Publications by authors named "Steven P Daniels"

16 Publications

  • Page 1 of 1

Imaging Evaluation of Medial and Lateral Elbow Pain: Acute and Chronic Tendon Injuries of the Humeral Epicondyles.

Semin Musculoskelet Radiol 2021 Aug 27;25(4):589-599. Epub 2021 Oct 27.

Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York.

Medial and lateral elbow pain are often due to degenerative tendinosis and less commonly due to trauma. The involved structures include the flexor-pronator tendon origin in medial-sided pain and the extensor tendon origin in lateral-sided pain. Multimodality imaging is often obtained to verify the clinically suspected diagnosis, evaluate the extent of injury, and guide treatment decisions. Image-guided procedures can provide symptom relief to support physical therapy and also induce tendon healing. Surgical debridement and repair are typically performed in refractory cases, resulting in good to excellent outcomes in most cases. In this article, we review and illustrate pertinent anatomical structures of the distal humerus, emphasizing the structure and contributions of the flexor-pronator and extensor tendon origins in acute and chronic tendon abnormalities. We also discuss approaches to image-guided treatment and surgical management of medial and lateral epicondylitis.
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http://dx.doi.org/10.1055/s-0041-1731790DOI Listing
August 2021

US-guided Musculoskeletal Interventions of the Body Wall and Core with MRI and US Correlation.

Radiographics 2021 Nov-Dec;41(7):2011-2028. Epub 2021 Oct 8.

From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, New York, NY 10016 (S.P.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (C.D.V., A.B.R., J.Y.T., K.S.L.); and Department of Medical Imaging, University of Toronto, Scarborough Health Network, Scarborough, ON, Canada (J.I.B.).

Chest, abdominal, and groin pain are common patient complaints that can be due to a variety of causes. Once potentially life-threatening visceral causes of pain are excluded, the evaluation should include musculoskeletal sources of pain from the body wall and core muscles. Percutaneous musculoskeletal procedures play a key role in evaluating and managing pain, although most radiologists may be unfamiliar with applications for the body wall and core muscles. US is ideally suited to guide these less commonly performed procedures owing to its low cost, portability, lack of ionizing radiation, and real-time visualization of superficial soft-tissue anatomy. US provides the operator with added confidence that the needle will be placed at the intended location and will not penetrate visceral or vascular structures. The authors review both common and uncommon US-guided procedures targeting various portions of the chest wall, abdominal wall, and core muscles with the hope of familiarizing radiologists with these techniques. Procedures include anesthetic and corticosteroid injection as well as platelet-rich plasma injection to promote tendon healing. Specific anatomic structures discussed include the sternoclavicular joint, costochondral joint, interchondral joint, intercostal nerve, scapulothoracic bursa, anterior abdominal cutaneous nerve, ilioinguinal nerve, iliohypogastric nerve, genitofemoral nerve, pubic symphysis, common aponeurotic plate, and adductor tendon origin. Relevant US anatomy is depicted with MRI correlation, and steps to performing successful safe US-guided injections are discussed. Confidence in performing these procedures will allow radiologists to continue to play an important role in diagnosis and management of many musculoskeletal pathologic conditions. RSNA, 2021.
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http://dx.doi.org/10.1148/rg.2021210050DOI Listing
November 2021

3D MRI of the Shoulder.

Semin Musculoskelet Radiol 2021 Jun 21;25(3):480-487. Epub 2021 Sep 21.

Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York.

Magnetic resonance imaging provides a comprehensive evaluation of the shoulder including the rotator cuff muscles and tendons, glenoid labrum, long head biceps tendon, and glenohumeral and acromioclavicular joint articulations. Most institutions use two-dimensional sequences acquired in all three imaging planes to accurately evaluate the many important structures of the shoulder. Recently, the addition of three-dimensional (3D) acquisitions with 3D reconstructions has become clinically feasible and helped improve our understanding of several important pathologic conditions, allowing us to provide added value for referring clinicians. This article briefly describes techniques used in 3D imaging of the shoulder and discusses applications of these techniques including measuring glenoid bone loss in anterior glenohumeral instability. We also review the literature on routine 3D imaging for the evaluation of common shoulder abnormalities as 3D imaging will likely become more common as imaging software continues to improve.
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http://dx.doi.org/10.1055/s-0041-1728813DOI Listing
June 2021

Intravenous contrast does not improve detection of nerve lesions or active muscle denervation changes in MR neurography of the common peroneal nerve.

Skeletal Radiol 2021 Dec 22;50(12):2483-2494. Epub 2021 May 22.

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

Objective: To evaluate the effect of intravenous (IV) contrast on sensitivity, specificity, and accuracy of magnetic resonance (MR) neurography of the knee with attention to the common peroneal nerve (CPN) in identifying nerve lesions and active muscle denervation changes.

