@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}

}

@article{pmid32258460,

title = {Kinetic evaluation of a partially packed upflow anaerobic fixed film reactor treating low-strength synthetic rubber wastewater},

author = {I Nor Faekah and S Fatihah and Zawawi Samba Mohamed},

doi = {10.1016/j.heliyon.2020.e03594},

issn = {2405-8440},

year  = {2020},

date = {2020-03-01},

journal = {Heliyon},

volume = {6},

number = {3},

pages = {e03594},

abstract = {A bench-scale model of a partially packed upflow anaerobic fixed film (UAF) reactor was set up and operated at five different hydraulic retention times (HRTs) of (17, 14, 10, 8, and 5) days. The reactor was fed with synthetic rubber wastewater consisting of a chemical oxygen demand (COD) concentration of 6355-6735 mg/L. The results were analyzed using the Monod model, the Modified Stover-Kincannon models, and the Grau Second-Order Model. The Grau Second-Order model was found to best fit the experimental data. The biokinetic constant values, namely the growth yield coefficient (Y) and the endogenous coefficient (K) were 0.027 g VSS/g COD and 0.1705 d, respectively. The half-saturation constant (K) and maximum substrate utilization rate (K) returned values of 84.1 mg/L and 0.371 d, respectively, whereas the maximum specific growth rate of the microorganism (μ) was 0.011 d. The constants, U and K of the Stover-Kincannon model produced values of 6.57 g/L/d and 6.31 g/L/d, respectively. Meanwhile, the average second-order substrate removal rate, k, was 105 d. These models gave high correlation coefficients with the value of R = 80-99% and these indicated that these models can be used in designing UAF reactor consequently predicting the behaviour of the reactor.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31435716,

title = {The effect of music on pain and subjective experience in image-guided musculoskeletal corticosteroid injections: a randomized controlled trial},

author = {Weier Li and Roy G Bryan and Arvin Kheterpal and Frank J Simeone and Connie Y Chang and Martin Torriani and Ambrose J Huang},

doi = {10.1007/s00256-019-03298-7},

issn = {1432-2161},

year  = {2020},

date = {2020-03-01},

journal = {Skeletal Radiol},

volume = {49},

number = {3},

pages = {435--441},

abstract = {PURPOSE: To investigate the role of music on subjects undergoing routine image-guided musculoskeletal corticosteroid injections and its effect on post-procedure pain and subjective overall experience.nnMATERIALS AND METHODS: This prospective study was IRB-approved and HIPAA-compliant. A total of 126 subjects referred for outpatient image-guided musculoskeletal corticosteroid injections were enrolled in the study and randomized into a music offered group ((+)MO) and a no music offered group ((-)MO). (+)MO subjects were given the opportunity to listen to music during their corticosteroid injection. All subjects were then given an anonymous survey on which they recorded their pre-procedural and post-procedural pain on a scale from 0 to 9 and rated their overall experience and how likely they were to recommend our department for musculoskeletal procedures on scales from 1 to 5.nnRESULTS: (+)MO subjects had significantly lower post-procedural pain (p = 0.013) and significantly greater decrease in pain (p = 0.031) compared to (-)MO subjects. Among the (+)MO subjects, there was no statistically significant difference in post-procedure pain (p = 0.34) or change in pain (p = 0.62) if music was accepted or declined. However, subjects who listened to music did have lower post-procedural pain compared to those who did not listen to music (p = 0.012), although the differences in the decrease of pain between the two groups did not quite reach statistical significance (p = 0.062).nnCONCLUSIONS: Playing music during image-guided musculoskeletal corticosteroid injections may reduce patients' post-procedure pain. Offering patients some measure of control over their procedure may be a factor that contributes to decreased post-procedure pain as well.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{677379,

title = {Di Capua CA, Cabarcas JC, Di Capua JF, Low S, Chang CY, Gilman AJ, Rosenthal DI, Vazquez R. A Retrospective Comparison of Percutaneous Radiofrequency Ablation of Osteoid Osteoma Using Three Anesthesia Modalities. Am J of Interv Radiol 2020. Pub Online.},

url = {https://americanjir.com/a-retrospective-comparison-of-percutaneous-radiofrequency-ablation-of-osteoid-osteoma-using-three-anesthesia-modalities/},

year  = {2020},

date = {2020-01-01},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{669981,

title = {Hemke R, Takayesu J, Hughes KS, Chang C, DeLaney TF, De Amorim Bernstein K, Bredella MA. Novel Body Composition Predictors of Outcome in Patients with Angiosarcoma of the Breast: A Preliminary Study. J Comput Assist Tomogr. Jul/Aug 2020;44(4):605:6},

url = {https://pubmed.ncbi.nlm.nih.gov/32697532/},

year  = {2020},

date = {2020-01-01},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{669981b,

title = {Hemke R, Takayesu J, Hughes KS, Chang C, DeLaney TF, De Amorim Bernstein K, Bredella MA. Novel Body Composition Predictors of Outcome in Patients with Angiosarcoma of the Breast: A Preliminary Study. J Comput Assist Tomogr. Jul/Aug 2020;44(4):605:6},

url = {https://pubmed.ncbi.nlm.nih.gov/32697532/},

year  = {2020},

date = {2020-01-01},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{669980,

title = {Yeung CM, Lans J, Kuechle JB, Wright Z, Chang CY, Lozano-Calderon SA. Evaluation of the Proximal Ulna Dorsal Angulation for Ulnar Component Sizing in Elbow Prosthetic Reconstruction After Distal Humeral Resection of Tumor. JAAOS Glob Res Rev. Open Access},

url = {https://journals.lww.com/jaaosglobal/Fulltext/2020/05000/Evaluation_of_the_Proximal_Ulna_Dorsal_Angulation.13.aspx?context=FeaturedArticles&collectionId=1},

year  = {2020},

date = {2020-01-01},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{669989,

title = {Chebib, I, Chang CY, Lozano-Calderon S, Nielsen GP. Histopathology of Fibro-osseous and Cystic Tumors of Bone. Diagnostic Histopathology, 2020; 26(10): 461-473},

year  = {2020},

date = {2020-01-01},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30850870,

title = {Osteoblastoma of the clavicle at the site of a previous fracture-first case report and review of the literature},

author = {Adriana C Moreira and David I Suster and Sterling Ellis Eide and Daniel I Rosenthal and Connie Y Chang},

