had an incremental cost-effectiveness ratio ($334,043) greater than the willingness to pay threshold. Probabilistic sensitivity analysis found non-imaging based biopsy to be the most cost-effective in 100% of simulations and at all willingness to pay thresholds up to $200,000.nnCONCLUSION: No-imaging based biopsy appears to be the most cost-effective strategy for bone marrow core biopsy in patients suspected of MM.nnCLINICAL RELEVANCE: No imaging guidance is the preferred strategy, although image-guidance may be required for challenging anatomy. CT image interpretation may be helpful for planning biopsies. Establishing a non-imaging guided biopsy service with greater patient anxiety and pain support may be warranted.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38042625,

title = {Five Years of the Musculoskeletal Radiology Fellowship Match: Trends and Perspectives},

author = {Robert W Morris and Maxine E Kresse and Connie Y Chang and Eric M Goodman},

doi = {10.1016/j.acra.2023.11.019},

issn = {1878-4046},

year  = {2023},

date = {2023-12-01},

journal = {Acad Radiol},

abstract = {RATIONALE AND OBJECTIVES: The 2023 Match marks 5 years since the Musculoskeletal (MSK) Radiology Fellowship Match first took place in June 2019. The objective of this study is to analyze trends in the MSK Match over its 5-year course.nnMATERIALS AND METHODS: Data from the National Resident Matching Program were evaluated for the number of applicants, medical school type of matched applicants, number of programs, and number of positions. Programs were grouped according to geographic region, program size, and ACGME accreditation status. These data were plotted to look for trends over time and by program characteristics.nnRESULTS: There has been little variation in the number of eligible programs registering for the Match (range 80-83). The number of available positions has had a wider variation (range 204-218), and the number of applicants preferring MSK has varied from 156 to 178. The gap between positions and applicants has resulted in a percentage of positions filled that has ranged from 70.9% to 82.4%. Program size is positively correlated with Match rates, with 100% of programs with five or more positions filling ≥ 50% in 4 out of 5 years.nnCONCLUSION: The variable numbers of fellowship positions and applicants have resulted in variable success of the Match by all metrics. Maintaining or increasing the number of applicants is the most critical factor for ongoing Match success.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38133671,

title = {Current state of musculoskeletal fellowship program directors and future directions},

author = {Maxine E Kresse and Robert W Morris and Jennifer S Weaver and Connie Y Chang},

doi = {10.1007/s00256-023-04553-8},

issn = {1432-2161},

year  = {2023},

date = {2023-12-01},

journal = {Skeletal Radiol},

abstract = {OBJECTIVE: To better understand the current state of musculoskeletal fellowship program directors and identify opportunities for formal training that could increase job satisfaction, provide a broader knowledge base for mentoring/advising trainees and increase diversity in musculoskeletal radiology.nnMATERIALS AND METHODS: Eighty-one fellowship program directors who signed the Fellowship Match Memorandum of Understanding with the Society of Skeletal Radiology were sent a survey with questions about demographics, career, background, and training both for musculoskeletal radiology and for the fellowship director role.nnRESULTS: A 57/81 (70%) of program directors responded, representing 27 different states with a range of 1-9 fellowship positions. Nearly half are in their forties (48%) with most identifying as White (67%) followed by Asian (30%). The majority are male (72%) with over half (60%) remaining at the institution where they completed prior training. Over half plan to change roles within 5 years and do not feel adequately compensated. Top qualities/skills identified as important for the role include effective communication, being approachable, and clinical excellence. Other than clinical excellence, most do not report formal training in skills identified as important for the role.nnCONCLUSIONS: Given the high amount of interaction with trainees, program directors play a key role in the future of our subspecialty. The low diversity among this group, the lack of formal training, and the fact that most do not feel adequately compensated could limit mentorship and recruitment. Program directors identified effective communication, organizational/planning skills, and conflict resolution as the top skills they would benefit from formal training.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38097764,

title = {CT-guided lumbar facet cyst rupture and corticosteroid injection: technique, approach, and procedural and clinical success rates},

author = {Ronald W Mercer and Joao R T Vicentini and Steven J Staffa and Ukasha Habib and Rosa Cho and Connie Y Chang},

doi = {10.1007/s00256-023-04544-9},

issn = {1432-2161},

year  = {2023},

date = {2023-12-01},

journal = {Skeletal Radiol},

abstract = {PURPOSE: To evaluate success rates of computed tomography (CT)-guided lumbar facet synovial cyst (LFC) rupture.nnMATERIALS AND METHODS: We retrospectively reviewed all LFC ruptures performed by a single musculoskeletal radiologist with > 10 years of experience, using posterior facet approach and/or direct puncture by ipsilateral/contralateral interlaminar, or transforaminal approach. All patients also received a corticosteroid injection. Rupture rates were calculated, and clinical success rate was determined through medical record review. Pre-procedure magnetic resonance imaging (MRI) images and CT procedure images were also reviewed for LFC and facet joint imaging features that may predict rupture.nnRESULTS: There were 37 patients, 17 (46%) female and 20 (54%) male, ages 62 ± 12 (range 39-87) years. Thirty-four (92%) of LFC were successfully ruptured, 17 (50%) by facet approach and 17 (50%) by direct cyst puncture. At least one direct puncture approach was possible in 35 (95%) patients. No MRI or CT LFC or facet joint features predicted cyst rupture. Thirty-one (91%) of patients reported immediate pain relief, and 19 (53%) did not have further intervention for LFC-related pain. Sixteen (84%) of these patients remained pain-free for an average follow-up time period of 28 months. Fourteen (39%) of patients required surgical intervention. There were no complications.nnCONCLUSION: Our systematic approach to CT-guided LFC rupture is safe and has high technical and clinical success rates similar to prior studies. Since there are no definitive imaging features that determine rupture success, this procedure can almost always be attempted as a first-line treatment for LFC.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38133671b,

title = {Current state of musculoskeletal fellowship program directors and future directions},

author = {Maxine E Kresse and Robert W Morris and Jennifer S Weaver and Connie Y Chang},

doi = {10.1007/s00256-023-04553-8},

issn = {1432-2161},

year  = {2023},

date = {2023-12-01},

journal = {Skeletal Radiol},

abstract = {OBJECTIVE: To better understand the current state of musculoskeletal fellowship program directors and identify opportunities for formal training that could increase job satisfaction, provide a broader knowledge base for mentoring/advising trainees and increase diversity in musculoskeletal radiology.nnMATERIALS AND METHODS: Eighty-one fellowship program directors who signed the Fellowship Match Memorandum of Understanding with the Society of Skeletal Radiology were sent a survey with questions about demographics, career, background, and training both for musculoskeletal radiology and for the fellowship director role.nnRESULTS: A 57/81 (70%) of program directors responded, representing 27 different states with a range of 1-9 fellowship positions. Nearly half are in their forties (48%) with most identifying as White (67%) followed by Asian (30%). The majority are male (72%) with over half (60%) remaining at the institution where they completed prior training. Over half plan to change roles within 5 years and do not feel adequately compensated. Top qualities/skills identified as important for the role include effective communication, being approachable, and clinical excellence. Other than clinical excellence, most do not report formal training in skills identified as important for the role.nnCONCLUSIONS: Given the high amount of interaction with trainees, program directors play a key role in the future of our subspecialty. The low diversity among this group, the lack of formal training, and the fact that most do not feel adequately compensated could limit mentorship and recruitment. Program directors identified effective communication, organizational/planning skills, and conflict resolution as the top skills they would benefit from formal training.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38097764b,

title = {CT-guided lumbar facet cyst rupture and corticosteroid injection: technique, approach, and procedural and clinical success rates},

author = {Ronald W Mercer and Joao R T Vicentini and Steven J Staffa and Ukasha Habib and Rosa Cho and Connie Y Chang},

doi = {10.1007/s00256-023-04544-9},

issn = {1432-2161},

year  = {2023},

date = {2023-12-01},

journal = {Skeletal Radiol},

abstract = {PURPOSE: To evaluate success rates of computed tomography (CT)-guided lumbar facet synovial cyst (LFC) rupture.nnMATERIALS AND METHODS: We retrospectively reviewed all LFC ruptures performed by a single musculoskeletal radiologist with > 10 years of experience, using posterior facet approach and/or direct puncture by ipsilateral/contralateral interlaminar, or transforaminal approach. All patients also received a corticosteroid injection. Rupture rates were calculated, and clinical success rate was determined through medical record review. Pre-procedure magnetic resonance imaging (MRI) images and CT procedure images were also reviewed for LFC and facet joint imaging features that may predict rupture.nnRESULTS: There were 37 patients, 17 (46%) female and 20 (54%) male, ages 62 ± 12 (range 39-87) years. Thirty-four (92%) of LFC were successfully ruptured, 17 (50%) by facet approach and 17 (50%) by direct cyst puncture. At least one direct puncture approach was possible in 35 (95%) patients. No MRI or CT LFC or facet joint features predicted cyst rupture. Thirty-one (91%) of patients reported immediate pain relief, and 19 (53%) did not have further intervention for LFC-related pain. Sixteen (84%) of these patients remained pain-free for an average follow-up time period of 28 months. Fourteen (39%) of patients required surgical intervention. There were no complications.nnCONCLUSION: Our systematic approach to CT-guided LFC rupture is safe and has high technical and clinical success rates similar to prior studies. Since there are no definitive imaging features that determine rupture success, this procedure can almost always be attempted as a first-line treatment for LFC.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38015622b,

title = {[11C]-PBR28 positron emission tomography signal as an imaging marker of joint inflammation in knee osteoarthritis},

