Publications by authors named "Jonathan D Samet"

13 Publications

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Pediatric discoid meniscus: can magnetic resonance imaging features coupled with clinical symptoms predict the need for surgery?

Pediatr Radiol 2021 May 4. Epub 2021 May 4.

Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.

Background: Magnetic resonance imaging (MRI) criteria for evaluating discoid meniscus is limited in the pediatric population.

Objective: To assess MRI features of intact discoid meniscus and correlate with clinical outcomes.

Materials And Methods: In this institutional review board (IRB)-approved retrospective cohort study, knee MRIs at our institution from 2008 to 2019 were reviewed. The inclusion criterion was diagnosis of discoid meniscus on MRI. Exclusion criteria were torn discoid meniscus at presentation, previous meniscal surgery and confounding knee conditions. MRI features of discoid meniscus collected were craniocaudal dimension, transverse dimension, transverse dimension to tibial plateau (TV:TP) ratio and increased intrameniscal signal. The clinical course was reviewed for knee pain, mechanical symptoms and treatment type.

Results: Two hundred and nineteen of 3,277 (6.7%) patients had discoid meniscus. Of the 219 patients, 71 (32.4%) satisfied inclusion criteria. Seven patients had discoid meniscus of both knees resulting in 78 discoid menisci. The average patient age was 11.1 years (min: 2.0, max: 17.0). The average follow-up was 30.6 months. Of the 78 discoid menisci, 14 (17.9%) required surgery. Increased intrameniscal signal was found more in discoid meniscus requiring surgery (surgical: 10/14, nonsurgical: 19/64, P=0.009). Surgically treated discoid meniscus had a statistically significant increase in transverse dimension (surgical: 18.3±5.0 mm, nonsurgical: 15.7±4.3 mm, P=0.045) and TV:TP ratio (surgical: 0.55±0.15, nonsurgical: 0.47±0.12, P=0.036). Mechanical symptoms (surgical: 9/11, nonsurgical: 21/60, P=8.4×10) and pain ≥1 month (surgical: 11/11, nonsurgical: 17/60, P=0.006) were found more often in surgical patients. Clinical and imaging criteria of mechanical symptoms and knee pain ≥1 month and at least one of (1) increased intrameniscal signal or (2) TV:TP ratio greater than 0.47 identified discoid menisci that developed a tear and/or required surgery with a sensitivity of 0.86 and specificity of 0.88.

Conclusion: Mechanical symptoms and knee pain ≥1 month, and at least one of (1) increased intrameniscal signal or (2) TV:TP ratio greater than or equal to 0.47, identified discoid menisci that would go on to tear and/or require surgery with a sensitivity and specificity of 0.86 and 0.88, respectively.
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http://dx.doi.org/10.1007/s00247-021-05063-2DOI Listing
May 2021

Pediatric solid intra-articular masses of the knee: prevalence, imaging features and etiologies.

Pediatr Radiol 2021 Apr 9. Epub 2021 Apr 9.

Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL, 60611, USA.

Background: The etiologies of pediatric solid intra-articular soft-tissue masses are not well described and can present diagnostic dilemmas.

Objective: Our hypothesis was that these entities have a limited differential diagnosis and are mostly benign.

Materials And Methods: We reviewed knee magnetic resonance imaging (MRI) scans performed at our tertiary care institution between 2001 and 2019 (n=3,915). Our inclusion criterion was knee MRI with a solid intra-articular soft-tissue mass. Our exclusion criteria were cases with no masses or non-solid intra-articular lesions with clear radiologic diagnoses. Multiple radiologic characteristics were evaluated. Radiologic and histological diagnoses were collected when available. Cases without histology were assigned a suspected diagnosis.

