Publications (18)23.19 Total impact
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Article: The Cuboid Bone: Cornerstone of the Lateral Column Of the Foot
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ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.Contemporary Diagnostic Radiology. 11/2011; 34(23):1–5. -
Article: MRI of the cuboid bone: analysis of changes in diabetic versus non-diabetic patients and their clinical significance.
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ABSTRACT: (1) To investigate the association between diabetes and marrow changes in the cuboid; and (2) to evaluate the influence of age, gender, body mass index (BMI) and use of insulin in the occurrence of marrow changes in the cuboid. MR and X-ray foot examinations of 237 patients [94 males, 143 females; mean age, 47.1 years (range 16-93 years)], five of whom underwent bilateral examinations, were reviewed. MR and radiographic studies were analyzed for the presence of marrow edema and fractures in the cuboid. Findings were correlated with demographic data (age, gender) and clinical information (BMI and use of insulin). Two hundred and forty two feet - 69 diabetic and 173 non-diabetic - were retrospectively evaluated. There was a higher prevalence of marrow edema and fractures in the diabetic cuboid (n=31, 45%) compared to non-diabetic cuboid (n=25, 14%, p=0.02). A fracture line was seen in fourteen (20%) diabetic cuboid bones compared to 4 (2%) in non-diabetic cuboid bones (p<0.0001). Eleven (79%) cases of cuboid fractures in the diabetic population were radiographically occult. Multivariate data analysis revealed an adjusted odds ratio of 4.416 (95% CI; 2.307, 8.454) for the relationship between marrow changes (edema and fractures) in the cuboid and diabetes. For each year of age, the odds of changes in the cuboid increased by 2.2% (95% CI; 1.001, 1.044). Despite not bearing weight, the cuboid bone is more vulnerable to marrow edema and fractures in diabetic patients compared to non-diabetic patients. Age seems to be an influential factor.European journal of radiology 11/2011; 81(10):2771-5. · 2.65 Impact Factor -
Article: The Guyon's canal in perspective: 3-T MRI assessment of the normal anatomy, the anatomical variations and the Guyon's canal syndrome.
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ABSTRACT: (1) To revisit the anatomical boundaries of the canal, its contents and its two channels, (2) to describe the anatomical variations of the canal's borders and the variations of its contents, and (3) to discuss the clinical relevance of the Guyon's canal syndrome. Two hundred and fifty MR wrists examinations were reviewed. MR spin echo T1-weighted axial slices were used to analyze the Guyon's canal. The anatomical boundaries, the cross-sectional area and length of the canal were calculated. The anatomical variations of the canal's walls and contents and their prevalence were sought. Changes related to Guyon's canal syndrome were also evaluated. From the 250 wrists, the anatomy of the Guyon's canal was normal in 168 (67.2%) wrists; 73 (29.2%) wrists presented with anatomical variations; and 9 (3.6%) wrists had derangements causing Guyon's canal syndrome. The cross-sectional area of the canal was 33 ± 11 mm² proximally and 45 ± 19 mm² distally. The canal's length was approximately 40 ± 4 mm. Among the 73 wrists with anatomical variations, there were aberrant muscles in 39 (53.4%) wrists, multiple ulnar nerve branching in 22 (30%) cases, increased amount of fat tissue inside the canal in 9 (12.3%) cases and hypoplastic hamulus in 3 (4.1%) cases. There were 9 (3.6%) symptomatic wrists with clinical and radiological features attributed to Guyon's canal syndrome. MRI is an excellent modality for the evaluation of the Guyon's canal.Anatomia Clinica 06/2011; 33(10):897-903. · 0.93 Impact Factor -
Article: MRI spectrum of bone changes in the diabetic foot.