author = {Angelica Sandström and Angel Torrado-Carvajal and Erin J Morrissey and Minhae Kim and Zeynab Alshelh and Yehui Zhu and Matthew D Li and Connie Y Chang and Mohamed Jarraya and Oluwaseun Akeju and Andrew Schrepf and Richard E Harris and Young-Min Kwon and Hany Bedair and Antonia F Chen and Nathaniel D Mercaldo and Norman Kettner and Vitaly Napadow and Nicola Toschi and Robert R Edwards and Marco L Loggia},

doi = {10.1097/j.pain.0000000000003114},

issn = {1872-6623},

year  = {2023},

date = {2023-11-01},

journal = {Pain},

abstract = {Although inflammation is known to play a role in knee osteoarthritis (KOA), inflammation-specific imaging is not routinely performed. In this article, we evaluate the role of joint inflammation, measured using [11C]-PBR28, a radioligand for the inflammatory marker 18-kDa translocator protein (TSPO), in KOA. Twenty-one KOA patients and 11 healthy controls (HC) underwent positron emission tomography/magnetic resonance imaging (PET/MRI) knee imaging with the TSPO ligand [11C]-PBR28. Standardized uptake values were extracted from regions-of-interest (ROIs) semiautomatically segmented from MRI data, and compared across groups (HC, KOA) and subgroups (unilateral/bilateral KOA symptoms), across knees (most vs least painful), and against clinical variables (eg, pain and Kellgren-Lawrence [KL] grades). Overall, KOA patients demonstrated elevated [11C]-PBR28 binding across all knee ROIs, compared with HC (all P's < 0.005). Specifically, PET signal was significantly elevated in both knees in patients with bilateral KOA symptoms (both P's < 0.01), and in the symptomatic knee (P < 0.05), but not the asymptomatic knee (P = 0.95) of patients with unilateral KOA symptoms. Positron emission tomography signal was higher in the most vs least painful knee (P < 0.001), and the difference in pain ratings across knees was proportional to the difference in PET signal (r = 0.74, P < 0.001). Kellgren-Lawrence grades neither correlated with PET signal (left knee r = 0.32, P = 0.19; right knee r = 0.18, P = 0.45) nor pain (r = 0.39, P = 0.07). The current results support further exploration of [11C]-PBR28 PET signal as an imaging marker candidate for KOA and a link between joint inflammation and osteoarthritis-related pain severity.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37875572,

title = {Decreased rotator cuff muscle cross-sectional areas in subjects with adhesive capsulitis: a study comparing male and female subjects},

author = {Ivanna Zorgno and F Joseph Simeone and Marilyn E Galdamez and Connie Y Chang and Florian A Huber and Martin Torriani},

doi = {10.1007/s00256-023-04487-1},

issn = {1432-2161},

year  = {2023},

date = {2023-10-01},

journal = {Skeletal Radiol},

abstract = {OBJECTIVE: To compare rotator cuff (RC) muscle cross-sectional areas (CSA) in subjects with adhesive capsulitis (AC) to age- and sex-matched controls.nnMATERIALS AND METHODS: We retrospectively analyzed 97 shoulder MRIs or MR arthrography studies, of which 42 were clinically diagnosed with AC (27 female, 15 male) and 55 were age- and sex-matched controls (38 female, 17 male). All AC subjects underwent imaging ≥ 6 months after symptom onset. All imaging was examined to exclude RC full-thickness tears and prior surgery. A standardized T1 sagittal MR image was segmented in each subject to obtain the CSA of subscapularis (SSC), supraspinatus (SSP), and infraspinatus (ISP) muscles. Differences in CSAs between AC and control subjects were analyzed by sex (females and males separately) and all subjects combined.nnRESULTS: AC females had significantly decreased SSC (P = 0.002) and total (P = 0.006) CSAs compared to controls. Male AC subjects showed decreased SSC (P = 0.044), SSP (P = 0.001), and total (P = 0.005) CSAs. Across all subjects, male and female, the AC cohort had significantly decreased SSC (P = 0.019) and total (P = 0.029) CSAs compared to controls.nnCONCLUSION: Decreased RC muscle CSAs were present in AC subjects with ≥ 6 months of symptom duration, with decreased SSC and total CSAs in male and female subjects, and decreased SSP CSA in males.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37839692,

title = {Innovation Grants to Advance the Careers of Clinical Radiology Faculty},

author = {Miriam A Bredella and Carmen Alvarez and Connie Y Chang and James A Brink and James H Thrall},

doi = {10.1016/j.jacr.2023.03.027},

issn = {1558-349X},

year  = {2023},

date = {2023-10-01},

journal = {J Am Coll Radiol},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37542655,

title = {Posterior capsule edema in adhesive capsulitis: comparison with established non-contrast MRI findings and multivariable analysis},

author = {Rajdeep Kapoor and Jad S Husseini and Steven J Staffa and William E Palmer and Martin Torriani and Connie Y Chang and F Joseph Simeone},

doi = {10.1007/s00330-023-09966-6},

issn = {1432-1084},

year  = {2023},

date = {2023-08-01},

journal = {Eur Radiol},

abstract = {OBJECTIVES: To evaluate posterior glenohumeral capsule edema compared to other MRI findings in adhesive capsulitis (AC).nnMETHODS: This study was approved by the local Institutional Review Board and it is HIPAA compliant. A retrospective search identified subjects who received fluoroscopically guided intra-articular corticosteroid injections for AC and had an MRI within 6 months prior to injection. The study group was compared with an age-, sex-, and side-matched control group who underwent the same procedures but did not have AC. MRIs were evaluated for edema of posterior capsule, anterior capsule, axillary pouch, coracohumeral ligament (CHL) and rotator interval (RI), thickness of axillary pouch and CHL, thickness of anterior capsule, RI and subcoracoid fat replacement, and teres minor atrophy and edema. Multivariable analysis was performed.nnRESULTS: A total of 57 subjects with AC and 57 matched controls were studied: mean age 52 ± 7 (range 31-71) years, 37 female and 20 male, 22 right and 35 left. Posterior capsule edema was more common in the AC group vs. control group (66.7 vs 17.5%, p < 0.001). Multivariable analysis showed posterior capsule edema, CHL edema, and axillary pouch (glenoid) thickness (optimum cutoff = 4 mm) were significant independent predictors of AC. Simplified analysis using these three variables had an area under the curve of 0.860 (95%CI: 0.792-0.928). With all three variables present, the sensitivity and specificity for AC were 32% and 98%, respectively.nnCONCLUSIONS: Posterior joint capsule edema may be helpful to confirm AC. Posterior capsule edema, CHL edema, and axillary pouch (glenoid) thickness produce a strong model for distinguishing AC from controls.nnCLINICAL RELEVANCE STATEMENT: Edema involving the posterior shoulder joint capsule is an imaging marker of capsulitis and is useful in differentiating patients with adhesive capsulitis from those without in conjunction with other proven MRI findings.nnKEY POINTS: • Posterior capsule edema has a sensitivity of 66.7% and a specificity of 82.5% for the detection of adhesive capsulitis. • Posterior capsule edema, coracohumeral ligament (CHL) edema, and axillary pouch (glenoid) thickness were significant independent predictors of adhesive capsulitis, and combining these variables together produces a very strong model for distinguishing cases from controls (AUC = 0.860). • Optimal cutoff values for CHL, axillary pouch (humeral), axillary pouch (glenoid), and axillary pouch (total) thickness were 2.5, 2.6, 4, and 6.3 mm, respectively.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37635152,

title = {Intraosseous pressure measurement during iliac bone marrow biopsy: its feasibility and difference of IOP in diseased marrow and non-diseased marrow},

author = {Joao Rafael T Vicentini and Sina Habibollahi and Ukasha Habib and Connie Y Chang},

doi = {10.1007/s00256-023-04431-3},

issn = {1432-2161},

year  = {2023},

date = {2023-08-01},

journal = {Skeletal Radiol},

abstract = {OBJECTIVE: The purposes of this study were (1) to establish the feasibility and safety of an imaging-guided technique for intraosseous pressure (IOP) measurement in a large cohort of patients, and (2) to compare IOP values between normal and diseased bone marrow.nnMETHODS: Adult patients undergoing CT-guided marrow biopsy were prospectively and consecutively enrolled from November 2020 to February 2022. IOP measurements were obtained connecting the biopsy needle to a monitoring device using a standard arterial line setup. Clinical data including sex, age and pathology results were obtained. Student t test and Pearson correlation were used for continuous variables comparisons. Univariable analyses were performed using Fisher's exact test. A P value of .05 was considered statistically significant.nnRESULTS: A total of 139 participants were initially enrolled, and four were excluded during technique optimization. There were no complications related to the measurement technique. Ninety participants (90/135, 67%) had histology confirming marrow pathology. The participants in the diseased marrow group were older than those in the normal marrow group (63 ± 14 vs. 55 ± 14 years; P < .01). There was no difference in mean IOP between both groups (66 ± 23 vs. 64 ± 28 mmHg; P = .69). There was no correlation between mean arterial blood pressure and mean IOP (P = .08).nnCONCLUSION: There was no difference in IOP measurements between patients with normal and diseased marrow undergoing CT-guided biopsy. IOP does not appear to be influenced by systemic blood pressure. No complication occurred during the procedures.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37632549,

title = {Anterior and posterior hip osteoarthritis: prevalence and potential value of CT compared to radiographs},

author = {Ronald W Mercer and Cynthia Assimta Peter and Ukasha Habib and Juliana Xie and Adam Graeber and F Joseph Simeone and Connie Y Chang},

