Publications by authors named "Jim S Wu"

87 Publications

CT-Guided Core Needle Biopsy of Non-Spinal Bone Lesions: Comparison of Occult and Visible Bone Lesions.

AJR Am J Roentgenol 2022 Jun 22. Epub 2022 Jun 22.

Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA.

CT guidance may be used for biopsy of indeterminate bone lesions detected by MRI or PET that are not visible (i.e., occult) by CT due to equipment-, patient-, and operator-related factors. To assess diagnostic yield (DY) and diagnostic performance of CT-guided core needle biopsy (CNB) of occult non-spinal bone lesions and to identify the most common benign and malignant diagnoses for occult lesions undergoing CNB. This retrospective study included 1033 adult patients who underwent CT-guided non-spinal bone CNB between January 2004 and December 2020. Lesions were classified as occult or visible on CT; biopsies of occult lesions relied on targeting anatomic landmarks using prebiopsy MRI or PET/CT. Pathologic results of CNB were classified as diagnostic or nondiagnostic to calculate DY of CNB. For nondiagnosti CNBs, final diagnoses were established by subsequent pathologic, clinical, and imaging follow-up. The sample included 70 occult lesions (mean age, 56.8 years; 38 women, 32 men) and 963 visible lesions (59.6 years; 475 women, 488 men). Malignancy rate was lower for occult than visible lesions (42.9% vs 60.8%; p=.004). DY was lower for occult than visible lesions (37.1% vs 76.9%; p<.001). Diagnostic performance for detecting malignancy based on final diagnoses was lower for occult than visible lesions in terms of sensitivity (76.7% vs 93.7%; p=.003), specificity (7.9% vs 54.5%; p<.001), and accuracy (38.2% vs 80.0%; p<.001). Final diagnoses among malignant occult and visible lesions included metastasis (frequencies of 63.3% vs 65.4%), lymphoma/leukemia (33.3% vs 11.6%), and myeloma (3.3% vs 10.4%); final diagnoses among benign occult and visible lesions included red marrow (34.2% vs 8.2%), reactive marrow (26.3% vs 11.8%), and fracture (18.4% vs 3.8%). Occult lesions detected by MRI versus by PET/CT had lower malignancy rate (39.3% vs 68.0%; p=.03) and lower DY (30.4% vs 60.0%; p=.01). At CT-guided CNB, malignancy rate and DY are lower for occult than visible lesions. Leukemia/lymphoma and red marrow are more common among occult than visible lesions. Understanding these characteristics can help guide radiologists', referring providers', and patients' expectations when requesting and performing CNB of occult bone lesions.
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http://dx.doi.org/10.2214/AJR.22.27842DOI Listing
June 2022

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

Skeletal Radiol 2022 Sep 28;51(9):1743-1764. Epub 2022 Mar 28.

Beth Israel Deaconess Medical Center, Boston, USA.

The purpose of this article is to present algorithms for the diagnostic management of solitary bone lesions incidentally encountered on computed tomography (CT) and magnetic resonance (MRI) in adults. Based on review of the current literature and expert opinion, the Practice Guidelines and Technical Standards Committee of the Society of Skeletal Radiology (SSR) proposes a bone reporting and data system (Bone-RADS) for incidentally encountered solitary bone lesions on CT and MRI with four possible diagnostic management recommendations (Bone-RADS1, leave alone; Bone-RADS2, perform different imaging modality; Bone-RADS3, perform follow-up imaging; Bone-RADS4, biopsy and/or oncologic referral). Two algorithms for CT based on lesion density (lucent or sclerotic/mixed) and two for MRI allow the user to arrive at a specific Bone-RADS management recommendation. Representative cases are provided to illustrate the usability of the algorithms.
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http://dx.doi.org/10.1007/s00256-022-04022-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9283187PMC
September 2022

Imaging of traumatic shoulder injuries - Understanding the surgeon's perspective.

Eur J Radiol Open 2022 2;9:100411. Epub 2022 Mar 2.

Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA.

Imaging plays a key role in the assessment and management of traumatic shoulder injuries, and it is important to understand how the imaging details help guide orthopedic surgeons in determining the role for surgical treatment. Imaging is also crucial in preoperative planning, the longitudinal assessment after surgery and the identification of complications after treatment. This review discusses the mechanisms of injury, key imaging findings, therapeutic options and associated complications for the most common shoulder injuries, tailored to the orthopedic surgeon's perspective.
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http://dx.doi.org/10.1016/j.ejro.2022.100411DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8899241PMC
March 2022

Distant migration of gluteal augmentation fat presenting as a soft tissue knee mass.

Skeletal Radiol 2022 May 7;51(5):1093-1098. Epub 2021 Oct 7.

Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Gluteal augmentation with autologous fat grafting is an increasingly popular procedure. While complication rates are low, the clinical and imaging evaluation of the various complications can be challenging. We report a case of distal migration of a failed gluteal fat graft in a young female patient presenting as a soft tissue mass in the knee, mimicking a soft tissue sarcoma. Surgical resection of the migrated fat graft confirmed the diagnosis. The diagnosis was challenging as the patient was initially reluctant to disclose her surgical history due to perceived negative social stigmas related to cosmetic contouring procedures. This case highlights the imaging findings of a rare complication following autologous fat grafting for gluteal augmentation and the importance of obtaining a thorough medical history.
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http://dx.doi.org/10.1007/s00256-021-03931-4DOI Listing
May 2022

Artificial intelligence to assess body composition on routine abdominal CT scans and predict mortality in pancreatic cancer- A recipe for your local application.

Eur J Radiol 2021 Sep 24;142:109834. Epub 2021 Jun 24.

MIT Computer Science & Artificial Intelligence Laboratory, 32 Vassar St, Cambridge, MA 02139, United States; Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, 20 Kent Street, Brookline, MA 02445, United States. Electronic address:

Background: Body composition is associated with mortality; however its routine assessment is too time-consuming.

Purpose: To demonstrate the value of artificial intelligence (AI) to extract body composition measures from routine studies, we aimed to develop a fully automated AI approach to measure fat and muscles masses, to validate its clinical discriminatory value, and to provide the code, training data and workflow solutions to facilitate its integration into local practice.

Methods: We developed a neural network that quantified the tissue components at the L3 vertebral body level using data from the Liver Tumor Challenge (LiTS) and a pancreatic cancer cohort. We classified sarcopenia using accepted skeletal muscle index cut-offs and visceral fat based its median value. We used Kaplan Meier curves and Cox regression analysis to assess the association between these measures and mortality.

Results: Applying the algorithm trained on LiTS data to the local cohort yielded good agreement [>0.8 intraclass correlation (ICC)]; when trained on both datasets, it had excellent agreement (>0.9 ICC). The pancreatic cancer cohort had 136 patients (mean age: 67 ± 11 years; 54% women); 15% had sarcopenia; mean visceral fat was 142 cm. Concurrent with prior research, we found a significant association between sarcopenia and mortality [mean survival of 15 ± 12 vs. 22 ± 12 (p < 0.05), adjusted HR of 1.58 (95% CI: 1.03-3.33)] but no association between visceral fat and mortality. The detector analysis took 1 ± 0.5 s.

Conclusions: AI body composition analysis can provide meaningful imaging biomarkers from routine exams demonstrating AI's ability to further enhance the clinical value of radiology reports.
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http://dx.doi.org/10.1016/j.ejrad.2021.109834DOI Listing
September 2021

Evolution of the Interventional Radiology (IR) Pathway-Various Changes and Interrelation to Diagnostic Radiology (DR).

Acad Radiol 2021 09 24;28(9):1253-1263. Epub 2021 Apr 24.

Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston Massachusetts. Electronic address:

Interventional radiology continues to evolve into a more robust and clinically dynamic specialty underpinned by significant advancements in training, education, and practice. This article, prepared by members of the 2020-2021 Association of University Radiologists' task force of the Radiology Research Alliance, will review these developments, highlighting the evolution of interventional radiology pathways with attention to growing educational differences, interrelation to diagnostic radiology training, post-training practice patterns, distribution of procedures and future trends, amongst other key features important to those pursuing a career in interventional radiology as well as those in practice.
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http://dx.doi.org/10.1016/j.acra.2021.03.017DOI Listing
September 2021

Image-Guided Core Needle Biopsy of Adipocytic Tumors: Diagnostic Accuracy and Concordance With Final Surgical Pathology.

AJR Am J Roentgenol 2021 04 24;216(4):997-1002. Epub 2021 Feb 24.

Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215.

Diagnostic accuracy of core needle biopsy (CNB) for adipocytic tumors can be low because of sampling error from these often large, heterogeneous lesions. The purpose of this study was to evaluate the diagnostic accuracy of image-guided CNB for various adipocytic tumors in comparison with excisional pathology. Adipocytic tumors ( = 77) of all adult patients undergoing image-guided CNB and subsequent surgical excision of an adipocytic tumor at a tertiary referral center between 2005 and 2019 were studied. To determine concordance, we compared pathologic diagnoses based on CNB to the reference standard of pathologic diagnoses after surgical excision. Tumors were divided into three categories (benign lipomatous tumors [lipoma, lipoma variants, hibernomas], atypical lipomatous tumors [ALTs] or well-differentiated liposarcomas [WDLs], and higher grade liposarcomas [myxoid, dedifferentiated, pleomorphic]), and diagnostic accuracy was calculated for each category. In 73 of 77 adipocytic tumors (95%), diagnosis at CNB and diagnosis after excision were concordant. Accuracy of diagnosis was poorer for ALTs and WDLs than for the other two categories, and the difference was statistically significant ( < .002). For the 29 benign lipomatous tumors and the 27 higher-grade liposarcomas, diagnoses at CNB and after excision were concordant in all cases (100%). Seventeen of the 21 tumors (81%) diagnosed as ALTs or WDLs at CNB had a concordant diagnosis after excision; four of the 21 were upgraded (dedifferentiated liposarcoma, = 3; myxoid liposarcoma, = 1). CNB provides high diagnostic accuracy for adipocytic tumors, particularly for benign lipomatous tumors and higher grade liposarcomas. However, though still high at 81%, diagnostic accuracy of CNB is not as high for tumors diagnosed as ALTs or WDLs. Awareness of this limitation is important when determining management, particularly of cases of ALT or WDL for which surgery is not planned.
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http://dx.doi.org/10.2214/AJR.20.23080DOI Listing
April 2021

