Lauren M. Shapiro

Cartilage morphology at 3.0T: assessment of three-dimensional magnetic resonance imaging techniques.

To compare six new three‐dimensional (3D) magnetic resonance (MR) methods for evaluating knee cartilage at 3.0T.

Advances in Musculoskeletal MRI – Technical Considerations

The technology of musculoskeletal magnetic resonance imaging (MRI) is advancing at a dramatic rate. MRI is now done at medium and higher field strengths with more specialized surface coils and with more variable pulse sequences and postprocessing techniques than ever before. These innumerable technical advances are advantageous as they lead to an increased signal‐to‐noise ratio and increased variety of soft‐tissue contrast options. However, at the same time they potentially produce more imaging artifacts when compared with past techniques. Substantial technical advances have considerable clinical challenges in musculoskeletal radiology such as postoperative patient imaging, cartilage mapping, and molecular imaging. In this review we consider technical advances in hardware and software of musculoskeletal MRI along with their clinical applications. J. Magn. Reson. Imaging 2012;36:775–787.

MRI of weight bearing and movement

Conventional, static magnetic resonance imaging (MRI) is able to provide a vast amount of information regarding the anatomy and pathology of the musculoskeletal system. However, patients, especially those whose pain is position dependent or elucidated by movement, may benefit from more advanced imaging techniques that allow for the acquisition of functional information. This manuscript reviews a variety of advancements in MRI techniques that are used to image the musculoskeletal system dynamically, while in motion or under load. The methodologies, advantages and drawbacks of stress MRI, cine-phase contrast MRI and real-time MRI are discussed as each has helped to advance the field by providing a scientific basis for understanding normal and pathological musculoskeletal anatomy and function. Advancements in dynamic MR imaging will certainly lead to improvements in the understanding, prevention, diagnosis and treatment of musculoskeletal disorders. It is difficult to anticipate that dynamic MRI will replace conventional MRI, however, dynamic MRI may provide additional valuable information to findings of conventional MRI.

Magnetic Resonance Imaging of the Knee: Optimizing 3 Tesla Imaging

Magnetic resonance imaging (MRI), with its multiplanar capabilities and excellent soft-tissue contrast, has established itself as the leading modality for noninvasive evaluation of the musculoskeletal system (1-5). It is regarded as the top imaging and diagnostic tool for the knee joint as a result of its ability to evaluate a wide range of anatomy and pathology varying from ligamentous injuries to articular cartilage lesions. Imaging of the knee requires excellent contrast, high resolution and the ability to visualize very small structures, all of which can be provided by MR imaging. The development of advanced diagnostic MR imaging tools for the joints is of increased clinical importance as it has been recently shown that musculoskeletal imaging is the most rapidly growing field in MR imaging, second only to neuroradiology applications (6). Currently, most clinical evaluation of the musculoskeletal system is performed at intermediate field strengths of 1.5 T or lower. High field systems, like 3.0 T, are now becoming increasingly available for clinical use. Although at first used primarily for neurological imaging, an increasing number of studies have demonstrated the abilities and advantages of 3.0 T systems in musculoskeletal imaging (7-10). The most notable advantage includes an increased signal-to-noise ratio (SNR) which can lead to a shorter imaging time or improved image resolution. However, with the increase to a 3.0 T field strength comes a various number of considerations that must be dealt with in order to optimize its intrinsically superior imaging capabilities.

Predictors of an Academic Career on Radiology Residency Applications

RATIONALE AND OBJECTIVES To evaluate radiology residency applications to determine if any variables are predictive of a future academic radiology career. MATERIALS AND METHODS Application materials from 336 radiology residency graduates between 1993 and 2010 from the Department of Radiology, Duke University and between 1990 and 2010 from the Department of Radiology, Stanford University were retrospectively reviewed. The institutional review boards approved this Health Insurance Portability and Accountability Act-compliant study with a waiver of informed consent. Biographical (gender, age at application, advanced degrees, prior career), undergraduate school (school, degree, research experience, publications), and medical school (school, research experience, manuscript publications, Alpha Omega Alpha membership, clerkship grades, United States Medical Licensing Examination Step 1 and 2 scores, personal statement and letter of recommendation reference to academics, couples match status) data were recorded. Listing in the Association of American Medical Colleges Faculty Online Directory and postgraduation publications were used to determine academic status. RESULTS There were 72 (21%) radiologists in an academic career and 264 (79%) in a nonacademic career. Variables associated with an academic career were elite undergraduate school (P = .003), undergraduate school publications (P = .018), additional advanced degrees (P = .027), elite medical school (P = .006), a research year in medical school (P < .001), and medical school publications (P < .001). A multivariate cross-validation analysis showed that these variables are jointly predictive of an academic career (P < .001). CONCLUSIONS Undergraduate and medical school rankings and publications, as well as a medical school research year and an additional advanced degree, are associated with an academic career. Radiology residency selection committees should consider these factors in the context of the residency application if they wish to recruit future academic radiologists.

Mechanisms of osteoarthritis in the knee: MR imaging appearance

Osteoarthritis has grown to become a widely prevalent disease that has major implications in both individual and public health. Although originally considered to be a degenerative disease driven by “wear and tear” of the articular cartilage, recent evidence has led to a consensus that osteoarthritis pathophysiology should be perceived in the context of the entire joint and multiple tissues. MRI is becoming an increasingly more important modality for imaging osteoarthritis, due to its excellent soft tissue contrast and ability to acquire morphological and biochemical data. This review will describe the pathophysiology of osteoarthritis as it is associated with various tissue types, highlight several promising MR imaging techniques for osteoarthritis and illustrate the expected appearance of osteoarthritis with each technique. J. Magn. Reson. Imaging 2014;39:1346–1356.