doi = {10.1007/s00256-023-04434-0},

issn = {1432-2161},

year  = {2023},

date = {2023-08-01},

journal = {Skeletal Radiol},

abstract = {PURPOSE: To determine the added value of computed tomography (CT) to identify severe hip osteoarthritis (OA).nnMATERIALS AND METHODS: A retrospective query of all cases of hip or knee arthroplasty planning CTs between January 2018 and March 2022 was performed. Age, sex, and symptoms were collected from the medical record. CTs were evaluated for the degree of osteoarthritis and classified using an adapted Kellgren-Lawrence (KL) grading system in the anterior, posterior, superior, and superomedial hip. Frontal hip or pelvis radiographs within 1 year of the CT were also graded.nnRESULTS: There were 265 eligible hips in 178 subjects, age 66 ± 11 (range 31-93) years, with 85/178 (48%) males and 93/178 (52%) females, and 127/265 (48%) right and 138/265 (52%) left hips. The posterior hip joint was the most common location for grade 2/3 OA (20%), followed by superior hip joint (14%). Anterior or posterior grade 2/3 OA occurred concurrently with superior or superomedial grade 2/3 OA in 32/68 (47%) of hips. Grade 2/3 OA was detected on CT more commonly than on XR both in the superior (14 vs 8.6%, P = 0.0016) and superomedial (8.7 vs 4.8%, P = 0.016) hip joint. Of the 71 symptomatic hips, 22 (31%) hips demonstrated either anterior and/or posterior grade 2/3 OA on CT, and 9 (9/22, 41%) of these hips had superior or superomedial grade 0/1 OA.nnCONCLUSION: CT may be warranted when the patient has pain suggestive of osteoarthritis not detected on radiographs.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36651936,

title = {Original research: utilization of a convolutional neural network for automated detection of lytic spinal lesions on body CTs},

author = {Connie Y Chang and Florian A Huber and Kaitlyn J Yeh and Colleen Buckless and Martin Torriani},

doi = {10.1007/s00256-023-04283-x},

issn = {1432-2161},

year  = {2023},

date = {2023-07-01},

journal = {Skeletal Radiol},

volume = {52},

number = {7},

pages = {1377--1384},

abstract = {OBJECTIVE: To develop, train, and test a convolutional neural network (CNN) for detection of spinal lytic lesions in chest, abdomen, and pelvis CT scans.nnMATERIALS AND METHODS: Cases of malignant spinal lytic lesions in CT scans were identified. Images were manually segmented for the following classes: (i) lesion, (ii) normal bone, (iii) background. If more than one lesion was on a single slice, all lesions were segmented. Images were stored as 128×128 pixel grayscale, with 10% segregated for testing. The training pipeline of the dataset included histogram equalization and data augmentation. A model was trained on Keras/Tensorflow using an 80/20 training/validation split, based on U-Net architecture. Additional testing of the model was performed on 1106 images of healthy controls. Global sensitivity measured detection of any lesion on a single image. Local sensitivity and positive predictive value (PPV) measured detection of all lesions on an image. Global specificity measured false positive rate in non-pathologic bone.nnRESULTS: Six hundred images were obtained for model creation. The training set consisted of 540 images, which was augmented to 20,000. The test set consisted of 60 images. Model training was performed in triplicate. Mean Dice scores were 0.61 for lytic lesion, 0.95 for normal bone, and 0.99 for background. Mean global sensitivity was 90.6%, local sensitivity was 74.0%, local PPV was 78.3%, and global specificity was 63.3%. At least one false positive lesion was noted in 28.8-44.9% of control images.nnCONCLUSION: A task-trained CNN showed good sensitivity in detecting spinal lytic lesions in axial CT images.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36355218,

title = {Helical CT versus intermittent CT fluoroscopic guidance for musculoskeletal needle biopsies: impact on radiation exposure, procedure time, diagnostic yield, and adverse events},

author = {A M Cahalane and S Habibollahi and S J Staffa and K Yang and F J Fintelmann and C Y Chang},

doi = {10.1007/s00256-022-04226-y},

issn = {1432-2161},

year  = {2023},

date = {2023-06-01},

journal = {Skeletal Radiol},

volume = {52},

number = {6},

pages = {1119--1126},

abstract = {OBJECTIVE: Image-guided percutaneous needle biopsies are essential in the workup of musculoskeletal (MSK) lesions. While helical CT (HCT) is well established, intermittent CT fluoroscopy (iCTF) is an increasingly used alternative. The purpose of this study is to establish whether differences in subject radiation exposure, procedure time, yield, or adverse events exist between HCT and iCTF guidance.nnMATERIALS AND METHODS: This retrospective cohort study included consecutive MSK needle biopsies performed on a single-CT scanner over a 12-month period at a tertiary academic center. Subject demographics, radiation dose, and outcomes were abstracted from the medical record. Comparisons between the two cohorts were performed using Student's t-test for continuous data and using Fisher's exact test for categorical data and a two-tailed p value less than 0.05 was considered significant.nnRESULTS: Two hundred sixteen adults (115 (53.2%) females) with a mean age of 58.8 ± 18.4 years, underwent 216 biopsies (109 (50.5%) HCT guided, 107 (49.5%) iCTF guided) between June 2017 and June 2018. Dose-length product (DLP) and volume CT dose index (CTDIvol) were significantly higher for the HCT cohort (HCT 698.9 ± 400.8 mGycm vs iCTF 312.8 ± 170.8 mGycm; p < 0.005 and HCT 19.1 mGy ± 8.8 vs iCTF 6.9 mGy ± 1.5, p < 0.001). No significant difference in diagnostic yield, procedure time, or adverse event rate was identified.nnCONCLUSION: For CT-guided MSK needle biopsies, iCTF decreases subject radiation dose compared to HCT without negatively affecting outcomes. iCTF should be strongly considered by radiologists performing MSK biopsies given the reduced patient radiation exposure.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chang2023,

title = {Image-Guided Biopsy in Acute Diskitis-Osteomyelitis: A Systematic Review and Meta-Analysis},

author = {Connie Y. Chang and Casey Pelzl and Mary Kate Jesse and Sina Habibollahi and Ukasha Habib and Soterios Gyftopoulos},

doi = {10.2214/ajr.22.28423},

issn = {1546-3141},

year  = {2023},

date = {2023-04-00},

journal = {American Journal of Roentgenology},

volume = {220},

number = {4},

pages = {499--511},

publisher = {American Roentgen Ray Society},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35581686,

title = {Prevalence of Paget's disease of bone: review of consecutive abdominopelvic CT scans and literature},

author = {Jad S Husseini and Ruben Oganesyan and Steven J Staffa and Emily Huang and Sina Habibollahi and Robert Hemke and Connie Chang},

doi = {10.1177/02841851221101881},

issn = {1600-0455},

year  = {2023},

date = {2023-03-01},

journal = {Acta Radiol},

volume = {64},

number = {3},

pages = {1086--1092},

abstract = {BACKGROUND: Previous studies suggest an overall decrease of Paget's disease of bone (PDB) prevalence. However, a large number of asymptomatic patients make previously reported prevalence likely underrepresented.nnPURPOSE: To evaluate the prevalence of PDB in our patient population.nnMATERIAL AND METHODS: We retrospectively identified 1295 (mean age = 59 years; age range = 18-98 years) consecutive abdominopelvic computed tomography (CT) scans over a 15-day period in 2014. Abdominopelvic CT images were reviewed to assess for the presence of PDB in the lower thoracic spine, lumbar spine, pelvis, or proximal femora. This prevalence was compared with prevalence reported in earlier literature using Fisher's exact test.nnRESULTS: Of the included patients, 5/1295 (0.39%) patients had imaging findings of PDB on abdominopelvic CT. Those five patients were all aged ≥55 years and had pelvic bone involvement, with one patient having additional involvement of multiple lower thoracic vertebral bodies. In our studied cohort, 812/1295 (62.7%) patients were aged ≥55 years, which corresponds to a prevalence of 0.62% (5/812) of PDB in patients aged ≥55 years. When accounting for fact that bones of the pelvis are involved in 40%-91% of patients with PDB, the prevalence is estimated at 0.43%-0.98% in the total adult population and estimated at 0.68%-1.55% in older adults. The prevalence was greater than two studies before 1960, and less than some studies during 1960-2019.nnCONCLUSION: We found that the prevalence of PDB on abdominopelvic CTs was 0.39% of all adult patients with an increase after the age of 55 years.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36332985,

title = {Ten-Year Follow-up of Internal Neurofibroma Growth Behavior in Adult Patients With Neurofibromatosis Type 1 Using Whole-Body MRI},

author = {K Ina Ly and Vanessa L Merker and Wenli Cai and Miriam A Bredella and Alona Muzikansky and Raquel D Thalheimer and Jennifer Liwei Da and Christina C Orr and Hamilton P Herr and Mary E Morris and Connie Y Chang and Gordon J Harris and Scott R Plotkin and Justin T Jordan},

