Publications by authors named "Avneesh Chhabra"

235 Publications

Sacrum magnetic resonance imaging for low back and tail bone pain: A quality initiative to evaluate and improve imaging utility.

World J Methodol 2021 Jul 20;11(4):110-115. Epub 2021 Jul 20.

Department of Radiology, UT Southwestern, Dallas, TX 75390, United States.

As quality and cost effectiveness become essential in clinical practice, an evidence-based evaluation of the utility of imaging orders becomes an important consideration for radiology's value in patient care. We report an institutional quality improvement project including a retrospective review of utility of sacrum magnetic resonance (MR) imaging for low back pain at our institution over a four-year period and follow-up results after physician education intervention. Sacral MR imaging for low back pain and tailbone pain were only positive for major findings in 2/98 (2%) cases, and no major changes in patient management related to imaging findings occurred over this period, resulting in almost $500000 cost without significant patient benefit. We distributed these results to the Family Medicine department and clinics that frequently placed this order. An approximately 83% drop in ordering rate occurred over the ensuing 3 mo follow-up period. Sacrum MR imaging for low back pain and tail bone pain has not been a cost-effective diagnostic tool at our institution. Physician education was a useful tool in reducing overutilization of this study, with a remarkable drop in such studies after sharing these findings with primary care physicians at the institution. In conclusion, sacrum MR imaging rarely elucidates the cause of low back/tail pain diagnosed in a primary care setting and is even less likely to result in major changes in management. The practice can be adopted in other institutions for the benefit of their patients and improve cost efficiency.
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http://dx.doi.org/10.5662/wjm.v11.i4.110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299904PMC
July 2021

Correlation of the Imaging Features of Femoroacetabular Impingement Syndrome With Clinical Findings and Patient Functional Scores.

Orthopedics 2021 Jul-Aug;44(4):e577-e582. Epub 2021 Jul 1.

The relationship among the severity of the imaging features of femoroacetabular impingement syndrome (FAIS), patient symptoms, and function has not been elucidated. Understanding this relationship helps to improve the prognostic value of imaging. The goal of this study was to examine the correlation of clinical findings, patient pain, and function with severity, as measured with radiographic and 3-dimensional magnetic resonance imaging (3D-MRI). Data collected prospectively through a longitudinally maintained hip database were reviewed, and 37 hips from 31 patients were included. All patients were examined by an experienced orthopedic surgeon, and preoperative radiographs and 3D-MRI were obtained. Preoperatively, the patients completed validated patient-reported outcome measures (PROMs). Mean±SD alpha angles were 69.4°±10.3°, 70.0°±10.3°, 70.6°±8.4°, and 74.8°±9.2° at 12 o'clock, 1 o'clock, 2 o'clock, and 3 o'clock, respectively. Mean lateral center edge angle was 30.1°±5.3°. The authors did not observe a statistically significant correlation between PROMs and the features measured by radiographs and 3D-MRI (>.05). In this subset of prospectively imaged patients with FAIS, the authors did not find a correlation between the severity of symptoms measured by PROMs and features on radiographs and 3D-MRI. The severity of dysfunction is multifactorial, and anatomic severity, as measured radiographically and with 3D-MRI, may not correlate with symptoms. Further investigation is necessary to address the sources of patient pain. [. 2021;44(4):e577-e582.].
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http://dx.doi.org/10.3928/01477447-20210618-20DOI Listing
July 2021

Visceral Adipose Tissue Volumetrics Inform Odds of Treatment Response and Risk of Subsequent Surgery in IBD Patients Starting Antitumor Necrosis Factor Therapy.

Inflamm Bowel Dis 2021 Jul 22. Epub 2021 Jul 22.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Texas at Austin Dell Medical School, Austin,  TX, USA.

Background: Data describing the effect of obesity on antitumor necrosis factor (anti-TNF) treatment response are inconsistent. Visceral adipose tissue (VAT) is a superior marker of adiposity to body mass index. However, its effect on treatment response is unclear. We aimed to evaluate the effect of VAT on anti-TNF treatment response.

Methods: Inflammatory bowel disease (IBD) patients starting anti-TNF agents between January 1, 2009, and July 31, 2019, were included. 3-dimensional measurements of VAT volume and visceral fat index (visceral:subcutaneous adipose tissue ratio; VFI) were obtained from computed tomography (CT) scans. Subjects were categorized by predefined volume cutoffs (<1500cm3, 1500-2999cm3, ≥3000cm3) and VFI (<0.33, 0.33-0.66, ≥0.67). Primary outcomes included a composite treatment response end point at 6 and 12 months. Secondary outcomes were surgery at 6 and 12 months. Multivariable logistic regression was used to calculate adjusted odds ratio (aOR) and 95% confidence interval (CI).

Results: The final cohort included 176 patients. No significant differences in treatment response at 6 months was observed. At 12 months, compared with volume <1500cm3, patients with volume 1500-2999cm3 had higher odds of response (aOR, 3.52; 95% CI, 1.16-10.71; P = .023), whereas volume ≥3000cm3 did not. Compared with VFI<0.33, VFI ≥0.67 had higher odds of surgery at 6 (aOR, 48.22; 95% CI, 4.73-491.57; P = .023) and 12 months (aOR, 20.94; 95% CI, 3.14-139.67; P = .004). Post hoc analysis suggested VAT may affect drug pharmacokinetics.

Conclusions: We found VAT volume is associated with anti-TNF treatment response in a nondose dependent manner, and VFI may inform risk of surgery after anti-TNF initiation. If confirmed by prospective studies, VAT volumetrics are potentially useful biomarkers to inform IBD treatment decisions.
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http://dx.doi.org/10.1093/ibd/izab167DOI Listing
July 2021

Osseous Tumor Reporting and Data System-Multireader Validation Study.

J Comput Assist Tomogr 2021 Jul 13. Epub 2021 Jul 13.

From the Department of Radiology, UT Southwestern Medical Center, Dallas, TX Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX Department of Population and Data Sciences UT Southwestern Medical Center, Dallas, TX.

Objective: To develop and validate an Osseous Tumor Reporting and Data System (OT-RADS) with the hypothesis that the proposed guideline is reliable and assists in separating benign from malignant osseous tumors with a good area under the curve, and that could assist further patient management.

