Diego Jaramillo

The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

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Publications (98)208.51 Total impact

  • Kassa Darge, Yocabel Gorfu, Diego Jaramillo
    Pediatric Radiology 06/2014; 44(6):642. · 1.57 Impact Factor
  • Pediatric Radiology 06/2014; 44(6):670-1. · 1.57 Impact Factor
  • Diego Jaramillo, Juana M Vallejo, Kassa Darge
    Pediatric Radiology 06/2014; 44(6):643. · 1.57 Impact Factor
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    ABSTRACT: Bilateral agenesis of the anterior cruciate ligament (ACL) is extremely rare. We describe a 13-year-old girl who presented with bilateral knee pain without history of trauma; she has two family members with knee instability. Magnetic resonance imaging showed bilateral absence of the ACL, and medial posterior horn meniscal tears. Bilateral arthroscopic partial meniscectomy and anterior cruciate ligament reconstruction was performed.
    Pediatric Radiology 04/2014; · 1.57 Impact Factor
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    ABSTRACT: Several attempts have been made at imaging the fetus at 3 T as part of the continuous search for increased image signal and better anatomical delineation of the developing fetus. Until very recently, imaging of the fetus at 3 T has been disappointing, with numerous artifacts impeding image analysis. Better magnets and coils and improved technology now allow imaging of the fetus at greater magnetic strength, some hurdles in the shape of imaging artifacts notwithstanding. In this paper we present the preliminary experience of evaluating the developing fetus at 3 T and discuss several artifacts encountered and techniques to decrease them, as well as safety concerns associated with scanning the fetus at higher magnetic strength.
    Pediatric Radiology 04/2014; 44(4):376-86. · 1.57 Impact Factor
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    ABSTRACT: To describe magnetic resonance imaging (MRI) findings of plexiform neurofibromas (PNF) involving the liver and pancreas in paediatric patients with neurofibromatosis type 1 (NF1). A retrospective search of the hospital database was undertaken to find cases of PNF in the porta hepatis, hilar neurofibroma, and hepatic neurofibroma over a 12 year period. The images were analysed and a review of the charts was undertaken. Five paediatric patients were identified with extensive PNFs involving the liver. In all cases, the PNFs involved the liver along the intrahepatic portal distribution. Additionally, the gallbladder fossa was affected in 2/5 patients, the pancreatic head in 4/5 patients, the pancreatic neck in 2/5 patients, and the pancreatic tail in 1/5 patients. All tumours showed low signal intensity (SI) on T1-weighted images and high SI with a central target sign on water-sensitive sequences. No patient showed any signs or symptoms, nor required treatment or surgery related to hepatic or pancreatic involvement. Intrahepatic PNFs were stable over a median follow-up time of 3.6 years (range 3 months to 8.8 years). Intrahepatic and pancreatic involvement, although rare, does occur in paediatric NF1 patients. The MRI findings of the tumour are similar to the PNFs that occur more commonly elsewhere in this population. The hallmark of liver involvement is the periportal distribution.
    Clinical radiology 03/2014; · 1.65 Impact Factor
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    ABSTRACT: The normal development of the sternum using CT imaging is not known. To describe the normal development of the sternum in children on chest CT imaging. CT imaging of 300 patients (150 male, 150 female), mean age: 4.97 years (range: 0.01-9.9 years), were evaluated retrospectively. The presence and number of ossification centers in the manubrium, each individual mesosternal segment and the xiphoid were reviewed. Additionally, the vertical and horizontal fusion between ossification centers was evaluated. Differences among age and gender were calculated. Descriptive statistics, analysis of variances (ANOVA), chi-square and Fisher exact tests were performed for statistical analysis. Manubrium: A single ossification center was seen in 88% of cases and two or three ossification centers were seen in 12%. More manubrial ossification centers were correlated to a younger age (P < 0.001, R = -0.2). Mesosternum: Majority of patients had a single ossification center in the first segment (85%). The majority of patients had double ossification centers in the second and third segments (51% and 64%, respectively). No ossification center was seen in the fourth segment in 38% of patients. No significant difference among the age of vertical ossification between mesosternal segments was found. (ANOVA; P > 0.05). Xiphoid: Absence was seen in 67% of the patients. Bifid xiphoid was seen in 1% of the patients. The normal development of the different components of the sternum is a process with wide variation among children. The large variability of mesosternal ossification center types should not be confused with pathology.