doi = {10.1212/WNL.0000000000201535},

issn = {1526-632X},

year  = {2023},

date = {2023-02-01},

journal = {Neurology},

volume = {100},

number = {7},

pages = {e661--e670},

abstract = {BACKGROUND AND OBJECTIVES: Internal neurofibromas, including plexiform neurofibromas (PNF), can cause significant morbidity in patients with neurofibromatosis type 1 (NF1). PNF growth is most pronounced in children and young adults, with more rapid growth thought to occur in a subset of PNF termed distinct nodular lesions (DNL). Growth behavior of internal neurofibromas and DNL in older adults is not well documented; yet knowledge thereof is important for patient risk stratification and clinical trial design. The primary objective of this study was to evaluate the long-term growth behavior of internal neurofibromas in adults with NF1. Secondary objectives were to correlate tumor growth behavior with patient-specific, tumor-specific, and patient-reported variables.nnMETHODS: In this prospective cohort study, internal neurofibromas were identified on coronal short TI inversion recovery sequences on baseline and follow-up whole-body MRIs (WBMRIs). Tumor growth and shrinkage were defined as a volume change ≥20%. The association between tumor growth and patient-specific (baseline age, sex, and genotype), tumor-specific (morphology, location, DNL presence on baseline WBMRI, and maximum standardized uptake value on baseline PET imaging), and patient-reported variables (endogenous and exogenous hormone exposure, pain intensity, and quality of life) was assessed using the Spearman correlation coefficient and Kruskal-Wallis test.nnRESULTS: Of 106 patients with a baseline WBMRI obtained as part of a previous research study, 44 had a follow-up WBMRI. Three additional patients with WBMRIs acquired for clinical care were included, generating 47 adults for this study. The median age during baseline WBMRI was 42 years (range 18-70). The median time between WBMRIs was 10.4 years. Among 324 internal neurofibromas, 62.8% (56% of PNF and 62.1% of DNL) shrank spontaneously without treatment and 17.1% (17.9% of PNF and 13.8% of DNL) grew. Growth patterns were heterogeneous within participants. Patient-specific, tumor-specific, and patient-reported variables (including endogenous and exogenous hormone exposure) were not strong predictors of tumor growth.nnDISCUSSION: Internal neurofibroma growth behavior in older adults differs fundamentally from that in children and young adults, with most tumors, including DNL, demonstrating spontaneous shrinkage. Better growth models are needed to understand factors that influence tumor growth. These results will inform clinical trial design for internal neurofibromas.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35787202,

title = {Relationship of Imaging-guided Corticosteroid Injections to COVID-19 Incidence in the Pandemic Recovery Period},

author = {Joao R T Vicentini and Sina Habibollahi and Steven J Staffa and Frank J Simeone and Arvin B Kheterpal and Adam R Graeber and Miriam A Bredella and Connie Y Chang},

doi = {10.1148/radiol.220271},

issn = {1527-1315},

year  = {2023},

date = {2023-01-01},

journal = {Radiology},

volume = {306},

number = {1},

pages = {237--243},

abstract = {Background Corticosteroids injected for the treatment of musculoskeletal pain are systemically absorbed and can affect the immune response to viral infections. Purpose To determine the incidence of symptomatic COVID-19 disease in individuals receiving image-guided corticosteroid injections for musculoskeletal pain compared with the general population during the pandemic recovery period. Materials and Methods In this prospective cohort multicenter study, adults with a history of musculoskeletal pain who underwent imaging-guided intra-articular and spine corticosteroid injections from April 2020 to February 2021 were consecutively enrolled. Participants were followed for a minimum of 28 days through their electronic medical record (EMR) or by direct phone communication to screen for COVID-19 test results or symptoms. Clinical data, including body mass index (BMI), were also obtained from the EMR. The incidence of COVID-19 in the state was obtained using the Massachusetts COVID-19 Response Reporting website. The Student  test was used for continuous variable comparisons. Univariable analyses were performed using the Fisher exact test. Results A total of 2714 corticosteroid injections were performed in 2190 adult participants (mean age, 59 years ± 15 [SD]; 1031 women). Follow-up was available for 1960 participants (89%) who received 2484 injections. Follow-up occurred a mean of 97 days ± 33 (range, 28-141 days) after the injection. Of the 1960 participants, 10 had COVID-19 within 28 days from the injection (0.5% [95% CI: 0.24, 0.94]) and 43 had COVID-19 up to 4 months after the injection (2.2% [95% CI: 1.6, 2.9]). These incidence rates were lower than that of the population of Massachusetts during the same period (519 195 of 6 892 503 [7.5%],  < .001 for both 28 days and 4 months). Participants diagnosed with COVID-19 ( = 10) within 28 days from the injection had a higher BMI than the entire cohort ( = 1960) (mean, 32 kg/m ± 10 vs 28 kg/m ± 6;  = .04). Conclusion Adults who received image-guided corticosteroid injections for pain management during the pandemic recovery period had a lower incidence of symptomatic COVID-19 compared with the general population. © RSNA, 2022 },

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35876864,

title = {A novel core biopsy needle with shorter dead space for percutaneous image-guided musculoskeletal biopsies - how does it compare with an established core biopsy needle?},

author = {Alexis M Cahalane and Ukasha Habib and Rene Balza and Jad S Husseini and F Joseph Simeone and Santiago Lozano-Calderon and Connie Y Chang},

doi = {10.1007/s00256-022-04130-5},

issn = {1432-2161},

year  = {2023},

date = {2023-01-01},

journal = {Skeletal Radiol},

volume = {52},

number = {1},

pages = {99--109},

abstract = {PURPOSE: To compare diagnostic yield and utility of a novel core biopsy needle (NCBN) with shortened tip dead space for percutaneous musculoskeletal biopsies with an established core biopsy needle (ECBN).nnMETHODS: This study was IRB approved and HIPAA compliant. All percutaneous biopsies using an NCBN performed between July 2020 and August 2021 were retrospectively reviewed. Data on patient demographics, biopsy technique, biopsy needle, and histopathology were collated.nnRESULTS: Thirty-six patients were included in this study, 16 (44%) undergoing biopsy with both an NCBN and an ECBN, and 20 (56%) with an NCBN only. All 36 NCBN biopsies were 16 gauge. Fifteen (94%) of the ECBN biopsies were 14 gauge, and 1 (6%) was 16 gauge. Thirty-four (94%) of the NCBN and 15 (94%) of the ECBN biopsies were diagnostic. No adverse events were identified.nnCONCLUSION: Both the NCBN and ECBN have high diagnostic rates. No adverse events were identified. NCBN could be considered for biopsy of lesions limited by anatomic location or near adjacent critical structures.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35761094b,

title = {Radiographic imaging of carbon fiber implants in the appendicular skeleton in orthopedic oncology},

author = {Adam Graeber and Sina Habibollahi and Ukasha Habib and Connie Chang and Santiago Lozano-Calderon},

doi = {10.1007/s00256-022-04100-x},

issn = {1432-2161},

year  = {2022},

date = {2022-12-01},

journal = {Skeletal Radiol},

volume = {51},

number = {12},

pages = {2237--2244},

abstract = {Carbon fiber/poly-ether-ether-ketone implants are increasingly being used in orthopedic oncology. An understanding of how to evaluate the normal appearance of these implants is critical for detecting any failures or complications that may arise. The purpose of this manuscript is to provide primarily a radiographic review of the normal radiographic appearance of carbon fiber-reinforced poly-ether-ether-ketone implants in the appendicular skeleton with some cross-sectional imaging discussion. We additionally aim to highlight some of the unique clinical benefits compared to metal implants, review the unique appearance of failures of these implants, and propose a standardized radiologic method for their evaluation. Our review is based on a retrospective case review of 31 patients with carbon fiber-reinforced poly-ether-ether-ketone implants placed in a single center orthopedic oncology practice from 2017 to 2021.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35761094,

title = {Radiographic imaging of carbon fiber implants in the appendicular skeleton in orthopedic oncology},

author = {Adam Graeber and Sina Habibollahi and Ukasha Habib and Connie Chang and Santiago Lozano-Calderon},

doi = {10.1007/s00256-022-04100-x},

issn = {1432-2161},

year  = {2022},

date = {2022-12-01},

journal = {Skeletal Radiol},

volume = {51},

number = {12},

pages = {2237--2244},

abstract = {Carbon fiber/poly-ether-ether-ketone implants are increasingly being used in orthopedic oncology. An understanding of how to evaluate the normal appearance of these implants is critical for detecting any failures or complications that may arise. The purpose of this manuscript is to provide primarily a radiographic review of the normal radiographic appearance of carbon fiber-reinforced poly-ether-ether-ketone implants in the appendicular skeleton with some cross-sectional imaging discussion. We additionally aim to highlight some of the unique clinical benefits compared to metal implants, review the unique appearance of failures of these implants, and propose a standardized radiologic method for their evaluation. Our review is based on a retrospective case review of 31 patients with carbon fiber-reinforced poly-ether-ether-ketone implants placed in a single center orthopedic oncology practice from 2017 to 2021.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35642759,

title = {Postoperative Imaging of the Rotator Cuff: A Systematic Review and Meta-Analysis},

author = {Soterios Gyftopoulos and Madalena Da Silva Cardoso and Tatiane Cantarelli Rodrigues and Kun Qian and Connie Y Chang},

doi = {10.2214/AJR.22.27847},

issn = {1546-3141},

year  = {2022},

date = {2022-11-01},

journal = {AJR Am J Roentgenol},

volume = {219},

number = {5},

pages = {717--723},

abstract = { It is unclear which, MRI or ultrasound (US), is the most useful imaging tool to diagnose rotator cuff retears.  The objective of this study was to evaluate MRI and US in terms of diagnosing retear of a repaired rotator cuff tendon using a systematic review and meta-analysis.  A comprehensive literature search was performed on the main concepts of MRI (including noncontrast MRI and MR arthrography), US, and rotator cuff repairs. Inclusion criteria consisted of original research studies that assessed the diagnostic accuracy of MRI and US (index tests) for the diagnosis of rotator cuff tendon retear after prior rotator cuff repair using surgical findings as the reference standard. QUADAS-2 was used to assess methodologic quality. Meta-analyses were performed to compare MRI and US studies in the diagnosis of all retears and of full-thickness retears. Study variation was analyzed using the Cochran  test and  statistic.  Eight studies (MRI,  = 6; US,  = 2) satisfied inclusion and exclusion criteria, consisting of 304 total patients (MRI,  = 221; US,  = 83) and 309 shoulders (MRI,  = 226; US,  = 83). Years of publication ranged from 1993 to 2006 for the MRI studies and from 2003 to 2018 for the US studies. Two studies had high risk of bias in terms of applicability to clinical practice because of patient selection. Five studies had potential risk of bias in two categories, whereas two had potential risk of bias in three categories. For all retears, mean sensitivity and specificity for MRI were 81.4% (95% CI, 73.3-87.5%) and 82.6% (95% CI, 76.3-87.5%) and 83.7% (95% CI, 67.4-92.7%) and 90.7% (95% CI, 73.6-97.1%) for US. For full-thickness retears, mean sensitivity and specificity for MRI were 85.9% (95% CI, 80.2-90.2%) and 89.1% (95% CI, 84.6-92.4%) and 89.7% (95% CI, 75.6-96.1%) and 91.0% (95% CI, 75.5-97.1%) for US. There was no significant difference in terms of sensitivity or specificity for either comparison ( = .28-.76).  Our analyses revealed no significant difference between US and MRI for the diagnosis of rotator cuff tendon tears after prior cuff repair.  Either MRI or US can be considered a first-line imaging option to assess suspected rotator cuff retear after prior repair.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35344076,