Methods: In this multireader cross-sectional validation study, an agreement was reached for OT-RADS categories based on previously described magnetic resonance imaging features and consensus of expert musculoskeletal radiologists. World Health Organization classification was used, and a wide spectrum of benign and malignant osseous tumors was evaluated. Magnetic resonance imaging categories were as follows: OT-RADS 0-incomplete imaging; OT-RADS I-negative; OT-RADS II-definitely benign; OT-RADS III-probably benign; OT-RADS IV-suspicious for malignancy or indeterminate; OT-RADS V-highly suggestive of malignancy; and OT-RADS VI-known biopsy-proven malignancy or recurrent malignancy in the tumor bed. Four blinded readers categorized each tumor according to OT-RADS classification. Intraclass correlation (ICC) and Conger κ were used. Diagnostic performance measures including area under the receiver operating curve were reported. Osseous Tumor Reporting and Data System was dichotomized as benign (I-III) and malignant (IV and V) for calculating sensitivity and specificity.

Results: Interreader agreement for OT-RADS (ICC = 0.78) and binary distinction of benign versus malignant (κ = 0.67) were good to excellent, while agreement for individual tumor feature characteristics were poor to fair (ICC = 0.25-0.36; κ = 0.16-0.39). The sensitivities, specificities, and area under the receiver operating curve of the readers ranged from 0.93-1.0, 0.71-0.86, and 0.92-0.97, respectively.

Conclusions: Osseous Tumor Reporting and Data System lexicon is reliable and helps stratify tumors into benign and malignant categories. It can be practically used by radiologists to guide patient management, improve multidisciplinary communications, and potentially impact outcomes.
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http://dx.doi.org/10.1097/RCT.0000000000001184DOI Listing
July 2021

Hyperpolarized C MR Spectroscopy Depicts in Vivo Effect of Exercise on Pyruvate Metabolism in Human Skeletal Muscle.

Radiology 2021 Jun 22:204500. Epub 2021 Jun 22.

From the Advanced Imaging Research Center (J.M.P., C.E.H., J.M., J.C., J.R., J.L., G.D.R., A.C., C.R.M.), Department of Radiology (J.M.P., A.C., C.R.M.), Department of Neurology and Neurotherapeutics (R.G.H.), and Department of Internal Medicine (C.R.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8568; Department of Electrical and Computer Engineering, University of Texas at Dallas, Dallas, Tex (J.M.P.); Department of Diagnostic Imaging and Radiology, Developing Brain Institute, Children's National Hospital, Washington, DC (Z.Z.); Department of Pediatrics and Radiology, George Washington University, Washington, DC (Z.Z.); GE Healthcare, Dallas, Tex (G.D.R.); Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, Calif (T.J.); and Veterans Affairs North Texas Healthcare System, Dallas, Tex (C.R.M.).

Background Pyruvate dehydrogenase (PDH) and lactate dehydrogenase are essential for adenosine triphosphate production in skeletal muscle. At the onset of exercise, oxidation of glucose and glycogen is quickly enabled by dephosphorylation of PDH. However, direct measurement of PDH flux in exercising human muscle is daunting, and the net effect of covalent modification and other control mechanisms on PDH flux has not been assessed. Purpose To demonstrate the feasibility of assessing PDH activation and changes in pyruvate metabolism in human skeletal muscle after the onset of exercise using carbon 13 (C) MRI with hyperpolarized (HP) [1-C]-pyruvate. Materials and Methods For this prospective study, sedentary adults in good general health (mean age, 42 years ± 18 [standard deviation]; six men) were recruited from August 2019 to September 2020. Subgroups of the participants were injected with HP [1-C]-pyruvate at resting, during plantar flexion exercise, or 5 minutes after exercise during recovery. In parallel, hydrogen 1 arterial spin labeling MRI was performed to estimate muscle tissue perfusion. An unpaired test was used for comparing C data among the states. Results At rest, HP [1-C]-lactate and [1-C]-alanine were detected in calf muscle, but [C]-bicarbonate was negligible. During moderate flexion-extension exercise, total HP C signals (tC) increased 2.8-fold because of increased muscle perfusion ( = .005), and HP [1-C]-lactate-to-tC ratio increased 1.7-fold ( = .04). HP [C]-bicarbonate-to-tC ratio increased 8.4-fold ( = .002) and returned to the resting level 5 minutes after exercise, whereas the lactate-to-tC ratio continued to increase to 2.3-fold as compared with resting ( = .008). Conclusion Lactate and bicarbonate production from hyperpolarized (HP) [1-carbon 13 {C}]-pyruvate in skeletal muscle rapidly reflected the onset and the termination of exercise. These results demonstrate the feasibility of imaging skeletal muscle metabolism using HP [1-C]-pyruvate MRI and the sensitivity of in vivo pyruvate metabolism to exercise states. © RSNA, 2021
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http://dx.doi.org/10.1148/radiol.2021204500DOI Listing
June 2021

MRI nomenclature for musculoskeletal infection.

Skeletal Radiol 2021 Jun 18. Epub 2021 Jun 18.

Thomas Jefferson University Hospital, Philadelphia, PA, USA.

The Society of Skeletal Radiology (SSR) Practice Guidelines and Technical Standards Committee identified musculoskeletal infection as a White Paper topic, and selected a Committee, tasked with developing a consensus on nomenclature for MRI of musculoskeletal infection outside the spine. The objective of the White Paper was to critically assess the literature and propose standardized terminology for imaging findings of infection on MRI, in order to improve both communication with clinical colleagues and patient care.A definition was proposed for each term; debate followed, and the committee reached consensus. Potential controversies were raised, with formulated recommendations. The committee arrived at consensus definitions for cellulitis, soft tissue abscess, and necrotizing infection, while discouraging the nonspecific term phlegmon. For bone infection, the term osteitis is not useful; the panel recommends using terms that describe the likelihood of osteomyelitis in cases where definitive signal changes are lacking. The work was presented virtually to SSR members, who had the opportunity for review and modification prior to submission for publication.
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http://dx.doi.org/10.1007/s00256-021-03807-7DOI Listing
June 2021

Role of magnetic resonance neurography in intercostal neuralgia; diagnostic utility and efficacy.

Br J Radiol 2021 Jun 7;94(1122):20200603. Epub 2021 May 7.

Department of Radiology, Musculoskeletal Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Objective: To evaluate the utility and efficacy of MR neurography (MRN) in the diagnostic work-up for intercostal neuralgia and to assess the treatment course and outcomes in MRN-imaged clinically suspected intercostal neuropathy cases of chronic chest and abdominal wall pain syndromes.