Imaging of Acute Shoulder Trauma.

Semin Roentgenol 2021 Jan 31;56(1):5-21. Epub 2020 Jul 31.

Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Electronic address:

Acute injuries to the shoulder girdle are common and frequently encountered by the practicing radiologist. The type of injury is highly dependent on the age of the patient and mechanism of trauma with injuries occurring at the site of greatest mechanical weakness. In this review, we discuss the main clinical features and key imaging findings for the most common shoulder injuries. For each injury, we also provide a section on the important features that the orthopedic surgeon needs to know in order to guide surgical versus nonsurgical management.
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http://dx.doi.org/10.1053/j.ro.2020.07.018DOI Listing
January 2021

Consensus survey on pre-procedural safety practices in radiological examinations: a multicenter study in seven Asian regions.

Br J Radiol 2020 Sep 2;93(1113):20200082. Epub 2020 Jul 2.

Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.

Objective: To understand the status of pre-procedural safety practices in radiological examinations at radiology residency training institutions in various Asian regions.

Methods: A questionnaire based on the Joint Commission International Accreditation Standards was electronically sent to 3 institutions each in 10 geographical regions across 9 Asian countries. Questions addressing 45 practices were divided into 3 categories. A five-tier scale with numerical scores was used to evaluate safety practices in each institution. Responses obtained from three institutions in the United States were used to validate the execution rate of each surveyed safety practice.

Results: The institutional response rate was 70.0% (7 Asian regions, 21 institutions). 44 practices (all those surveyed except for the application of wrist tags for identifying patients with fall risks) were validated using the US participants. Overall, the Asian participants reached a consensus on 89% of the safety practices. Comparatively, most Asian participants did not routinely perform three pre-procedural practices in the examination appropriateness topic.

Conclusion: Based on the responses from 21 participating Asian institutions, most routinely perform standard practices during radiological examinations except when it comes to examination appropriateness. This study can provide direction for safety policymakers scrutinizing and improving regional standards of care.

Advances In Knowledge: This is the first multicenter survey study to elucidate pre-procedural safety practices in radiological examinations in seven Asian regions.
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http://dx.doi.org/10.1259/bjr.20200082DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465868PMC
September 2020

Association of aspirin and other non-steroidal anti-inflammatory drugs with bleeding complications in image-guided musculoskeletal biopsies.

Skeletal Radiol 2020 Nov 13;49(11):1849-1854. Epub 2020 Jun 13.

Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.

Objective: To evaluate the safety of continuing aspirin and other non-steroidal anti-inflammatory drugs (NSAID) in patients undergoing image-guided musculoskeletal biopsies.

Material And Methods: Prior to October 2017, patients undergoing image-guided musculoskeletal biopsy had aspirin and NSAIDs withheld for the preceding 5-7 days. The policy changed in October 2017 based on new guidelines from the Society of Interventional Radiology such that aspirin and other NSAIDs were not withheld. A retrospective review of patient records was performed for all biopsies prior to and after the policy change to assess for differences in biopsy-related bleeding complications. Additional clinical and biopsy factors including age, gender, liver disease, coagulopathy, biopsy tissue type, and histological diagnosis were assessed.

Results: In the pre-policy change group, there were 1853 total biopsies with 43 biopsy-related bleeding complications (2.3%). Within this group, 362 patients were on aspirin with 7 bleeding complications (1.9%) and 260 patients were on NSAIDs with 5 bleeding complications (1.9%). There were 409 total biopsies in the post-policy change group and 7 bleeding complications (1.7%). Within this group, 71 patients were on aspirin with 1 bleeding complication (1.4%). No bleeding complications were recorded in patients on NSAIDs (0%). There was no significant difference in bleeding complication between the pre- and post-policy change groups overall (p = 0.58) and in patients on aspirin (p = 1.00) or other NSAIDs (p = 1.00).