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ABSTRACT: (1) To assess the prevalence of bone marrow changes in the diabetic foot and (2) to discuss the clinical significance of these changes. 85 patients with radiographic and magnetic resonance imaging (MRI) foot examinations were selected. Inclusion criteria were clinical diagnosis of diabetes and bone changes on radiographs and MRI. The material was selected from the image storage (PACS) system. We searched for vascular (infarct and necrosis), traumatic (bruise and occult fractures), destruction and debris, dislocation, osteochondritis, osteomyelitis. Five patients had bilateral examinations. A total of 90 feet were evaluated. From 90 feet, 17 (18.9%) presented with vascular changes, from them, 11 feet had infarct and 6 feet had necrosis. Twenty (22.2%) feet had traumatic changes; of them, 10 (50%) had edema on MRI. Five (25%) cases had occult fracture on MRI; and 5 (25%) had visible fracture on both X-ray and MRI. Bone destruction was detected in 8 (8.9%) feet. Bony debris was visualized in three of them. Bone dislocation was visualized in 11 (12.2%) feet. There was evidence of osteochondritis in twenty-four (26.7%) feet. Osteomyelitis was diagnosed in ten (11.1%) feet. Diabetic foot is a challenge for both clinicians and radiologists due to its complexity. The bone derangements inherent to the diabetic foot can be evaluated with high accuracy with MRI.European journal of radiology 05/2011; 81(7):1625-9. · 2.65 Impact Factor -
Article: MRI of the Achilles tendon: a comprehensive review of the anatomy, biomechanics, and imaging of overuse tendinopathies.
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ABSTRACT: The Achilles tendon is the largest tendon in the body; it plays an important role in the biomechanics of the lower extremity. It can withstand great forces, especially during sporting exercises and pivoting. The pathologies related to the Achilles tendon are diverse and many carry undesirable consequences. We retrospectively analyzed the images of patients who underwent examinations of the ankle/foot region to review the anatomy of the Achilles tendon and its surroundings and to search for pathologies consistent with overuse injuries. The anatomy of the tendon is described from origin to insertion. The imaging characteristics of the Achilles tendon including pitfalls are reviewed. We also describe the Achilles overuse injuries: paratenonitis, tendinosis, tendon tear, atypical tear, tendon re-tear, retrocalcaneal bursitis, retro-Achilles bursitis, Haglund's deformity, and tendon calcification. We present other entities like tendon ossification and failed transplanted Achilles tendon, with emphasis on MRI.Acta Radiologica 05/2010; 51(4):438-54. · 1.37 Impact Factor -
Article: MRI of the median nerve and median artery in the carpal tunnel: prevalence of their anatomical variations and clinical significance.
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ABSTRACT: Anatomical variations of the median nerve and the persistent median artery (PMA) in the carpal tunnel (CT) are important to understand for their clinical and surgical significance. The aim of this cohort retrospective study was to investigate the prevalence of aberrant median nerve branches and persistent median artery in the CT in a selected population using magnetic resonance imaging (MRI). MR wrist images of 194 patients, 77 males and 117 females, aged 12-80 years were randomly selected and retrieved from our clinical and radiology data base. The MR examinations were performed using either 1.5-T or 3.0-T magnet using a cylindrical receive-transmit wrist coil for all cases. The course of the bifurcation of the median nerve was followed on axial T2-weighted and axial proton density fat saturated images and classified as either proximal, within, or distal to the CT. The flexor retinaculum proximally and the metacarpal bases were used as anatomic landmarks to subdivide these three categories. In addition, the median artery was searched in order to assess the prevalence of its presence inside the CT. A total of 194 wrists were analyzed by two musculoskeletal-trained radiologists. They were blinded on the population age, gender, and the sides of the wrists. Agreement was reached by consensus. Among the 194 wrists, there was bifurcation of the nerve proximal to the CT in 12 (6.1%) wrists. There was nerve bifurcation within the CT in 36 (18%) wrists. Nerve bifurcation distal to the CT was more frequently observed, occurring in 147 (75%) wrists. Only one nerve trifurcation was seen within the CT. There was no gender predominance for the nerve bifurcation within the tunnel. There were 107 right wrists and 87 left wrists. On the right side, bifurcation of the nerve within the CT was seen in 21 (19.6%) wrists; and on the left side bifurcation of the nerve was present in 15 (17.2%) wrists. Statistically, we found no significant difference in the prevalence of the bifid nerve within the tunnel in the subgroups based on age, gender, or side of the wrists. A persistent median artery (PMA) within the tunnel was observed in 21 (11%) wrists--10 males and 11 females. Of these, four (19%) cases were presented with coexistent PMA and bifid median nerve within the tunnel. Statistically, we found that the two variations are not independent traits, and their covariance is not null. There was a high prevalence of bifid median nerve (19%) and PMA (11%) within the tunnel regardless of gender or age. The PMA was more frequent on the left side.Anatomia Clinica 03/2010; 32(3):315-22. · 0.93 Impact Factor -
Article: Recombinant human bone morphogenetic protein 2-induced heterotopic ossification of the retroperitoneum, psoas muscle, pelvis and abdominal wall following lumbar spinal fusion.
