scholarly journals Focal Bone Marrow Lesions: A Complication of Ultrasound Diathermy

2019 ◽  
Vol 22 (1) ◽  
pp. 40-45
Author(s):  
Seung Jae J. Kim ◽  
Yusuhn Kang ◽  
Dae Ha Kim ◽  
Jae Young Lim ◽  
Joo Hyun Park ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Magnetic Resonance ◽  
Soft Tissue ◽  
Musculoskeletal Disorders ◽  
Complete Resolution ◽  
Soft Tissue Injuries ◽  
Therapeutic Modality ◽  
Bone Lesions ◽  
Temporal Lesion

Ultrasound diathermy is widely used for the treatment of musculoskeletal disorders and other soft tissue injuries. Its use as a therapeutic modality is believed to be safe, with very few reported complications. Here, we report two patients who developed focal bone marrow abnormalities after receiving ultrasound diathermy. Both patients’ magnetic resonance (MR) evaluations revealed linear subchondral bone lesions of the superolateral humeral head similar to those in osteonecrosis. The patients’ symptoms subsequently improved, and available follow-up MR evaluation revealed near complete resolution of bone lesions. These findings suggest that ultrasound diathermy, and its interaction with bone tissue through thermal mechanisms, can cause focal bone marrow abnormalities. Furthermore, the bone marrow abnormalities seem to be transient, resolving upon cessation of ultrasound diathermy, therefore osteonecrosis should be differentiated from this temporal lesion.

scholarly journals Magnetic Resonance Imaging of the Hindfoot

Foot & Ankle ◽  
1989 ◽  
Vol 10 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Julia R. Crim ◽  
Andrea Cracchiolo ◽  
Lawrence W. Bassett ◽  
Leanne L. Seeger ◽  
Charles A. Soma ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Bone Marrow ◽  
Magnetic Resonance ◽  
Soft Tissue ◽  
Soft Tissue Injuries ◽  
Foot And Ankle ◽  
Normal Anatomy ◽  
Resonance Imaging ◽  
Ct Evaluation ◽  
Magnetic Resonance Imaging Mri

This article demonstrates normal anatomy of the foot and ankle as visualized with magnetic resonance imaging (MRI) in the sagittal, axial, and coronal planes. Additionally, selected cases chosen from our experience with more than 100 clinical scans are shown to highlight the primary areas in which we have found MRI to be clinically useful: bone marrow abnormalities, especially osteomyelitis and osteonecrosis, soft tissue injuries and masses, and cases in which metallic fixators make CT evaluation problematic.

The Role of Magnetic Resonance Imaging for Diagnosing Soft Tissue Lesions Associated with Anterior Cruciate Ligament Injuries

2018 ◽  
Vol 69 (9) ◽  
pp. 2498-2500
Author(s):  
Bogdan Sendrea ◽  
Antoine Edu ◽  
George Viscopoleanu
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Soft Tissue ◽  
Traumatic Event ◽  
Cruciate Ligament ◽  
Soft Tissue Injuries ◽  
Resonance Imaging ◽  
Soft Tissue Lesions ◽  
Anterior Cruciate

Magnetic resonance imaging has become the gold standard for soft tissue lesions evaluation especially after a traumatic event where there is need for diagnostic confirmation. The objective of the current paper was to evaluate the ability of magnetic resonance imaging in diagnosing soft tissue lesions in patients who underwent anterior cruciate ligament reconstruction compared with arthroscopic findings. Through the ability to diagnose soft tissue injuries, particularly meniscal lesions, magnetic resonance imaging should be considered as fundamental in guiding therapeutic management in patients with anterior cruciate ligament lesions.

scholarly journals Bone marrow abnormalities detected by magnetic resonance imaging as initial sign of hematologic malignancies

2018 ◽  
Author(s):  
Ida Sofie Grønningsæter ◽  
Aymen Bushra Ahmed ◽  
Nils Vetti ◽  
Silje Johansen ◽  
Øystein Bruserud ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Bone Marrow ◽  
Magnetic Resonance ◽  
Case Reports ◽  
Cell Types ◽  
Hematologic Malignancies ◽  
Resonance Imaging ◽  
Initial Sign ◽  
Magnetic Resonance Imaging Mri