Materials And Methods: A retrospective search for contrast-enhanced MR neurography cases evaluating the CPN at the knee was performed. Patients with electrodiagnostic testing (EDX) within 3 months of imaging were included and those with relevant prior surgery were excluded. Two radiologists independently reviewed non-contrast sequences and then 4 weeks later evaluated non-contrast and contrast sequences. McNemar's tests were performed to detect a difference between non-contrast only and combined non-contrast and contrast sequences in identifying nerve lesions and active muscle denervation changes using EDX as the reference standard.

Results: Forty-four exams in 42 patients (2 bilateral) were included. Twenty-eight cases had common peroneal neuropathy and 29, 21, and 9 cases had active denervation changes in the anterior, lateral, and posterior compartment/proximal muscles respectively on EDX. Sensitivity, specificity, and accuracy of non-contrast versus combined non-contrast and contrast sequences for common peroneal neuropathy were 50.0%, 56.2%, and 52.3% versus 50.0%, 56.2%, and 52.3% for reader 1 and 57.1%, 50.0%, and 54.5% versus 64.3%, 56.2%, and 61.4% for reader 2. Sensitivity, specificity, and accuracy of non-contrast and combined non-contrast and contrast sequences in identifying active denervation changes for anterior, lateral, and posterior compartment muscles were not significantly different. McNemar's tests were all negative.

Conclusion: IV contrast does not improve the ability of MR neurography to detect CPN lesions or active muscle denervation changes.
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http://dx.doi.org/10.1007/s00256-021-03812-wDOI Listing
December 2021

Lesion characteristics and biopsy techniques influencing diagnostic yield of CT-guided spine biopsy.

J Neurointerv Surg 2021 Sep 13;13(9):771-772. Epub 2021 May 13.

Radiology, Weill Cornell Medicine, New York, New York, USA

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http://dx.doi.org/10.1136/neurintsurg-2021-017699DOI Listing
September 2021

Ultrasound-guided microwave ablation in the treatment of inguinal neuralgia.

Skeletal Radiol 2021 Mar 30;50(3):475-483. Epub 2020 Sep 30.

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

Chronic groin pain can be due to a variety of causes and is the most common complication of inguinal hernia repair surgery. The etiology of pain after inguinal hernia repair surgery is often multifactorial though injury to or scarring around the nerves in the operative region, namely the ilioinguinal nerve, genital branch of the genitofemoral nerve, and the iliohypogastric nerve, is thought to be a key factor in causing chronic post-operative hernia pain or inguinal neuralgia. Inguinal neuralgia is difficult to treat and requires a multidisciplinary approach. Radiologists play a key role in the management of these patients by providing accurate image-guided injections to alleviate patient symptoms and identify the pain generator. Recently, ultrasound-guided microwave ablation has emerged as a safe technique, capable of providing durable pain relief in the majority of patients with this difficult to treat condition. The objectives of this paper are to review the complex nerve anatomy of the groin, discuss diagnostic ultrasound-guided nerve injection and patient selection for nerve ablation, and illustrate the microwave ablation technique used at our institution.
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http://dx.doi.org/10.1007/s00256-020-03618-2DOI Listing
March 2021

Contrast-enhanced ultrasound-guided musculoskeletal biopsies: our experience and technique.

Skeletal Radiol 2021 Apr 15;50(4):673-681. Epub 2020 Sep 15.

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

Objective: To present our experience with contrast-enhanced ultrasound (CEUS)-guided musculoskeletal soft tissue biopsies in a busy interventional clinic.

Materials And Methods: After IRB approval was obtained and informed consent was waived, we retrospectively reviewed all CEUS-guided musculoskeletal biopsies performed from December 1, 2018 to March 2, 2020. Relevant pre-procedure imaging was reviewed. Number of samples, suspected necrosis on pre-procedure imaging, specimen adequacy for pathologic analysis, correlation with pathologic diagnosis of surgical resection specimens, and procedural complications were recorded.

Results: Thirty-six CEUS-guided musculoskeletal biopsies were performed in 32 patients (mean age 57, range 26-88; 22 males, 10 females). All procedures were performed using 16-gauge biopsy needles, and all procedures provided adequate samples for pathologic analysis as per the final pathology report. Between two and seven core specimens were obtained (mean 3.7). In 30/36 cases (83%), a contrast-enhanced MRI was obtained prior to biopsy, and 10/30 (33%) of these cases showed imaging features suspicious for necrosis. In 15/36 cases, surgical resection was performed, and the core biopsy and surgical resection specimens were concordant in 14/15 cases (93%). One patient noted transient leg discomfort at the time of microbubble bursting. Otherwise, no adverse reactions or procedural complications were observed.

