Hyojeong Mulcahy

Integrative clinical genomics of advanced prostate cancer

Toward development of a precision medicine framework for metastatic, castration-resistant prostate cancer (mCRPC), we established a multi-institutional clinical sequencing infrastructure to conduct prospective whole-exome and transcriptome sequencing of bone or soft tissue tumor biopsies from a cohort of 150 mCRPC affected individuals. Aberrations of AR, ETS genes, TP53, and PTEN were frequent (40%-60% of cases), with TP53 and AR alterations enriched in mCRPC compared to primary prostate cancer. We identified new genomic alterations in PIK3CA/B, R-spondin, BRAF/RAF1, APC, β-catenin, and ZBTB16/PLZF. Moreover, aberrations of BRCA2, BRCA1, and ATM were observed at substantially higher frequencies (19.3% overall) compared to those in primary prostate cancers. 89% of affected individuals harbored a clinically actionable aberration, including 62.7% with aberrations in AR, 65% in other cancer-related genes, and 8% with actionable pathogenic germline alterations. This cohort study provides clinically actionable information that could impact treatment decisions for these affected individuals.

The Anterolateral Ligament of the Knee: MRI Appearance, Association With the Segond Fracture, and Historical Perspective

OBJECTIVE. A recent publication has drawn attention to the anterolateral ligament, a structure of the knee with which most radiologists are unfamiliar. We evaluate this structure on MRI; clarify its origin, insertion, meniscal relationship, and morphologic appearance; and identify its relationship with the Segond fracture. MATERIALS AND METHODS. A total of 53 routine knee MRI studies interpreted as normal were reviewed to characterize the anterolateral ligament. A further 20 knee MRI studies with a Segond fracture were assessed to determine a relationship between the fracture and the anterolateral ligament. RESULTS. In all 53 cases, a structure was present along the lateral knee connecting the distal femur to the proximal tibia, with meniscofemoral and meniscotibial components. This structure was somewhat ill defined and sheetlike, inseparable from the adjacent fibular collateral ligament proximally and iliotibial band distally. Aside from one case limited by anatomic distortion, all cases with a Segond fracture exhibited attachment of this structure to the fracture fragment (19/20 cases). CONCLUSION. An ill-defined sheetlike structure along the lateral knee exists attaching the distal femur, body of lateral meniscus, and proximal tibia. This structure has been referenced in the literature dating back to Paul Segonds original description of the Segond fracture in 1879. The structure is identifiable on MRI and appears to be attached to the Segond fracture fragment. For the radiologist, it may be best to forgo an attempt to separate this structure into discrete divisions, such as the anterolateral ligament, because these individual components are inseparable on routine MRI.

Erratum: Integrative Clinical Genomics of Advanced Prostate Cancer

Dan Robinson, Eliezer M. Van Allen, Yi-Mi Wu, Nikolaus Schultz, Robert J. Lonigro, Juan-Miguel Mosquera, Bruce Montgomery, Mary-Ellen Taplin, Colin C. Pritchard, Gerhardt Attard, Himisha Beltran, Wassim Abida, Robert K. Bradley, Jake Vinson, Xuhong Cao, Pankaj Vats, Lakshmi P. Kunju, Maha Hussain, Felix Y. Feng, Scott A. Tomlins, Kathleen A. Cooney, David C. Smith, Christine Brennan, Javed Siddiqui, Rohit Mehra, Yu Chen, Dana E. Rathkopf, Michael J. Morris, Stephen B. Solomon, Jeremy C. Durack, Victor E. Reuter, Anuradha Gopalan, Jianjiong Gao, Massimo Loda, Rosina T. Lis, Michaela Bowden, Stephen P. Balk, Glenn Gaviola, Carrie Sougnez, Manaswi Gupta, Evan Y. Yu, Elahe A. Mostaghel, Heather H. Cheng, Hyojeong Mulcahy, Lawrence D. True, Stephen R. Plymate, Heidi Dvinge, Roberta Ferraldeschi, Penny Flohr, Susana Miranda, Zafeiris Zafeiriou, Nina Tunariu, Joaquin Mateo, Raquel Perez-Lopez, Francesca Demichelis, Brian D. Robinson, Andrea Sboner, Marc Schiffman, David M. Nanus, Scott T. Tagawa, Alexandros Sigaras, Kenneth W. Eng, Olivier Elemento, Andrea Sboner, Elisabeth I. Heath, Howard I. Scher, Kenneth J. Pienta, Philip Kantoff, Johann S. de Bono, Mark A. Rubin, Peter S. Nelson, Levi A. Garraway, Charles L. Sawyers,* and Arul M. Chinnaiyan* *Correspondence: sawyersc@mskcc.org (C.L.S.), arul@umich.edu (A.M.C.) http://dx.doi.org/10.1016/j.cell.2015.06.053

Current Concepts of Hip Arthroplasty for Radiologists: Part 2, Revisions and Complications

OBJECTIVE This article reviews the imaging features of revisions and complications of hip replacement arthroplasty and relates these features to the current understanding about how and why these failures occur. CONCLUSION Short-term failures of hip replacements are most commonly the result of instability and dislocation. Complications ranging from osteolysis caused by granulomatous reaction to particulate wear debris lead to many long-term failures. Attempts to reduce wear debris through changes in design and materials have reduced the rate of some complications but have resulted in new ones. Infection remains a devastating complication that is difficult to resolve.