Methods: Following a retrospective cross-sectional study, a consecutive series of patients who underwent MRN of torso for suspected intercostal neuralgia were included. Patient demographics, pain location/level/duration, previous work-up for the same indication, MRN imaging results, and MRN cost per patient were recorded. An inter-reader reliability assessment was performed on the MRN findings using Cohen's weighted κ analysis. Post-MRN treatment choice, as well as success rates of MRN directed perineural injections and surgical management were also evaluated.

Results: A total of 28 patients (mean ± SD age, 48.3 ± 18.0 years, female/male = 3.0) were included. Pain and/or numbness in the right upper quadrant were the most common complaints. The mean maximum pain level experienced was 7.4 ± 2.5 on a 1 (lowest pain level) - 10 (highest pain level) visual analog scale. The duration of pain before MRN work-up was 36.9 ± 37.9 months. The patients had seen an average of 5 ± 2.8 physicians for such syndromes. 20 (71%) patients had one or multiple other imaging studies for prior work-up. MRN identified positive intercostal nerve abnormality in 19 cases with clinical symptoms of intercostal neuralgia. From the inter-reader reliability assessment, a Cohen's weighted κ value of 0.78 was obtained. The costs of work-up was about one-third with MRN for diagnostic purposes with less financial and psychological harm. Among the MRN-positive cases, 9/19 patients received perineural injections, of which 6 reported improvement after their first round, lasting an average of 41.1 ± 83 days. Among the nine MRN-negative cases, two received perineural injections, of which none reported improvement. Surgical management was mostly successful with a positive outcome in six out of seven operated cases (85.7%).

Conclusion: MRN is useful in diagnostic algorithm of intercostal neuralgia and MRN-positive cases demonstrate favorable treatment response to perineural injections and subsequent surgical management.

Advances In Knowledge: The use of MRN in intercostal neuralgia is an application that has not been previously explored in the literature. This study demonstrates that MRN offers superior visualization of pathology in intercostal neuralgia and confirms that treatment directed at MRN identified neuropathy results in good outcomes while maintaining cost efficiency.
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http://dx.doi.org/10.1259/bjr.20200603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173696PMC
June 2021

Conventional and advanced MR imaging insights of synovial sarcoma.

Clin Imaging 2021 Aug 11;76:149-155. Epub 2021 Feb 11.

Department of Radiology, UT Southwestern, United States of America; Department of Orthopedic Surgery, UT Southwestern, United States of America.

Objectives: Synovial sarcomas commonly involve extremities. The purpose of this study was to systematically assess and describe the appearance of pathologically proven synovial sarcomas on conventional MR sequences, diffusion weighted imaging and dynamic contrast enhanced imaging.

Methods: In this cross-sectional retrospective study, fifteen pre-operative MRIs were analyzed separately by two musculoskeletal radiologists and a fellow. MRI features of synovial sarcomas were evaluated in a systematic fashion on conventional and advanced MR sequences.

Results: The tumors demonstrated heterogeneous appearance on conventional MR sequences. Peritumoral edema was absent in four of 15 (27%) lesions including grade 2 and grade 3 tumors. Average minimum ADC was 0.8 × 10-3 mm/s and average mean ADC was 1.2 × 10-3 mm/s. There was avid early arterial phase enhancement on contrast imaging. Average relative enhancement of the tumors was 5.7 times compared to the adjacent skeletal muscle.

Conclusion: Synovial sarcomas demonstrate avid early arterial phase post-contrast enhancement on contrast images, low ADC values, and heterogeneous appearance on conventional MRI sequences. Peritumoral edema may be absent in such tumors despite being high grade tumors.
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http://dx.doi.org/10.1016/j.clinimag.2021.02.010DOI Listing
August 2021

Short Term Radiographic and Patient Outcomes of a Biplanar Plating System for Triplanar Hallux Valgus Correction.

J Foot Ankle Surg 2021 May-Jun;60(3):461-465. Epub 2020 Aug 15.

Assistant Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address:

Hallux valgus is a complex deformity with a variety of techniques described for correction. A biplanar plating system for triplanar correction system has been developed to address both the translation and rotational component of the hallux valgus deformity and allow an accelerated weightbearing protocol. The purpose of this study was to determine the correction and complications using radiographic parameters and patient reported outcomes. We sought to determine prognostic factors for successful correction, including age, gender, and preoperative deformity. From the medical records, we collected preoperative data. Patient-reported outcomes were obtained using AOFAS Hallux Metatarsophalangeal-Interphalangeal score, FAAM, and SF-12 scores preoperatively and postoperatively. Imaging was reviewed at preoperative and postoperative visits to determine hallux valgus angle, intermetatarsal angle, and tibial sesamoid position. Fifty-seven procedures, in 55 patients, were performed. There were 7 complications and mean follow-up time was 45.7 weeks (+ 28.3 weeks). Age over 62.5 years were associated with an increased risk of complications (p = .018). Males had an increased rate of complications (71%) compared with females. Radiographic parameters were significantly improved from preoperative values at alltime points (p < .05). Only the AOFAS Hallux Metatarsophalangeal-Interphalangeal score was statistically significant at 3, 6 and 12 months. We sought to determine the effectiveness of biplanar plating and triplanar correction procedure with early weightbearing. Over a 12 month follow-up period, our results showed significant improvement in deformity and maintained correction. AOFAS Hallux Metatarsophalangeal-Interphalangeal scores significantly improved from the preoperative to the postoperative state. Our results show a nonunion rate of 5.2%, which is comparable to prior studies.
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http://dx.doi.org/10.1053/j.jfas.2020.06.026DOI Listing
June 2021

Are the Sanders-Frykberg and Brodsky-Trepman Classifications Reliable in Diabetic Charcot Neuroarthropathy?

J Foot Ankle Surg 2021 May-Jun;60(3):432-435. Epub 2021 Feb 3.

Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

The purpose of this study was to assess the intra- and inter-reader reliability of the 2 Charcot neuroarthropathy classifications (Sanders-Frykberg and Brodsky-Trepman), as well as Eichenholtz staging. We hypothesized that the inter-reader reliability, with respect to these 3 classification systems, would be moderate at best. Digital radiographic images were organized in a digital slide presentation without clinical information. All 5 reviewers underwent a standard training session administered by the principal investigator, reviewing 5 cases of Charcot neuroarthropathy. Images of 55 cases of Charcot neuroarthropathy and 5 normal cases were distributed to each of the 5 physicians electronically, who independently rated all 60 cases according to the 3 classification systems. The 95% confidence interval of the intraclass correlation coefficient estimate for Sanders-Frykberg was 0.9601 to 0.9833 at week 0 and 0.9579 to 0.9814 at week 8, which can be regarded as "excellent" reliability. For Trepman-Brodsky, the 95% confidence interval of the intraclass correlation coefficient estimate was 0.8463 to 0.9327 at week 0 and 0.8129 to 0.9226 at week 8, which can be regarded as "good" to "excellent" reliability. For Eichenholtz, the 95% confidence interval of the intraclass correlation coefficient estimate was 0.6841 to 0.8640 and 0.6931 to 0.8730 at weeks 0 and 8, respectively, which can be regarded as "moderate" to "good" reliability. The classification systems of Charcot neuroarthropathy are an important tool for communication among physicians. Based on the results at our institution, the Sanders-Frykberg classification exhibited the best inter-reader performance. The Trepman-Brodsky classification exhibited good to excellent reliability as well. The intraclass correlation coefficient of the Eichenholtz classification was moderate to good.
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http://dx.doi.org/10.1053/j.jfas.2020.03.003DOI Listing
June 2021

Piriformis syndrome: pain response outcomes following CT-guided injection and incremental value of botulinum toxin injection.

Diagn Interv Radiol 2021 Jan;27(1):126-133

Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA; Department of Orthopedics, UT Southwestern Medical Center, Dallas, Texas, USA.

Purpose: Piriformis syndrome is a common pain condition affecting the buttock and posterior hip with or without radiation to the leg, and management of the condition involves many treatments. In this study, we hypothesize that a CT-guided injection with botulinum toxin is more effective in providing pain relief than a CT-guided injection without Botox.

Methods: Overall, 97 consecutive patients with piriformis syndrome presented for a CT-guided injection of the piriformis muscle and perineural injection of the sciatic nerve. After the injection, the patients received a visual analog scale pain log to record their pain level until the follow-up appointment. P values of less than 0.2 were considered as confounder and adjusted by inverse probability of treatment weighting (IPTW) via propensity score. The effect of botulinum toxin on 48-hour response and duration of response was tested using weighted chi-square test and weighted Kaplan-Meier analysis.

Results: There was a total of 97 patients in the study, and 111 injections, as some patients had bilateral injections. Patients in the Botox group had more 48-hour response than patients in the non-botulinum toxin group (P < 0.001 with IPTW, P = 0.005 without IPTW). Median pain-free survival was 30 days for Botox group and 1 day for non-Botox group (P = 0.059 with IPTW, P = 0.10 without IPTW).

Conclusion: CT-guided injections with botulinum toxin for patients with piriformis syndrome are more likely to lead to a positive response and a longer duration of response than patients who receive a CT-guided injection without botulinum toxin. We hope that this study facilitates future prospective randomized blind trials for patients with suspected piriformis syndrome.
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http://dx.doi.org/10.5152/dir.2020.19444DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837716PMC
January 2021

Quantitative CT Detects Undiagnosed Low Bone Mineral Density in Oncologic Patients Imaged With 18F-FDG PET/CT.

Clin Nucl Med 2021 Jan;46(1):8-15

From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas.

Purpose: We assessed the prevalence of low bone mineral density (BMD) in oncologic patients undergoing F-FDG PET/CT.

Patients And Methods: This is a retrospective analysis of 100 patients who underwent F-FDG PET/CT at a single center from October 2015 till May 2016. Quantitative CT (QCT) was used to assess BMD at the lumbar spine (BMDQCT) and femoral necks (BMDCTXA). SUVmax was used to evaluate metabolic activity of the bone marrow. Risk of osteoporosis-related fractures was calculated with femoral neck BMDCTXA and the FRAX algorithm, which was compared against measurements of CT attenuation of the trabecular bone at L1 (L1HU).

Results: Osteoporosis and osteopenia were respectively present in 16% and 46% of patients 50 years and older. Bone marrow SUVmax was correlated with BMD at the lumbar spine (ρ = 0.36, P < 0.001). Increased age and low marrow SUVmax were associated with low BMDQCT at the lumbar spine (both P < 0.001), whereas increased age, female sex, and low marrow SUVmax were associated with low BMDCTXA at the femoral necks (P < 0.001, P < 0.001, P = 0.01, respectively). L1HU had an area under the curve of 0.95 (95% confidence interval [CI], 0.90-0.99) for detecting increased risk for osteoporosis-related fracture, with best threshold of 125.8 HU (95% CI, 115.7-144.9) yielding sensitivity of 100% (95% CI, 0.92-1.00), specificity of 0.90 (95% CI, 0.76-0.97), and accuracy of 0.91 (95% CI, 0.79-0.97).

Conclusions: Low BMD is frequent in oncologic patients undergoing F-FDG PET/CT. Decreased F-FDG avidity of the bone marrow correlates with decreased BMD, validating the link between osteoporosis and bone marrow fat. L1HU could be a simple and accurate approach for detecting patients at risk for osteoporosis-related fractures using PET/CTdata.
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http://dx.doi.org/10.1097/RLU.0000000000003416DOI Listing
January 2021

Magnetic Resonance Imaging of Diabetic Foot Osteomyelitis: Imaging Accuracy in Biopsy-Proven Disease.

J Foot Ankle Surg 2021 Jan-Feb;60(1):17-20. Epub 2020 Nov 17.

Associate Professor, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.

Magnetic resonance imaging (MRI) is the recommended diagnostic imaging technique for diabetic foot osteomyelitis (DFO). The gold standard to diagnose osteomyelitis is bone biopsy with a positive culture and/or histopathology finding consistent with osteomyelitis. The purpose of this study is to assess the accuracy of MRI readings in biopsy-proven diabetic foot osteomyelitis with a second read done by a blinded, expert musculoskeletal radiologist. A retrospective chart review of 166 patients who received a bone biopsy to confirm the diagnosis of a suspected DFO at a large county hospital between 2010 and 2014. A second, blinded musculoskeletal radiologist reviewed the images for accuracy, once the official reading was recorded. Imaging results were correlated with the final diagnosis of osteomyelitis determined by bone biopsy. In 17 of 58 patients (29.3%), the diagnosis of DFO by MRI was not confirmed by bone biopsy. There were 12 false positives and 5 false negatives. After the second expert read, there were 5 false positives and 4 false negatives. The overall accuracy was 84% for the second read. Our study demonstrated results comparable to the previously reported meta-analysis findings. There is a clear variation on the read of MRI that could lead to an incorrect diagnosis of DFO. An integrated approach with evaluation of clinical findings, communication with radiologist about the MRI results when indicated, and bone biopsy is warranted for accurate diagnosis management of DFO.
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http://dx.doi.org/10.1053/j.jfas.2020.02.012DOI Listing
June 2021

A 15-Year Analysis of International Medical Graduates Matching Into Diagnostic Radiology Residency Programs in the United States.