Conclusion: Bleeding complications for musculoskeletal biopsies are rare. Leaving patients on aspirin or other NSAIDs during a musculoskeletal biopsy does not increase the incidence of bleeding complications.
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http://dx.doi.org/10.1007/s00256-020-03510-zDOI Listing
November 2020

CORR® Tumor Board: Is the Width of a Surgical Margin Associated with the Outcome of Disease in Patients with Peripheral Chondrosarcoma of the Pelvis? A Multicenter Study.

Clin Orthop Relat Res 2019 11;477(11):2429-2431

M. E. Anderson, Orthopaedic Oncology Surgeon, Beth Israel Deaconess Medical Center and Boston Children's Hospital, Boston, MA, USA J. S. Wu, Musculoskeletal Radiologist, Beth Israel Deaconess Medical Center, Boston, MA, USA S. O Vargas, Staff Pathologist, Boston Children's Hospital, Boston, MA, USA.

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http://dx.doi.org/10.1097/CORR.0000000000000983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6903844PMC
November 2019

CORR® Tumor Board: Can Navigation Improve the Ability to Achieve Tumor-free Margins in Pelvic and Sacral Primary Bone Sarcoma Resections? A Historically Controlled Study.

Clin Orthop Relat Res 2019 07;477(7):1544-1547

M. E. Anderson, Orthopaedic Oncology Surgeon, Beth Israel Deaconess Medical Center and Boston Children's Hospital, Boston, MA, USA J. S. Wu, Musculoskeletal Radiologist, Beth Israel Deaconess Medical Center, Boston, MA, USA S. O. Vargas, Staff Pathologist, Boston Children's Hospital, Boston, MA, USA.

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http://dx.doi.org/10.1097/CORR.0000000000000821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6999966PMC
July 2019

Exploring the relationship between electrical impedance myography and quantitative ultrasound parameters in Duchenne muscular dystrophy.

Clin Neurophysiol 2019 04 12;130(4):515-520. Epub 2019 Feb 12.

Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address:

Objectives: Quantitative ultrasound (QUS), including grayscale level analysis (GLA) and quantitative backscatter analysis (QBA), and electrical impedance myography (EIM) have been proposed as biomarkers in Duchenne muscular dystrophy (DMD). However, the relationship between these methods has not been assessed.

Methods: QUS values (including GLA and QBA) and several EIM measures were recorded from six muscles in 36 DMD and 29 healthy boys between ages 5 and 13 years at baseline, 6-months, and 12-months.

Results: In the DMD boys, a moderate correlation was noted between QUS and EIM parameters, with the strongest correlations being identified for averaged muscle values. Of the individual muscles, biceps brachii and deltoid showed the strongest correlations. For example, in biceps, the QBA/EIM correlation coefficient (Spearman rho) was ≥0.70 (p < 0.01). Importantly, changes in QUS values over 12 months also correlated moderately with changes in EIM parameters and EIM/QBA rho values mostly varied between -0.53 and -0.70 (p ≤ 0.02). No significant correlations were identified in the healthy boys.

Conclusions: A moderate correlation of QUS with EIM in DMD boys suggests that the two technologies provide related data but are sensitive to different pathological features of muscle.

Significance: The use of both technologies jointly in assessing DMD progression and response to therapy should be considered.
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http://dx.doi.org/10.1016/j.clinph.2019.01.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6411427PMC
April 2019

Correlation of Soft Tissue Swelling and Timing to Surgery With Acute Wound Complications for Operatively Treated Ankle and Other Lower Extremity Fractures.

Foot Ankle Int 2019 May 28;40(5):526-536. Epub 2019 Jan 28.

2 Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Background: Considerable debate exists regarding how soft-tissue edema should influence timing of surgery for ankle and other lower extremity fractures. Assessment of swelling is subjective, and timing varies among surgeons. However, timing of surgery is one of the few modifiable factors in fracture care. Ultrasonography can objectively measure swelling and help determine optimal timing. The purposes of this study were to determine whether objective measures of swelling, timing to surgery, and patient-specific risk factors correlated with wound complications and to try to create a prediction model for postoperative wound complications based on identified modifiable and nonmodifiable risk factors.

Methods: Patients with closed ankle and other lower extremity fractures requiring surgery with an uninjured, contralateral extremity were included. Demographic information and sonographic measurements on both lower extremities were obtained pre-operatively. Subjects were followed for 3 months and wound complications were documented. A predictive algorithm of independent risk factors was constructed, determining wound complication risk. Given that patients with ankle fractures made up the majority of the study cohort (75/93 or 80%), a separate statistical analysis was performed on this group. A total of 93 subjects completed the study, with 75/93 sustaining ankle fractures.