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ABSTRACT: A 45-year-old man presented with vertebral collapse at L5 as an initial manifestation of multiple myeloma and underwent spinal fusion surgery using recombinant human bone morphogenetic protein-2 (rhBMP-2). Subsequent computed tomography (CT) scans and X-rays revealed heterotopic ossification of the left psoas muscle, pelvis, and anterior abdominal wall. While the occurrence of heterotopic ossification has previously been reported when rhBMP-2 has been used for spinal fusion surgery, this case demonstrates that it can occur to a much greater degree than previously seen.Skeletal Radiology 02/2010; 39(5):501-4. · 1.54 Impact Factor -
Chapter: Contrast Media for MRI of the Gastrointestinal Tract
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ABSTRACT: MR contrast media catalytically improve the inherent image contrast between normal and pathologic tissues. This is achieved by mechanisms that increase the relaxation rates of water protons in areas where these agents are distributed. The first generations of systemic, intravenous contrast media are unspecific in action owing to their distribution in the extracellular compartments. The newer agents are more specific and are limited to anatomic target tissues. But in the future, contrast media are expected to act on processes even at the cellular level. Gastrointestinal MR agents have two main purposes: to improve the signals and contrast resolution between the bowel lumen and wall and to distend the gut. Water or watery solutions are the media most frequently used in this concept owing to the favorable signal characteristics, excellent distribution, and good tolerance. But to avoid absorption of water and the subsequent “collapse” of the gut, nonabsorbable particles need to be dissolved in the solution. By increasing the osmolarity, the distension of the intestine increases linearly as a consequence of the dose—response relationship that exists between these two parameters. The oral application of contrast is usually preferred for most of the gastrointestinal MR examinations except for the imaging of the large bowel, although the best degree of small bowel distension is obtained with enteroclysis.12/2009: pages 33-49; -
Article: Congenital absence of the semimembranosus muscle: case report.
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ABSTRACT: Congenital anomalies of the muscles of the lower extremity are rare. A case of complete absence of the semimembranosus muscle incidentally found with magnetic resonance imaging is reported. The patient was a 55-year-old female presenting with knee pain and no previous history of trauma. Clinical and imaging findings were consistent with meniscal tears. Two cases of uncommon distal insertion of the semimembranosus tendon are also described to illustrate the anatomical variations in this area. The anatomical and biomechanical relations between the semimembranosus muscle and the posteromedial corner of the knee are examined in this case report.Anatomia Clinica 10/2009; 32(5):519-23. · 0.93 Impact Factor -
Article: Multiple occult wrist bone injuries and joint effusions: prevalence and distribution on MRI.