doi = {10.1007/s00256-019-03197-x},

issn = {1432-2161},

year  = {2019},

date = {2019-10-01},

journal = {Skeletal Radiol},

volume = {48},

number = {10},

pages = {1623--1628},

abstract = {Osteoblastoma is a rare, benign primary tumor of bone, accounting for < 1% of all bone tumors. We report the case of a 27-year-old female who developed pain and swelling five and a half years after a clavicular fracture and was subsequently found to have an osteoblastoma arising at the fracture site. This is the first reported case of an osteoblastoma developing after a fracture, although osteoid osteomas, which are histologically indistinguishable from osteoblastomas, have been reported at prior fracture sites. This report demonstrates that secondary neoplasms such as osteoblastomas should be considered in the differential diagnosis for pain at a healed fracture site recurring years after the initial trauma.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30850870b,

title = {Osteoblastoma of the clavicle at the site of a previous fracture-first case report and review of the literature},

author = {Adriana C Moreira and David I Suster and Sterling Ellis Eide and Daniel I Rosenthal and Connie Y Chang},

doi = {10.1007/s00256-019-03197-x},

issn = {1432-2161},

year  = {2019},

date = {2019-10-01},

journal = {Skeletal Radiol},

volume = {48},

number = {10},

pages = {1623--1628},

abstract = {Osteoblastoma is a rare, benign primary tumor of bone, accounting for < 1% of all bone tumors. We report the case of a 27-year-old female who developed pain and swelling five and a half years after a clavicular fracture and was subsequently found to have an osteoblastoma arising at the fracture site. This is the first reported case of an osteoblastoma developing after a fracture, although osteoid osteomas, which are histologically indistinguishable from osteoblastomas, have been reported at prior fracture sites. This report demonstrates that secondary neoplasms such as osteoblastomas should be considered in the differential diagnosis for pain at a healed fracture site recurring years after the initial trauma.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30840099,

title = {Are patients more likely to have hip osteoarthritis progression and femoral head collapse after hip steroid/anesthetic injections? A retrospective observational study},

author = {F Joseph Simeone and Joao R T Vicentini and Miriam A Bredella and Connie Y Chang},

doi = {10.1007/s00256-019-03189-x},

issn = {1432-2161},

year  = {2019},

date = {2019-09-01},

journal = {Skeletal Radiol},

volume = {48},

number = {9},

pages = {1417--1426},

abstract = {OBJECTIVE: To evaluate progression of osteoarthritis and femoral head articular surface collapse in hip steroid/anesthetic injection patients (HIPs).nnMATERIALS AND METHODS: This study was IRB-approved and HIPAA-compliant. Two musculoskeletal radiologists performed retrospective, blinded reviews of radiography for 70 HIPs (40 mg triamcinolone/4 mL 0.5% preservative-free ropivacaine) with a 3- to 10-month follow-up and two control groups: demographic-matched patients with similar hip radiograph follow-up duration but no injection; and glenohumeral joint injection patients. Discordant evaluations were adjudicated by a third, senior reader. Groups were compared using Fisher's exact and unpaired t tests.nnRESULTS: There were 70 HIPs (mean age 67 ± 17 (range 19-92) years; 44 women, 26 men), who were followed for a mean of 6 ± 2 (3-12) months. Thirty-one (31 out of 70, 44%) of HIPs had progression of osteoarthritis after injection, versus 17 out of 70 (24%) of hip controls (HCs) and 13 out of 44 (30%) of glenohumeral injection patients (GIPs). This difference between HIPs and HCs was statistically significant (p = 0.02) but not that between HIPs and GIPs (0.17). Twelve (12 out of 70, 17%) HIPs had new collapse, compared with 1 out of 70 (1%) of HCs and 1 out of 44 (2%) of GIPs. This difference was statistically significant (HCs: p = 0.002; GIPs: p = 0.02).nnCONCLUSION: Hip steroid/anesthetic injection patients are more likely to demonstrate osteoarthritis progression and femoral head collapse than HC and GIPs in the injected joint 3-12 months after steroid and anesthetic injection. Further evaluation of hip injectates and the injection population is warranted.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30206677,

title = {Ultrasound-guided injection for the diagnosis and treatment of posteromedial knee friction syndrome},

author = {F Joseph Simeone and Arvin Kheterpal and Connie Y Chang and William E Palmer and Miriam A Bredella and Ambrose J Huang and Martin Torriani},

doi = {10.1007/s00256-018-3060-z},

issn = {1432-2161},

year  = {2019},

date = {2019-04-01},

journal = {Skeletal Radiol},

volume = {48},

number = {4},

pages = {563--568},

abstract = {OBJECTIVE: To describe an ultrasound guided injection technique for diagnosing and treating posteromedial knee friction syndrome, which occurs between the sartorius/gracilis tendons and medial femoral condyle (MFC).nnMATERIALS AND METHODS: Our study was IRB-approved and HIPAA-compliant. We identified patients via a retrospective review of medical records and MRI with posteromedial knee pain and isolated edema between MFC and sartorius/gracilis tendons and no evidence for meniscal tear, ruptured Baker's cyst or degenerative joint disease. Patients were referred for an ultrasound-guided procedure to inject anesthetic and corticosteroid at the site of edema. Procedures were evaluated for technical success, which was defined as satisfactory identification of the injection site and adequate delivery of medication. Follow-up was available up to 8 weeks after the procedure to determine the response and any potential complications.nnRESULTS: Fourteen subjects with MRI and symptoms of posteromedial knee friction syndrome underwent 14 injections. Technical success was achieved in all procedures, with no complications. At 8 weeks' follow-up, 92% of patients had symptom improvement. VAS before and 8 weeks after the procedure changed from 5.2 ± 2.7 to 0.9 ± 2.1 (p = 0.0002), respectively.nnCONCLUSION: Ultrasound-guided injection of edema between the MFC and sartorius/gracilis tendons supports the diagnosis of a posteromedial knee friction syndrome and successfully treats its associated symptoms.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{645287,

title = {Florance J, Hemke R, Chang CY, Torriani M, Bredella MA. Effects of Intra-articular Corticosteroid Injections on Lumbar Trabecular Density. Skeletal Radiology 2019. Accepted December 4, 2019},

year  = {2019},

date = {2019-01-01},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid29858916,

title = {Acute posterior cruciate ligament injuries: effect of location, severity, and associated injuries on surgical management},

author = {Mark A Anderson and F Joseph Simeone and William E Palmer and Connie Y Chang},