    Pediatric Radiology 12/2013; · 1.57 Impact Factor
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    ABSTRACT: Objective. To evaluate the distribution of enthesitis and accuracy of physical examination (PE) with a dolorimeter for the detection of enthesitis in children, using ultrasound (US) assessment as the reference standard. Methods. We performed a prospective cross-sectional study of 30 enthesitis-related arthritis (ERA) subjects and 30 controls. The following tendon insertion sites were assessed by standardized PE with a dolorimeter and US: common extensor on lateral humerus epicondyle, common flexor on medial humerus epicondyle, quadriceps at superior patella, patellar ligament at inferior patella, Achilles, and plantar fascia at the calcaneus. Results. Abnormal US findings were detected most commonly at the insertions of the quadriceps (30%; N= 18/60 sites), common extensor (12%; N=7/60), and Achilles (10%; N=6/60) tendons. The intra-and inter-rater reliability of US (kappa) were 0.78 (95% CI: 0.63, 0.93) and 0.81 (95% CI: 0.67, 0.95), respectively. Tenderness detected by standardized dolorimeter exam had poor positive predictive value for US-confirmed enthesitis. In comparison to controls, ERA subjects reported more pain and had lower pain thresholds at every site, including control sites (all p-values <0.01). Inter-rater reliability of dolorimeter exam for detection of enthesitis was low (kappa 0.49, 95% CI: 0.33, 0.65). Conclusions. Compared to US, standardized dolorimeter examination for the detection of enthesitis in children has poor accuracy and reliability. The decreased pain threshold of ERA subjects likely contributed to the limited accuracy of PE. Future research is warranted regarding the utility of US for identifying enthesitis at JIA diagnosis, accurately predicting disease progression, and guiding therapeutic decisions. © 2013 American College of Rheumatology.
    Arthritis & Rheumatology 09/2013; · 7.48 Impact Factor
  • Victor M Ho-Fung, Diego Jaramillo
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    ABSTRACT: Evaluation of hyaline cartilage in pediatric patients requires in-depth understanding of normal physiologic changes in the developing skeleton. Magnetic resonance (MR) imaging is a powerful tool for morphologic and functional imaging of the cartilage. In this review article, current imaging indications for cartilage evaluation pertinent to the pediatric population are described. In particular, novel surgical techniques for cartilage repair and MR classification of cartilage injuries are summarized. The authors also provide a review of the normal anatomy and a concise description of the advances in quantitative cartilage imaging (ie, T2 mapping, delayed gadolinium-enhanced MR imaging of cartilage, and T1rho).
    Radiologic Clinics of North America 07/2013; 51(4):689-702. · 1.95 Impact Factor
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    ABSTRACT: OBJECTIVE. Prenatal diagnosis of skeletal dysplasia is often difficult and based on findings with ultrasound, a technique with 40-60% sensitivity. The purpose of this study was to evaluate a preliminary experience in assessing severe prenatal osseous abnormalities with low-dose fetal CT. The hypothesis was that use of CT may improve the prenatal diagnosis of skeletal dysplasia beyond the available capabilities of ultrasound. MATERIALS AND METHODS. Retrospective search of a radiology database (July 2008-February 2011) yielded the records of unenhanced CT examinations of patients referred because of abnormal fetal bones. The original ultrasound and CT reports as interpreted at image acquisition were independently analyzed by two radiologists blinded to the final diagnosis and to the findings of the opposing imaging modality. Blinded review of the images was also performed. Correlation was made with the postmortem and postnatal findings. RESULTS. According to the reports of the studies, 5 of 21 cases were interpreted correctly with CT and incorrectly with ultrasound. In 17 cases, CT revealed additional osseous findings not in the ultrasound report. There were no cases in which ultrasound findings were correct and CT findings were incorrect. Blinded review of the images revealed that CT outperformed ultrasound (p < 0.001). There were a total of four CT errors among 218 total measures recorded and a total of 19 ultrasound errors among 218 total measures. CONCLUSION. Although low-dose fetal CT should never be used as the initial diagnostic modality in cases of suspected skeletal dysplasia, it is a powerful imaging adjunct that depicts the fetal bones in exquisite detail. Use of CT of fetuses at risk of skeletal dysplasia may provide clinicians with more accurate information for counseling of families regarding neonatal morbidity and mortality.