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ABSTRACT: This study aims (1) to assess the prevalence and distribution of multiple occult injuries of the carpal bones and the distal forearm in patients with wrist pain and negative radiographs following trauma and (2) to evaluate the distribution and significance of joint effusions in the wrists with multiple osseous injuries. One hundred and thirty-one subjects, 74 men and 57 women, were consecutively examined in two institutions. All were acute trauma patients with negative X-rays whose clinical examination suggested possible fracture at the wrist or the distal forearm. Magnetic resonance (MR) wrist imaging was performed with and without fat saturation sequences. The MR images were analysed for detection of occult trabecular contusions and cortical discontinuity in the carpus, the distal forearm and the metacarpal bases. The prevalence and distribution of the injuries were assessed along with the distribution of joint effusions. Eight patients were excluded due to inadequate image quality. Two patients had bilateral injury. A total of 125 wrists were analysed. Seventy-eight (62.4%) wrists had occult bone injuries. Among these 78, 53 (68%) wrists had more than one injured bone. Twenty-five wrists (32%) had one injured bone. The highest number of injured bones per wrist was six. Injuries with a visible fracture line were seen in 29 (37.1%) wrists on MRI. The distal radius was the most frequent location for occult fracture line (11 cases). The injuries without a fracture line (contusion) were present in 49 (63%) wrists; they were detected more frequently in the scaphoid (35 cases). The lunate (29 cases) and the triquetrum (26 cases) were almost equally affected. The bone that was less frequently injured was the pisiform (four cases). Joint effusions were present in all 53 wrists with multiple bone lesions but more often situated in the ulnocarpal space [27 (50.3%) wrists]. There was no correlation between effusions in multiple locations (grades III and IV) and multiple bone injuries. This study revealed the presence of multifocal trabecular contusions without correlation with increased joint effusions in patients with negative radiographs and persistent pain. The clinical significance of these findings deserves further investigation.Emergency Radiology 09/2009; 17(3):179-84. -
Article: Magnetic resonance imaging of the triangular fibrocartilage complex lesions: a comprehensive clinicoradiologic approach and review of the literature.
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ABSTRACT: This article illustrates the frequent lesions of the triangular fibrocartilage complex (TFCC) by means of magnetic resonance imaging. We performed a retrospective chart review of the magnetic resonance images of 109 patients from our database. All subjects had history of trauma, and all underwent both radiographic and magnetic resonance imaging examination of the wrist. The changes (degeneration, tears) of the TFCC were assessed. Ten patients were excluded because of incomplete imaging protocol (4 patients) and low-quality images (6 patients). From the 99 wrists remaining, the TFCC was normal in 30 (30.3%). Degenerative changes were found in 40 (40.4%) wrists. Partial and complete tears were present in 17 (17.1%) and 12 (12.1%) wrists, respectively. The TFCC lesions in acute traumatic wrists should not be overlooked; they may contribute to wrist pain and disability after treatment of existing bone injuries.Journal of manipulative and physiological therapeutics 10/2007; 30(7):522-6. · 1.06 Impact Factor -
Article: Osmolarity: a decisive parameter of bowel agents in intestinal magnetic resonance imaging.
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ABSTRACT: The aim was to evaluate the importance of the osmolarity of different oral agents for bowel distension and the level of related adverse events. The longitudinal design included the exposition of different oral MR agents on two separate occasions. Four groups of volunteers were randomly given 350 ml gastrografin of three different concentrations and water. On the second occasion they received mannitol, iohexol or iodixanol with equivalent osmolarities, but the control group (water) received mannitol. We recorded the outcomes as the degree of bowel distension determined as the mean bowel section area and the total level of discomfort recorded from a visual analogue scale (VAS). The statistical analysis included scatter plots with the best-fitted line with linear regression to study the association between osmolarity and section area and the association between osmolarity and adverse events. A dose-response association was found between increasing osmolarity levels and bowel area in square centimeters (P = 0.00001). A similar dose-response association existed between increasing levels of osmolarity and adverse events (P = 0.001). Osmolarity appears to be more important for bowel distension than the physico-chemical characteristics of the nonabsorbable oral agents. The optimum osmolarity level is determined by the patient's tolerance of the adverse events.European Radiology 07/2006; 16(6):1331-6. · 3.22 Impact Factor -
Article: Postlymphoproliferative disorder affecting bone after a renal transplantation.