doi = {10.1007/s00256-018-2977-6},

issn = {1432-2161},

year  = {2018},

date = {2018-11-01},

journal = {Skeletal Radiol},

volume = {47},

number = {11},

pages = {1523--1532},

abstract = {OBJECTIVE: To correlate MRI findings of patients with posterior cruciate ligament (PCL) injury and surgical management.nnMATERIALS AND METHODS: A retrospective search yielded 79 acute PCL injuries (36 ± 16 years old, 21 F, 58 M). Two independent readers graded PCL tear location (proximal, middle, or distal third) and severity (low-grade or high-grade partial/complete) and evaluated injury of other knee structures. When available, operative reports were examined and the performed surgical procedure was compared with injury grade, location, and presence of associated injuries.nnRESULTS: The most commonly injured knee structures in acute PCL tears were posterolateral corner (58/79, 73%) and anterior cruciate ligament (ACL) (48/79, 61%). Of the 64 patients with treatment information, 31/64 (48%) were managed surgically: 12/31 (39%) had PCL reconstruction, 13/31 (42%) had ACL reconstruction, 10/31 (32%) had posterolateral corner reconstruction, 9/31 (29%) had LCL reconstruction, 8/31 (26%) had meniscectomy, and 8/31 (26%) had fixation of a fracture. Proximal third PCL tear and multiligamentous injury were more commonly associated with surgical management (P < 0.05). Posterolateral and posteromedial corner, ACL, collateral ligament, meniscus, patellar retinaculum, and gastrocnemius muscle injury, and fracture were more likely to result in surgical management (P < 0.05). Patients with high-grade partial/complete PCL tear were more likely to have PCL reconstruction as a portion of surgical management (P < 0.05).nnCONCLUSIONS: Location of PCL tear and presence of other knee injuries were associated with surgical management while high-grade/complete PCL tear grade was associated with PCL reconstruction. MRI reporting of PCL tear location, severity, and of other knee structure injuries is important for guiding clinical management.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid29502131,

title = {Clinical, radiological, and pathological features of extraskeletal osteosarcoma},

author = {Lauren A Roller and Ivan Chebib and Miriam A Bredella and Connie Y Chang},

doi = {10.1007/s00256-018-2908-6},

issn = {1432-2161},

year  = {2018},

date = {2018-09-01},

journal = {Skeletal Radiol},

volume = {47},

number = {9},

pages = {1213--1220},

abstract = {OBJECTIVE: To evaluate clinical and radiological features of pathology-proven extraskeletal osteosarcomas.nnMETHODS: This retrospective study was IRB-approved and HIPAA-compliant. Our pathology database was queried for cases of extraskeletal osteosarcoma. Tumor location, size, imaging appearance, presence of metastases, and clinical outcome were documented.nnRESULTS: Nineteen patients met inclusion criteria (age 59 ± 15 (range 28-85) years; 15 male, 4 female). Tumors occurred in the lower extremities (12 out of 19, 63%), pelvis/gluteal region (3 out of 19, 16%), upper extremity (2 out of 19, 5%), thorax (1 out of 19, 5%), and neck (1 out of 19, 5%). Two out of 19 (11%) patients had undergone radiation to the tumor site previously. According to pathology, 16 out of 19 tumors were high-grade (84%). Tumors presented as soft-tissue masses measuring 9.5 ± 6.8 (2-29) cm. Tumor mineralization was present in 5 out of 19 cases (26%) and local invasion was found in 1 out of 19 cases (6%). On MRI, tumors typically appeared hyperintense on T2-weighted sequences with enhancement in 15 out of 15 (100%) contrast-enhanced studies, and with central necrosis in 10 out of 19 (53%) cases. Low-grade tumors were smaller (<4 cm; 3 out of 3, 100%) and lacked central necrosis (3 out of 3, 100%). 8 out of 19 patients (42%) had metastases, most commonly to the lung (7 out of 19, 37%) and bone (2 out of 19,11%). Two out of 8 patients (25%) with metastases and 8 out of 11 (73%) without metastases achieved recurrence-free survival (mean follow-up 3.8 ± 4.0 [0.2-14.2]) years. No metastases or deaths occurred in patients with low-grade histology.nnCONCLUSIONS: Extraskeletal osteosarcomas are rare, typically high-grade malignancies that commonly metastasize to lung and bones. Low-grade tumors and those without metastases have a good prognosis. MRI appearance is nonspecific, with T2 hyperintense signal and heterogeneous enhancement. Unlike conventional osteosarcoma, mineralization is rare.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid29314220,

title = {Histopathology of synovial cysts of the spine},

author = {Ivan Chebib and Connie Y Chang and Joseph H Schwab and Darcy A Kerr and Vikram Deshpande and G Petur Nielsen},

doi = {10.1111/his.13465},

issn = {1365-2559},

year  = {2018},

date = {2018-05-01},

journal = {Histopathology},

volume = {72},

number = {6},

pages = {923--929},

abstract = {AIMS: Cystic lesions derived from the synovial and ligamentous structures of the spine have varied histological appearances. Not uncommonly, there is discrepancy between the clinicoradiological diagnosis and histology. Therefore, we sought to characterise the histological features of tissue submitted as 'synovial cysts' of the spine.nnMETHODS AND RESULTS: Resected specimens of the spine labelled 'synovial cysts' and 'lumbar cysts' were histologically evaluated and classified on the basis of histopathological features. Seventy-five histological samples of spinal cysts were identified. Thirty-one were classified as synovial cysts (definite synovial lining), 28 showed pseudocystic degeneration of the ligamentum flavum, seven showed pseudocyst formation without evidence of a synovial lining or degeneration of the ligamentum flavum, and eight showed cyst contents only or no histological evidence of cyst wall for evaluation. Twenty-five cases (33%), especially those showing pseudocystic degeneration of the ligamentum flavum, were associated with very characteristic tumour calcinosis-like calcium deposition with a surrounding foreign-body giant-cell reaction.nnCONCLUSION: Histology of 'synovial cysts' of the spine shows varied types of cyst; a large proportion are not synovial-lined cysts, but rather show pseudocystic degenerative changes of the ligamentum flavum, often associated with very characteristic finely granular calcifications and a foreign-body giant-cell reaction. This may have implications not only for understanding the pathogenesis of these lesions, but also for their varied responses to non-surgical interventions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid29143113,

title = {Percutaneous CT-guided sacroiliac joint sampling for infection: aspiration, biopsy, and technique},

author = {David Knipp and F Joseph Simeone and Sandra B Nelson and Ambrose J Huang and Connie Y Chang},