Acad Radiol 2020 Nov 3. Epub 2020 Nov 3.

Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Electronic address: https://twitter.com/DrRoopaRam.

Rationale And Objectives: To analyze the trends in international medical graduates (IMGs) matching into diagnostic radiology residency programs in the United States (US).

Materials And Methods: The National Resident Match Program data was accessed for years 2005-2020 and diagnostic radiology residency-specific data was extracted for US MD, osteopathic (DO), and IMG applicants. IMGs were categorized into US-citizen IMGs and non-US citizen IMGs per the National Residency Match Program. Variables collected for each year included the number of positions, number of applicants in each group, positions filled/unfilled, and fill rate of each group. Additional data for some years included USMLE Step 1 score, United States Medical Licensing Examination (USMLE) Step 2 clinical knowledge (CK) score, number of research experiences, number of abstracts/publications, and additional degrees obtained. Trends were analyzed using simple linear regression model and p value <0.05 was considered significant.

Results: The number of diagnostic radiology residency programs increased from 203 (2006) to 212 (2020). The total number of diagnostic radiology residency positions increased from 1011 (2006) to 1113 (2020), with the peak of 1145 in 2014. The overall "match rate," that is, proportion of positions filled to positions available, increased from 96.4% (2006) to 97.3% (2020), with a brief decline to 86.7% in 2015. Among the filled positions, the proportion filled by US medical school graduates significantly declined from 89.7% (2006) to 69.2% (2020) (p < 0.001), and the proportion of positions filled by osteopathic seniors and graduates significantly increased from 2.2% (2006) to 15.1% (2020; p < 0.001). The proportion of US IMGs increased from 3.2% (2006) to 5.4% (2020), while the proportion of non-US IMGs increased from 4.4% (2006) to 9.4% (2020), with overall IMG match rate increased significantly from 7.6% to 14.9% (p = 0.009). The mean Step 1 scores of US IMGs and non-US IMGs were 238 and 237.3, and the mean Step 2 CK scores were 241.67 and 241, respectively. Cumulatively over the study period, a total of 736 US IMGs and 1051 non-US IMGs have matched into diagnostic radiology residency.

Conclusion: There is an increasing proportion of IMGs, especially the non-US citizen IMGs, matching into US radiology residency programs in the last decade. Diagnostic radiology remains a competitive specialty evidenced by average USMLE scores higher than national average and research experiences of matched candidates.
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http://dx.doi.org/10.1016/j.acra.2020.09.018DOI Listing
November 2020

Sclerotic bone lesions caused by non-infectious and non-neoplastic diseases: a review of the imaging and clinicopathologic findings.

Skeletal Radiol 2021 May 11;50(5):847-869. Epub 2020 Oct 11.

Radiology, UT Southwestern Medical Center, Dallas, TX, USA.

Bone sclerosis is a focal, multifocal, or diffuse increase in the density of the bone matrix on radiographs or computed tomography (CT) imaging. This radiological finding can be caused by a broad spectrum of diseases, such as congenital and developmental disorders, depositional disorders, and metabolic diseases. The differential diagnosis can be effectively narrowed by an astute radiologist in the light of the clinical picture and typical findings on imaging. Some of these lesions are rare and have been described as case reports and series in the literature. This article aims to collate the clinical-radiologic findings of non-infectious and non-neoplastic causes of bone sclerosis with relevant imaging illustrations.
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http://dx.doi.org/10.1007/s00256-020-03644-0DOI Listing
May 2021

Kinematic simulations of static radiographs provides discriminating features of multiple hip pathologies.

Annu Int Conf IEEE Eng Med Biol Soc 2020 07;2020:4992-4995

Osteoarthritis is one of the most common causes of ambulatory disability. Developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI) may lead to premature osteoarthritis in a young adult population. Current clinical assessments of DDH and FAI include clinical history, static radiological metrics, and physical examinations. Methods involving dynamic radiography such as fluoroscopy are costly and time-consuming for both patient and physician. Therefore, our aim was to simulate dynamic gait on 3D static radiological images of hips to generate "virtual interference" points between the femur and acetabulum with three methods of center-of-rotation (COR): static spherical, dynamic spherical, and dynamic ellipsoidal. We simulated the gait kinematics on pre-segmented CT images for three groups: DDH (N=10), FAI (N=10), and asymptomatic normal (N=11). The femoral head was divided into four medial quadrants to compare the ratios of virtual interference within the regions along the gait cycle and as a temporal mean. We hypothesized that discriminating characteristics would exist between the two pathologies and for the dynamic COR methods to have more discriminating characteristics than the static COR method. For each COR method, we found the temporal mean of virtual interference to be significantly different in almost every region between the hip conditions. The significance was most distinct when using the static spherical method of COR. These results are promising to individual clinical assessments of hip pathologies using static radiographs and ultimately work towards preventing premature hip disease.
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http://dx.doi.org/10.1109/EMBC44109.2020.9176846DOI Listing
July 2020

How to Measure Glenoid Bone Stock and Version and Why It Is Important: A Practical Guide.

Radiographics 2020 Oct;40(6):1671-1683

From the School of Medicine (A.S., M.J.S.) and Department of Radiology and Orthopedic Surgery (A.C.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8585.

Shoulder osteoarthritis (OA) is a common and debilitating condition and a source of high morbidity and medical expenditures across the world among individuals older than 60 years. Shoulder OA results in the gradual destruction of articular cartilage of the humeral head and glenoid component, causing inflammation, pain, and a restricted range of motion. Most patients are diagnosed with shoulder OA after experiencing shoulder pain and stiffness, and the diagnosis is often made after medical and physical histories are obtained and physical and imaging examinations are performed. Use of various surgical techniques such as total anatomic or reverse shoulder arthroplasty and hemiarthroplasty has increased in recent years, resulting in reduced morbidity and improved functional status of patients. However, the rate of surgical complications such as premature loosening of components is significant, reducing the effectiveness of such procedures. Data in the literature indicate that high-grade fatty infiltration of the rotator cuff muscle before surgery is associated with postoperative glenoid component loosening. High-grade rotator cuff fatty infiltration and atrophy have been found to be associated with more severe Walch classification-based glenoid morphology subtypes, increased joint line medialization, glenoid bone loss, and increased pathologic glenoid version. The authors describe how advanced imaging techniques are used for preoperative evaluation of the shoulder and discuss how to measure glenoid version and bone stock and classify glenoid morphology types on the basis of Walch classification, as these parameters are commonly used in surgical planning. Methods involving the use of Friedman and paleoglenoid lines for respective measurements are illustrated by using three-dimensional CT and MRI case examples. RSNA, 2020.
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http://dx.doi.org/10.1148/rg.2020200008DOI Listing
October 2020

Corrigendum to "Three tesla and 3D multiparametric combined imaging evaluation of axial spondyloarthritis and pelvic enthesopathy" [Eur. J. Radiol. (2020) 108916].