Results: Overall wound complication rate was 18.3%. Timing to surgery showed no correlation with wound complications. A heel-pad edema index >1.4 was independently associated with wound complications. Subgroup analysis of ankle fractures demonstrated a 3.4× increase in wound complications with a heel-pad edema index >1.4. Tobacco history and BMI >25 were independent predictors of wound complications. An algorithm was established based on heel-pad edema index, BMI >25, and tobacco history. Patients with none of the 3 factors had a 3% probability of a wound complication. Patients with 1/3, 2/3 and 3/3 factors had a 12-36%, 60-86% and 96% probability of a wound complication, respectively.

Conclusions: Timing to surgery had no correlation with wound complications. Heel-pad edema index >1.4, BMI >25, and tobacco-use correlated with wound complications. When separately analyzing the cohort that sustained ankle fractures, the heel-pad edema index of >1.4 was still demonstrated to be predictive of wound complications corresponding to a 3.4× increase in wound complication rates (11.1% vs 37.5%). Risk of wound complications significantly increased with each factor. In patients with increased BMI and/or tobacco use, resolution of heel edema may significantly reduce wound complications in lower extremity trauma.

Level Of Evidence: Level II, prognostic, prospective cohort study.
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http://dx.doi.org/10.1177/1071100718820352DOI Listing
May 2019

Imaging Features of Soft-Tissue Calcifications and Related Diseases: A Systematic Approach.

Korean J Radiol 2018 Nov-Dec;19(6):1147-1160. Epub 2018 Oct 18.

Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.

Soft-tissue calcification refers to a broad category of lesions. Calcifications are frequently identified by radiologists in daily practice. Using a simple algorithm based on the distribution pattern of the lesions and detailed clinical information, these calcified lesions can be systematically evaluated. The distribution pattern of the calcific deposits enables initial division into calcinosis circumscripta and calcinosis universalis. Using laboratory test results (serum calcium and phosphate levels) and clinical history, calcinosis circumscripta can be further categorized into four subtypes: dystrophic, iatrogenic, metastatic, and idiopathic calcification. This pictorial essay presents a systematic approach to the imaging features of soft-tissue calcifications and related diseases.
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http://dx.doi.org/10.3348/kjr.2018.19.6.1147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6201973PMC
April 2019

Different References for Valgus Cut Angle in Total Knee Arthroplasty.

Arch Bone Jt Surg 2018 Jul;6(4):289-293

Department of knee Surgery, Firoozgar Hospital, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: The valgus cut angle (VCA) of the distal femur in Total Knee Arthroplasty (TKA) is measured preoperatively on three-joint alignment radiographs. The anatomical axis of the femur can be described as the anatomical axis of the full length of the femur or as the anatomical axis of the distal half of the femur, which may result in different angles in some cases. During TKA, the anatomical axis of the femur is determined by intramedullary femoral guides, which may follow the distal half or near full anatomical axis, based on the length of the femoral guide. The aim of this study was to compare using the anatomical axis of the full length of the femur versus the anatomical axis of the distal half of the femur for measuring VCA, in normal and varus aligned femurs. We hypothesized that the VCA would be different based upon these two definitions of the anatomical axis of the femur.

Methods: Full-length weight bearing radiographs were used to determine three-joint alignment in normal aligned (Lateral Distal Femoral Angle; LDFA = 87º ± 2º) and varus aligned (LDFA >89º) femurs. Full-length anatomical axis-mechanical axis angle (angle 1) and distal half anatomical axis-mechanical axis angle (angle 2) were measured in all subjects by two independent orthopedic surgeons using a DICOM viewer software (PACS). Angles 1 and 2 were compared in normal and varus aligned subjects to determine whether there was a significant difference.

Results: Ninety-seven consecutive subjects with normally aligned femurs and 97 consecutive subjects with varus aligned femurs were included in this study. In normally aligned femurs, the mean value of angle 1 was 5.05° ± 0.76° and for angle 2 was 3.62° ± 1.19°, which were statistically different (). In varus aligned femurs, the mean value of angle 1 was 5.42° ± 0.85° and for angle 2 was 4.23° ± 1.27°, which were also statistically different ().

Conclusion: The two different methods of outlining the anatomical axis of the femur lead to different results in both normal and varus-aligned femurs. This should be considered in determination of the valgus cut angle on pre-operative radiographs and be adjusted according to the length of the intramedullary guide.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110428PMC
July 2018

Effect of Chemotherapy on Dual-Energy X-ray Absorptiometry (DXA) Body Composition Precision Error in Head and Neck Cancer Patients.

J Clin Densitom 2019 Jul - Sep;22(3):437-443. Epub 2018 Jul 31.

Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, USA.

Background: Precision error in dual-energy X-ray absorptiometry (DXA) is defined as difference in results due to instrumental and technical factors given no biologic change. The aim of this study is to compare precision error in DXA body composition scans in head and neck cancer patients before and 2 months after chemotherapy.

