Christopher J. Burke

Sonography of Small Bowel Perforation

OBJECTIVE This article aims to illustrate the spectrum of sonographic findings in perforation of the small bowel due to a variety of causes and discusses the potential role of sonography in the diagnosis. CONCLUSION Although sonography is not the first-line investigation of choice in suspected small intestinal perforation, an understanding of the characteristic appearances seen during general abdominal sonography may aid the radiologist in the early diagnosis. Recognition of small bowel perforation on general abdominal sonography will shorten the time to diagnosis and ultimate surgical management.

Ultrasound-Guided Percutaneous Tendon Treatments

OBJECTIVE The purpose of this article is to review currently available tendon treatments, especially those performed with sonographic guidance. CONCLUSION Treatments of tendon disease have continued to develop and expand, and multiple therapeutic options have become available, all with varying levels of supportive clinical evidence of their efficacy. The use of ultrasound to direct these treatments improves accuracy and performance by facilitating visualization of the target and relevant adjacent structures.

The Potential Use of Ultrasound-Magnetic Resonance Imaging Fusion Applications in Musculoskeletal Intervention

We sought to assess the potential use of an application allowing real‐time ultrasound spatial registration with previously acquired magnetic resonance imaging in musculoskeletal procedures. The ultrasound fusion application was used to perform a range of outpatient procedures including piriformis, sacroiliac joint, pudendal and intercostal nerve perineurial injections, hamstring‐origin calcific tendonopathy barbotage, and 2 soft tissue biopsies at our institution in 2015. The application was used in a total of 7 procedures in 7 patients, all of which were technically successful. The ages of patients ranged from 19 to 86 years. Particular use of the fusion application compared to sonography alone was noted in the biopsy of certain soft tissue lesions and in perineurial therapeutic injections.

Use of a Simple, Inexpensive Dual-Modality Phantom as a Learning Tool for Magnetic Resonance Imaging-Ultrasound Fusion Techniques: Magnetic Resonance Imaging-Ultrasound Fusion Phantom

We describe an easily constructed, customizable phantom for magnetic resonance imaging–ultrasound fusion imaging and demonstrate its role as a learning tool to initiate clinical use of this emerging modality. Magnetic resonance imaging–ultrasound fusion can prove unwieldy to integrate into routine practice. We demonstrate real‐time fusion with single‐sequence magnetic resonance imaging uploaded to the ultrasound console. Phantom training sessions allow radiologists and sonographers to practice fiducial marker selection and improve efficiency with the fusion hardware and software interfaces. Such a tool is useful when the modality is first introduced to a practice and in settings of sporadic use, in which intermittent training may be useful.

Ultrasound and PET-CT Correlation in Shoulder Pathology: A 5-Year Retrospective Analysis

Purpose To correlate shoulder ultrasound and radiography with 18F-FDG PET-CT to establish FDG uptake and therefore range of metabolic activity, as defined by SUV analysis, in various symptomatic shoulder pathologies. Methods Retrospective database query was performed for shoulder ultrasound and PET-CT scans between January 2012 and January 2017. Patients who had both studies within 1 year were included. Age- and sex-matched control patients with PET-CT scans only were also included. Retrospective image review determined shoulder pathology, and 18F-FDG SUVmax was measured using regions of interest placed at the glenohumeral joint, rotator cuff/bursa, and bicipital groove. Glenohumeral and acromioclavicular osteoarthrosis was assessed by radiography using the Kellgren-Lawrence classification system. Results Thirty-three patients had both imaging studies within 1 year. Ten patients (11 cases) were included, ranging in age from 56 to 90 years (mean, 67.9 years). Control subjects were selected among patients receiving PET-CT within 1 week of symptomatic patients. Glenohumeral osteoarthrosis was mild in 3 (27%), moderate in 2 (18%), and severe in 2 (18%). Six full-thickness rotator cuff tears (55%) were identified. SUVmax means were compared between the pathologic and control groups and were significantly higher in the former: glenohumeral joint (1.96 vs 1.32; P = 0.016), rotator cuff/bursa (2.80 vs 2.0; P = 0.005), and bicipital groove (2.19 vs 1.48; P = 0.007). The highest values were seen in full-thickness rotator cuff tear and severe biceps tenosynovitis. Conclusions Increased metabolic activity about the shoulder is associated with a spectrum of rotator cuff, glenohumeral joint, and other soft tissue pathology that can be correlated with diagnostic ultrasound findings.