Current Concepts of Hip Arthroplasty for Radiologists: Part 1, Features and Radiographic Assessment

OBJECTIVE This article will systematically review radiographic assessment of hip arthroplasty including classifications based on different types and techniques of hip arthroplasty, terminology for prosthetic designs and materials, surgical techniques, and initial and follow-up radiographic assessments. CONCLUSION Assessment of postoperative hip arthroplasty radiographs is extremely important. It is well known that patients with complications may be asymptomatic, and for this reason, routine radiographic follow-up is recommended for all patients with hip arthroplasty. The foundation of radiologic interpretation of hip arthroplasty is knowledge of the normal appearance of the many different types of prostheses. A standard approach to radiologic reporting should be undertaken.

Imaging Key Wrist Ligaments: What the Surgeon Needs the Radiologist to Know

OBJECTIVE Although much attention is paid to the scapholunate ligament, lunotriquetral ligament, and the triangular fibrocartilage complex, additional intrinsic and extrinsic ligaments in the wrist play an important part in carpal stability. With improved MRI techniques, the radiologist can increasingly visualize these ligaments. CONCLUSION The anatomy, MRI appearance, and clinical significance of the scapholunate ligament, lunotriquetral ligament, triangular fibrocartilage complex, carpal metacarpal ligaments, and volar and dorsal extrinsic ligaments are reviewed.

Prevalence of burnout among musculoskeletal radiologists

ObjectiveBurnout is a job-related psychological syndrome with three aspects: emotional exhaustion, depersonalization, and perceived lack of personal accomplishment. Burnout is associated with deleterious effects on both workers and their work. When burnout affects physicians, their well-being, longevity, and care of patients are at risk. Recent studies concerning physician burnout treat specialists such as radiologists as one group. We studied burnout in musculoskeletal (MSK) subspecialist radiologists.Materials and methodsAn institutional review board exemption was obtained. Society of Skeletal Radiology members received invitations to an anonymous survey that included questions from the Maslach Burnout Inventory ™ (MBI) measuring all three aspects of burnout. The response rate was 36.4% (433/1190).ResultsThe prevalence of emotional exhaustion was 61.7% (255/413), of depersonalization 53.3% (219/411), and of perceived lack of personal accomplishment 39.6% (161/407). Only 19.5% (79/405) of MSK radiologists reported no burnout, while 80.5% (326/405) reported burnout along one or more dimensions. For all three dimensions, the prevalence was higher and the mean severity was worse for private practice compared with academic practice. The prevalence of burnout was affected more by practice setting than by gender. Burnout prevalence and severity also varied systematically with years since completion of training.ConclusionAmong MSK radiologists, we found a much higher prevalence and greater severity of burnout than has been previously reported for radiologists and other physicians. There were differences in prevalence and severity of burnout among practice settings, genders, and longevity cohorts.

Current Concepts in Knee Replacement: Complications

OBJECTIVE The purposes of this article are to review current concepts of knee replacement, including features of traditional and newer prosthetic designs, materials, and surgical techniques; illustrate normal and abnormal postoperative imaging findings; and to relate the complications to current understanding of how and why these failures occur. CONCLUSION Complications after knee replacement may be asymptomatic. For this reason, assessment with postoperative imaging is important. The foundation of radiologic interpretation of knee replacement is knowledge of the physiologic purpose, orthopedic trends, imaging findings, and complications.

Fracture of the distal radius: epidemiology and premanagement radiographic characterization.

OBJECTIVE Fractures of the distal radius are common and frequently encountered by the radiologist. We review the epidemiology, classification, as well as the concept of instability. Salient qualitative and quantitative features of the distal radius fracture identifiable on the routine radiography series are highlighted. We conclude with a synopsis of descriptors that are of greatest utility to the clinician for treatment planning and that should be addressed in the radiology report. CONCLUSION A detailed understanding of the intricacies of the distal radius fracture is necessary for the radiologist to provide a clinically relevant description.

Current Concepts in Knee Replacement: Features and Imaging Assessment

OBJECTIVE This article reviews current concepts of knee replacement. Features of traditional and new prosthetic designs, materials, and surgical techniques are discussed. Normal and abnormal postoperative imaging findings are illustrated. Complications are reviewed and related to the current understanding about how and why these failures occur. CONCLUSION It is well known that after knee replacement, patients with complications may be asymptomatic, and, for this reason, assessment of postoperative imaging is important. The foundation of radiologic interpretation of knee replacement is knowledge of the physiologic purpose, orthopedic trends, imaging findings, and complications.