Methodology: A total of 34 male head and neck cancer patients with normal body mass index (BMI) were prospectively enrolled and all patients received 2 consecutive DXA scans both before and after 2 months of chemotherapy for a total of 4 scans. The precision error of 3 DXA body composition values (lean mass, fat mass, and bone mineral content) was calculated for total body and 5 body regions (arms, legs, trunk, android, and gynoid). Precision errors before and after treatment were compared using generalized estimating equation model.

Results: There was no significant change in precision error for the DXA total body composition values following chemotherapy; lean mass (0.33%-0.40%, p = 0.179), total fat mass (1.39%-1.70%, p = 0.259) and total bone mineral content (0.42%-0.56%, p = 0.243). However, there were significant changes in regional precision error; trunk lean mass (1.19%-1.77%, p = 0.014) and android fat mass (2.17%-3.72%, p = 0.046).

Conclusions: For head and neck cancer patients, precision error of DXA total body composition values did not change significantly following chemotherapy; however, there were significant changes in fat mass in the android and lean mass in the trunk. Caution should be exercised when interpreting longitudinal DXA body composition data in those body parts.
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http://dx.doi.org/10.1016/j.jocd.2018.07.011DOI Listing
July 2020

CORR® Tumor Board: Micrometastatic Drug Screening Platform Shows Heterogeneous Response to MAP Chemotherapy in Osteosarcoma Cell Lines.

Clin Orthop Relat Res 2018 07;476(7):1396-1399

M. E. Anderson, Orthopaedic Oncology Surgeon, Beth Israel Deaconess Medical Center and Boston Children's Hospital, Boston, MA, USA J. S. Wu, Musculoskeletal Radiologist, Beth Israel Deaconess Medical Center, Boston, MA, USA S. O. Vargas, Staff Pathologist, Boston Children's Hospital, Boston, MA, USA.

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http://dx.doi.org/10.1097/CORR.0000000000000349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437562PMC
July 2018

Electrical impedance imaging of human muscle at the microscopic scale using a multi-electrode needle device: A simulation study.

Clin Neurophysiol 2018 08 25;129(8):1704-1708. Epub 2018 May 25.

Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215-5491, USA. Electronic address:

Objective: To use a standard modeling approach to evaluate the feasibility of imaging healthy and diseased skeletal muscle at the microscopic scale with a novel electrical impedance imaging (EII) needle.

Methods: We modeled an EII needle containing 16 impedance electrodes arranged circumferentially around the shaft of a non-conductive 19-gauge needle in 4 planes. We then combined the finite element method approach with a reconstruction algorithm to create imaging simulations of the electrical properties of the triceps brachii by localized intramuscular fat (as might be seen in any chronic neuromuscular disease) and by localized edema (as in inflammatory myositis or after direct muscle injury).

Results: We were able to image a 1 cm radial region of interest with a resolution of 200 µm. Modeling localized deposition of fat and pockets of inflammatory cells, showing clear differences between the two modeled clinical states.

Conclusions: This modeling study shows needle EII's ability to image the internal composition of muscle. These results can serve as an initial guide in designing and manufacturing prototype EII needles for experimental testing in animals and eventually in humans.

Significance: Needle EII could serve as a new minimally invasive technique for imaging human muscle at the microscopic scale, potentially serving as a new biomarker to assess disease response to therapy.
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http://dx.doi.org/10.1016/j.clinph.2018.04.746DOI Listing
August 2018

CORR Insights®: Is Core Needle Biopsy Reliable in Differentiating Between Aggressive Benign and Malignant Radiolucent Bone Tumors?

Authors:
Jim S Wu

Clin Orthop Relat Res 2018 03;476(3):578-579

J. S. Wu, Associate Professor in Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.

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http://dx.doi.org/10.1007/s11999.0000000000000219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260041PMC
March 2018

Progressive Sarcopenia in Patients With Colorectal Cancer Predicts Survival.

AJR Am J Roentgenol 2018 Mar 24;210(3):526-532. Epub 2018 Jan 24.

4 Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Objective: The purpose of this study was to evaluate the relationship between sarcopenia and overall and progression-free survival in patients with colorectal cancer.

Materials And Methods: This study was retrospective and complied with HIPAA. Patients with colorectal cancer who underwent CT at the time of and 6-18 months after diagnosis were included. Patients were followed for at least 5 years after diagnosis. Skeletal muscle index (SMI) and mean muscle attenuation of the psoas and paraspinal muscles at the L4 level determined the degree of sarcopenia. Composite measurements combining psoas and paraspinal muscles (total muscle) were also obtained. Univariate and multivariate Cox proportional hazard analysis was performed to evaluate the association between survival and changes in SMI and changes in attenuation. Kaplan-Meier analysis was also performed.