Shear wave elastography in the pronator quadratus muscle following distal radial fracture fixation: A feasibility study comparing the operated versus nonoperated sides

The aim of this study was to assess changes in shear wave velocity within the pronator quadratus muscle in patients following volar plate fixation for distal radial fractures compared to the contralateral nonoperated side. Shear wave velocity values were obtained in the short and long axis of the pronator quadratus muscle, which were analyzed separately. Patients were also stratified by age below or above 66 years. Statistical analysis was performed using paired sample Wilcoxon signed rank and t tests. Pearson and Spearman rank correlations were also used. Seventeen patients (nine women and eigth men; age range 33–82, mean 62.4 years) were prospectively assessed following open reduction volar plate fixation of distal radial fracture. A statistically significant reduction in the velocities of the treated versus the nontreated side was observed in the long axis of the muscle (3.29 versus 3.59 m/second; t test p = 0.035). The data provide evidence for shear wave elastography as a quantitative measure to assess postoperative changes in muscle and a potential tool to monitor the efficacy of rehabilitation.

Clinical Utility of Continuous Radial MRI Acquisition at 3T in Patellofemoral Kinematic Assessment

Objectives: Continuous gradient-echo (GRE) acquisition or “dynamic magnetic resonance imaging”, allows for high-speed examination of pathologies based on joint motion. We sought to assess the efficacy of a radial GRE sequence with in the characterization of patellofemoral maltracking. Methods: Patients with suspected patellofemoral maltracking and asymptomatic volunteers were scanned using GRE (Siemens LiveView WIP; Malvern, PA, USA) at 3T in the axial plane at the patella level through a range of flexion-extension (0-30°). The mean time to perform the dynamic component ranged from 3-7 mins. Lateral maltracking (amount patella moved laterally through knee ranging) was measured. Patella lateralization was categorized as normal (≤ 2mm), mild (2-5mm), moderate (5-10mm), or severe (>10mm). Tibial tuberosity:trochlear groove (TT:TG) distance, trochlea depth, Insall-Salvati ratio, and patellofemoral cartilage quality (according to the modified Outerbridge grading system) were also assessed. Results: Eighteen symptomatic (6 men; 12 women, age range 14-51 years) and 10 asymptomatic subjects (6 men; 4 women, age range 25-68 years) were included. Two symptomatic patients underwent bilateral examinations. Lateralization in the symptomatic group was normal (n=10), mild (n=2), moderate (n=5) and severe (n=3). There was no abnormal maltracking in the volunteer group. Lateral tracking significantly correlated with TT:TG distance (F=38.0; p<.0001), trochlea depth (F=5.8; p=.023), Insall-Salvati ratio (F=4.642; p=.04) and Outerbridge Patella score (F=6.6; p=.016). Lateral tracking did not correlate with Outerbridge Trochlear score. Conclusion: Lateral tracking measured on GRE was found to significantly correlate with current measures of patellar instability including, TT:TG, trochlea depth, and the Insall-Salvati ratio. GRE is a rapid and easily performed addition to the standard protocol for kinematic patellofemoral motion and can add dynamic information on patellofemoral tracking. This may be help determine if an isolated MPFL or an MPFL reconstruction and tibial tubercle osteotomy is needed to treat patella instability.

Tibial Nerve Block Using an Ultrasound‐Guided Inframalleolar Medial Plantar Nerve Perineural Injection: A Technical Note

Sonographic‐guided tibial nerve block allows for rapid anesthetization of the heel and plantar regions of the foot. We describe a variant technique for tibial nerve regional anesthesia utilizing perineural injection of the medial plantar nerve proximal to the sustentaculum tali where the nerve is superficial and readily accessed, with resultant retrograde flow of local anesthetic proximally. Perineural injection of the medial plantar nerve at the inframalleolar level provides a simple, safe, and effective alternative method to achieve tibial nerve block for regional anesthesia in a variety of procedures.

Imaging of Proximal Tibiofibular Joint Instability: A 10 year retrospective case series

OBJECTIVE Detail the imaging findings in patients with proximal tibiofibular instability treated with surgical stabilization. METHODS Retrospective analysis of preoperative imaging in patients with clinically confirmed tibiofibular instability. RESULTS Operative fixation of the 16 patients was as follows: 11 using a fiberwire suture construct and 5 using screw fixation. Proximal tibiofibular ligamentous abnormalities were present in 100% of acute (< 6 months) and 85.7% of chronic (>6 months) instability cases who underwent MRI. CONCLUSION MRI is sensitive in the evaluation of tibiofibular ligamentous integrity in proximal tibiofibular instability. Chronic instability should be considered in younger adults with isolated tibiofibular osteoarthritis.

Subchondroplasty: What the Radiologist Needs to Know

OBJECTIVE Subchondroplasty is a novel minimally invasive procedure that is used to treat painful bone marrow lesions in patients with knee osteoarthritis or insufficiency fractures. The objective of this article is to describe the surgical technique and the pre- and postoperative imaging findings of a small case series acquired at a single center. CONCLUSION The radiologist should be familiar with the anticipated postoperative imaging appearances after subchondroplasty and the potential complications.