    American Journal of Roentgenology 05/2013; 200(5):989-1000. · 2.90 Impact Factor
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    ABSTRACT: BACKGROUND: Infantile Blount disease is a developmental condition characterized by disorganized endochondral ossification in the medial aspect of the proximal tibial physis. OBJECTIVE: To describe the MR imaging abnormalities in the proximal tibia, distal femur, menisci and ligaments of children with infantile Blount disease. MATERIALS AND METHODS: We retrospectively evaluated 11 children (18 total knee MR examinations) with infantile Blount disease and compared them with an age-matched control group with normal MR examinations. Morphological and morphometric measurements were performed. RESULTS: The medial menisci were enlarged with increased T2 signal intensity in all MR examinations. The medial femoral epiphyseal cartilage showed abnormal foci of increased signal intensity in nine (50%). The mid-coronal thickness of the medial tibial epiphyseal cartilage was decreased with concomitant increase in the mid-coronal joint space distance. Angular measurements of the proximal tibia demonstrated posteromedial down-sloping configuration. CONCLUSIONS: Most severe abnormalities of infantile Blount disease occur in the medial compartment of the knee, especially at the medial tibial physis and epiphysis. However, other important structures of the knee and the lateral compartment are often affected. MR imaging helps to delineate the extent of multiple tibial and extra-tibial abnormalities, including meniscal abnormalities, perichondrial membrane changes and premature physeal closure.
    Pediatric Radiology 04/2013; · 1.57 Impact Factor
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    ABSTRACT: BACKGROUND: No reported data demonstrate the usefulness of magnetic resonance arthrography of the shoulder in children. OBJECTIVE: To evaluate the sensitivity, specificity and accuracy of MR arthrography in the assessment of superior labral anteroposterior (SLAP) tears of the shoulder, Bankart-type injuries and Hill-Sachs lesions in children as compared to arthroscopy. MATERIALS AND METHODS: We retrospectively interpreted 66 MR arthrograms of the shoulder and compared them with surgical findings. Assessment included evaluation of the osseous structures, labral-ligamentous complex and determination of skeletal maturity. We calculated sensitivity, specificity and accuracy and compared sensitivity and specificity between skeletally mature and immature children. RESULTS: MR arthrography demonstrated a sensitivity, specificity and accuracy of 88%, 98% and 94%, respectively, for depiction of SLAP tears; 94%, 92% and 94% for detection of Bankart-type injuries; and 100%, 94% and 97% for diagnosing Hill-Sachs lesions. There was no statistical difference between the skeletally immature and skeletally mature groups. CONCLUSION: There is no significant difference in the diagnostic accuracy of MR arthrography in skeletally immature versus skeletally mature children. MR shoulder arthrography is an effective method for the detection of labral and bone pathology.