Eur J Radiol 2020 Nov 18;132:109260. Epub 2020 Sep 18.

Division of Musculoskeletal Radiology, Department of Radiology, UT Southwestern Medical Center, Dallas, TX, United States.

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http://dx.doi.org/10.1016/j.ejrad.2020.109260DOI Listing
November 2020

"Periosteum: An imaging review".

Eur J Radiol Open 2020 27;7:100249. Epub 2020 Aug 27.

Radiology & Orthopeadic Surgery, UT Southwestern, Harry Hines Boulevard, 5323, Dallas, TX, United States.

Periosteum is a fibrous sheath, coating the external bone, except in the articular surfaces, tendon insertions and sesamoid bone surface¹. It changes its aspects and characteristics with aging, becoming progressively less elastic and more firm. It is composed of two different layers: outer fibrous (firm, collagen-filled) and inner proliferative (cambium, containing osteoprogenitor cells). Four vascular systems are responsible for the blood supply of the periosteum: the intrinsic periosteal system, located between fibrous and proliferative layer; the periosteocortical, the main nutritional arteries of the periosteum; the musculoperiosteal, responsible for the callus formation after fractures; the fascioperiosteal, specifically for each bone.³ It is crucial to bone formation and resorption, reacting to insults in the cortical bone, such as tumors, infections, traumas, medications and arthritic diseases. The aggressiveness of the reaction can be suggested by its radiological aspect and appearance. The periosteum in children is looser compared to adults, resulting in earlier and more exuberant reactions. All these aspects will be detailed, so the essential information all radiologists need to know will be discussed.
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http://dx.doi.org/10.1016/j.ejro.2020.100249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7475123PMC
August 2020

Three-dimensional and 3-Tesla MRI morphometry of knee meniscus in normal and pathologic state.

Clin Anat 2021 Jan 23;34(1):143-153. Epub 2020 Sep 23.

Radiology, UT Southwestern Medical Center, Dallas, Texas, USA.

Introduction: To conduct a morphometric analysis of intact and torn menisci using isotropic meniscus plane three-dimensional (3D) reconstructions on 3-Tesla MRI and compare 2D versus 3D MRI for meniscus tear characterization.

Materials And Methods: One hundred thirty three normal menisci from 92 patients (39 male, 53 female), and 38 arthroscopy-proven torn menisci from 36 patients (23 male, 13 female) were evaluated using 3D isotropic multi-planar MRI reconstructions and 2D MRI. Two observers measured the tibial plateau height and area, meniscal height, axial plane cross-sectional areas, and extrusion of intact menisci. Two observers also measured the meniscal tear length, tear area, and residual area of pathological menisci on 2D and 3D MRI. Intraclass correlation coefficients (ICC) were obtained. Institutional Review Board approval was obtained, and the informed consent was waived.

Results: Medial meniscus (MM) and lateral meniscus (LM) areas were 503.6 ± 85.1 mm and 396.6 ± 72.0 mm for Observer 1, and 515.8 ± 82.1 mm and 408.0 ± 68.3 mm for Observer 2 (ICC:0.86, 0.87). In torn menisci, average tear length, area, and residual area were 36.3 ± 13.6 mm, 182.6 ± 139.3 mm , and 235.4 ± 140.3 mm , respectively for Observer 1, and 38.9 ± 14.7 mm, 181.2 ± 135.6 mm , 238.2 ± 140.5 mm for Observer 2. In the MM and LM, bucket-handle and complex tears were largest in areas, respectively. ICCs were excellent (0.91-1.0) on 3D MRI and moderate-good (0.57-0.81) on 2D MRI.

Conclusion: Meniscus morphometry on 3D MRI shows moderate to excellent inter-observer reliability and meniscus tear extent is more reliably defined on 3D MRI than 2D MRI. Residual meniscus-area calculation can be performed on 3D MRI.
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http://dx.doi.org/10.1002/ca.23679DOI Listing
January 2021

Differences in citation counts of radiology journals between citation databases.

Clin Imaging 2021 01 30;69:182-184. Epub 2020 Jul 30.

Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.

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http://dx.doi.org/10.1016/j.clinimag.2020.07.015DOI Listing
January 2021

Abdominal muscle segmentation from CT using a convolutional neural network.

Proc SPIE Int Soc Opt Eng 2020 Feb 28;11317. Epub 2020 Feb 28.

Department of Bioengineering, University of Texas at Dallas, Richardson, TX.

CT is widely used for diagnosis and treatment of a variety of diseases, including characterization of muscle loss. In many cases, changes in muscle mass, particularly abdominal muscle, indicate how well a patient is responding to treatment. Therefore, physicians use CT to monitor changes in muscle mass throughout the patient's course of treatment. In order to measure the muscle, radiologists must segment and review each CT slice manually, which is a time-consuming task. In this work, we present a fully convolutional neural network (CNN) for the segmentation of abdominal muscle on CT. We achieved a mean Dice similarity coefficient of 0.92, a mean precision of 0.93, and a mean recall of 0.91 in an independent test set. The CNN-based segmentation method can provide an automatic tool for the segmentation of abdominal muscle. As a result, the time required to obtain information about changes in abdominal muscle using the CNN takes a fraction of the time associated with manual segmentation methods and thus can provide a useful tool in the clinical application.
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http://dx.doi.org/10.1117/12.2549406DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309562PMC
February 2020

Spectrum of common and uncommon causes of knee joint hyaline cartilage degeneration and their key imaging features.

Eur J Radiol 2020 Aug 1;129:109097. Epub 2020 Jun 1.