The increasing use of radiological examination, especially magnetic resonance imaging (MRI), will probably increase the risk of unintended discovery of bone marrow abnormalities in patients where a hematologic disease would not be expected. In this paper we present four patients with different hematologic malignancies of nonplasma cell types. In all patients the MRI bone marrow abnormalities represent an initial presentation of the disease. These case reports illustrate the importance of a careful diagnostic follow-up without delay of patients with MRI bone marrow abnormalities, because such abnormalities can represent the first sign of both acute promyelocytic leukemia as well as other variants of acute leukemia.

scholarly journals Optimal timing of follow-up cardiac magnetic resonance in patients with acute myocarditis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Ciabatti ◽  
L Ferri ◽  
A Camporeale ◽  
E Saletti ◽  
M Chioccioli ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Complete Resolution ◽  
Time Course ◽  
Acute Myocarditis ◽  
Left Ventricular ◽  
Optimal Timing ◽  
2D Echocardiography ◽  
Prognostic Stratification

Abstract Background Cardiac magnetic resonance (CMR) plays a central role in the diagnosis, follow-up and prognostic stratification of acute myocarditis. Several CMR features, including the extent of late gadolinium enhancement (LGE) at baseline, have been proposed as factors associated with a worse outcome. Recent studies evaluated temporal evolution of LGE and edema repeating CMR either at 6 months or at 12 months, demonstrating that persistence or worsening of LGE represents a negative prognostic marker. However, the time-course of edema resolution and LGE stabilization is currently unknown and therefore the optimal timing to repeat CMR for acute myocarditis prognostic stratification remains unclear. Purpose We aimed to assess the time course of edema and LGE evolution in order to identify the optimal timing to repeat CMR in patients with acute myocarditis. Methods We enrolled 36 patients with a diagnosis of acute myocarditis according to ESC position statement definition. All patients underwent CMR at clinical presentation (CMR-1), after 3–4 months (CMR-2) and after 12-months (CMR-3) follow-up. CMR evaluation included assessment of edema and LGE, and evaluation of structural and functional parameters including left (LVEF) and right ventricular ejection fraction (RVEF), left (LVGLS) and right ventricular global longitudinal strain (RVGLS) and indexed left ventricular mass (iLVM). After CMR-3 all patients were followed-up by yearly clinical evaluation, electrocardiogram (ECG) and 2D-echocardiography. Results The mean age was 28,8±10,3 years with 35 (97%) being male. All patients showed edema and LGE at CMR-1 with a LVEF of 58,5±12,2. At CMR-2 a significant reduction of edema (T2 positive segments 0,4±0,9 vs. 4,1±3,2 p<0.0001) and LGE extent (LGE ≥5SD 5,1±5,3 vs. 9,6±8,4 p<0.0001) was observed, with only 3 patients showing edema persistence. A significant improvement of LVEF (62,7±5,6 vs. 58,5±12,2 p<0.05), RVGLS (−24,4±5,4 vs. −21,6±7,4 p<0.05), associated with a significant reduction of iLVM (71,2±13,7 vs 78,1±15,2 g/mq) was also observed. At CMR-3 no further significant reduction of LGE extent was observed with no further improvement of LVEF, RVGLS and iLVM. In the 3 patients with persisting edema at CMR-2, a complete resolution was observed at CMR-3. After a mean follow-up of 60±23 months, no major cardiovascular events nor myocarditis recurrences were observed, with no patients showing left ventricular dysfunction nor progression to dilated cardiomyopathy at 2D-echocardiography. Conclusions In most patients with acute myocarditis a complete resolution of the inflammatory process with LGE stabilization and normalization of left ventricular function and mass can be observed after 3–4 months. Further CMR assessment should limited to patients with persisting oedema at 3–4 months CMR. Our findings suggest to redefine the follow-up schedule and imaging-based prognostic stratification strategies in patients with acute myocarditis. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

scholarly journals Comparison of Bone Marrow Aspirate Concentrate and Allogenic Human Umbilical Cord Blood Derived Mesenchymal Stem Cell Implantation on Chondral Defect of Knee: Assessment of Clinical and Magnetic Resonance Imaging Outcomes at 2-Year Follow-Up

2020 ◽  
Vol 29 ◽  
pp. 096368972094358
Author(s):  
Dong Jin Ryu ◽  
Yoon Sang Jeon ◽  
Jun Sung Park ◽  
Gi Cheol Bae ◽  
Jeong-seok Kim ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Stem Cells ◽  
Bone Marrow ◽  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Bone Marrow Aspirate ◽  
Human Umbilical Cord Blood ◽  
Human Umbilical Cord ◽  
Resonance Imaging

