Murray A. Reicher

Location preference and flavor aversion reinforced by amphetamine in rats

To associate the identical drug state with both a location and a flavor, rats were given intraperitoneal amphetamine injections and then confined for 20 min in one side of a shuttlebox with access to a flavored solution; on control trials without injections, they were confined for 20 min in the opposite side with a different flavor. In the first experiment, the rats were placed in the shuttlebox immediately after injections; in the second experiment, they were placed in the shuttlebox 20 min after injections. Subsequent free-choice tests in both experiments revealed an increased choice of the side of the shuttlebox associated with amphetamine but also an aversion to the flavored solution associated with the drug.

Magnetic resonance imaging as a tool for evaluation of traumatic knee injuries Anatomical and pathoanatomical correlations

Traumatic injury to the knee remains a diagnostic and therapeutic challenge. Magnetic resonance imaging (MRI) has been applied to musculoskeletal pathoa natomy and has been shown to be an effective tool for definition and characterization of knee pathology. A systematic approach is taken to establish anatomical and pathoanatomical correlations, as well as the role of MRI in the management of knee injuries. Imaging was performed at the UCLA Medical Center using a permanent magnet system and a combination of solenoidal surface coils and thin-section, high-reso lution scanning techniques. Images depict structural anatomical and spatial details of the knee that correlate well with corresponding cadaveric cryosections. To determine pathoanatomical correlations and the effi cacy of MRI, 105 patients with preoperative diagnoses of meniscal tears, anterior and posterior cruciate liga ment tears, tibial plateau fracture, and patella and quad riceps injuries were imaged. Results indicated that for the medial meniscus MRI demonstrated a 95.7% sensitivity, 81.8% specificity, 90% accuracy, 88.2% positive predictive value (PPV), and 93.1 % negative predictive value (NPV). Imaging of the lateral meniscus demonstrated a 75% sensitivity, 95% specificity, 91 % accuracy, 80% PPV, and 94% NPV. MRI of the ACL revealed 100% sensitivity, spec ificity, accuracy, positive and negative predictive values. MRI is a noninvasive tool which uses no ionizing radiation and can accurately define and characterize anatomy and pathoanatomy. This study indicates that MRI in conjunction with clinical evaluation can contrib ute to treatment decision-making processes and assist in preoperative planning. An algorithm demonstrating the potential clinical use of MRI is presented.

Achilles tendon injuries: the role of MR imaging.

Eight magnetic resonance (MR) examinations were performed in seven patients with Achilles tendon injuries and correlated with physical examination and surgical and clinical follow-up. The MR examinations depicted the Achilles tendon in excellent detail and Achilles tendon abnormalities with greater accuracy than physical examination. Of five tendons shown to be at least partially torn on MR, palpable tendinous defects were found in only one, and plantarflexion weakness was found in four. The MR and surgical findings precisely correlated in one case. Magnetic resonance proved valuable in the evaluation of clinically equivocal Achilles tendon tears and may ultimately play a greater role as a research tool in the determination of optimal forms of therapy for specific Achilles tendon injuries.

The use of MRI to assist in diagnosis of pigmented villonodular synovitis of the knee joint.

Pigmented villonodular synovitis (PVNS) of the knee joint remains a difficult and elusive entity to define and characterize. This entity most often appears in the young adult knee with nonspecific clinical features, including a painful range of motion and perhaps a sensation of locking. Detection and diagnosis of this localized soft-tissue mass are difficult because plain roentgenograms may be totally within normal limits. The case of a 21-year-old woman illustrates the use of magnetic resonance imaging (MRI) as an effective technique to define and characterize PVNS. Advantages of MRI include high-resolution/high-contrast multiplanar sections that depict bone, marrow, ligaments and tendons, fat, menisci, and articular cartilage in one image. In addition, MRI is noninvasive and requires no ionized radiation. MRI is an excellent clinical tool for the evaluation of intraarticular tumors of the knee joint.

The Painful Shoulder: MR Imaging of the Glenohumeral Joint

We used magnetic resonance imaging in 41 patients with shoulder pain. Magnetic resonance was found useful in depicting the spectrum of rotator cuff abnormalities associated with mechanical impingement including both large and small rotator cuff tears as well as tendinitis. Abnormalities of the capsular mechanism, osseous tumors, osteonecrosis, and injuries to the supporting musculature are also well depicted.

Magnetic resonance imaging in the early diagnosis of ischemic necrosis of the femoral head. Preliminary results.

