Hythem Omar

ISAKOS classification of meniscal tears—illustration on 2D and 3D isotropic spin echo MR imaging

Magnetic Resonance Imaging is modality of choice for the non-invasive evaluation of meniscal tears. Accurate and uniform documentation of meniscal pathology is necessary for optimal multi-disciplinary communication, to guide treatment options and for validation of patient outcomes studies. The increasingly used ISAKOS arthroscopic meniscus tear classification system has been shown to provide sufficient interobserver reliability among the surgeons. However, the terminology is not in common use in the radiology world. In this article, the authors discuss the MR imaging appearances of meniscal tears based on ISAKOS classification on 2D and multiplanar 3D isotropic spin echo imaging techniques and illustrate the correlations of various meniscal pathologies with relevant arthroscopic images.

Spring ligament complex: Illustrated normal anatomy and spectrum of pathologies on 3T MR imaging

The spring (plantar calcaneonavicular) ligament complex connects the calcaneus and navicular bone of the foot and serves as the primary static stabilizer of the medial longitudinal arch of the foot. In this article, we describe the normal anatomy of the spring ligament complex, illustrate 3T magnetic resonance imaging appearances in its normal and abnormal states, and discuss the pathological associations with relevant case examples.

The Role of a Radiology Electronic Notification System in the Emergency Department Setting and Its Impact on Patient Care

Background To determine the impact of a radiology electronic notification system (ENS) on emergency department (ED) patient care. Materials and Methods A retrospective review of de-identified patient data for a 2-year period (1 year prior to and 1 year following ENS implementation) was approved by the hospital’s institutional review board. The effect of a radiology ENS on ED patient care was investigated by analyzing the intervals between completion of a chest radiograph and the times antibiotics were ordered/administered on patients presenting with symptoms of community acquired pneumonia (CAP). The square root transformation of the means was analyzed with an ANOVA model to determine statistical significance. Results During the 24-month study protocol, 1,341 patients who were evaluated in the ED met the study eligibility criteria. The least square estimates of the mean times from when the chest radiograph was completed to when antibiotics were ordered prior to and after the implementation of the ENS were 89 and 107 minutes, respectively (P < 0.01). The least square estimates of the mean times from when the chest radiograph was completed to when antibiotics were administered prior to and after the implementation of the ENS were 115 and 132 minutes, respectively (P = 0.02). Conclusion The implementation of a radiology ENS does have advantages for the radiologist in streamlining the communication and documentation processes but may negatively impact time to treatment and thus patient care.

Cross-Sectional Imaging for Inflammatory Arthropathy of the Pelvis

Inflammatory arthropathy predominantly affecting the axial skeleton can cause pain, stiffness, disability, and ankylosis. This article discusses the use of cross-sectional imaging in the domain of inflammatory pelvic and axial arthropathy highlighting the key distinguishing features of common known diseases and their differential diagnoses.

Atypical infections versus inflammatory conditions of the hand: The role of imaging in diagnosis

Summary: Atypical infections may manifest in the setting of low clinical suspicion and, because of some similarity to other inflammatory conditions regarding their clinical and imaging findings, misdiagnosis or delayed diagnosis is not infrequent. The latter may lead to elevated risk of severe bone and joint destruction, and higher morbidity. This review addresses the challenging subject of discussing the imaging characteristics of atypical infections and a variety of inflammatory conditions of the hand, and emphasizes the key points that assist in the differentiation of the two broad clinical categories of infections versus inflammatory causes.

Nonreducible Shoulder Due to Acute Posterior Dislocation of the Long Head of the Biceps Tendon: A Case Report and Review of the Literature

Posterior dislocation of the biceps tendon is a rare complication of high-energy shoulder trauma. Inability to successfully relocate an anterior shoulder dislocation caused by a highly traumatic mechanism should raise suspicion for this rare injury. Knowledge of this condition is important because it requires open surgical reduction and repair. We present a case of a surgically proven posterior dislocation of the biceps tendon complicating an acute anterior shoulder dislocation. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A forty-four-year-old man presented to the Emergency Department following a high-speed motorcycle collision. Upon arrival, the patient’s symptoms included right shoulder pain and decreased range of motion. On physical examination, the humeral head was displaced anteriorly, resulting in loss of the normal contour of the shoulder. The entire right upper extremity was swollen. Sensation was intact throughout the axillary, radial, median, and ulnar distributions, and a 2+ radial pulse was noted at the wrist. Active and passive shoulder range of motion was limited, and additional attempts at assessing shoulder range of motion were not tolerated because of severe pain. Initial radiographs (Figs. 1-A and 1-B) of the right shoulder revealed an anterior glenohumeral dislocation with osseous fragments in the glenohumeral joint space. The humeral head was displaced medial and inferior to the coracoid process. Figs. 1-A and 1-B Anteroposterior radiographs of the right shoulder show anterior glenohumeral dislocation with many osseous fragments in the glenohumeral joint space. The humeral head is displaced medial and inferior to the coracoid process. Fig. 1-A Fig. 1-B Under moderate sedation, attempts to reduce the right shoulder dislocation were performed without success. Computed tomography (CT) of the shoulder (Figs. 2-A and 2-B) obtained after the attempted reduction revealed a persistent anterior dislocation with intra-articular fracture fragments and avulsion of the greater tuberosity. Subsequent magnetic resonance imaging (MRI) (Figs. 3-A through 3-D) showed massive rotator cuff tearing with complete tears of the supraspinatus, infraspinatus, and teres minor tendons. Their myotendinous junctions were retracted to the level of the …