title = {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)},

author = {Connie Y Chang and Hillary W Garner and Shivani Ahlawat and Behrang Amini and Matthew D Bucknor and Jonathan A Flug and Iman Khodarahmi and Michael E Mulligan and Jeffrey J Peterson and Geoffrey M Riley and Mohammad Samim and Santiago A Lozano-Calderon and Jim S Wu},

doi = {10.1007/s00256-022-04022-8},

issn = {1432-2161},

year  = {2022},

date = {2022-09-01},

journal = {Skeletal Radiol},

volume = {51},

number = {9},

pages = {1743--1764},

abstract = {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.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34605957,

title = {Percutaneous CT-guided corticosteroid injection for the treatment of osseous Langerhans cell histocytosis: a three institution retrospective analysis},

author = {Connie Y Chang and Julio Brandao Guimares and Gabby Joseph and Marcelo de Toledo Petrilli and Santiago Lozano-Calderon and Miriam A Bredella and Thomas M Link},

doi = {10.1007/s00256-021-03917-2},

issn = {1432-2161},

year  = {2022},

date = {2022-05-01},

journal = {Skeletal Radiol},

volume = {51},

number = {5},

pages = {1037--1046},

abstract = {PURPOSE: The aim of this study is to evaluate the safety and effectiveness of CT-guided corticosteroid injection for the treatment of osseous Langerhans cell histiocytosis (LCH) in a multi-institutional study.nnMATERIALS AND METHODS: This IRB-approved study included patients from three institutions. We retrospectively reviewed clinical, procedural, and imaging data for corticosteroid injections performed to treat osseous LCH. Location of the lesion, lesion maximum dimension and volume, corticosteroid type and dose, and time interval between injection and change in lesion size/volume and symptoms were recorded. Generalized estimating equations (accounting for multiple lesions per subject) were used to evaluate the association between predictors (dose, maximum lesion dimension, and lesion volume) and outcomes (time to partial and complete radiographic resolution, and time to pain control). This analysis was adjusted by anatomic site.nnRESULTS: Forty corticosteroid injections were performed in 36 patients (20 (56%) females, and 16 (44%) males, ages 12 ± 11 (2-57) years). Mean lesion maximum dimension was 3.2 ± 1.7 cm, and volume was 10 ± 17 cm. Imaging and clinical follow-up were available for 22/40 (55%) and 34/40 (85%) of injections, respectively. All lesions responded to corticosteroid injection. Times to partial and complete imaging resolution were 13 ± 9 and 32 ± 13 weeks, respectively, and time to pain resolution was 22 ± 14 weeks. There were no complications.nnCONCLUSION: CT-guided corticosteroid injection is a safe and effective treatment for LCH. Pain resolution was achieved in all patients and imaging did not show progressive disease in any of the patients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35236595,

title = {Common Soft Tissue Mass-like Lesions that Mimic Malignancy},

author = {Sina Habibollahi and Santiago Lozano-Calderon and Connie Y Chang},

doi = {10.1016/j.rcl.2021.11.008},

issn = {1557-8275},

year  = {2022},

date = {2022-03-01},

journal = {Radiol Clin North Am},

volume = {60},

number = {2},

pages = {301--310},

abstract = {Benign and malignant soft tissue tumors have many overlapping and potentially confusing imaging features. Here we discuss imaging and clinical features of 6 soft tissue tumor mimics: myositis ossificans, acute traumatic hematoma, geyser lesion, tumoral calcinosis, gout, and myonecrosis. These 6 lesions are some of the most common benign soft tissue mass-like lesions erroneously labeled as "malignancy." Familiarity with these lesions can potentially spare the patient biopsy, other invasive and noninvasive work-up, and anxiety.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35236595b,

title = {Common Soft Tissue Mass-like Lesions that Mimic Malignancy},

author = {Sina Habibollahi and Santiago Lozano-Calderon and Connie Y Chang},

doi = {10.1016/j.rcl.2021.11.008},

issn = {1557-8275},

year  = {2022},

date = {2022-03-01},

journal = {Radiol Clin North Am},

volume = {60},

number = {2},

pages = {301--310},

abstract = {Benign and malignant soft tissue tumors have many overlapping and potentially confusing imaging features. Here we discuss imaging and clinical features of 6 soft tissue tumor mimics: myositis ossificans, acute traumatic hematoma, geyser lesion, tumoral calcinosis, gout, and myonecrosis. These 6 lesions are some of the most common benign soft tissue mass-like lesions erroneously labeled as "malignancy." Familiarity with these lesions can potentially spare the patient biopsy, other invasive and noninvasive work-up, and anxiety.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34291325,

title = {Automated detection and segmentation of sclerotic spinal lesions on body CTs using a deep convolutional neural network},

author = {Connie Y Chang and Colleen Buckless and Kaitlyn J Yeh and Martin Torriani},

doi = {10.1007/s00256-021-03873-x},

issn = {1432-2161},

year  = {2022},

date = {2022-02-01},

journal = {Skeletal Radiol},

volume = {51},

number = {2},

pages = {391--399},

abstract = {PURPOSE: To develop a deep convolutional neural network capable of detecting spinal sclerotic metastases on body CTs.nnMATERIALS AND METHODS: Our study was IRB-approved and HIPAA-compliant. Cases of confirmed sclerotic bone metastases in chest, abdomen, and pelvis CTs were identified. Images were manually segmented for 3 classes: background, normal bone, and sclerotic lesion(s). If multiple lesions were present on a slice, all lesions were segmented. A total of 600 images were obtained, with a 90/10 training/testing split. Images were stored as 128 × 128 pixel grayscale and the training dataset underwent a processing pipeline of histogram equalization and data augmentation. We trained our model from scratch on Keras/TensorFlow using an 80/20 training/validation split and a U-Net architecture (64 batch size, 100 epochs, dropout 0.25, initial learning rate 0.0001, sigmoid activation). We also tested our model's true negative and false positive rate with 1104 non-pathologic images. Global sensitivity measured model detection of any lesion on a single image, local sensitivity and positive predictive value (PPV) measured model detection of each lesion on a given image, and local specificity measured the false positive rate in non-pathologic bone.nnRESULTS: Dice scores were 0.83 for lesion, 0.96 for non-pathologic bone, and 0.99 for background. Global sensitivity was 95% (57/60), local sensitivity was 92% (89/97), local PPV was 97% (89/92), and local specificity was 87% (958/1104).nnCONCLUSION: A deep convolutional neural network has the potential to assist in detecting sclerotic spinal metastases.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{695516,

title = {Cahalane AM, Habibollahi S, Staffa SJ, Yang K, Fintelmann FJ, Chang CY. Helical CT vs CT Fluoroscopic Guidance for Musculoskeletal Needle Biopsies: The Impact on Technique, Radiation Exposure and Outcome. Skeletal Rad. Accepted October 2022.},

year  = {2022},

date = {2022-01-01},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{686946,

title = {Oganesyan R, Anderson MA, Simeone FJ, Chang CY, Tanaka M. Sex Differences in Posterior Cruciate Ligament Injuries. Journal of Women’s Sports Medicine. https://jwomenssportsmed.org/index.php/jwsm/issue/view/2},

year  = {2022},

date = {2022-01-01},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34416016,

title = {Adjunct diagnostic strategies in improving diagnostic yields in image-guided biopsies of musculoskeletal neoplasms-A cost-effectiveness analysis},

author = {Dipak B Ramkumar and Sean P Kelly and Niveditta Ramkumar and Soterios Gyftopoulos and Kevin A Raskin and Santiago A Lozano-Calderon and Connie Y Chang},

doi = {10.1002/jso.26654},

issn = {1096-9098},

year  = {2021},

date = {2021-12-01},

journal = {J Surg Oncol},

volume = {124},

number = {8},

pages = {1499--1507},

abstract = {BACKGROUND: Routine use of adjunct intraprocedural fresh frozen biopsy (FFP) or point-of-care (POC) cytology at the time of image-guided biopsy can improve diagnostic tissue yields for musculoskeletal neoplasms, but these are associated with increased costs.nnOBJECTIVE: This study aimed to ascertain the most cost-effective adjunctive test for image-guided biopsies of musculoskeletal neoplasms.nnMETHODS: This expected value cost-effectiveness microsimulation compared the payoffs of cost (2020 United States dollars) and effectiveness (quality-adjusted life, in days) on each of the competing strategies. A literature review and institutional data were used to ascertain probabilities, diagnostic yields, utility values, and direct medical costs associated with each strategy. Payer and societal perspectives are presented. One- and two-way sensitivity analyses evaluated model uncertainties.nnRESULTS: The total cost and effectiveness for each of the strategies were $1248.98, $1414.09, $1980.53, and 80.31, 79.74, 79.69 days for the use of FFP, permanent pathology only, and POC cytology, respectively. The use of FFP dominated the competing strategies. Sensitivity analyses revealed FFP as the most cost-effective across all clinically plausible values.nnCONCLUSIONS: Adjunct FFP is most cost-effective in improving the diagnostic yield of image-guided biopsies for musculoskeletal neoplasms. These findings are robust to sensitivity analyses using clinically plausible probabilities.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34742489,