    Pediatric Radiology 04/2013; · 1.57 Impact Factor
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    ABSTRACT: BACKGROUND: Children undergoing total body irradiation (TBI) often develop delayed skeletal complications. Bone-age studies in these children often reveal subtle paraphyseal changes including physeal widening, metaphyseal irregularity and paraphyseal exostoses. OBJECTIVE: To investigate whether paraphyseal changes on a bone-age study following TBI indicate a predisposition toward developing other radiation-associated skeletal complications. MATERIALS AND METHODS: We retrospectively reviewed medical records and bone-age studies of 77 children receiving TBI at our institution between 1995 and 2008 who had at least 2 years of clinical follow-up and one bone-age study after TBI. We graded bone-age studies according to the severity of paraphyseal changes. All documented skeletal complications following TBI were tabulated. Kendall's tau-b was used to examine associations between degree of paraphyseal change and development of a skeletal complication. RESULTS: Kendall's tau analyses showed that physeal widening and metaphyseal irregularity/sclerosis (tau = 0.87, P < 0.001) and paraphyseal exostoses (tau = 0.68, P < 0.001) seen on bone-age studies were significantly positively associated with the development of delayed skeletal complications following TBI. Thirty percent of children with no or mild paraphyseal changes developed a delayed skeletal complication, compared with 58% of children with moderate paraphyseal changes and 90% of children with severe paraphyseal changes. CONCLUSION: Paraphyseal changes identified on a bone-age study correlate positively with the development of delayed skeletal complications elsewhere in the skeleton following TBI.
    Pediatric Radiology 03/2013; · 1.57 Impact Factor
  • Randheer Shailam, Diego Jaramillo, J. Herman Kan
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    ABSTRACT: Identification of congenital and acquired etiologies causing alignment disorders and leg-length discrepancies (LLD) in children is important for management. Minor differences in the lengths of the lower extremities are considered a normal variation and usually have no clinical significance. However, LLD of greater than 1 cm can cause altered biomechanics, resulting in scoliosis, back and lower extremity joint pain, pelvic tilt, abnormal gait and premature degenerative joint disease. The purpose of this pictorial essay is to review the imaging spectrum of growth arrest and resultant alignment and leg-length discrepancies in children.
    Pediatric Radiology 01/2013; 43(1). · 1.57 Impact Factor
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    ABSTRACT: Osteoid osteoma is a common benign bone-forming lesion that is composed of a nidus of vascular osteoid tissue and woven bone lined by osteoblasts. It is frequently associated with considerable surrounding inflammation. The diagnosis is usually straightforward when imaging reveals a radiolucent nidus surrounded by variable degrees of reactive sclerosis. However, the diagnosis can be elusive when osteoid osteomas occur in atypical locations, as they may have a nonspecific and misleading appearance on different imaging modalities, particularly on MRI. The purpose of this pictorial essay is to review the typical and atypical features of osteoid osteomas on different imaging modalities, and the appearance of osteoid osteomas in different locations. We also review growth disturbances caused by osteoid osteomas and potential mimickers, with imaging characteristics that can aid in diagnosis.
    Pediatric Radiology 10/2012; · 1.57 Impact Factor
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    ABSTRACT: The hypertrophic changes that occur in the cartilage of an epiphysis prior to the onset of ossification are known as the pre-ossification center. Awareness of the appearance of the pre-ossification center on MR images is important to avoid confusing normal developmental changes with pathology. The purpose of this study was to determine the characteristics of the trochlear pre-ossification center on MR imaging and examine age and gender differences. We retrospectively analyzed MR images from 61 children. The trochleas were categorized into three types on the basis of signal intensity (SI). Trochlear types were compared to age and gender. There was no significant difference between the ages of boys and girls. Type 1 trochleas showed homogeneous SI on all pulse sequences. Type 2 trochleas demonstrated a focus of high SI in the epiphyseal cartilage on fat-suppressed water-sensitive sequences, with high or intermediate SI on gradient-echo images (pre-ossification center). Type 3 trochleas showed low SI on fat-suppressed water-sensitive sequences and gradient-echo images. Thirty-seven trochleas were described as type 1, sixteen as type 2 and eight as type 3. ANOVAs confirmed a statistically significant difference in the age of children with type 3 trochleas and those with types 1 and 2 (P < 0.001). Spearman rank correlations determined a positive relationship between trochlear type and age of the children (r = 0.53). Development-related changes in the trochlea follow a predictable pattern. The signal characteristics of the pre-ossification center likely reflect normal chondrocyte hypertrophy and an increase in free water in the matrix.