Results: Twenty-five out of 3,915 (<1%) cases met the inclusion/exclusion criteria. Twenty patients underwent biopsy. Patient age ranged from 1 to 19 years with a mean age of 12 years. Lesion size ranged from 1 to 7 cm with a mean of 3.3 cm. The top three histological diagnoses were pigmented villonodular synovitis (PVNS) (7/20, 35%), vascular malformations (2/20, 10%) and inflammatory arthritis (2/20, 10%). There was one malignant case of synovial sarcoma (1/20, 5%). Of the five cases without biopsies, PVNS was the most common diagnosis (3/5, 60%). Five out of 10 (50%) PVNS cases were focal and 5/10 (50%) were multifocal. All PVNS cases (10/10, 100%) had hypointense signal on T2.

Conclusion: Solid intra-articular soft-tissue masses of the knee in children are rare, with a prevalence of <1% in our study. The vast majority are benign with PVNS being the most common diagnosis.
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http://dx.doi.org/10.1007/s00247-021-04993-1DOI Listing
April 2021

Quantitative magnetic resonance imaging for determining bone marrow fat fraction at 1.5 T and 3.0 T: a technique to noninvasively assess cellularity and potential malignancy of the bone marrow.

Pediatr Radiol 2021 01 5;51(1):94-102. Epub 2020 Sep 5.

Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD, USA.

Background: Pediatric bone marrow assessment by MRI is challenging and primarily experiential and qualitative, with a paucity of clinically useful quantitative imaging techniques.

Objective: MRI fat fraction (MRI-FF) is a technique used to quantify the degree of fat in other organ systems. The purpose of this study was to assess whether MRI-FF accurately measures bone marrow composition.

Materials And Methods: This two-part study included a validation phase, followed by an application phase. For the validation phase, the MRI-FF of piglet bones (6 long bones, 8 axial bones) was performed at 1.5 tesla (T) and 3.0 T, and correlated to the histological fat fraction (H-FF). We used Bland-Altman plots to compare MRI-FF at 1.5 tesla T and 3.0 T. For the application phase, five children with malignant marrow disease were recruited along with seven age- and gender-matched control subjects. The MRI-FF in the children was correlated to the H-FF. Boxplots were used to compare the MRI-FF of patients and control subjects.

Results: For the validation animal study, the MRI-FF of piglet bones at both 1.5 T and 3.0 T demonstrated moderate positive correlation to H-FF (r=0.41 and 0.42, respectively). MRI-FF at 1.5 T and 3.0 T were in good agreement, on average 7.7% apart. For the application phase, we included 5 children (4 with leukemia, 1 rhabdomyosarcoma) with median age 7 years, range (3-10 years). All children had MRI-FF and H-FF below 10%. The MRI-FF in patients (3.8±1.2) was significantly lower than that of control subjects (46.1±12.3%) (P<0.01).

Conclusion: MRI-FF is a valid technique to assess bone marrow fat fraction at both 1.5 T and 3.0 T. The MRI-FF in children with malignant marrow processes is significantly lower than in control subjects with normal marrow.
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http://dx.doi.org/10.1007/s00247-020-04809-8DOI Listing
January 2021

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

Burden of emergency department utilization and abdominal imaging for hereditary angioedema.

J Allergy Clin Immunol Pract 2020 Apr 5;8(4):1443-1446.e2. Epub 2019 Nov 5.

Department of Pediatrics and Allergy-Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill.

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http://dx.doi.org/10.1016/j.jaip.2019.10.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394264PMC
April 2020

Physeal separation in pediatric osteomyelitis.

Pediatr Radiol 2019 08 16;49(9):1229-1233. Epub 2019 May 16.

Department of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.