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ABSTRACT: To illustrate a posttransplant lymphoproliferative lymphoma presenting as a solitary osseous lesion situated in the rib. A 53-year-old man was referred to a surgical department because of persistent local pain over the lower part of his left posterior hemithorax. Due to a previous history of chronic glomerulonephritis, a renal transplant was performed 7 years previously, followed by immunosuppressive therapy with azathioprine cyclophosphamide. Surgical removal of the rib lesion was performed because of the patient's history of the organ transplant. The histological study of the surgically removed tissue revealed diffuse infiltration of the marrow by lymphoid-like cells. There was evidence of interstitial fibrosis, and further immunohistochemical examination showed the presence of B cells in the specimen confirming the diagnosis of B-cell lymphoma. This case report discusses an unusual presentation of a lymphoma induced by immunosuppressive therapy in a patient who had received an organ transplant. Such lesions may appear in any organ or system, although this is distinctively unusual to involve the skeletal system.Journal of manipulative and physiological therapeutics 02/2005; 28(1):64-6. · 1.06 Impact Factor -
Article: Deforming lipoblastomatosis of the lower extremity.
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ABSTRACT: Lipoblastomatosis is a rare disorder in infants and children and nonexistent in adults. We discuss a case of a newborn child with lipoblastomatosis extensively involving the pelvis and lower extremities. The clinical and radiological characteristics of the disorder are discussed. A 2-month-old male had an enlarging deformity of the pelvis and lower extremities with progression of the condition from birth. There was no family history related to the disease. No other clinical abnormalities were present. Lipoblastomatosis is initially treated with surgical excision of the lipomatous neoplastic tissue. The postsurgical outcome is satisfactory; however, the likelihood of recurrence has been reported. We present the features of lipoblastomatosis, an uncommon disorder affecting infants and children. The clinical and radiologic manifestations of the disease are assessed with emphasis on magnetic resonance imaging.Journal of Manipulative and Physiological Therapeutics 03/2004; 27(2):119-22. · 1.36 Impact Factor -
Article: Pediatric excretory MR urography: comparative study of enhanced and non-enhanced techniques.
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ABSTRACT: Our purpose was to compare the quality of ureteral imaging in pediatric patients using two different MR sequences: the non-enhanced heavily T2-weighted (W) turbo spin-echo sequence (TSE) and the gadolinium-enhanced T1W fast-field-echo sequence (T1 FFE). An experimental study on three pigs was first performed. The TSE, before and after furosemide injection, was followed by the T1 FFE sequence. The clinical study included 11 infants and 10 children. With some modifications the same MR parameters and techniques were used as in the animal study. The TSE with TR 8000 ms and TE 650 ms implied 6 radial stacks each of 40 mm thickness. The T1 FFE included TR 18 ms, TE 2.9 ms, flip angle 60, and 50 slices with thickness 0.7 mm. After post-processing, image reconstructions qualitative and quantitative analysis were performed. Complete visualization of the ureters was achieved in 35 of 42 (83%) cases. Seventy-four percent of the ureters were completely visualized with T1 FFE compared with only 19% with TSE. Sixty-nine percent of the ureters were better imaged with T1 FFE than TSE and 21% equally well imaged. Four ureters (10%), either obstructed or due to poor renal function, were better imaged with TSE. The two sequences are complementary. Visualization of non-obstructed ureters is excellent with T1 FFE and the sequence is superior to TSE. The TSE, however, may be equal to or even better than T1 FFE in visualizing obstructed ureters or ureters draining malfunctioning kidneys.European Radiology 07/2003; 13(6):1423-7. · 3.22 Impact Factor -
Article: Clinical and radiological manifestations of the rheumatoid wrist. A comprehensive review.