Approach to MR Imaging of the Elbow and Wrist: Technical Aspects and Innovation

Wrist and elbow MR imaging technology is advancing at a dramatic rate. Wrist and elbow MR imaging is performed at medium and higher field strengths with more specialized surface coils and more variable pulse sequences and postprocessing techniques. High field imaging and improved coils lead to an increased signal-to-noise ratio and increased variety of soft tissue contrast options. Three-dimensional imaging is improving in terms of usability and artifacts. Some of these advances have challenges in wrist and elbow imaging, such as postoperative patient imaging, cartilage mapping, and molecular imaging. This review considers technical advances in hardware and software and their clinical applications.

Hip arthroscopy in the United States: an update following coding changes in 2011

Abstract The purpose of this study is to define the incidence of hip arthroscopy-related procedures in the United States prior to and following 2011 and to determine if the rise in incidence has coincided with an increase in the complexity and diversity of procedures performed. Patients who underwent hip arthroscopy were identified from a publicly available US database. A distinction was made between ‘traditional’ and ‘extended’ codes. CPT-29999 (unlisted arthroscopy) was considered extended and counted only if associated with a hip pathology diagnosis. Codes directed toward femoroacetabular impingement pathology were also considered extended codes and were analyzed separately based on increased technical skill. Unpaired student t-tests and z-score tests were performed. From 2007 to 2014, there were a total of 2581 hip arthroscopies performed in the database (1.06 cases per 10 000 patients). The number of hip arthroscopies increased 117% from 2007 to 2014 (P < 0.001) and 12.5% from 2011 to 2014 (P = 0.045). Hip arthroscopies using extended codes increased 475% from 2007 to 2014 (P < 0.001) compared to 24% for traditional codes (P < 0.001). Codes addressing femoroacetabular impingement (FAI) pathology increased 55.7% between 2011 to 2014 (P < 0.001). The ratio of labral repair to labral debridement in patients younger than 50 years exceeded >1.0 starting in 2011 (P < 0.001). The total number of hip arthroscopies in addition to the complexity and diversity of hip arthroscopy procedures performed in the United States continues to rise. FAI-based procedures and labral repairs are being performed more frequently in younger patients, likely reflecting both improved technical ability and current evidence-based research.

Cytokines as a predictor of clinical response following hip arthroscopy: minimum 2-year follow-up.

Hip arthroscopy in patients with osteoarthritis has been shown to have suboptimal outcomes. Elevated cytokine concentrations in hip synovial fluid have previously been shown to be associated with cartilage pathology. The purpose of this study was to determine whether a relationship exists between hip synovial fluid cytokine concentration and clinical outcomes at a minimum of 2 years following hip arthroscopy. Seventeen patients without radiographic evidence of osteoarthritis had synovial fluid aspirated at time of portal establishment during hip arthroscopy. Analytes included fibronectin–aggrecan complex as well as a multiplex cytokine array. Patients completed the modified Harris Hip Score, Western Ontario and McMaster Universities Arthritis Index and the International Hip Outcomes Tool pre-operatively and at a minimum of 2 years following surgery. Pre and post-operative scores were compared with a paired t-test, and the association between cytokine values and clinical outcome scores was performed with Pearson’s correlation coefficient with an alpha value of 0.05 set as significant. Sixteen of seventeen patients completed 2-year follow-up questionnaires (94%). There was a significant increase in pre-operative to post-operative score for each clinical outcome measure. No statistically significant correlation was seen between any of the intra-operative cytokine values and either the 2-year follow-up scores or the change from pre-operative to final follow-up outcome values. No statistically significant associations were seen between hip synovial fluid cytokine concentrations and 2-year follow-up clinical outcome assessment scores for those undergoing hip arthroscopy.

Diagnostic Accuracy of 3 Physical Examination Tests in the Assessment of Hip Microinstability

Background: Hip microinstability is a diagnosis gaining increasing interest. Physical examination tests to identify microinstability have not been objectively investigated using intraoperative confirmation of instability as a reference standard. Purpose: To determine the test characteristics and diagnostic accuracy of 3 physical examination maneuvers in the detection of hip microinstability. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A review was conducted of 194 consecutive hip arthroscopic procedures performed by a sports medicine surgeon at a tertiary-care academic center. Physical examination findings of interest, including the abduction–hyperextension–external rotation (AB-HEER) test, the prone instability test, and the hyperextension–external rotation (HEER) test, were obtained from prospectively collected data. The reference standard was intraoperative identification of instability based on previously published objective criteria. Test characteristics, including sensitivity, specificity, positive and negative predictive values, and accuracy, were calculated for each test as well as for combinations of tests. Results: A total of 109 patients were included in the analysis. The AB-HEER test was most accurate, with a sensitivity of 80.6% (95% CI, 70.8%-90.5%) and a specificity of 89.4% (95% CI, 80.5%-98.2%). The prone instability test had a low sensitivity (33.9%) but a very high specificity (97.9%). The HEER test performed second in both sensitivity (71.0%) and specificity (85.1%). The combination of multiple tests with positive findings did not yield significantly greater accuracy. All tests had high positive predictive values (range, 86.3%-95.5%) and moderate negative predictive values (range, 52.9%-77.8%). When all 3 tests had positive findings, there was a 95.0% (95% CI, 90.1%-99.9%) chance that the patient had microinstability. Conclusion: The AB-HEER test most accurately predicted hip instability, followed by the HEER test and the prone instability test. However, the high specificity of the prone instability test makes it a useful test to “rule in” abnormalities. A positive result from any test predicted hip instability in 86.3% to 90.9% of patients, but a negative test result did not conclusively rule out hip instability, and other measures should be considered in making the diagnosis. The use of these tests may aid the clinician in diagnosing hip instability, which has been considered a difficult diagnosis to make because of its dynamic nature.