Daria Motamedi

Thermal Ablation of Osteoid Osteoma: Overview and Step-by-Step Guide

Osteoid osteoma is a small, benign but painful lesion with specific clinical and imaging characteristics. Computed tomography is the imaging modality of choice for visualization of the nidus and for treatment planning. Complete surgical excision of the nidus is curative, providing symptomatic relief, and is the traditionally preferred treatment. However, surgery has disadvantages, including the difficulty of locating the lesion intraoperatively, the need for prolonged hospitalization, and the possibility of postoperative complications ranging from an unsatisfactory cosmetic result to a fracture. Percutaneous radiofrequency (RF) ablation, which involves the use of thermal coagulation to induce necrosis in the lesion, is a minimally invasive alternative to surgical treatment of osteoid osteoma. With reported success rates approaching 90%, RF ablation should be considered among the primary options available for treating this condition.

Localization of deletion to a 300 Kb interval of chromosome 11q13 in cervical cancer

Previous molecular genetic studies on HeLa cell (a cervical cancer cell line) derived non-tumorigenic and tumorigenic hybrids have localized a tumor suppressor gene to the long arm of chromosome 11. Analysis of cervical cancer cell lines using chromosome 11 specific probes showed deletion and translocation of 11q13 sequences in five out of eight cell lines. Fluorescence in situ hybridization (FISH), using 11q13 specific probes, has shown interstitial deletion of 11q13 sequences in the HeLa cells. In order to determine whether 11q13 deletions occur in primary cervical tumors, we analysed 36 tumors using 20 different microsatellite and RFLP markers. Semi automated fluorescein based allelotyping was performed to identify loss of heterozygosity (LOH) in tumors. The results showed allelic loss in 17 (47%) tumors. Three different regions of loss, one near MEN1, the second near D11S913, and the third near INT2 locus were observed. The smallest region of deletion overlap at the D11S913 locus was localized to a 300 Kb distance between D11S4908 and D11S5023. Fluorescence in situ hybridization (FISH), using 11q13 specific cosmid and BAC (bacterial artificial chromosome) probes, confirmed allelic deletion in the tumors. PCR analysis further identified homozygous deletion of 11q13 sequences in a primary tumor, in HeLa cells and in two HeLa cell derived tumorigenic hybrid cell lines. The homozygous deletion in the cell lines was mapped to a 5.7 kb sequence of 11q13. We hypothesize therefore that a putative cervical cancer tumor suppressor gene exists within the 300 kb of chromosome 11q13.

Superior Labral Anteroposterior Lesions of the Shoulder: Part 2, Mechanisms and Classification

OBJECTIVE The objectives of this article are to discuss the 10 distinct patterns of superior labral anteroposterior (SLAP) tears to facilitate adequate diagnosis and treatment. Correlations with clinical presentation, mechanism of injury, and treatment will enhance understanding. CONCLUSION Imaging plays an important role in the diagnosis of SLAP tears. Knowledge of glenolabral anatomy, related structures and variants, proper imaging techniques, and a systematic approach to MRI interpretation is important in the diagnosis and treatment planning of the 10 types of SLAP lesions. Arthroscopy offers a means for definitive diagnosis.

Loaded versus unloaded magnetic resonance imaging (MRI) of the knee: Effect on meniscus extrusion in healthy volunteers and patients with osteoarthritis.

Highlights • Increased extrusion of the medial meniscus with loaded MRI compared to unloaded.• No change in lateral meniscus extrusion between loaded and unloaded MRI.• Increased extrusion of the medial meniscus with loaded MRI in those with tears.

Pitfalls in Shoulder MRI: Part 1—Normal Anatomy and Anatomic Variants

OBJECTIVE The purpose of this article is to review frequently encountered pitfalls as they pertain to normal and variant anatomy of the shoulder, including the rotator cuff and rotator cable, blood vessels, glenoid labrum, and the glenohumeral ligaments. CONCLUSION MRI is the preferred method for evaluating internal derangement of the shoulder. Radiologists interpreting MR images should have a detailed understanding of pertinent anatomy and knowledge of common and uncommon pitfalls to avoid during image interpretation.

Pitfalls in Shoulder MRI: Part 2—Biceps Tendon, Bursae and Cysts, Incidental and Postsurgical Findings, and Artifacts

OBJECTIVE The purpose of this article is to review frequently encountered pitfalls as they pertain to the biceps tendon, bursae and cysts around the shoulder, incidental findings, postsurgical findings, and frequently encountered imaging artifacts. CONCLUSION Imaging pitfalls in and around the shoulder are not limited to normal anatomy and anatomic variants. Radiologists must be cognizant of the vast variability of structures in the shoulder and of the incidental and postsurgical findings and artifacts affecting them.