Radiology, Orthopedic Surgery, UT Southwestern Medical Center, Dallas, United States. Electronic address:

Hyaline cartilage lining the surfaces of diarthrodial joints is an important construct for transmission of load and to reduce friction between the bones. Normal wear and tear accounts for about 3-5 percent knee cartilage loss ever year in otherwise healthy people after the age of 30 years. Several conditions and diseases lead to premature cartilage degeneration. Standardized description of cartilage loss, detailed evaluation of the joint health and determining the underlying etiology of cartilage loss are important for effective reporting, multidisciplinary communications and patient management. In this article, the authors discuss normal and abnormal imaging appearances of the hyaline cartilage of knee with focus on using controlled terminology and MRI classifications. The reader will benefit and learn key MR imaging features of a spectrum of common and uncommon conditions and diseases affecting the knee cartilage, such as trauma, secondary injury associated with meniscus and ligament injury related instability, arthritis, ischemia, idiopathic, and hereditary conditions including Matrix metalloproteinase-2 (MMP-2) mutations and mucopolysaccharidosis type IX disease with illustrative case examples.
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http://dx.doi.org/10.1016/j.ejrad.2020.109097DOI Listing
August 2020

Three tesla and 3D multiparametric combined imaging evaluation of axial spondyloarthritis and pelvic enthesopathy.

Eur J Radiol 2020 May 6;126:108916. Epub 2020 Mar 6.

Department of Radiology, United States.

Purpose: Axial spondyloarthritis (SpA) is a group of diseases with temporally disseminated symptoms and clinical signs, which render the diagnosis challenging. Laboratory and MRI findings are used in addition for confirming the diagnosis and evaluation of disease activity. The purpose of this study was to evaluate clinically suspected axial SpA to determine the technical success of a multiparametric and 3D rheumatology lumbosacral MR imaging (MRLI) protocol and to assess the disease distribution, inter-reader reliability, and impact on patient management.

Methods: A consecutive series of patients with clinical suspicion of axial SpA were included. Two rheumatologists recorded the clinical findings and disease activity on a confidence scale before and after MRLI. Two musculoskeletal (MSK) radiologists read the imaging data including enthesitis, arthritis, osseous lesions, ADC values, and enhancement. Prevalence-adjusted and bias-adjusted kappa (PABAK), ICC and Fisher exact test were calculated.

Results: There were 41 patients including 31 females and 10 males with ages of 41 ± 10 and 41 ± 12 (mean ± SD), respectively. The spine T2W imaging received the highest quality scores followed by whole abdomen-pelvis 3D-T2W imaging, 3D-CEMR (contrast-enhanced MRI), and DWI. On spine imaging, acute and chronic lesions of lumbar spine and sacroiliac joints were seen in 4/41, 18/41 and 6/41, and 27/41 of the patients, respectively. Several additional enthesopathy lesions were seen on the whole abdomen-pelvis 3D sequence. ADC value of bone lesions was different 0.95 ± 0.23 (mean ± SD) than normal bone (0.20 ± 0.1). PABAK for acute and chronic findings ranged 0.70-1.0 and 0.41-0.51, respectively. Imaging changed the diagnosis in 17 of 41 patients. No association was noted with respect to treatment change (p = 1) or clinical response (p = 0.2).

Conclusion: Multiparametric lumbosacral MR imaging is a technically successful modality to identify multiple spinal and additional extraspinal sites of involvement in SpA, which are helpful in establishing the diagnosis of axial SpA. Larger patient population study is warranted to evaluate further impact on the treatment efficacy.
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http://dx.doi.org/10.1016/j.ejrad.2020.108916DOI Listing
May 2020

Quantifying differences in femoral head and neck asphericity in CAM type femoroacetabular impingement and hip dysplasia versus controls using radial 3DCT imaging and volumetric segmentation.

Br J Radiol 2020 Jun 18;93(1110):20190039. Epub 2020 Mar 18.

Radiology Department, UT Southwestern Medical Center, Dallas, Texas, USA.

Objective: Femoroacetabular impingement (FAI) and hip dysplasia are the most common causes of groin pain originating from the hip joint. To date, there is controversy over cut-off values for the evaluation of abnormal femoral head-neck anatomy with significant overlap between the normal and abnormal hips. Our aim was to perform three-dimensional CT analysis of femoral head and bump anatomy to quantify common hip pathologies (FAI and hip dysplasia) controls.

Methods: Consecutive patients who underwent three-dimensional CT imaging for hip dysplasia or CAM type FAI were compared to asymptomatic controls. α angles on radial CT and 3D volumetric femoral head and bump segmentations were performed by two readers. Inter- and intrapatient comparisons were performed including interreader and receiver operating characteristic analyses.

Results: 25 FAI patients, 16 hip dysplasia patients and 38 controls were included. FAI and dysplasia patients exhibited higher α angles and higher bump-head volume ratios than the controls ( < 0.05). Larger bump volumes were found among FAI than dysplasia patients and contralateral hips of FAI patients were also different than the controls. α angle at 2 o'clock and bump to head ratio showed the highest area under the curve for patients controls. The interreader reliability was better for volumetric segmentation (intraclass correlation coefficient = 0.35-0.84) as compared to the α angles (intraclass correlation coefficient = 0.11-0.44).

Conclusion: Patients with FAI and dysplasia exhibit different femoral head anatomy than asymptomatic controls. Volumetric segmentation of femoral head and bump is more reliable and better demonstrates the bilateral femoral head anatomy differences in hip patients controls.

Advances In Knowledge: Utilizing information from 3D volumetric bump assessment in patients with FAI and dysplasia, the physicians may be able to more objectively and reliably evaluate the altered anatomy for better pre-surgical evaluation.
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http://dx.doi.org/10.1259/bjr.20190039DOI Listing
June 2020

Correction to: Qualitative and quantitative analysis of glenoid bone stock and glenoid version: inter-reader analysis and correlation with rotator cuff tendinopathy and atrophy in patients with shoulder osteoarthritis.

Skeletal Radiol 2020 Jun;49(6):995-1003

Radiology, UT Southwestern Medical Center, Dallas, TX, USA.