doi = {10.1007/s00256-017-2809-0},

issn = {1432-2161},

year  = {2018},

date = {2018-04-01},

journal = {Skeletal Radiol},

volume = {47},

number = {4},

pages = {473--482},

abstract = {OBJECTIVE: To evaluate methods of CT-guided sacroiliac joint sampling in patients with suspected infection.nnMATERIALS AND METHODS: All CT-guided sacroiliac joint sampling procedures for suspected infection were reviewed for sampling type (aspiration, lavage aspiration, biopsy), microbiology results, and clinical and imaging follow-up. The primary gold standard was anatomic pathology. If pathology was not available, then positive blood culture with the same organism as SIJ sampling, imaging and clinical follow-up, or clinical follow-up only were used. Anterior and posterior joint distention was evaluated by MRI within 7 days of the procedure.nnRESULTS: A total of 34 patients (age 39 ± 20 (range, 6-75) years; 21 F, 13 M) were included. Aspiration samples only were obtained in 13/34 (38%) cases, biopsy samples only in 9/34 (26%) cases, and both samples in 12/34 (35%) cases. There was an overall 54% sensitivity and 86% specificity. For the aspiration samples, sensitivity and specificity were 60 and 81%, respectively, compared to 45 and 90% for the biopsy samples. In cases with both samples, biopsy did not add additional microbial information. Seventeen (17/34, 50%) patients had an MRI. The anterior joint was more distended than the posterior joint in 15/17 (88%) of patients, and this difference was significant (P = 0.0003). All of these 17 patients had an attempted aspiration by a posterior approach; 6/17 (35%) resulted in a successful aspiration.nnCONCLUSIONS: Aspiration of the sacroiliac joint has a higher sensitivity than biopsy and should always be attempted first. MRI may be helpful for procedure planning.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid29301144,

title = {Imaging of Tendons of the Knee: Much More than just the Extensor Mechanism},

author = {Jad S Husseini and Connie Y Chang and William E Palmer},

doi = {10.1055/s-0037-1617418},

issn = {1938-2480},

year  = {2018},

date = {2018-02-01},

journal = {J Knee Surg},

volume = {31},

number = {2},

pages = {141--154},

abstract = {The tendons of the knee play a critical role in the motion and stability of the knee. Knee pain, a common clinical complaint, can frequently be attributed to pathology of these structures. While the cornerstones of the radiological evaluation of the knee are radiography and magnetic resonance imaging, ultrasound can also play an important diagnostic role and can be useful for guided interventional procedures. Understanding the utility of each modality in the assessment for tendon pathology and a familiarity with the normal and abnormal imaging appearance of these structures are crucial for accurate diagnosis.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid29301144b,

title = {Imaging of Tendons of the Knee: Much More than just the Extensor Mechanism},

author = {Jad S Husseini and Connie Y Chang and William E Palmer},

doi = {10.1055/s-0037-1617418},

issn = {1938-2480},

year  = {2018},

date = {2018-02-01},

journal = {J Knee Surg},

volume = {31},

number = {2},

pages = {141--154},

abstract = {The tendons of the knee play a critical role in the motion and stability of the knee. Knee pain, a common clinical complaint, can frequently be attributed to pathology of these structures. While the cornerstones of the radiological evaluation of the knee are radiography and magnetic resonance imaging, ultrasound can also play an important diagnostic role and can be useful for guided interventional procedures. Understanding the utility of each modality in the assessment for tendon pathology and a familiarity with the normal and abnormal imaging appearance of these structures are crucial for accurate diagnosis.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid28667362,

title = {Quantitative contrast-enhanced CT attenuation evaluation of osseous metastases following chemotherapy},

author = {Connie Y Chang and F Joseph Simeone and Martin Torriani and Miriam A Bredella},

doi = {10.1007/s00256-017-2706-6},

issn = {1432-2161},

year  = {2017},

date = {2017-10-01},

journal = {Skeletal Radiol},

volume = {46},

number = {10},

pages = {1385--1395},

abstract = {PURPOSE: Osseous metastases often undergo an osteoblastic healing response following chemotherapy. The purpose of our study was to demonstrate the quantitative CT changes in attenuation of osseous metastases before and after chemotherapy.nnMATERIALS AND METHODS: Our study was IRB approved and HIPAA compliant. Our cohort consisted of 86 consecutive cancer patients with contrast-enhanced CTs before and 14 ± 2 (12-25) months after initiation of chemotherapy (60 ± 11 years, 36 males, 50 females). The average and maximum metastasis attenuations were measured in Hounsfield units (HU) by two readers. Treatment effects were assessed using paired t-tests and Fisher exact tests. Intraclass correlation coefficients (ICCs) were calculated. Patient records were reviewed to determine the patient's clinical status (worse, unchanged, or improved) at the time of follow-up CT.nnRESULTS: The distribution of lesion types was as follows: lytic (30/86, 35%), blastic (43/86, 50%), and mixed lytic-blastic (13/86, 15%). There was a significant increase in average and maximum CT attenuation of metastases following chemotherapy for all patients, which remained statistically significant when stratified by lesion type, clinical status (worsening or improving/stable), cancer type (breast, lung), and radiation therapy (P < 0.05). In a subgroup of patients whose osseous metastases decreased in average attenuation (14/86, 16%), more patients had a worse clinical status (11/14, 79%) (P = 0.02). ICC was almost perfect for average attenuation and substantial for maximum attenuation.nnCONCLUSION: Quantitative assessment of osseous metastatic disease using CT attenuation measurements demonstrated a statistically significant increase in attenuation more than 12 months after initiation of chemotherapy.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid28660403,

title = {MR imaging features of hemispherical spondylosclerosis},

author = {Joao R T Vicentini and Edgar L Martinez-Salazar and Connie Y Chang and Miriam A Bredella and Daniel I Rosenthal and Martin Torriani},

doi = {10.1007/s00256-017-2699-1},

issn = {1432-2161},

year  = {2017},

date = {2017-10-01},

journal = {Skeletal Radiol},

volume = {46},

number = {10},

pages = {1367--1378},

abstract = {OBJECTIVE: Hemispherical spondylosclerosis (HS) is a rare degenerative entity characterized by dome-shaped sclerosis of a single vertebral body that may pose a diagnostic dilemma. The goal of this study was to describe the MR imaging features of HS.nnMATERIALS AND METHODS: We identified spine radiographs and CT examinations of subjects with HS who also had MR imaging for correlation. Two musculoskeletal radiologists independently assessed sclerosis characteristics, presence of endplate erosions, marrow signal intensity, and disk degeneration (Pfirrmann scale).nnRESULTS: We identified 11 subjects (six males, five females, mean 48 ± 10 years) with radiographic/CT findings of HS. The most commonly affected vertebral body was L4 (6/11; 55%). On MR imaging, variable signal intensity was noted, being most commonly low on T1 (8/11, 73%) and high on fat-suppressed T2-weighted (8/11, 73%) images. In two subjects, diffuse post-contrast enhancement was seen in the lesion. Moderate disk degeneration and endplate bone erosions adjacent to sclerosis were present in all subjects. Erosions of the opposite endplate were present in two subjects (2/11, 18%). CT data from nine subjects showed the mean attenuation value of HS was 472 ± 96 HU.nnCONCLUSIONS: HS appearance on MR imaging is variable and may not correlate with the degree of sclerosis seen on radiographs or CT. Disk degenerative changes and asymmetric endplate erosions are consistent markers of HS.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid28389821,

