Publications by authors named "David Gimarc"

6 Publications

  • Page 1 of 1

Improving Secondary Fracture Prevention After Vertebroplasty: Implementation of a Fracture Liaison Service.

J Am Coll Radiol 2021 Jun 22. Epub 2021 Jun 22.

Director of Musculoskeletal Ultrasound and Fellowship Director for Musculoskeletal Imaging and Intervention, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. Electronic address:

Objective: The aim of our study was to evaluate a multidisciplinary fracture liaison service (FLS) to improve osteoporosis treatment and secondary fracture prevention for patients after vertebroplasty.

Methods: A retrospective chart review of consecutive vertebroplasty patients from January 2016 to January 2020. FLS began in December 2016 allowing for before-and-after comparison. Statistical analysis included patient demographics and procedure characteristics. Proportion of patients evaluated by the FLS clinic and treatment modification were evaluated. Opt-in versus opt-out referral strategies were compared. Dual energy x-ray absorptiometry scans or vitamin D levels within 3 months before or after vertebroplasty were assessed. Time to event analysis was used to evaluate secondary fracture occurrence.

Results: There were 137 vertebroplasty patients, 39 before FLS and 98 after FLS, included. Only 15% of all patients were already being treated in a bone health clinic. Of those referred and evaluated by the FLS, 73.0% had their osteoporosis treatment modified. Patients evaluated by the FLS were more likely to have a dual energy x-ray absorptiometry scan or a vitamin D level drawn (P < .001 for both). The opt-out referral was more effective with a 75.0% referral rate (P = .71). Secondary fracture of any kind occurred in 23.4% of all patients. Time to event analysis demonstrated a trend toward a reduced risk of secondary spinal fractures in the fracture prevention group with an adjusted hazard ratio of 0.39 (0.13-1.11, 95% confidence interval).

Discussion: A multidisciplinary FLS can be implemented for patients after vertebroplasty to evaluate osteoporotic risk factors and optimize osteoporosis therapy, both of which are important factors in preventing secondary vertebral fractures.
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http://dx.doi.org/10.1016/j.jacr.2021.06.004DOI Listing
June 2021

Osseous Pathology on Wrist Magnetic Resonance Imaging.

Authors:
David C Gimarc

Top Magn Reson Imaging 2020 Oct;29(5):245-261

Department of Radiology, University of Colorado School of Medicine - Anschutz Medical Campus, Aurora, CO.

Advanced imaging of the osseous structures of the wrist by magnetic resonance imaging (MRI) yields powerful information regarding marrow composition and overall bone structure. Various forms of pathology, both benign and malignant, have unique marrow signal abnormalities that can be easily detected by MRI given its high sensitivity to radiographically occult processes. In particular, osseous pathology can be seen in the setting of traumatic, degenerative, congenital, infectious, and neoplastic conditions. The acuity or chronicity of these conditions can often be determined by imaging to aid in appropriate therapy. A thorough understanding of the breadth of pathology and corresponding MRI appearances can allow the interpreting radiologist to formulate a concise and accurate assessment of an examination.
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http://dx.doi.org/10.1097/RMR.0000000000000257DOI Listing
October 2020

Radiculopathy Following Vertebral Body Compression Fracture: The Role of Percutaneous Cement Augmentation.

Pain Physician 2020 06;23(3):315-324

University of Colorado, Aurora, Colorado.

Background: Vertebral cement augmentation is a commonly used procedure in patients with vertebral body compression fractures from primary or secondary osteoporosis, metastatic disease, or trauma. Many of these patients present with radiculopathy as a presenting symptom, and can experience symptomatic relief following the procedure.

Objectives: To determine the incidence of preprocedural radiculopathy in patients with vertebral body compression fractures presenting for cement augmentation, and present their postoperative outcomes.

Study Design: Retrospective cohort study.

Setting: Interventional pain practice in a tertiary care university hospital.

Methods: In this cohort study, all patients who underwent kyphoplasty (KP) or vertebroplasty (VP) procedures in a 7-year period within our practice were evaluated through a search of the electronic medical records. The primary endpoint was to evaluate the prevalence of noncompressive preprocedural radiculopathy in our patients. Evaluation of each patient's relative improvement following the procedure, respective to the initial presence or absence of radicular symptoms (including and above T10, above and below T10, and below T10) was included as a secondary endpoint. Additional subanalysis was performed with respect to patients demographics, fracture location, and primary indication for the procedure (osteoporosis, trauma, etc.).

Results: A total of 302 procedures were performed during this time period, encompassing 544 total vertebral body levels. After exclusion criteria were applied to this cohort, 31.6% of patients demonstrated radiculopathy prior to the procedure that could not be explained by nerve impingement. Nearly half of patients demonstrated an optimal clinical outcome (48.5% nearly complete/complete resolution of symptoms, 40.1% partial resolution of symptoms, 11.4% little to no resolution of symptoms). Patients with fractures above T10 were more likely to see complete resolution, whereas patients with fractures above and below T10 were likely to not see any resolution. Men and women without initial radiculopathy symptoms were more likely to see little to no resolution, regardless of fracture location.

Limitations: This retrospective study used an electronic chart review of clinicians' notes to determine the presence of radiculopathy and their relative improvement following the procedure.

Conclusions: Preprocedural radiculopathy is a common symptom of patients presenting for the evaluation of VP or KP. The presence of radiculopathy in the absence of nerve impingement may be an important marker for those patients who may experience greater benefit from the procedure.

Key Words: Radiculopathy, kyphoplasty, vertebroplasty, osteoporosis, compression fracture, spine, cement augmentation.
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June 2020

Shoulder MR Imaging Versus Ultrasound: How to Choose.

Magn Reson Imaging Clin N Am 2020 May 26;28(2):317-330. Epub 2020 Feb 26.

Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/342, Madison, WI 53792, USA.

Imaging evaluation of the shoulder is performed using multiple modalities, including ultrasound (US) and MR imaging. Clinicians often wonder which modality to use to work up their patients with shoulder pain. Although MR imaging has remained the workhorse of shoulder imaging, US has increased in popularity among academic and private institutions. Both modalities offer similar diagnostic information in regards to rotator cuff pathology and other soft tissues, although they differ in their technique, indications, and interpretation. A thorough understanding of these differences is imperative to appropriately use these modalities in clinical practice, including the unique interventional opportunities available with US.
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http://dx.doi.org/10.1016/j.mric.2019.12.012DOI Listing
May 2020

Big Data and Machine Learning: A Resident's Perspective of the 2016 Intersociety Conference.

J Am Coll Radiol 2018 01 9;15(1 Pt A):114-115. Epub 2017 Sep 9.

Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Florida.

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http://dx.doi.org/10.1016/j.jacr.2017.07.021DOI Listing
January 2018

To First-Year Radiology Residents: On Struggle, Change, and Professional Development.

J Am Coll Radiol 2016 Aug 5;13(8):1018-9. Epub 2016 May 5.

Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado.

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http://dx.doi.org/10.1016/j.jacr.2016.03.003DOI Listing
August 2016