In children, acute osteomyelitis, an infection of the bone, is most commonly hematogeneous in origin. Osteomyelitis is most often diagnosed with magnetic resonance imaging (MRI) and findings may include marrow signal changes on T1 and T2, with abnormal enhancement after gadolinium. Imaging helps detect any associated intraosseous or subperiosteal abscesses, which may require orthopedic drainage. In this pictorial essay, we demonstrate the association of acute pediatric osteomyelitis with physeal separation, resulting in what may be confused for simple trauma, although there was no known history of trauma in any of the cases we researched. All of the cases had a large subperiosteal fluid collection with marked separation of the epiphysis from the metaphysis. It is important to recognize this potential association in osteomyelitis, as it is readily visible by radiographs and may lead to diagnostic uncertainty.
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http://dx.doi.org/10.1007/s00247-019-04410-8DOI Listing
August 2019

MRI characterization of brown adipose tissue under thermal challenges in normal weight, overweight, and obese young men.

J Magn Reson Imaging 2018 04 11;47(4):936-947. Epub 2017 Aug 11.

Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.

Purpose: To implement quantitative Dixon magnetic resonance imaging (MRI) methods for brown adipose tissue (BAT) characterization at inactive and cold-activated states in normal weight, overweight, and obese subjects. The hypotheses are that MRI characteristics of BAT would differentiate between nonobese and obese subjects, and activation of BAT in response to thermal challenges that are detected by MRI would be correlated with BAT activity measured by positron emission tomography / computed tomography (PET/CT).

Materials And Methods: Fifteen male subjects (20.7 ± 1.5 years old) including six normal weight, five overweight, and four obese subjects participated in the study. A multiecho Dixon MRI sequence was performed on a 1.5T scanner. MRI was acquired under thermoneutral, nonshivering thermogenesis, and subsequent warm-up conditions. Fat fraction (FF), R2*, and the number of double bonds (ndb) were measured by solving an optimization problem that fits in- and out-of-phase MR signal intensities to the fat-water interference models. Imaging acquisition and postprocessing were performed by two MRI physicists. In each subject, Dixon MRI measurements of FF, R2*, and ndb were calculated for each voxel within all BAT regions of interest (ROIs) under each thermal condition. Mean FF, R2*, and ndb were compared between nonobese (ie, normal-weight/overweight) and obese subjects using the two-sample t-test. Receiver operating characteristic (ROC) analyses were performed to differentiate nonobese vs. obese subjects. BAT MRI measurement changes in response to thermal condition changes were compared with hypermetabolic BAT volume/activity measured by PET/CT using the Pearson's correlation. In addition, BAT MRI measurements were compared with body adiposity using the Pearson's correlation. P < 0.05 was considered statistically significant.

Results: Obese subjects showed higher FF and lower R2* than nonobese subjects under all three thermal conditions (P < 0.01). ROC analyses demonstrated that FF and R2* were excellent predictors for the differentiation of nonobese from obese subjects (100% specificity and 100% sensitivity). FF changes under thermal challenges were correlated with hypermetabolic BAT volume (r = -0.55, P = 0.04 during activation, and r = 0.72, P = 0.003 during deactivation), and with BAT activity (r = 0.69, P = 0.006 during deactivation), as measured by PET/CT. FF and R2* under all three thermal conditions were highly correlated with body adiposity (P ≤ 0.002).

Conclusion: MRI characteristics of BAT differentiated between nonobese and obese subjects in both inactivated and activated states. BAT activation detected by Dixon MRI in response to thermal challenges were correlated with glucose uptake of metabolically active BAT.

Level Of Evidence: 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:936-947.
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http://dx.doi.org/10.1002/jmri.25836DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5808911PMC
April 2018

Melorheostosis mimicking synovial osteochondromatosis.