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ABSTRACT: The intent of this review article is to present the common clinical and radiological features of the rheumatoid wrist as seen in everyday practice. Imaging of the rheumatoid wrist is discussed with emphasis on magnetic resonance imaging (MRI) and its current and future role in the diagnosis and treatment follow-up of the disease. A search of the current medical literature from 1990 to present through PubMed was performed without constraints. Search terms used included: MRI, rheumatoid arthritis, wrist, treatment, diagnosis, radiology, clinical manifestations, and incidence. The articles included in this review were selected by historical significance, date of publication, pertinent review information, and, most specifically, those articles studying the current uses for imaging the rheumatoid wrist. This review demonstrated an overall agreement between numerous studies that the usefulness of MRI evaluation of the rheumatoid wrist is in its early stages of development. Many of the features of this examination of the wrist are discussed and contrasted with plain film radiographic examination. The role of the clinician in the diagnosis and treatment, including complementary care, as well as the follow-up of rheumatoid arthritis in the wrist is unquestionable. The role of plain film examination as a diagnostic tool is excellent. The current and future role of MRI of rheumatoid arthritis is becoming obvious and will likely become the diagnostic imaging tool of choice in the near future. MRI provides more specific information on rheumatoid lesions in the wrist than plain film imaging. This is especially true when intravenous contrast is utilized. The clinician's use of physical examination, laboratory examination, radiography, and MRI will provide for early diagnosis, treatment, and follow-up of RA in the wrist.Journal of Manipulative and Physiological Therapeutics 07/2003; 26(5):323-9. · 1.36 Impact Factor -
Article: Magnetic resonance assessment of the double-crush phenomenon in patients with carpal tunnel syndrome: a bilateral quantitative study.
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ABSTRACT: Our main goal was to assess the coexistence of narrowed cervical foramens and cervical canal stenosis in patients with carpal tunnel syndrome (CTS). We took magnetic resonance (MR) images of 120 wrists and 480 foramens in 60 age and sex matched subjects (30 patients with CTS and 30 controls). All patients had nerve conduction velocity tests before MR examination. We measured the volume of the carpal canal in all participants bilaterally. We also quantified the cross-sectional areas of the cervical foramens on both sides from C4 to T1 and measured the diameter of the cervical canal in all participants. We searched for the prevalence and location of cervical spondylosis and disc prolapse on the side of the symptomatic wrist(s). All patients had CTS-related neurophysiological findings. There was no correlation between the symptoms and the reduced carpal canal volume. The mean (SD) area of the foramens was 109.5 (12.8) mm2 in the patients compared with the controls 126.4 (28.7) mm2 (p = 0.007). Cervical spondylosis and disc prolapse were more common in the patients than the controls at the C5-C6 and C6-C7 levels, and their locations were on the same side as the symptoms in the wrist(s) in 50% of cases. There was no difference in the size of the cervical canal between the two groups. The higher incidence of narrowed cervical foramens in the patients and its concordance with affected nerve roots on the same side as the CTS symptoms support the hypothesis of a double-crush phenomenon.Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery 02/2003; 37(1):46-53. · 0.94 Impact Factor -
Article: Quantitative MRI and electrophisiology of preoperative carpal tunnel syndrome in a female population
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ABSTRACT: Sumario: The tunnel size is reported to play a role in median neuropathy. The aim of the study was to quantify the volume of the carpal tunnel in a selected population with idiopathic carpal tunnel syndrome (CTS), as the narrowest point of the canal was noted. All participants were women. Both groups underwent nerve conduction studies and magnetic resonance (MR) of the wrists
Top co-authors
Top Journals
Institutions
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2009–2011
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Emory University
- Department of Radiology
Atlanta, GA, USA
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2010
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George Washington University
Washington, D. C., DC, USA
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2007
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Sahlgrenska University Hospital
Göteborg, Vaestra Goetaland, Sweden
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2005
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Institut Franco Europeen de Chiropratique
Paris, Ile-de-France, France
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