title = {Fibrous and Fibro-Osseous Lesions of Bone},

author = {Ivan Chebib and Connie Y Chang and Santiago Lozano-Calderon},

doi = {10.1016/j.path.2021.06.011},

issn = {1875-9157},

year  = {2021},

date = {2021-12-01},

journal = {Surg Pathol Clin},

volume = {14},

number = {4},

pages = {707--721},

abstract = {Fibrous and fibro-osseous tumors are some of the most common benign lesions involving bones. Although many of the histomorphologic features of these tumors overlap significantly, an interdisciplinary approach helps to consolidate the classification of these tumors. Herein, the clinical, radiologic, and pathologic features of lesions within these categories are described.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34534997,

title = {Reducing Time and Patient Radiation of Computed Tomography-guided Thoracic Needle Biopsies With Single-rotation Axial Acquisitions: An Alternative to "CT Fluoroscopy"},

author = {Reece J Goiffon and Till D Best and Maria M Wrobel and Shaunagh McDermott and Amita Sharma and Connie Y Chang and Kai Yang and Florian J Fintelmann},

doi = {10.1097/RTI.0000000000000609},

issn = {1536-0237},

year  = {2021},

date = {2021-11-01},

journal = {J Thorac Imaging},

volume = {36},

number = {6},

pages = {389--396},

abstract = {PURPOSE: To investigate the effect on procedure time and patient radiation indices of replacing helical acquisitions for needle guidance during thoracic needle biopsy (TNB) with intermittent single-rotation axial acquisitions.nnMATERIALS AND METHODS: This retrospective intervention study included 215 consecutive TNBs performed by a single operator from 2014 to 2018. Characteristics of patients, lesions, and procedures were compared between TNBs guided only by helical acquisitions initiated in the control room (helical group, n=141) and TNBs guided in part by intermittent single-rotation axial computed tomography controlled by foot pedal (single-rotation group, n=74). Procedure time and patient radiation indices were primary outcomes, complications, and radiologist radiation dose were secondary outcomes.nnRESULTS: Patient, lesion, and procedural characteristics did not differ between helical and single-rotation groups. Use of single-rotation axial acquisitions decreased procedure time by 10.5 minutes (95% confidence interval [CI]: 8.2-12.8 min) or 27% (95% CI: 22%-32%; P<0.001). Patient dose in cumulative volume computed tomography dose index decreased by 23% (95% CI: 12%-33%) or 8 mGy (95% CI: 4.3-31.6 mGy; P=0.01). Dose-length product decreased by 50% (95% CI: 40%-60%) or 270 mGy cm (95% CI: 195-345 mGy cm; P<0.001). No operator radiation exposure was detected. Rate of diagnostic result, pneumothorax, hemoptysis, and hemorrhage did not differ between groups.nnCONCLUSIONS: Replacing helical acquisitions with intermittent single-rotation axial acquisitions significantly decreases TNB procedure time and patient radiation indices without adversely affecting diagnostic rate, procedural complications, or operator radiation dose.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33336581,

title = {Best Practices: CT-Guided Percutaneous Sampling of Vertebral Discitis-Osteomyelitis and Technical Factors Maximizing Biopsy Yield},

author = {Jad S Husseini and Sina Habibollahi and Sandra B Nelson and Daniel I Rosenthal and Connie Y Chang},

doi = {10.2214/AJR.20.24313},

issn = {1546-3141},

year  = {2021},

date = {2021-11-01},

journal = {AJR Am J Roentgenol},

volume = {217},

number = {5},

pages = {1057--1068},

abstract = {Vertebral discitis-osteomyelitis is an infection of the intervertebral disk and vertebral bodies that may extend to adjacent paraspinal and epidural soft tissues. Its incidence is increasing, likely because of improved treatments and increased life expectancy for patients with predisposing chronic disease and increased rates of IV drug use and intravascular intervention. Because blood cultures are frequently negative in patients with vertebral discitis-osteomyelitis, biopsy is often indicated to identify a causative microorganism for targeted antimicrobial therapy. The reported yield of CT-guided percutaneous sampling is 31-91%, which is lower than the reported yield of open biopsy of 76-91%. However, the less invasive approach may be favored given its relative safety and low cost. If paravertebral fluid collections are present, CT-guided aspiration should be performed. If aspiration is unsuccessful or no paravertebral fluid collections are present, CT-guided percutaneous biopsy should be performed, considering technical factors (e.g., anatomic approach, needle selection, and needle angulation) that may improve microbiologic yield. Although antimicrobial therapy should be withheld for 1-2 weeks before biopsy if clinically feasible, biopsy may still be performed without stopping antimicrobial therapy if needed. Because of the importance of targeted antimicrobial therapy, repeat biopsy should be considered after 72 hours if initial biopsy does not identify a pathogen.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33438459,

title = {Impact of Patient-Reported Symptom Information on Agreement in the MRI Diagnosis of Presumptive Lumbar Spine Pain Generator},

author = {Rene Balza and Sarah F Mercaldo and Connie Y Chang and Ambrose J Huang and Jad S Husseini and Arvin B Kheterpal and F Joseph Simeone and William E Palmer},

doi = {10.2214/AJR.20.25210},

issn = {1546-3141},

year  = {2021},

date = {2021-10-01},

journal = {AJR Am J Roentgenol},

volume = {217},

number = {4},

pages = {947--956},

abstract = { Lumbar spine MRI is associated with a high prevalence of interpretive errors by radiologists. Treating physicians can obtain symptom information, correlate symptoms with MRI findings, and distinguish presumptive pain generators from incidental abnormalities.  The purpose of this study was to capture symptom information using a patient questionnaire, review lumbar spine MRI examinations with and without symptom information, diagnose pain generators, and compare MRI diagnoses with clinical reference diagnoses.  In this prospective study, 120 participants (70 men and 50 women; median age, 64 years; interquartile range, 49.5-74 years) were recruited from patients referred for lumbar spine injections between February and June 2019. Participants completed electronic questionnaires regarding their symptoms before receiving the injections. For three research arms, six radiologists diagnosed pain generators in MRI studies reviewed with symptom information from questionnaires, MRI studies reviewed without symptom information, and MRI reports. Interreading agreement was analyzed. Blinded to the questionnaire results, the radiologists who performed injections obtained patient histories, correlated symptoms with MRI findings, and diagnosed presumptive pain generators. These diagnoses served as clinical reference standards. Pain generators were categorized by type, level, and side and were compared using kappa statistics. Diagnostic certainty was recorded using numeric values (0-100) and was compared using Wilcoxon rank-sum test  When compared with the reference standard, agreement for the type, level, and side of pain generator was almost perfect in MRI examinations reviewed with symptom information (κ = 0.82-0.90), fair to moderate in MRI examinations reviewed without symptom information (κ = 0.28-0.51) (all  < .001), and fair to moderate in MRI reports (κ = 0.27-0.45) (all  < .001). Interreading agreement was almost perfect when MRI examinations were reviewed with symptom information (κ = 0.82-0.90) but was only moderate without symptom information (κ = 0.42-0.56) (all  < .001). Diagnostic certainty levels were highest for radiologists performing injections (mean [± SD], 90.0 ± 9.9) and were significantly higher for MRI review with symptom information versus without symptom information (means for reading 1, 84.6 ± 13.1 vs 62.9 ± 20.7;  < .001).  In lumbar spine MRI, presumptive pain generators diagnosed using symptom information from electronic questionnaires showed almost perfect agreement with pain generators diagnosed using symptom information from direct patient interviews.  Patient-reported symptom information from a brief questionnaire can be correlated with MRI findings to distinguish presumptive pain generators from incidental abnormalities.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34174207,

title = {Current Gaps in Breast Cancer Screening Among Asian and Asian American Women in the United States},

author = {Young-Jin Sohn and Connie Y Chang and Randy C Miles},

doi = {10.1016/j.jacr.2021.06.002},

issn = {1558-349X},

year  = {2021},

date = {2021-10-01},

journal = {J Am Coll Radiol},

volume = {18},

number = {10},

pages = {1376--1383},

abstract = {Over the past two decades, the US Asian population has increased 72%, representing the fastest growth rate of any major racial group. Currently, there are over 20 million Asian and Asian American women in the United States, who identify with at least 1 of 19 different origin groups. Although women of Asian ancestry have traditionally been considered low risk for experiencing adverse breast cancer-specific outcomes, aggregated data may mask health disparities seen among subgroups. In the United States, recent data demonstrate that the burden of breast cancer among Asian women has increased each year over the past decade. We aim to characterize challenges faced by Asian and Asian American women in the United States related to cultural stigma, socioeconomic status, and overall access to breast cancer care. An increased understanding of barriers to breast cancer prevention and treatment efforts is needed to develop more effective strategies aimed at reducing disparities in care among segments of this heterogenous population.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33188487,

title = {A measuring technique for intra-osseous pressure},

author = {Connie Y Chang and Kaitlyn J Yeh and Lauren A Roller and Martin Torriani},