Conclusion: CEUS is an accurate way to safely target representative areas of soft tissue lesions for biopsy and can be implemented in a busy interventional clinic. Our early experience has shown this to be a promising technique, especially in targeting representative areas of heterogeneous lesions and lesions with areas of suspected necrosis on prior imaging.
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http://dx.doi.org/10.1007/s00256-020-03604-8DOI Listing
April 2021

Reply to "The Lateral C1-C2 Puncture".

AJR Am J Roentgenol 2019 11;213(5):W247

New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY.

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http://dx.doi.org/10.2214/AJR.19.22171DOI Listing
November 2019

Scurvy Due to Selective Diet in a Seemingly Healthy 4-Year-Old Boy.

Pediatrics 2019 09 14;144(3). Epub 2019 Aug 14.

Division of Pediatric Radiology and.

Scurvy is a rare disease in developed nations. In the field of pediatrics, it primarily is seen in children with developmental and behavioral issues, malabsorptive processes, or diseases involving dysphagia. We present the case of an otherwise developmentally appropriate 4-year-old boy who developed scurvy after gradual self-restriction of his diet. He initially presented with a limp and a rash and was subsequently found to have anemia and hematuria. A serum vitamin C level was undetectable, and after review of the MRI of his lower extremities, the clinical findings supported a diagnosis of scurvy. Although scurvy is rare in developed nations, this diagnosis should be considered in a patient with the clinical constellation of lower-extremity pain or arthralgias, a nonblanching rash, easy bleeding or bruising, fatigue, and anemia. This case highlights the importance of carefully assessing a child's dietary and developmental status at well-child visits, which can help avoid a more invasive workup.
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http://dx.doi.org/10.1542/peds.2018-2824DOI Listing
September 2019

Imaging of the post-operative medial elbow in the overhead thrower: common and abnormal findings after ulnar collateral ligament reconstruction and ulnar nerve transposition.

Skeletal Radiol 2019 Dec 15;48(12):1843-1860. Epub 2019 Jun 15.

Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th St., New York, NY, 10021, USA.

Ulnar collateral ligament (UCL) reconstruction is now being performed more commonly and on younger patients than in prior decades. As a result, radiologists will increasingly be asked to evaluate elbow imaging of patients presenting with pain who have had UCL reconstruction. It is essential for radiologists to understand the normal and abnormal imaging appearances after UCL reconstruction and ulnar nerve transposition, which is also commonly performed in overhead-throwing athletes. Doing so will allow radiologists to provide accurate interpretations that appropriately guide patient management.
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http://dx.doi.org/10.1007/s00256-019-03246-5DOI Listing
December 2019

Current Fixation Options for Elbow, Forearm, Wrist, and Hand Fractures.

Semin Musculoskelet Radiol 2019 Apr 29;23(2):109-125. Epub 2019 Mar 29.

Weill Cornell Medical College, New York, New York.

The universal goals of upper limb fracture management are to restore anatomic alignment, establish stable fracture fixation (while preserving blood supply), and allow for early mobilization of the elbow, wrist, and digits. However, the indications for operative management and fixation constructs are specific to each fracture type. This article systematically reviews current classifications and treatment options for adult fractures of the distal humerus, radius, ulna, scaphoid, metacarpals, and phalanges. For each anatomic location, we discuss the salient imaging features to guide management decisions (conservative versus internal and/or external fixation). Specifically, we emphasize the amount of displacement, angulation, comminution, and/or intra-articular involvement typically guiding operative management for each fracture type. Through this understanding of the surgical indications, rationale behind different fixation options, and common complications, the radiologist can better support the orthopaedic surgeon via more informed fracture reporting.
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http://dx.doi.org/10.1055/s-0039-1677699DOI Listing
April 2019

Cough-induced costal cartilage fracture.

Clin Imaging 2019 May - Jun;55:161-164. Epub 2019 Mar 13.

Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY 10065, United States of America.

We present two cases of atraumatic costal cartilage fracture secondary to violent coughing. Although costal cartilage fractures due to trauma and bony rib fractures due to violent coughing have been described, to our knowledge there have been no prior reported cases of cough-induced costal cartilage fracture. It is important for radiologists to consider costal cartilage fractures, which are often more subtle than osseous injuries, in patients with chest pain, and understand that they may not always be preceded by direct trauma. Identifying this injury is clinically important and will prevent patients from undergoing unnecessary examinations to rule out a cardiac cause of chest pain or a pulmonary embolism.
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http://dx.doi.org/10.1016/j.clinimag.2019.03.007DOI Listing
November 2019

The Lateral C1-C2 Puncture: Indications, Technique, and Potential Complications.

AJR Am J Roentgenol 2019 02 4;212(2):431-442. Epub 2018 Dec 4.

1 Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065.