Purpose Glenoid bone stock and morphology and rotator cuff muscle quality and tendon integrity affect the outcome of total shoulder arthroplasty. We hypothesized that glenoid bone loss correlates with rotator cuff muscle fatty infiltration (FI), tendinopathy, and atrophy.Design Forty-three 3-D CT scans and MRIs of 43 patients (mean age 62 years; SD 13 years; range 22-77 years) referred for primary shoulder pain were evaluated. Measurements of glenoid bone stock, version, and posterior humeral subluxation index (HSI) were assessed on an axial CT image reconstructed in the true scapular plane. Measurements utilized the Friedman line to approximate the pre-pathologic surface. Glenoid morphology was assigned by modified Walch classification. Rotator cuff FI, atrophy, and tendon integrity were assessed on corresponding MRIs.Results There was a very strong negative correlation between increasing glenoid version and HSI (r = - 0.908; p < 0.0001). There was a moderately negative correlation between anterior bone loss and HSI (r = - 0.562; p < 0.0001) and a moderately positive correlation between posterior bone loss and HSI (r = 0.555; p < 0.0001). Subscapularis muscle FI correlated moderately with increased anterior and central bone loss and increased humeral head medialization (r = 0.512, p = 0.0294; r = 0.479, p = 0.033; r = 0.494, p = 0.0294, respectively). Inter-observer reliability (intra-class correlation coefficient [ICC] and kappa) was good to excellent for all measurements and grading.Conclusion Glenoid anteversion and anterior and posterior bone loss are associated with varying HSI. Subscapularis muscle FI, not tendon integrity, correlates to anterior and central glenoid erosion. The study adds evidence that neither rotator cuff tendinopathy nor muscle atrophy exhibits a significant relationship to HSI.
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http://dx.doi.org/10.1007/s00256-020-03386-zDOI Listing
June 2020

Surgically relevant anatomy of the axillary and radial nerves in relation to the latissimus dorsi tendon in variable shoulder positions: A cadaveric study.

Shoulder Elbow 2020 Feb 5;12(1):24-30. Epub 2019 Feb 5.

Shoulder Service, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Background: The purpose of this study was to define the relationship of the axillary and radial nerves, particularly how these are affected with changing arm position.

Methods: Twenty cadaveric shoulders were dissected, identifying the axillary and radial nerves. Distances between the latissimus dorsi tendon and these nerves were recorded in different shoulder positions. Positions included adduction/neutral rotation, abduction/neutral rotation for the axillary nerve, adduction/internal rotation, adduction/neutral rotation, adduction/external rotation, and abduction/external rotation for the radial nerve.

Results: Width of the latissimus tendon at its humeral insertion was 29.3 ± 5.7 mm. Mean distance from the latissimus insertion to the axillary nerve in adduction/neutral rotation was 24.2 ± 7.1 mm, the distance increased to 41.1 ± 9.8 mm in abduction/neutral rotation. Mean distance from the latissimus insertion to the radial nerve was 15.3 ± 5.5 mm with adduction/internal rotation, 25.8 ± 6.9 mm in adduction/neutral rotation, and 39.5 ± 6.8 mm in adduction/external rotation. Mean distance increased with abduction/external rotated 51.1 ± 7.4 mm.

Conclusions: Knowing the axillary and radial nerve locations relative to the latissimus dorsi tendon decreases the risk of iatrogenic nerve injury. Understanding the dynamic nature of these nerves related to different shoulder positions is critical to avoid complications.
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http://dx.doi.org/10.1177/1758573218825476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6974889PMC
February 2020

MR neurography of the brachial plexus in adult and pediatric age groups: evolution, recent advances, and future directions.

Expert Rev Med Devices 2020 Feb;17(2):111-122

Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA.

: MR neurography (MRN) of the brachial plexus has emerged in recent years as a safe and accurate modality for the identification of brachial plexopathies in pediatric and adult populations. While clinical differentiation of brachial plexopathy from cervical spine-related radiculopathy or nerve injury has long relied upon nonspecific physical exam and electrodiagnostic testing modalities, MRN now permits detailed interrogation of peripheral nerve anatomy and pathology, as well as assessment of surrounding soft tissues and musculature, thereby facilitating accurate diagnosis. The reader will learn about the current state of brachial plexus MRN, including recent advances and future directions, and gain knowledge about the adult and pediatric brachial plexopathies that can be characterized using these techniques.: The review details recent developments in brachial plexus MRN, including increasing availability of 3.0-T MR scanners at both private and academic diagnostic imaging centers, as well as the advent of multiple new vascular and fat signal suppression techniques. A literature search of PubMed and SCOPUS was used as the principal source of information gathered for this review.: Refinement of fat-suppression, 3D techniques and diffusion MR imaging modalities has improved the accuracy of MRN, rendering it as a useful adjunct to clinical findings during the evaluation of suspected brachial plexus lesions.
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http://dx.doi.org/10.1080/17434440.2020.1719830DOI Listing
February 2020

Qualitative and quantitative analysis of glenoid bone stock and glenoid version: inter-reader analysis and correlation with rotator cuff tendinopathy and atrophy in patients with shoulder osteoarthritis.

Skeletal Radiol 2020 Jun 18;49(6):985-993. Epub 2020 Jan 18.

Radiology, UT Southwestern Medical Center, Dallas, TX, USA.

Purpose: Glenoid bone stock and morphology and rotator cuff muscle quality and tendon integrity affect the outcome of total shoulder arthroplasty. We hypothesized that glenoid bone loss correlates with rotator cuff muscle fatty infiltration (FI), tendinopathy, and atrophy.

Design: Forty-three 3D CT scans and MRIs of 43 patients (mean age 62 years; SD 13 years; range 22-77 years) referred for primary shoulder pain were evaluated. Measurements of glenoid bone stock, version, and posterior humeral subluxation index (HSI) were assessed on an axial CT image reconstructed in the true scapular plane. Measurements utilized the Friedman line to approximate the pre-pathologic surface. Glenoid morphology was assigned by modified Walch classification. Rotator cuff FI, atrophy, and tendon integrity were assessed on corresponding MRIs.

Results: There was a very strong negative correlation between increasing glenoid version and HSI (r = - 0.908; p < 0.0001). There was a moderately negative correlation between anterior bone loss and HSI (r = - 0.562; p < 0.0001) and a moderately positive correlation between posterior bone loss and HSI (r = 0.555; p < 0.0001). Subscapularis muscle FI correlated moderately with increased anterior and central bone loss and increased humeral head medialization (r = 0.512, p = 0.0294; r = 0.479, p = 0.033; r = 0.494, p = 0.0294; respectively). Inter-observer reliability (intra-class correlation coefficient [ICC] and kappa) was good to excellent for all measurements and grading.

Conclusion: Glenoid anteversion and anterior and posterior bone loss are associated with varying HSI. Subscapularis muscle FI, not tendon integrity, correlates to anterior and central glenoid erosion. The study adds evidence that neither rotator cuff tendinopathy nor muscle atrophy exhibits a significant relationship to HSI.
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http://dx.doi.org/10.1007/s00256-020-03377-0DOI Listing
June 2020
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