Results: A total of 101 patients were included (mean age ± SD, 63.7 ± 13.7 years; 68 men, 33 women). The hazard ratios for overall survival were 2.27, 1.68, and 1.54 for changes in SMI of the psoas muscle, paraspinal muscle, and total muscle (all p < 0.05). The hazard ratios for overall survival were 1.14, 1.18, and 1.24 for changes in attenuation of the psoas muscle, paraspinal muscle, and total muscle, respectively (all p < 0.05). The hazard ratios for progression-free survival were 1.33, 1.41, and 1.23 for changes in SMI of the psoas muscle, paraspinal muscle, and total muscle (not statistically significant). The hazard ratios for progression-free survival were 1.10, 1.21, and 1.23 for changes in attenuation of the psoas muscle, paraspinal muscle, and total muscle, respectively (p < 0.05). Kaplan-Meier analysis showed significant differences in overall and progression-free survival based on sex-specific quartiles of muscle quantity and quality.

Conclusion: Progressive sarcopenia after diagnosis of colorectal cancer has a significant negative prognostic association with overall and progression-free survival.
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http://dx.doi.org/10.2214/AJR.17.18020DOI Listing
March 2018

A Collision Tumor Involving a Primary Leiomyosarcoma of the Lower Extremity and a Metastatic Medullary Thyroid Carcinoma: A Case Report.

JBJS Case Connect 2017 Oct-Dec;7(4):e90

Departments of Radiology (J.S.W.) and Orthopaedics (M.E.A.) and Divisions of Hematology/Oncology (D.S.) and Anatomic Pathology (J.D.G.), Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Case: A 49-year-old man presented with a rapidly growing thigh mass. Histologic analyses demonstrated separate regions that were consistent with a collision tumor composed of a primary leiomyosarcoma and a metastatic medullary thyroid carcinoma. After responding to chemotherapy, the patient underwent resection of the tumor and a total thyroidectomy; he was disease-free 9 years after the diagnosis.

Conclusion: A wide diagnostic differential and thorough histologic analysis are necessary in patients presenting with neoplasms of the extremities. A leiomyosarcoma may be a hospitable location for metastatic disease, and the presence of a collision tumor should be considered when pathology findings are equivocal.
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http://dx.doi.org/10.2106/JBJS.CC.17.00041DOI Listing
July 2019

Effect of sarcopenia on clinical and surgical outcome in elderly patients with proximal femur fractures.

Skeletal Radiol 2018 Jun 15;47(6):771-777. Epub 2017 Dec 15.

Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.

Purpose: To investigate the relationship between sarcopenia with short-term surgical outcome in elderly patients with proximal femur fractures.

Methods And Materials: Following Institutional Review Board approval, a database of patients receiving a pelvis CT scan for acute trauma between January 2000-August 2016 was screened for an isolated proximal femur fracture. Patients were excluded if they were: < 50 years old, had conditions predisposing to sarcopenia (renal failure, congestive heart failure, muscular dystrophies), had undergone no surgical treatment, had other major traumatic injuries, or had a pathologic femur fracture. The paraspinal muscle density (PSD) at the L4 level was measured in Hounsfield units. The skeletal muscle index (SMI) was measured as the total skeletal muscle area at L4 divided by patient height. PSD and SMI were tested for association with surgical outcome measures: length of hospital stay, perioperative mortality, medical complications, in-hospital blood transfusion volume, and 90-day readmission rate, using multiple variable regression analysis. Pearson correlation of PSD and SMI was performed.

Results: Controlling for age, gender, body mass index (BMI), and fracture type, low PSD and SMI were both independently associated with longer length of hospitalization (p = 0.008 and p = 0.032, respectively). Low PSD was associated with a higher amount of blood transfusion volume during the perioperative period (p = 0.004). Pearson correlation revealed moderate positive correlation between the SMI and PSD (r = 0.579, p < 0.001).

Conclusion: In proximal femur fractures, elderly patients with sarcopenia are more likely to have prolonged hospitalization following surgery and require more blood transfusion volume during the perioperative period.
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http://dx.doi.org/10.1007/s00256-017-2848-6DOI Listing
June 2018

Safety of omitting routine bleeding tests prior to image-guided musculoskeletal core needle biopsy.

Skeletal Radiol 2018 Feb 6;47(2):215-221. Epub 2017 Oct 6.

Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.

Purpose: To evaluate the safety of withholding preprocedure international normalized ratio (INR) and platelet testing in patients undergoing musculoskeletal (MSK) core needle biopsy (CNB).

Material And Methods: Initially, a retrospective review of 1,162 consecutive patients undergoing MSK CNB with preprocedural INR and platelet testing was performed. Clinical (age, gender, bleeding disorder, liver disease, anticoagulation use, INR > 2, platelet count <50,000/ul) and biopsy factors (imaging modality, lesion type, biopsy needle gauge, number biopsy samples) were tested for association with bleeding complications. During the second phase, an additional 188 biopsies performed without preprocedural coagulation testing were studied. Categorical variables were compared using Chi-squared or Fisher's exact tests, continuous variables with a student t-test. Multivariate analysis was performed using logistic regression.