Objective: Lateral C1-C2 puncture can be used for CSF collection, contrast agent injection for myelography, and access for cordotomy. The objective of this article is to describe the indications, technique, and potential complications of this procedure.

Conclusion: Radiologists performing lumbar puncture or myelography should be comfortable gaining access to the subarachnoid space via the lateral C1-C2 approach when indicated. Familiarity with the technique and its potential complications is essential for a safe and efficient procedure.
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http://dx.doi.org/10.2214/AJR.18.19584DOI Listing
February 2019

Pseudoaneurysm after total knee arthroplasty: imaging findings in 7 patients.

Skeletal Radiol 2019 May 10;48(5):699-706. Epub 2018 Oct 10.

Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA.

Objective: To describe the clinical presentation of arterial pseudoaneurysms following total knee arthroplasty (TKA) and their diagnostic imaging features on ultrasound and magnetic resonance angiography (MRA) in 7 patients.

Materials And Methods: A search of our radiology report database from 2007 to 2017 yielded 7 patients with a pseudoaneurysm diagnosed by imaging after TKA. Clinical notes and imaging were reviewed.

Results: All 7 patients were male and ranged in age from 53 to 68 (mean 61) years. All patients presented with a painful swollen knee and hemarthrosis within the first month following surgery. Five patients presented after primary TKA. One patient presented after explantation for septic arthritis and another after partial synovectomy for septic arthritis without explantation. Ultrasound identified the pseudoaneurysm as a hypoechoic or hyperechoic mass with a "yin-yang" appearance of turbulent arterial flow and associated complex joint effusion. On MRA, the pseudoaneurysm was a mass next to a parent artery showing avid contrast enhancement in the arterial phase that persisted into the venous phase and washed out in the late venous phase. Six pseudoaneurysms arose from lateral geniculate arteries and 1 from a medial geniculate artery. There were no popliteal artery pseudoaneurysms. Five patients were treated endovascularly, 1 patient thrombosed without intervention, and 1 patient was treated with open surgery.

Conclusion: Pseudoaneurysm is a potential source of a painful swollen knee with hemarthrosis or a drop in hematocrit after TKA and can be identified with either ultrasound or MRA.
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http://dx.doi.org/10.1007/s00256-018-3084-4DOI Listing
May 2019

MRI of Foot Drop: How We Do It.

Radiology 2018 10 28;289(1):9-24. Epub 2018 Aug 28.

From the Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY (S.P.D., A.H.B.); Electrodiagnostic Services, Department of Physiatry (J.H.F.), and Department of Radiology & Imaging (J.A.C., D.B.S.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021.

Various pathologic conditions extending from the lumbar and pelvic regions to the lower leg may manifest as foot drop, or weakness of ankle dorsiflexion. Potential causes of foot drop include L5 radiculopathy, lumbosacral plexopathy, sciatic neuropathy, and peroneal neuropathy. Although the first-line test in lesion localization is most commonly electrodiagnostic testing, MR neurography has emerged as a useful tool to verify lesion site, to accurately characterize the cause of the neuropathy, and to guide patient treatment. MR neurography, when tailored and focused, can help overcome potential pitfalls in clinical and electrodiagnostic evaluation and is commonly performed in the authors' practice. MR neurography studies are protocoled in advance after careful review of clinical notes and electrodiagnostic findings and often after discussion with the referring clinician. Radiologists who interpret MR neurography studies should have a sound understanding not only of peripheral nerve anatomy and common pathologic conditions, but also of the clinical and electrodiagnostic evaluation performed in patients with foot drop. In this way, the radiologist can actively guide the referring clinician in ordering the most appropriate imaging examination, efficiently reaching the correct diagnosis, and deciding appropriate treatment.
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http://dx.doi.org/10.1148/radiol.2018172634DOI Listing
October 2018

Arthroscopic primary repair of the anterior cruciate ligament: what the radiologist needs to know.

Skeletal Radiol 2018 May 28;47(5):619-629. Epub 2017 Dec 28.

Orthopedic Trauma and Sports Medicine Services, Hospital for Special Surgery, 535 E. 70th St, New York, NY, 10021, USA.

Recently, there has been a renewed interest in primary repair of proximal anterior cruciate ligament (ACL) tears. Magnetic resonance imaging (MRI) plays an important role in preoperative patient selection and in postoperative ligament assessment. Knowledge of the imaging factors that make patients candidates for primary ACL repair, namely proximal tear location and good tissue quality, can help radiologists provide information that is meaningful for surgical decision making. Furthermore, an understanding of the surgical techniques can prevent misinterpretation of the postoperative MRI. This article reviews preoperative MRI characterization of ACL injuries, techniques of arthroscopic primary ACL repair surgery and examples of postoperative MRI findings.
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http://dx.doi.org/10.1007/s00256-017-2857-5DOI Listing
May 2018
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