doi = {10.1007/s00256-020-03671-x},

issn = {1432-2161},

year  = {2021},

date = {2021-07-01},

journal = {Skeletal Radiol},

volume = {50},

number = {7},

pages = {1461--1464},

abstract = {OBJECTIVE: Pulsatile intra-osseous pressures result in bone remodeling, and therefore may affect lesion growth and response to treatment. However, there is no known method used to measure intra-osseous pressures. The purpose of this study is to describe a novel image-guided technique for measuring intra-osseous pressures.nnMATERIALS AND METHODS: This study was IRB-approved and HIPAA compliant. Written informed consent was obtained. Intra-osseous pressure measurements were performed during a CT-guided bone marrow biopsy in eight patients (6 male, 2 female) with mean age 66 ± 13 years (median 72, range 45-87) and suspected or known bone marrow disease. Bone marrow pressure measurements were obtained connecting the biopsy needle to a dedicated monitor using a standard arterial line setup. Monitor data was collected at 5-s intervals in order to record continuous pressure measurements for 2 min.nnRESULTS: Pressure measurements were successfully performed in all 8 patients. The mean bone marrow pressures were 36.8 ± 7.2 mmHg (median 37.7, range 24.7-47.4). The peak and trough pressures varied by 11%, and the standard deviation of mean pressure measurement varied by 18%. Our findings for marrow pressure measures most closely approximate the pressure profile of the venous system.nnCONCLUSION: We describe a novel and minimally invasive technique able to provide functional data of bone marrow. This technique has the potential to provide insights into normal and diseased bone marrow and may be helpful to evaluate features of cystic and vascular tumors that may be amenable to percutaneous treatments.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33392624,

title = {Assessing the readability of patient-targeted online information on musculoskeletal radiology procedures},

author = {Phuong T Duong and Matthew P Moy and F Joseph Simeone and Connie Y Chang and Tony T Wong},

doi = {10.1007/s00256-020-03562-1},

issn = {1432-2161},

year  = {2021},

date = {2021-07-01},

journal = {Skeletal Radiol},

volume = {50},

number = {7},

pages = {1379--1387},

abstract = {OBJECTIVE: To assess the readability of patient-targeted online information on musculoskeletal radiology procedures.nnMETHODS: Eleven common musculoskeletal radiology procedures were queried in three online search engines (Google, Yahoo!, Bing). All unique patient-targeted websites were identified (n = 384) from the first three pages of search results. The reading grade level of each website was calculated using 6 separate validated metrics for readability assessment. Analysis of word and sentence complexity was also performed. Results were compared between academic vs. non-academic websites and between websites found on different pages of the search results. Statistics were performed using a t test.nnRESULTS: The mean reading grade level across all procedures was 10th-14th grade. Webpages for nerve block were written at a higher reading grade level on non-academic websites (p = 0.025). There was no difference in reading grade levels between academic and non-academic sources for all other procedures. There was no difference in reading grade levels between websites found on the first page of search results compared with the second and third pages. Across all websites, 16-22% of the words used had 3+ syllables and 31-43% of the words used had 6+ characters (complex words); 13-24% of the sentences used had 22+ words (complex sentences).nnCONCLUSION: Patient-targeted online information on musculoskeletal radiology procedures are written at the 10th-14th grade reading level, which is well beyond the AMA and NIH recommendation. Readability can be lowered by decreasing text complexity through limitation of high-syllable words and reduction in word and sentence length.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33108512,

title = {Symptomatic COVID-19 infections in outpatient image-guided corticosteroid injection patients during the lockdown phase},

author = {Connie Y Chang and Anand Prabhakar and Steven J Staffa and Jad S Husseini and Arvin B Kheterpal and F Joseph Simeone and Miriam A Bredella},

doi = {10.1007/s00256-020-03656-w},

issn = {1432-2161},

year  = {2021},

date = {2021-06-01},

journal = {Skeletal Radiol},

volume = {50},

number = {6},

pages = {1117--1123},

abstract = {BACKGROUND: Musculoskeletal pain is a debilitating problem treated with image-guided corticosteroid injections. During the COVID-19 pandemic, multiple societies issued caution statements because of the unknown effect of corticosteroids on the patient's immune system. The purpose is to determine if image-guided corticosteroid injections administered during the COVID-19 lockdown phase were associated with a higher infection rate compared to the general population.nnMATERIALS AND METHODS: In a prospective study, patients undergoing image-guided corticosteroid injections for pain management during the lockdown phase between April 15 and May 22, 2020, were enrolled. One month after the injection, patients were surveyed by telephone for any COVID-19-related symptoms, and the electronic medical record (EMR) was reviewed for symptoms and test results.nnRESULTS: Seventy-one subjects were recruited, 31 (44%) females, 40 (56%) males, ages 58 ± 17 (20-92) years. Follow-up was available in 66 (93%) of subjects, 60 (91%) by phone survey and EMR, 6 (9%) by EMR only, 45 ± 22 (19-83) days after injection. One (1/66, 1.52%; 95% CI 0.04-8.2%) 25-year-old male subject developed symptomatic infection 19 days after a tibiotalar injection. The prevalence of COVID-19 cases in the state of Massachusetts was 0.91% (62,726/6,892,503) during the study period. There was no significant difference in the rate of occurrence of new cases of COVID-19 infection between the corticosteroid injection group and the general population (p = 0.44).nnCONCLUSION: Image-guided corticosteroid injections for pain management performed during the lockdown phase of the COVID-19 pandemic were not associated with a higher infection rate compared to the general population.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{691732,

title = {Chebib I, Chang CY, Lozano-Calderon S. Fibrous and Fibro-Osseous Lesions of Bone. Surgical Pathology Clinics. 2021 Dec;14(4):707-722.},

year  = {2021},

date = {2021-01-01},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32050772,

title = {Fluoroscopically guided lumbar spine interlaminar and transforaminal epidural injections: inadvertent intravascular injection},

author = {Jad S Husseini and F Joseph Simeone and Steven J Staffa and William E Palmer and Connie Y Chang},

doi = {10.1177/0284185120903450},

issn = {1600-0455},

year  = {2020},

date = {2020-11-01},

journal = {Acta Radiol},

volume = {61},

number = {11},

pages = {1534--1540},

abstract = {BACKGROUND: Inadvertent intravascular injection is a rare but catastrophic complication of lumbar epidural injections.nnPURPOSE: To determine risk factors for inadvertent intravascular injection in fluoroscopically guided lumbar spine epidural injections.nnMATERIAL AND METHODS: A total of 212 patients who presented for lumbar interlaminar or transforaminal injection were prospectively enrolled. Patient demographics, history of surgery, injection side, site and approach, and volume of contrast injected were recorded.nnRESULTS: There were 89 (42%) interlaminar and 123 (58%) transforaminal injections. For 36 (17%) patients, there had been surgery at the injected or adjacent lumbar level. There were 25 (12%) inadvertent intravascular injections, with an incidence of 2/93 (2%) for interlaminar and 23/119 (19%) for transforaminal injections. The patients with inadvertent intravascular injection were older ( = 0.017) and had prior surgery at or adjacent to the level of injection ( < 0.0001). Transforaminal approach had a higher intravasation rate than interlaminar injections, both when comparing the entire cohort ( = 0.0001) and only patients without prior surgery ( = 0.01). In multivariable logistic regression analysis, transforaminal injections (odds ratio [OR] 9.77, 95% confidence interval [CI] 2.14-44.6,  = 0.003) and prior surgery at or adjacent to the level of injection (OR 5.71, 95% CI 2.15-15.15,  < 0.001) were independently associated with increased risk of inadvertent intravascular injections.nnCONCLUSION: Inadvertent intravascular injection occurred in 12% of our lumbar injection cohort and is more common with transforaminal injections, in older patients, and with prior lumbar surgery at or adjacent to the level of injection.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32306072,

title = {CT-guided discitis-osteomyelitis biopsies: needle gauge and microbiology results},

author = {Jad S Husseini and F Joseph Simeone and Sandra B Nelson and Connie Y Chang},

doi = {10.1007/s00256-020-03439-3},

issn = {1432-2161},

year  = {2020},

date = {2020-09-01},

journal = {Skeletal Radiol},

volume = {49},

number = {9},

pages = {1431--1439},

abstract = {PURPOSE: To compare the microbiology results and needle gauge for CT-guided biopsies of suspected discitis-osteomyelitis.nnMETHODS: All CT-guided biopsies performed for suspected discitis-osteomyelitis at our institution between 2002 and 2019 were reviewed. Biopsy location, needle type and gauge, microbiology, pathology, and clinical and imaging follow-up were obtained through chart review. Yield, sensitivity, specificity, and accuracy were calculated. A pairwise analysis of different needle gauges was also performed with calculations of odds ratios. Naïve Bayes predictive modeling was performed.nnRESULTS: 241 (age: 59 ± 18 years; 88 [35%] F, 162 [65%] M) biopsies were performed. There were 3 (1%) 11 gauge (G), and 13 (5%) 12-G biopsies; 23 (10%) 13-G biopsies; 75 (31%) 14-G biopsies; and 90 (37%) 16-G, 33 (14%) 18-G, and 4 (2%) 20 G biopsies. True disease status (presence of infection) was determined via either pathology findings (205, 86%) or clinical and imaging follow-up (36, 14%). The most common true positive pathogen was Staphylococcus aureus (31, 33%). Overall biopsy yield, sensitivity, specificity, and accuracy were 39%, 56%, 89%, and 66%, respectively. Pooled biopsy yield, sensitivity, specificity, and accuracy was 56%, 69%, 71%, and 69% for 11-13-G needles and 36%, 53%, 91%, and 65% for 14-20-G needles, respectively, with an odds ratio between the two groups of 2.29 (P = 0.021). Pooled biopsy yield, sensitivity, specificity, and accuracy was 48%, 63%, 85%, and 68% for 11-14-G needles and 32%, 49%, 91%, and 64% for 16-20-G needles, respectively, with an odds ratio between the two groups of 2.02 (P = 0.0086).nnCONCLUSION: The use of a larger inner bore diameter/lower gauge biopsy needle may increase the likelihood of culturing the causative microorganism for CT-guided biopsies of discitis-osteomyelitis.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32232499,

title = {CT-guided bone marrow aspirations and biopsies: retrospective study and comparison with blind procedures},