Magnetic resonance imaging (MRI) was performed on the hips of 25 patients with suspected ischemic necrosis of the femoral head. Twenty-six femoral heads manifested MRI changes of ischemic necrosis: diminished bone marrow signal in a ringlike, focal, or diffuse pattern. Plain radiographs were normal in 13 of 26 MRI-positive hips; six were asymptomatic. MRI was more effective in detecting early cases than conventional 99mTc-diphosphonate or 99mTc-sulfur colloid (SC) bone scanning. There were no false-negative MRI examinations, but diphosphonate scans were negative in nine hips with normal radiography and abnormal MRI. Sulfur colloid scans were normal in only two hips with positive MRI, but SC scan results were often equivocal because isotope deficits were bilaterally symmetric. The results of this preliminary investigation imply that MRI has extraordinary sensitivity for the detection of early ischemic necrosis. Unlike radionuclide scanning, MRI shows the exact location and extent of femoral head necrosis. Because MRI is expensive, it should be used in a cost-effective manner. Therefore, MRI is best suited for the diagnosis of early cases where less expensive tests are negative or equivocal and as a precursor to more costly interventional procedures, such as core biopsy study or decompression.

Comparison of conventional and computed arthrotomography with MR imaging in the evaluation of the shoulder

To compare conventional arthrography and computed arthrotomography (CAT) with magnetic resonance (MR) imaging in the evaluation of the shoulder, we studied 18 patients who underwent conventional double contrast arthrography and CAT, and T1-, balanced, and T2-weighted MR imaging. The arthrograms were independently reviewed by two of the authors and the MR images were independently reviewed by three other authors in a systematic fashion with the aid of a prewritten evaluation form. The findings were compared among reviewers and between imaging methods. We found MR comparable to conventional arthrography in the evaluation of the rotator cuff; however, MR also enabled evaluation of tendonitis, which could not be accomplished with conventional arthrography. Because of MRs superior soft tissue imaging capability, we were able to stage the impingement syndrome. Magnetic resonance also allowed evaluation of the glenoid labrum and capsuloligamentous structures and assessment of instability in a fashion similar to CAT. In most cases, information obtained from MR equaled or exceeded that obtained from conventional arthrography and CAT. With refinement in technique and increased experience, we believe that MR may replace arthrography in the evaluation of the shoulder.

A Prospective Clinical Study to Evaluate the Safety and Performance of Wireless Localization of Nonpalpable Breast Lesions Using Radiofrequency Identification Technology

OBJECTIVE The purpose of this study was to evaluate the safety and performance of localizing nonpalpable breast lesions using radiofrequency identification technology. SUBJECTS AND METHODS Twenty consecutive women requiring preoperative localization of a breast lesion were recruited. Subjects underwent placement of both a hook wire and a radiofrequency identification tag immediately before surgery. The radiofrequency identification tag was the primary method used by the operating surgeon to localize each lesion during excision, with the hook wire serving as backup in case of tag migration or failed localization. Successful localization with removal of the intended lesion was the primary outcome measured. Tag migration and postoperative infection were also noted to assess safety. RESULTS Twenty patients underwent placement of a radiofrequency identification tag, 12 under ultrasound guidance and eight with stereotactic guidance. In all cases, the radiofrequency identification tag was successfully localized by the reader at the level of the skin before incision, and the intended lesion was removed along with the radiofrequency identification tag. There were no localization failures and no postoperative infections. Tag migration did not occur before incision, but in three cases, occurred as the lesion was being retracted with fingers to make the final cut along the deep surface of the specimen. CONCLUSION In this initial clinical study, radiofrequency tags were safe and able to successfully localize nonpalpable breast lesions. Radiofrequency identification technology may represent an alternative method to hook wire localization.

Implementation of Certified EHR, Patient Portal, and “Direct” Messaging Technology in a Radiology Environment Enhances Communication of Radiology Results to Both Referring Physicians and Patients

Since 2009, the Federal government distributed over

Magnetic Resonance Imaging of the Knee

29 billion to providers who were adopting compliant electronic health record (EHR) technology. With a focus on radiology, we explore how EHR technology impacts interoperability with referring clinicians’ EHRs and patient engagement. We also discuss the high-level details of contributing supporting frameworks, specifically Direct messaging and health information service provider (HISP) technology. We characterized Direct messaging, a secure e-mail-like protocol built to allow exchange of encrypted health information online, and the new supporting HISP infrastructure. Statistics related to both the testing and active use of this framework were obtained from DirectTrust.org, an organization whose framework supports Direct messaging use by healthcare organizations. To evaluate patient engagement, we obtained usage data from a radiology-centric patient portal between 2014 and 2015, which in some cases included access to radiology reports. Statistics from 2013 to 2015 showed a rise in issued secure Direct addresses from 8724 to 752,496; a rise in the number of participating healthcare organizations from 667 to 39,751; and a rise in the secure messages sent from 122,842 to 27,316,438. Regarding patient engagement, an average of 234,679 patients per month were provided portal access, with 86,400 patients per month given access to radiology reports. Availability of radiology reports online was strongly associated with increased system usage, with a likelihood ratio of 2.63. The use of certified EHR technology and Direct messaging in the practice of radiology allows for the communication of patient information and radiology results with referring clinicians and increases patient use of patient portal technology, supporting bidirectional radiologist-patient communication.