title = {Variations of anatomy on MRI of the first extensor compartment of the wrist and association with DeQuervain tenosynovitis},

author = {Connie Y Chang and Arvin B Kheterpal and Joao Rafael Terneria Vicentini and Ambrose J Huang},

doi = {10.1007/s00256-017-2639-0},

issn = {1432-2161},

year  = {2017},

date = {2017-08-01},

journal = {Skeletal Radiol},

volume = {46},

number = {8},

pages = {1047--1056},

abstract = {OBJECTIVE: To study anatomical variations on MRI of the first extensor compartment of the wrist in DeQuervain tenosynovitis (DQT).nnMATERIALS AND METHODS: A retrospective search for DQT patients yielded 47 subjects (51 ± 15 years, 36 female, 11 male). The age-matched control group (normal first extensor compartment) was 49 ± 15 years (29 female, 18 male). Two independent readers reviewed: the number of abductor pollicis longus (APL) tendon slips, tendon sheath septations (compartmentalization), and APL and EPB cross-sectional area (CSA) at the radial styloid. A tendon slip was defined as a discrete structure for ≥5 contiguous slices with its own insertion.nnRESULTS: The distribution of APL tendon slips was different for the DQT and control groups (Reader 1/Reader 2: P = 0.0001 and 0.001). The most common arrangement for both groups was two APL tendon slips. One tendon slip was less common (P = 0.03 and 0.1) and compartmentalization was more common (P = 0.003; < 0.0001) for the DQT group than the control group. There was no difference in tendon slip insertions on one or multiple bones (P = 0.1; 0.7). APL and EPB compartment CSAs were also higher for the DQT group (combined first extensor compartment area: 21.3 ± 7.6 mm; 21.0 ± 7.1) than the control group (17.2 ± 3.8; 17.1 ± 3.9) (P = 0.002; 0.002).nnCONCLUSION: We found a statistically significantly increased proportion of supernumerary tendon slips and compartmentalization of the first extensor compartment in patients with DQT and greater CSA of the first extensor compartment at the radial styloid, consistent with previous anatomical, surgical, and ultrasound studies.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid27743037,

title = {Treatment of aneurysmal bone cysts by percutaneous CT-guided injection of calcitonin and steroid},

author = {Connie Y Chang and Susan V Kattapuram and Ambrose J Huang and F Joseph Simeone and Martin Torriani and Miriam A Bredella},

doi = {10.1007/s00256-016-2503-7},

issn = {1432-2161},

year  = {2017},

date = {2017-01-01},

journal = {Skeletal Radiol},

volume = {46},

number = {1},

pages = {35--40},

abstract = {OBJECTIVES: To determine the efficacy and safety of percutaneous calcitonin and steroid injection in the treatment of aneurysmal bone cysts (ABCs).nnMATERIALS AND METHODS: Our study was IRB-approved and HIPAA-compliant. We reviewed pre- and post-procedural imaging studies and medical records of all CT-guided percutaneous injections of ABCs with calcitonin and steroid performed at our institution between 2003 and 2015.nnRESULTS: Treatment success based on imaging was categorized as substantial (51-100 %), partial (1-50 %), or none (0 %) by comparing radiographs of the lesion before and after treatment. Our study group comprised 9 patients (7 female, 2 male; mean age 19 ± 5 (range 12-25) years). ABCs were located in the pubis (n = 3), femur (n = 2), and humerus/scapula/ilium/sacrum (n = 1 for each). One patient did not have any clinical or imaging follow-up. For the other 8 patients, clinical and imaging follow-up ranged from 1 to 93 months (mean 16 ± 29 months). One patient had two injections, and 1 patient had three injections. Six out of eight patients (75 %) had complete symptomatic relief and 2 patients (25 %) had partial symptomatic relief after initial injection. Imaging follow-up revealed substantial imaging response in 4 out of 8 patients (50 %). There was a partial imaging response in 2 patients (25 %) and no imaging response in 2 out of 8 patients (25 %), and all 4 of these patients had local recurrence. There were no complications.nnCONCLUSION: Percutaneous CT-guided injection of ABCs with calcitonin and steroid is a safe and effective treatment. Lack of imaging response may necessitate more aggressive treatment to minimize local recurrence.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid27771754,

title = {Long-term outcomes of percutaneous lumbar facet synovial cyst rupture},

author = {Ambrose J Huang and Stijn A Bos and Martin Torriani and F Joseph Simeone and Connie Y Chang and Stuart R Pomerantz and Miriam A Bredella},

doi = {10.1007/s00256-016-2513-5},

issn = {1432-2161},

year  = {2017},

date = {2017-01-01},

journal = {Skeletal Radiol},

volume = {46},

number = {1},

pages = {75--80},

abstract = {OBJECTIVE: To evaluate the therapeutic value, safety, and long-term clinical outcomes of percutaneous lumbar facet synovial cyst (LFSC) rupture.nnMATERIALS AND METHODS: Our study was institutional review board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPAA)-compliant. The study group comprised 71 patients (44 women, mean age: 65 ± 17 years) who underwent CT- or fluoroscopy-guided percutaneous LFSC rupture. The technical success of LFSC rupture, the long-term clinical outcome, including repeat procedures or surgery, and imaging findings on MRI and CT were recorded.nnRESULTS: Seventy-nine LFSC ruptures were performed in 71 patients. CT guidance was used in 57 cases and fluoroscopy guidance in 22 cases. LFSC rupture was technically successful in 58 out of 79 cases (73 %). Mean injection volume for cyst rupture was 3.6 ± 2.2 mL and a combination of steroid and anesthetic was injected in all cases. Over a mean follow-up time of 44 months, 12 % of patients underwent repeat cyst rupture, and 46 % eventually underwent surgery, whereas the majority of patients (55 %) experienced symptomatic relief and did not undergo surgery. There was no significant association between a successful outcome and age, sex, level, or size of LFSC (p > 0.1). LFSCs with T2 hypointensity were more likely to require surgery (p = 0.02). There was one complication, a bacterial skin infection that completely resolved following antibiotic therapy.nnCONCLUSION: Percutaneous LFSC rupture is an effective and safe nonsurgical treatment option for LFSC. More than half of treated patients were able to avoid subsequent surgery. Therefore, percutaneous LFSC rupture should be considered before surgical intervention.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid27726750,