    Pediatric Radiology 07/2012; 42(11):1364-71. · 1.57 Impact Factor
  • D M Biko, A L Miller, V Ho-Fung, D Jaramillo
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    ABSTRACT: The knee joint is the one of the most common locations for congenital and developmental musculoskeletal abnormalities. Initial imaging of the knee joint should always begin with conventional radiographs. However, evaluation of the bone marrow, cartilaginous, ligamentous, and other soft-tissue components of the knee joint are better characterized with magnetic resonance imaging (MRI). We present the MRI findings of prevalent congenital and developmental abnormalities in the paediatric knee with particular emphasis on the components of the growing skeleton.
    Clinical radiology 05/2012; · 1.65 Impact Factor
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    ABSTRACT: Magnetic resonance (MR) imaging is a modality widely used to assess shoulder abnormalities in children. A thorough understanding of the development of the shoulder and adequate MR techniques are crucial in the radiologic evaluation. The immature skeleton is particularly vulnerable to insults such as trauma, infection, and inflammation, and responds in unique ways. The pediatric shoulder can also be affected by complex congenital deformities such as brachial plexus injuries. In addition, certain neoplasms can be seen specifically in the young patient. MR imaging plays a critical role in the initial diagnostic evaluation and in assessing posttreatment responses.
    Magnetic resonance imaging clinics of North America 05/2012; 20(2):327-47, xi.
  • Nancy Chauvin, Diego Jaramillo
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    ABSTRACT: The authors describe a case of distal femoral physeal injury with disruption of the perichondrium in a 9-year-old girl after a sledding accident. The patient presented with knee pain, limited range of motion, and inability to bear weight. Initial radiographs were normal. A magnetic resonance imaging of the knee demonstrated abnormal signal and widening of the distal femoral physis with elevation of the posterior distal femoral periosteum. This case illustrates the main magnetic resonance imaging findings in an occult Salter Harris type I injury: increased physeal thickness and signal intensity on water-sensitive sequences, perichondrial disruption, and intracartilaginous fracture.
    Journal of computer assisted tomography 05/2012; 36(3):310-2. · 1.38 Impact Factor
  • Victor M Ho-Fung, Camilo Jaimes, Diego Jaramillo
    Seminars in roentgenology 04/2012; 47(2):171-81. · 0.70 Impact Factor

Publication Stats

1k Citations
208.51 Total Impact Points

Institutions

  • 2006–2014
    • The Children's Hospital of Philadelphia
      • Department of Radiology
      Philadelphia, Pennsylvania, United States
  • 2012
    • Walter Reed National Military Medical Center
      Washington, Washington, D.C., United States
  • 2011
    • Naval Medical Research Center
      Silver Spring, Maryland, United States
    • Seoul National University Hospital
      • Department of Orthopedic Surgery
      Seoul, Seoul, South Korea
    • NYU Langone Medical Center
      • Department of Radiology
      New York City, NY, United States
  • 2009
    • Cincinnati Children's Hospital Medical Center
      Cincinnati, Ohio, United States
  • 2004–2009
    • Boston Children's Hospital
      • • Department of Orthopaedic Surgery
      • • Department of Radiology
      Boston, MA, United States
  • 2008
    • Hospital of the University of Pennsylvania
      • Department of Radiology
      Philadelphia, PA, United States
    • Washington University in St. Louis
      San Luis, Missouri, United States
  • 2002–2007
    • Massachusetts General Hospital
      • Department of Radiology
      Boston, MA, United States
  • 2001
    • Harvard Medical School
      • Department of Radiology
      Boston, Massachusetts, United States