author = {C Y Chang and J S Husseini and A Moreira and F J Simeone and A J Yee and M A Bredella and R Hasserjian},

doi = {10.1007/s00256-020-03423-x},

issn = {1432-2161},

year  = {2020},

date = {2020-08-01},

journal = {Skeletal Radiol},

volume = {49},

number = {8},

pages = {1285--1294},

abstract = {PURPOSE: To compare the pathology results of CT-guided and blind bone marrow aspirations and biopsies.nnMETHODS: Ninety-eight consecutive CT-guided biopsies and 98 age- and gender-matched blind (non-CT-guided) posterior iliac crest bone marrow aspirations and biopsies performed in 2017 were reviewed for adequacy of core biopsies and aspirate smears. CT procedure images and CT abdomen/pelvis images were reviewed to evaluate anatomic features of the posterior ilium and soft tissues. Statistical analysis was performed using a T test, Fisher exact test, and Kruskal-Wallis test.nnRESULTS: There was no significant difference in the age and gender of the two groups (p > 0.05). However, the CT-guided group had a higher BMI (p = 0.0049) and posterior soft tissue thickness (p = 0.0016). More CT-guided biopsy samples (CT 93 (95%); blind 77 (79%); p = 0.0006) and aspirate smears (CT 90 (92%); blind 78 (80%); p = 0.042) were categorized as adequate. The CT-guided group had longer core lengths (CT 1.4 ± 0.6 (range 0.3-3.5) cm; blind 1.0 ± 0.60 (range 0-2.6) cm; p = 0.0001). Overall, 131/164 (80%) of the cases had at least one of the described features (slanted posterior ilium (angle > 30°), 30%; rounded posterior ilium, 20%; thick posterior ilium cortex, 13%; focal lesion in posterior ilium, 12%; prior procedure in posterior ilium, 5%; posterior soft tissue thickness > 3 cm, 40%).nnCONCLUSION: CT-guided bone marrow procedures were more likely to result in both adequate aspirate smears and biopsy samples and longer core lengths when compared with blind procedures.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31834434,

title = {Effects of intra-articular corticosteroid injections on lumbar trabecular density},

author = {Jonathon Florance and Robert Hemke and Connie Y Chang and Martin Torriani and Miriam A Bredella},

doi = {10.1007/s00256-019-03362-2},

issn = {1432-2161},

year  = {2020},

date = {2020-05-01},

journal = {Skeletal Radiol},

volume = {49},

number = {5},

pages = {787--793},

abstract = {PURPOSE: To determine the effect of intra-articular corticosteroid injections on lumbar spine trabecular density.nnMATERIALS AND METHODS: This retrospective study was IRB-approved and HIPAA-compliant. We identified 50 patients (26 F, 24 M, mean age 69 ± 14 years) who had undergone at least three medium or large joint corticosteroid injections using insoluble corticosteroids and a subsequent non-contrast abdominal CT within 5 years of the first injection. About 126 age- and sex-matched controls without history of prior corticosteroid use who had undergone non-contrast abdominal CT were identified. Cumulative corticosteroid dose was calculated. Density measurements (HU) of trabecular bone of L1 to L4 were performed, and measurements of L1 were compared to established normative data. Groups were compared using a two-sided paired t-test or a chi-squared test. Linear regression analysis between cumulative corticosteroid dose and trabecular density was performed.nnRESULTS: Patients underwent a mean of 4 corticosteroid injections (range 3 to 11) with a mean cumulative corticosteroid dose of 232 ± 100 mg triamcinolone equivalent (range 120 mg to 480 mg). There was no significant difference in trabecular density of L1 to L4 between cases and controls, and there was no significant difference in trabecular density at L1 compared to normative data (p > 0.2). There was no association between cumulative intra-articular corticosteroid dose and mean lumbar trabecular density (p > 0.3).nnCONCLUSION: Patients who underwent repetitive intra-articular insoluble corticosteroid injections showed no increased risk of bone loss compared to controls. Cumulative intra-articular corticosteroid dose was not associated with lumbar trabecular density.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31642975,

title = {Value of response to anesthetic injection during hip MR arthrography to differentiate between intra- and extra-articular pathology},

author = {Arvin B Kheterpal and Katherine M Bunnell and Jad S Husseini and Connie Y Chang and Scott D Martin and Adam C Zoga and Miriam A Bredella},

doi = {10.1007/s00256-019-03323-9},

issn = {1432-2161},

year  = {2020},

date = {2020-04-01},

journal = {Skeletal Radiol},

volume = {49},

number = {4},

pages = {555--561},

abstract = {PURPOSE: To determine the value of anesthetic injection during hip MR arthrography (anesthetic MRA) to differentiate between intra- and extra-articular pathology in patients with hip pain.nnMATERIALS AND METHODS: This retrospective study was IRB-approved and HIPAA-compliant. We included 75 consecutive adult patients (46 women, mean age 38 ± 13 years) who were referred for MRA. All patients underwent a focused hip examination including active flexion, passive flexion, and passive flexion with internal and external rotation, immediately prior to injection. Anesthetic MRA was performed following fluoroscopically guided intra-articular injection of contrast mixed with anesthetic. Following the injection, the hip examination was repeated, and the pain response was recorded. Clinical records, including response to corticosteroid injections, physical therapy notes, and operative reports were reviewed for verification of intra- and extra-articular pathology as the source of hip pain (gold standard). The positive (PPV) and negative predictive values (NPP) of anesthetic MRA to differentiate between intra- and extra-articular pathology were calculated.nnRESULTS: On MRI, 41 patients had only intra-articular and 5 patients only extra-articular pathology, while 29 patients had both, intra- and extra-articular pathology. Forty-three patients had pain relief and 32 patients had no pain relief after anesthetic injection. PPV of anesthetic MRA to detect intra-articular pathology was 91% and NPV was 67%.nnCONCLUSION: Anesthetic MRA can be used as an adjunct to define the origin of hip pain. A positive response suggests intra-articular pathology which can be helpful to localize the source of pain in equivocal cases where both intra- and extra-articular pathology are evident on MRI.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31900707,

title = {MRI and clinical features of acute fungal discitis/osteomyelitis},

author = {F Joseph Simeone and Jad S Husseini and Kaitlyn J Yeh and Santiago Lozano-Calderon and Sandra B Nelson and Connie Y Chang},

doi = {10.1007/s00330-019-06603-z},

issn = {1432-1084},

year  = {2020},

date = {2020-04-01},

journal = {Eur Radiol},

volume = {30},

number = {4},

pages = {2253--2260},

abstract = {OBJECTIVES: To compare imaging and clinical features of fungal and Staphylococcus aureus discitis-osteomyelitis (DO) for patients presenting for CT-guided biopsies.nnMETHODS: Our study was IRB-approved and HIPAA-compliant. A group of 11 fungal DO (FG) with MRI within 7 days of the biopsy and a control group (CG) of 19 Staphylococcus aureus DO were evaluated. Imaging findings (focal vs diffuse paravertebral soft tissue abnormality, partial vs complete involvement of the disc/endplate), biopsy location, pathology, duration of back pain, immune status, history of intravenous drug, history of prior infection, current antibiotic treatment, and history of invasive intervention. Differences were assessed using the Fisher exact test and Kruskal-Wallis test. Naïve Bayes predictive modeling was performed.nnRESULTS: The most common fungal organisms were Candida species (9/11, 82%). The FG was more likely to have focal soft tissue abnormality (p = 0.040) and partial disc/endplate involvement (p = 0.053). The clinical predictors for fungal DO, in order of importance, back pain for 10 or more weeks, current antibiotic use for 1 week or more, and current intravenous drug use. History of invasive instrumentation within 1 year was more predictive of Staphylococcus aureus DO.nnCONCLUSION: MRI features (focal partial soft tissue abnormality and partial involvement of the disc/endplate) in combination with clinical features may help to predict fungal species as a causative organism for DO.nnKEY POINTS: • MRI features of discitis-osteomyelitis (focal partial soft tissue abnormality and partial involvement of the disc/endplate) in combination with clinical features may help to predict fungal species as a causative organism for DO.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31760457,

title = {CT-guided discitis-osteomyelitis biopsies with negative microbiology: how many days should we wait before repeating the biopsy?},

author = {Kaitlyn J Yeh and Jad S Husseini and Robert Hemke and Sandra B Nelson and Connie Y Chang},

doi = {10.1007/s00256-019-03344-4},

issn = {1432-2161},

year  = {2020},

date = {2020-04-01},

journal = {Skeletal Radiol},

volume = {49},

number = {4},

pages = {619--623},

abstract = {PURPOSE: To determine the number of days to positive CT-guided biopsy sample culture in patients with discitis-osteomyelitis.nnMETHODS: Our study was IRB approved and HIPAA compliant. All CT-guided biopsies performed for acute discitis-osteomyelitis with positive microbiology between 2002 and 2018 were reviewed. Microbiological organism and days to positive biopsy were documented. Mean, median, skew, and standard deviation were calculated. The proportion of positive cultures that become positive after each day has elapsed was also calculated.nnRESULTS: There were 96 true positive cultures, with 64 (67%) male and 32 (33%) female, ages 57 ± 18 (range 19-87) years. Overall, including all culture results, the mean number of days to positive culture was 2.9 ± 3.5 days. The median number of days was 2, with a positive skew of 2.9. At days 1, 2, 3, 4, and 5, 48%, 68%, 78%, 85%, and 89%, respectively, of biopsy samples had a positive microbiology culture.nnCONCLUSION: Approximately three-quarters of discitis-osteomyelitis pathogens will be identified by biopsy sample culture by 3 days after CT-guided biopsy. This finding should be considered if planning for a repeat biopsy in the setting of a negative microbiology culture.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}