title = {Imaging Findings of Metabolic Bone Disease},

author = {Connie Y Chang and Daniel I Rosenthal and Deborah M Mitchell and Atsuhiko Handa and Susan V Kattapuram and Ambrose J Huang},

doi = {10.1148/rg.2016160004},

issn = {1527-1323},

year  = {2016},

date = {2016-10-01},

journal = {Radiographics},

volume = {36},

number = {6},

pages = {1871--1887},

abstract = {Metabolic bone diseases are a diverse group of diseases that result in abnormalities of (a) bone mass, (b) structure mineral homeostasis, (c) bone turnover, or (d) growth. Osteoporosis, the most common metabolic bone disease, results in generalized loss of bone mass and deterioration in the bone microarchitecture. Impaired chondrocyte development and failure to mineralize growth plate cartilage in rickets lead to widened growth plates and frayed metaphyses at sites of greatest growth. Osteomalacia is the result of impaired mineralization of newly formed osteoid, which leads to characteristic Looser zones. Hypophosphatasia is a congenital condition of impaired bone mineralization with wide phenotypic variability. Findings of hyperparathyroidism are the result of bone resorption, most often manifesting as subperiosteal resorption in the hand. Renal osteodystrophy is the collection of skeletal findings observed in patients with chronic renal failure and associated secondary hyperparathyroidism and can include osteopenia, osteosclerosis, and "rugger jersey spine." Hypoparathyroidism is most commonly due to iatrogenic injury, and radiographic findings of hypoparathyroidism reflect an overall increase in bone mass. Thyroid hormone regulates endochondral bone formation; and congenital hypothyroidism, when untreated, leads to delayed bone age and absent, irregular, or fragmented distal femoral and proximal tibial epiphyses. Soft-tissue proliferation of thyroid acropachy is most often observed in the hands and feet. The findings of acromegaly are due to excess growth hormone secretion and therefore proliferation of the bones and soft tissues. Vitamin C deficiency, or scurvy, impairs posttranslational collagen modification, leading to subperiosteal hemorrhage and fractures. RSNA, 2016.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid27726750b,

title = {Imaging Findings of Metabolic Bone Disease},

author = {Connie Y Chang and Daniel I Rosenthal and Deborah M Mitchell and Atsuhiko Handa and Susan V Kattapuram and Ambrose J Huang},

doi = {10.1148/rg.2016160004},

issn = {1527-1323},

year  = {2016},

date = {2016-10-01},

journal = {Radiographics},

volume = {36},

number = {6},

pages = {1871--1887},

abstract = {Metabolic bone diseases are a diverse group of diseases that result in abnormalities of (a) bone mass, (b) structure mineral homeostasis, (c) bone turnover, or (d) growth. Osteoporosis, the most common metabolic bone disease, results in generalized loss of bone mass and deterioration in the bone microarchitecture. Impaired chondrocyte development and failure to mineralize growth plate cartilage in rickets lead to widened growth plates and frayed metaphyses at sites of greatest growth. Osteomalacia is the result of impaired mineralization of newly formed osteoid, which leads to characteristic Looser zones. Hypophosphatasia is a congenital condition of impaired bone mineralization with wide phenotypic variability. Findings of hyperparathyroidism are the result of bone resorption, most often manifesting as subperiosteal resorption in the hand. Renal osteodystrophy is the collection of skeletal findings observed in patients with chronic renal failure and associated secondary hyperparathyroidism and can include osteopenia, osteosclerosis, and "rugger jersey spine." Hypoparathyroidism is most commonly due to iatrogenic injury, and radiographic findings of hypoparathyroidism reflect an overall increase in bone mass. Thyroid hormone regulates endochondral bone formation; and congenital hypothyroidism, when untreated, leads to delayed bone age and absent, irregular, or fragmented distal femoral and proximal tibial epiphyses. Soft-tissue proliferation of thyroid acropachy is most often observed in the hands and feet. The findings of acromegaly are due to excess growth hormone secretion and therefore proliferation of the bones and soft tissues. Vitamin C deficiency, or scurvy, impairs posttranslational collagen modification, leading to subperiosteal hemorrhage and fractures. RSNA, 2016.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid27101076,

title = {Distinguishing Untreated Osteoblastic Metastases From Enostoses Using CT Attenuation Measurements},

author = {Adam Ulano and Miriam A Bredella and Patrick Burke and Ivan Chebib and F Joseph Simeone and Ambrose J Huang and Martin Torriani and Connie Y Chang},

doi = {10.2214/AJR.15.15559},

issn = {1546-3141},

year  = {2016},

date = {2016-08-01},

journal = {AJR Am J Roentgenol},

volume = {207},

number = {2},

pages = {362--368},

abstract = {OBJECTIVE: The purpose of this study was to determine whether CT attenuation thresholds can be used to distinguish untreated osteoblastic metastases from enostoses.nnMATERIALS AND METHODS: The study group comprised 62 patients with 279 sclerotic bone lesions found at CT (126 enostoses in 37 patients and 153 metastases in 25 patients). The cause of sclerotic lesions was assessed histologically or by clinical and imaging follow-up. None of the patients had undergone prior treatment for the metastases. The mean and maximum attenuation were measured in Hounsfield units. ROC analysis was performed to determine sensitivity, specificity, AUC, 95% CIs, and cutoff values of CT attenuation to differentiate metastases from enostoses. Interreader reproducibility was assessed using an intraclass correlation coefficient with 95% CI.nnRESULTS: The mean and maximum CT attenuation values of enostoses were 1190 ± 239 HU and 1323 ± 234 HU, respectively, and those of osteoblastic metastases were 654 ± 176 HU and 787 ± 194 HU, respectively. Using a cutoff of 885 HU for mean attenuation, the AUC was 0.982, sensitivity was 95%, and specificity was 96%. Using a cutoff of 1060 HU for maximum CT attenuation, the AUC was 0.976, sensitivity was 95%, and specificity was 96%. The mean attenuation intraclass correlation coefficient was 0.987 for enostoses and 0.81 for metastases. The maximum attenuation intraclass correlation coefficient was 0.814 for enostoses and 0.980 for metastases.nnCONCLUSION: CT attenuation measurements can be used to distinguish untreated osteoblastic metastases from enostoses. A mean attenuation of 885 HU and a maximum attenuation of 1060 HU provide reliable thresholds below which a metastatic lesion is the favored diagnosis.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid26490678,