Ann Saudi Med 2014 Nov-Dec;34(6):547-50

Avneesh Chhabra, MD, Associate Professor of Radiology and MSK Radiology Division Chief,, MSK Radiology, University of Texas Southwestern Medical Center, 5323, Harry Hines Boulevard, Dallas, Texas, USA, T: 214-648-2122, F: 214-648-3904,

Melorheostosis is an uncommon, sporadic, sclerosing bone lesion that may affect the adjacent soft tissues. It has been associated with many entities such as osteopoikilosis, soft tissue vascular malformations, bone and soft tissue tumors, nephrotic syndrome, segmental limb contractures, osteosarcoma, desmoid tumor, and mesenteric fibromatosis. Synovial osteochondromatosis is a benign neoplasia of the hyaline cartilage presenting as nodules in the subsynovial tissue of a joint or tendon sheath. The intra-articular extension of melorheostosis mimicking synovial osteochondromatosis has not been reported before. In this article, the authors describe an unusual case mimicking synovial chondromatosis arising as a result of melorheostosis and their characteristic imaging findings.
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http://dx.doi.org/10.5144/0256-4947.2014.547DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6074574PMC
October 2015

Diverticulitis complicated by fistulous communication of sigmoid colon with anterior sacral meningocele in a patient with Marfan syndrome.

Radiol Case Rep 2012 7;7(1):442. Epub 2015 Dec 7.

Rare in the general public, dural ectasia is a common finding in patients with Marfan syndrome. Complications are not frequent but include constipation, urinary retention, and meningitis. Presented here is a case of bacterial meningitis secondary to fistulous communication between a sacral meningocele and sigmoid colon in the setting of diverticulitis.
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http://dx.doi.org/10.2484/rcr.v7i1.442DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899866PMC
June 2016

Dehiscence of coronary artery graft presenting as a right breast mass.

J Cardiovasc Comput Tomogr 2011 May-Jun;5(3):180-2. Epub 2011 Jan 20.

Northwestern University Feinberg School of Medicine, Department of Radiology, Chicago, IL, USA.

Coronary artery anastomotic dehiscence is a rare complication following aortic root repair in Marfan's disease. In this patient who presented several years after surgery with mediastinal and chest wall hematoma, gated IV contrast enhanced cardiac CT was able to noninvasively localize left main coronary artery anastomotic dehiscence as the source of bleeding.
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http://dx.doi.org/10.1016/j.jcct.2011.01.002DOI Listing
October 2011

Colonic endometriosis mimicking colon cancer on a virtual colonoscopy study: a potential pitfall in diagnosis.

Case Rep Med 2009 8;2009:379578. Epub 2009 Nov 8.

Department of Radiology, Northwestern Medical Faculty Foundation, Chicago, IL 60611, USA.

Colonic endometriosis has been reported in the literature to mimic colon cancer. Patients can present with symptoms almost identical to colon cancer. We present an exemplary case of a woman who was found to have a mass on conventional colonoscopy. Virtual colonoscopy was instrumental in characterizing the obstructive sigmoid mass. A biopsy of the mass revealed sigmoid endometriosis.
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http://dx.doi.org/10.1155/2009/379578DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2774483PMC
July 2011

Cronkhite-Canada Syndrome: Gastric Involvement Diagnosed by MDCT.

Case Rep Med 2009 4;2009:148795. Epub 2009 Aug 4.

Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair Street, Suite 800 Chicago, IL 60611, USA.

Chronkhite-Canada is a rare nonfamilial polyposis syndrome that usually presents as chronic malabsorption in adults. We present a case of a-73-year old woman with chronic gastrointestinal bleeding and malnutrition. On CT imaging she was found to have massive gastric polyps, which on biopsy was most consistent with Cronkhite-Canada syndrome.
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http://dx.doi.org/10.1155/2009/148795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729239PMC
July 2011

Invasive gastric mucormycosis: CT findings.

Emerg Radiol 2008 Sep 11;15(5):349-51. Epub 2007 Dec 11.

University of Maryland School of Medicine, Baltimore, MD, USA.

Mucormycosis is an uncommon fungal infection primarily seen in immunocompromised patients. We present a patient whose hospital course was rapidly complicated by invasive mucormycosis, which caused his death. Computed tomography (CT) was very helpful in characterizing the extent of involvement and directing clinical management.
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http://dx.doi.org/10.1007/s10140-007-0689-7DOI Listing
September 2008