Results: In the first phase, there was a complication rate of 2.6%, 30/1162. Of the 11 clinical and biopsy factors, soft tissue lesions (p = 0.029) and lesions biopsied under ultrasound (p = 0.048) had a higher rate of bleeding than bone lesions or lesions biopsied under CT, respectively. Only three patients had an INR >2, 0.3% (3/1162) and only four patients had platelet count <50,000/ul, 0.3% (4/1162). No patient with a bleeding complication had an abnormal preprocedure bleeding test. In the second phase, there was a bleeding complication rate of 1.1% (2/188).

Conclusion: Bleeding complications from MSK biopsy are low, even when preprocedure coagulation testing is omitted.
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http://dx.doi.org/10.1007/s00256-017-2784-5DOI Listing
February 2018

Muscle compression improves reliability of ultrasound echo intensity.

Muscle Nerve 2018 03 30;57(3):423-429. Epub 2017 Sep 30.

Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.

Introduction: Muscle echo intensity has been shown to correlate with disease status in muscle disorders, including Duchenne muscular dystrophy (DMD). We report the effect of sonographer-applied load on measurements of muscle echo intensity.

Methods: Quadriceps ultrasound scans were performed on 22 healthy boys and 16 boys with DMD between the ages of 2.2 and 15.3 years. Transducer contact force was increased linearly from 1.5 to 10 N, and echo intensity was measured throughout.

Results: Echo intensity increased linearly with strain at a rate of 42 (95% confidence interval [CI]: 21-63) and 74 (95% CI: 49-98) in the healthy and DMD populations, respectively. Echo intensity reliability was moderate at low strain (intraclass correlation coefficient [ICC] = 0.82) and was improved at high strain (ICC = 0.92).

Discussion: Sonographer-applied load introduces error in measurements of echo intensity, but it can be minimized by measuring echo intensity at near-maximal levels of compression. Muscle Nerve 57: 423-429, 2018.
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http://dx.doi.org/10.1002/mus.25779DOI Listing
March 2018

Clinical and Radiologic Predictive Factors of Rib Fractures in Outpatients With Chest Pain.

Curr Probl Diagn Radiol 2018 Mar - Apr;47(2):94-97. Epub 2017 May 30.

Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA. Electronic address:

Purpose: To identify the clinical and radiologic predictive factors of rib fractures in stable adult outpatients presenting with chest pain and to determine the utility of dedicated rib radiographs in this population of patients.

Method And Materials: Following Institutional Review Board approval, we performed a retrospective review of 339 consecutive cases in which a frontal chest radiograph and dedicated rib series had been obtained for chest pain in the outpatient setting. The frontal chest radiograph and dedicated rib series were sequentially reviewed in consensus by two fellowship-trained musculoskeletal radiologists blinded to the initial report. The consensus interpretation of the dedicated rib series was used as the gold standard. Multiple variable logistic regression analysis assessed clinical and radiological factors associated with rib fractures. Fisher exact test was used to assess differences in medical treatment between the 2 groups.

Results: Of the 339 patients, 53 (15.6%) had at least 1 rib fracture. Only 20 of the 53 (37.7%) patients' fractures could be identified on the frontal chest radiograph. The frontal chest radiograph had a sensitivity of 38% and specificity of 100% when using the rib series as the reference standard. No pneumothorax, new mediastinal widening or pulmonary contusion was identified. Multiple variable logistic regression analysis of clinical factors associated with the presence of rib fractures revealed a significant association of trauma history (odds ratio 5.7 [p < 0.05]) and age ≥40 (odds radio 3.1 [p < 0.05]). Multiple variable logistic regression analysis of radiographic factors associated with rib fractures in this population demonstrated a significant association of pleural effusion with rib fractures (odds ratio 18.9 [p < 0.05]). Patients with rib fractures received narcotic analgesia in 47.2% of the cases, significantly more than those without rib fractures (21.3%, p < 0.05). None of the patients required hospitalization.

Conclusion: In the stable outpatient setting, rib fractures have a higher association with a history of minor trauma and age ≥40 in the adult population. Radiographic findings associated with rib fractures include pleural effusion. The frontal chest radiograph alone has low sensitivity in detecting rib fractures. The dedicated rib series detected a greater number of rib fractures. Although no patients required hospitalization, those with rib fractures were more likely to receive narcotic analgesia.
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http://dx.doi.org/10.1067/j.cpradiol.2017.05.011DOI Listing
July 2018

Imaging of Musculoskeletal Soft Tissue Infection.

Semin Roentgenol 2017 Jan 18;52(1):55-62. Epub 2016 Oct 18.

Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Electronic address:

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http://dx.doi.org/10.1053/j.ro.2016.10.001DOI Listing
January 2017
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