Utility of Musculoskeletal Ultrasound in the Diagnosis and Treatment ofSuprapatellar Fat Pad Impingement: A Case Report

We report a case of suprapatellar fat pad impingement diagnosed and treated using musculoskeletal ultrasound. This report describes the utility of musculoskeletal ultrasound in making the diagnosis of suprapatellar fat pad impingement, which may potentially present as anterior knee pain, and more specifically, anterior superior knee pain. The importance of recognizing this entity on musculoskeletal ultrasound, especially when the imaging findings are subtle on prior MR imaging, is emphasized. Unconvincing suprapatellar fat pad edema on MR imaging, for example, should not preclude consideration of this entity at targeted ultrasound of the anterior knee in a patient with anterior knee pain. Furthermore, once the diagnosis is made using ultrasound, the suprapatellar fat pad impingement can be immediately and effectively treated with ultrasound-guided injection of steroid and anesthetic.

Arterial calcification due to CD73 deficiency (ACDC): imaging manifestations of ectopic mineralization.

Arterial calcification due to CD73 deficiency (ACDC) is a recently identified rare and debilitating adult-onset disorder caused by autosomal recessive NT5E gene mutations. ACDC is characterized by progressive and painful arterial calcifications primarily affecting the lower extremities, as well as calcifications affecting small joint capsules of the hands and feet. In this case report, the authors provide clinical follow-up for one of the first individuals identified by the National Institutes of Health (NIH) as having ACDC, focusing mainly on the imaging manifestations of periarticular joint mineralization, which are bilateral but slightly asymmetric, bulky up to the levels of the metacarpophalangeal and metatarsophalangeal joints, but smaller and more capsular in distribution at the proximal and distal interphalangeal joints, without erosive change or intra-articular mineralization. Differential considerations for similar appearing joint mineralization are provided.

Fibrodysplasia ossificans progressiva: a current review of imaging findings

ObjectiveFibrodysplasia ossificans progressiva is a rare genetic disorder characterized by congenital skeletal deformities and soft tissue masses that progress to heterotopic ossification. Deformities of the great toes are distinctive, and heterotopic ossification in the soft tissues follows an expected anatomic and temporal pattern. In addition to heterotopic ossification, osteochondromata, middle ear ossification, demyelination, lymphedema, and venous thrombosis are characteristic. Awareness of this constellation of findings is important to early diagnosis and surveillance.ConclusionsRecognition of the imaging manifestations of fibrodysplasia ossificans progressiva is imperative to early diagnosis in order to appropriately direct patient care and preclude unnecessary biopsies or surgical procedures.

Imaging-Based Prevalence of Superior Labral Anterior-Posterior Tears Significantly Increases in the Aging Shoulder

Background: Superior labral anterior-posterior (SLAP) tears can be associated with pain and shoulder dysfunction. Relatively little is known about the age-related prevalence of SLAP tears. Purpose: To investigate the age-related prevalence of imaging-diagnosed SLAP tears in a heterogeneous grouping of shoulder conditions in a large cohort at a single institution with multiple blinded reviewers. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 281 shoulder magnetic resonance imaging (MRI) scans obtained over 8 months were reviewed by a musculoskeletal radiologist and an orthopaedic surgeon. The mean ± SD age of the group was 49.6 ± 15.5 years, and 107 of the patients were female (38.1%). Patients were divided into 4 age groups: 35 years or younger, 36 to 50 years, 51 to 65 years, and older than 65 years. Statistical analyses were completed by use of the Fisher exact test to compare proportions of SLAP tears between age groups, odds ratios to determine the likelihood of having a SLAP tear in each age group, and a logistic regression to control for associated abnormalities. Results: There was a significant diffference in the proportion of SLAP tears found on the MRIs for each age group (P < .001). Patients were significantly more likely to have SLAP tears if aged 51 to 65 years (66.7%; odds ratio [OR], 2.00; 95% CI, 1.27-3.15) and if older than 65 years (81.2%; OR, 4.31; 95% CI, 2.36-7.88). No increased prevalence was observed in patients aged 35 years or younger (47.5%; OR, 0.91; 95% CI, 0.55-1.50) or 36 to 50 years (51.8%; OR, 1.08; 95% CI, 0.70-1.67). Logistic regression demonstrated that age was the only significant predictor for having a SLAP tear (P < .001). Kappa values were 0.46 to 0.65 between reviewers, indicating moderate to substantial agreement. Conclusion: An increasing prevalence of MRI-based SLAP tears was observed with increasing patient age. Patients older than 50 years were significantly more likely to have superior labral abnormalities regardless of other shoulder injury or disease.