title = {Dynamic sonography of snapping hip due to gluteus maximus subluxation over greater trochanter},

author = {Connie Y Chang and Jeffrey Kreher and Martin Torriani},

doi = {10.1007/s00256-015-2265-7},

issn = {1432-2161},

year  = {2016},

date = {2016-03-01},

journal = {Skeletal Radiol},

volume = {45},

number = {3},

pages = {409--412},

abstract = {We report on the dynamic sonographic findings of a 10-year-old avid female dancer who presented with symptoms of abrupt left hip motion and associated painful snapping sensation while performing lateral motions of the pelvis suggesting external snapping hip syndrome. Dynamic sonographic evaluation of both hips demonstrated that symptoms were due to gluteus maximus subluxation over the greater trochanter. This etiology of external snapping hip syndrome is rare with limited imaging descriptions in the literature. We present case history, physical examination, and dynamic ultrasound examination, including multiple still images and cine clips, comprehensively characterizing this uncommon source of external snapping hip syndrome.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid26613732,

title = {Radiation dose and intra-articular access: comparison of the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections},

author = {Ambrose J Huang and Rene Balza and Martin Torriani and Miriam A Bredella and Connie Y Chang and Frank J Simeone and William E Palmer},

doi = {10.1007/s00256-015-2300-8},

issn = {1432-2161},

year  = {2016},

date = {2016-03-01},

journal = {Skeletal Radiol},

volume = {45},

number = {3},

pages = {367--373},

abstract = {PURPOSE: To compare the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections with respect to successful intra-articular needle placement, fluoroscopy time, radiation dose, and dose area product (DAP).nnMATERIALS AND METHODS: This retrospective study was IRB-approved and HIPAA-compliant. 498 fluoroscopically guided tibiotalar joint injections were performed or supervised by one of nine staff radiologists from 11/1/2010-12/31/2013. The injection approach was determined by operator preference. Images were reviewed on a PACS workstation to determine the injection approach (lateral mortise versus anterior midline) and to confirm intra-articular needle placement. Fluoroscopy time (minutes), radiation dose (mGy), and DAP (μGy-m(2)) were recorded and compared using the student's t-test (fluoroscopy time) or the Wilcoxon rank sum test (radiation dose and DAP).nnRESULTS: There were 246 lateral mortise injections and 252 anterior midline injections. Two lateral mortise injections were excluded from further analysis because no contrast was administered. Intra-articular location of the needle tip was documented in 242/244 lateral mortise injections and 252/252 anterior midline injections. Mean fluoroscopy time was shorter for the lateral mortise group than the anterior midline group (0.7 ± 0.5 min versus 1.2 ± 0.8 min, P < 0.0001). Mean radiation dose and DAP were less for the lateral mortise group than the anterior midline group (2.1 ± 3.7 mGy versus 2.5 ± 3.5 mGy, P = 0.04; 11.5 ± 15.3 μGy-m(2) versus 13.5 ± 17.3 μGy-m(2), P = 0.006).nnCONCLUSION: Both injection approaches resulted in nearly 100% rates of intra-articular needle placement, but the lateral mortise approach used approximately 40% less fluoroscopy time and delivered 15% lower radiation dose and DAP to the patient.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid26490678b,

title = {Dynamic sonography of snapping hip due to gluteus maximus subluxation over greater trochanter},

author = {Connie Y Chang and Jeffrey Kreher and Martin Torriani},

doi = {10.1007/s00256-015-2265-7},

issn = {1432-2161},

year  = {2016},

date = {2016-03-01},

journal = {Skeletal Radiol},

volume = {45},

number = {3},

pages = {409--412},

abstract = {We report on the dynamic sonographic findings of a 10-year-old avid female dancer who presented with symptoms of abrupt left hip motion and associated painful snapping sensation while performing lateral motions of the pelvis suggesting external snapping hip syndrome. Dynamic sonographic evaluation of both hips demonstrated that symptoms were due to gluteus maximus subluxation over the greater trochanter. This etiology of external snapping hip syndrome is rare with limited imaging descriptions in the literature. We present case history, physical examination, and dynamic ultrasound examination, including multiple still images and cine clips, comprehensively characterizing this uncommon source of external snapping hip syndrome.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid26497542,

title = {Retrospective analysis of intravertebral collateral enhancement in patients with central venous obstruction},

author = {F Joseph Simeone and Debbie L Bennett and Connie Y Chang and Ambrose J Huang and Susan V Kattapuram and Miriam A Bredella and Martin Torriani},

doi = {10.1007/s00256-015-2274-6},

issn = {1432-2161},

year  = {2016},

date = {2016-02-01},

journal = {Skeletal Radiol},

volume = {45},

number = {2},

pages = {163--168},

abstract = {OBJECTIVE: To compare prevalence and patterns of intravertebral collateral enhancement in patients with and without central venous obstruction (CVO).nnMATERIALS AND METHODS: Chest CTs performed between 1/1/2000 and 12/15/2012 with reports containing terms indicating CVO were identified. All contrast enhanced CTs were examined for the presence of CVO and collateral venous pathways. If intravertebral collateral enhancement was present, the pattern was recorded as nodular, linear, or both.nnRESULTS: In 209 suspected cases of CVO, 53 (25 %) were confirmed with obstruction and 156 (75 %) were without obstruction. In patients with CVO, 47 % (25/53) demonstrated collateral venous flow through an intravertebral marrow pathway compared to 5 % (8/156) of patients without CVO (P < 0.0001). The most common level of enhancement was the upper thoracic spine, involving only the vertebral body. Nodular, linear, and combined nodular-linear enhancement patterns were seen with similar frequency. Nodular intravertebral collateral enhancement was mistaken for sclerotic metastases in 33 % (3/9) of cases.nnCONCLUSION: Intravertebral collateral enhancement was seen in almost half the patients with CVO and when nodular enhancement is present, it is important to differentiate between metastatic lesions and enhancement related to CVO.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid25533313,

title = {Comparison of the diagnostic accuracy of 99 m-Tc-MDP bone scintigraphy and 18 F-FDG PET/CT for the detection of skeletal metastases},

author = {Connie Y Chang and Corey M Gill and F Joseph Simeone and Atul K Taneja and Ambrose J Huang and Martin Torriani and Miriam A Bredella},

doi = {10.1177/0284185114564438},

issn = {1600-0455},

year  = {2016},

date = {2016-01-01},

journal = {Acta Radiol},

volume = {57},

number = {1},

pages = {58--65},

abstract = {BACKGROUND: Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is commonly performed for cancer staging, as it can detect metastatic disease in multiple organ systems. However, there has been some controversy in the scientific literature when comparing FDG PET/CT and technetium-99 m-bone scintigraphy (bone scan) for the detection of skeletal metastases.nnPURPOSE: To compare the accuracy of FDG PET/CT with bone scan for the detection of skeletal metastases.nnMATERIAL AND METHODS: The study group comprised 202 adult cancer patients who underwent both FDG PET/CT and bone scan within 31 days for staging. Bone scans and FDG PET/CT were evaluated by two musculoskeletal radiologists for the presence and location of skeletal metastatic disease. Confirmation of the final diagnosis was based on the CT or magnetic resonance imaging (MRI) appearance, follow-up imaging, or histology.nnRESULTS: The sensitivity, specificity, and accuracy for detecting skeletal metastatic disease of FDG PET/CT were 97%, 98%, and 98%, respectively, and of bone scan were 83%, 98%, and 93%, respectively. The lesions that bone scan most commonly missed were located in the pelvis, spine, and sacrum. FDG PET/CT missed mostly lesions that were outside of the field of view, but in all of these cases the patient had additional sites of skeletal metastatic disease. Bone scan falsely identified six metastatic lesions and FDG PET/CT falsely identified three metastatic lesions.nnCONCLUSION: FDG PET/CT is an accurate technique for detection of skeletal metastases, and is superior to bone scan, especially in the spine and pelvis.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid26360057,

title = {Rock Climbing Injuries: Acute and Chronic Repetitive Trauma},

author = {Connie Y Chang and Martin Torriani and Ambrose J Huang},

doi = {10.1067/j.cpradiol.2015.07.003},

issn = {1535-6302},

year  = {2016},

date = {2016-01-01},

journal = {Curr Probl Diagn Radiol},

volume = {45},

number = {3},

pages = {205--214},

abstract = {Rock climbing has increased in popularity as a sport, and specific injuries related to its practice are becoming more common. Chronic repetitive injuries are more common than acute injuries, although acute injuries tend to be more severe. We review both acute and chronic upper and lower extremity injuries. Understanding the injury pattern in rock climbers is important for accurate diagnosis.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid26360057b,

title = {Rock Climbing Injuries: Acute and Chronic Repetitive Trauma},

author = {Connie Y Chang and Martin Torriani and Ambrose J Huang},

doi = {10.1067/j.cpradiol.2015.07.003},

issn = {1535-6302},

year  = {2016},

date = {2016-01-01},

journal = {Curr Probl Diagn Radiol},

volume = {45},

number = {3},

pages = {205--214},

abstract = {Rock climbing has increased in popularity as a sport, and specific injuries related to its practice are becoming more common. Chronic repetitive injuries are more common than acute injuries, although acute injuries tend to be more severe. We review both acute and chronic upper and lower extremity injuries. Understanding the injury pattern in rock climbers is important for accurate diagnosis.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid26338069,

title = {Percutaneous CT-guided needle biopsies of musculoskeletal tumors: a 5-year analysis of non-diagnostic biopsies},

author = {Connie Y Chang and Ambrose J Huang and Miriam A Bredella and Martin Torriani and Elkan F Halpern and Daniel I Rosenthal and Dempsey S Springfield},

doi = {10.1007/s00256-015-2235-0},

issn = {1432-2161},

year  = {2015},

date = {2015-12-01},

journal = {Skeletal Radiol},

volume = {44},

number = {12},

pages = {1795--1803},

abstract = {OBJECTIVE: To study non-diagnostic CT-guided musculoskeletal biopsies and take steps to minimize them. Specifically we asked: (1) What malignant diagnoses have a higher non-diagnostic rate? (2) What factors of a non-diagnostic biopsy may warrant more aggressive pursuit? (3) Do intra-procedural frozen pathology (FP) or point-of-care (POC) cytology reduce the non-diagnostic biopsy rate?nnMATERIALS AND METHODS: This study was IRB-approved and HIPAA-compliant. We retrospectively reviewed 963 consecutive CT-guided musculoskeletal biopsies. We categorized pathology results as malignant, benign, or non-diagnostic and recorded use of FP or POC cytology. Initial biopsy indication, final diagnosis, method of obtaining the final diagnosis of non-diagnostic biopsies, age of the patient, and years of biopsy attending experience were recorded. Groups were compared using Pearson's χ(2) test or Fisher's exact test.nnRESULTS: In all, 140 of 963 (15%) biopsies were non-diagnostic. Lymphoma resulted in more non-diagnostic biopsies (P < 0.0001). While 67% of non-diagnostic biopsies yielded benign diagnoses, 33% yielded malignant diagnoses. Patients whose percutaneous biopsy was indicated due to the clinical context without malignancy history almost always generated benign results (96%). Whereas 56% of biopsies whose indication was an imaging finding of a treatable lesion were malignant, 20% of biopsies whose indication was a history of malignancy were malignant. There was no statistically significant difference in the nondiagnostic biopsy rates of pediatric versus adult patients (P = 0.8) and of biopsy attendings with fewer versus more years of experience (P = 0.5). The non-diagnostic rates of biopsies with FP (8%), POC cytology (25%), or neither (24%) were significantly different (P < 0.0001).nnCONCLUSION: Lymphoma is the malignant diagnosis most likely to result in a non-diagnostic biopsy. If the clinical and radiologic suspicion for malignancy is high, repeat biopsy is warranted. If the clinical context suggests a benign lesion, a non-diagnostic biopsy may be considered reassuring. Frozen pathology may decrease the non-diagnostic biopsy rate.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid26315889,

title = {Battery-powered bone drill: caution needed in densely blastic lesions},

author = {Connie Y Chang and F Joseph Simeone and Ambrose J Huang},

doi = {10.1007/s00256-015-2241-2},

issn = {1432-2161},

year  = {2015},

date = {2015-12-01},

journal = {Skeletal Radiol},

volume = {44},

number = {12},

pages = {1845--1848},

abstract = {Image-guided biopsies play an important role for pathologic diagnosis of bone tumors. Recently, motorized, battery powered bone marrow biopsy devices have been used to biopsy focal bone lesions with high accuracy. We present here two cases of densely blastic metastases where the biopsy sample could not be removed from the needle. These two cases suggest that if the lesion is densely blastic, then the sample should be small (<5 mm) to ensure that the biopsy specimen will not be stuck within the biopsy needle.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}