Biological repair of cartilage lesions remains a significant clinical challenge. A wide variety of methods involving mesenchymal stem cells (MSCs) have been introduced. Because of the limitation of the results, most of the treatment methods have not yet been approved by the Food and Drug Administration (FDA). However, bone marrow aspirate concentrate (BMAC) and human umbilical cord blood derived mesenchymal stem cells (hUCB-MSCs) implantation were approved by Korea FDA. The aim of this study was to evaluate clinical and magnetic resonance imaging (MRI) outcomes after two different types of MSCs implantation in knee osteoarthritis. Fifty-two patients (52 knees) who underwent cartilage repair surgery using the BMAC (25 knees) and hUCB-MSCs (27 knees) were retrospectively evaluated for 2 years after surgery. Clinical outcomes were evaluated according to the score of visual analogue scale (VAS), the International Knee Documentation Committee (IKDC) subjective, and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Cartilage repair was assessed according to the modified Magnetic Resonance Observation of Cartilage Repair Tissue (M-MOCART) score and the International Cartilage Repair Society (ICRS) cartilage repair scoring system. At 2-year follow-up, clinical outcomes including VAS, IKDC, and KOOS significantly improved ( P < 0.05) in both groups; however, there were no differences between two groups. There was no significant difference in M-MOCART [1-year ( P = 0.261), 2-year ( P = 0.351)] and ICRS repair score ( P = 0.655) between two groups. Both groups showed satisfactory clinical and MRI outcomes. Implantation of MSCs from BMAC or hUCB-MSCs is safe and effective for repairing cartilage lesion. However, large cases and a well-controlled prospective design with long-term follow-up studies are needed.

scholarly journals The Pedicled Latissimus Dorsi Flap Provides Effective Coverage for Large and Complex Soft Tissue Injuries Around the Elbow

Hand ◽  
2017 ◽  
Vol 13 (5) ◽  
pp. 586-592 ◽  
Author(s):  
Jacques H. Hacquebord ◽  
Douglas P. Hanel ◽  
Jeffrey B. Friedrich
Keyword(s):  
Soft Tissue ◽  
Latissimus Dorsi ◽  
Soft Tissue Injuries ◽  
Soft Tissue Defect ◽  
Latissimus Dorsi Flap ◽  
Soft Tissue Coverage ◽  
Effective Coverage ◽  
Latissimus Flap ◽  
Proximal Forearm

Background: The pedicled latissimus flap has been shown to provide effective coverage of wounds around the elbow with an average size of 100 to 147 cm2 but with complication rates of 20% to 57%. We believe the pedicled latissimus dorsi flap is an effective and safe technique that provides reliable and durable coverage of considerably larger soft tissue defects around the elbow and proximal forearm. Methods: A retrospective review was performed including all patients from Harborview Medical Center between 1998 and 2012 who underwent coverage with pedicled latissimus dorsi flap for defects around the elbow. Demographic information, injury mechanism, soft tissue defect size, complications (minor vs major), and time to surgery were collected. The size of the soft tissue defect, complications, and successful soft tissue coverage were the primary outcome measures. Results: A total of 18 patients were identified with variable mechanisms of injury. Average defect size around the elbow was 422 cm2. Three patients had partial necrosis of the distal most aspect of the flap, which was treated conservatively. One patient required a secondary fasciocutaneous flap, and another required conversion to a free latissimus flap secondary to venous congestion. Two were lost to follow-up after discharge from the hospital. In all, 88% (14 of 16) of the patients had documented (>3-month follow-up) successful soft tissue coverage with single-stage pedicled latissimus dorsi flap. Conclusions: The pedicled latissimus dorsi flap is a reliable option for large and complex soft tissue injuries around the elbow significantly larger than previous reports. However, coverage of the proximal forearm remains challenging.

Hypertensive Encephalopathy in Children with Sickle Cell Disease.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3790-3790
Author(s):  
Caterina P. Minniti ◽  
Steven L. Weinstein ◽  
Zarir Khademian
Keyword(s):  
Magnetic Resonance ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Complete Resolution ◽  
Clinical Symptoms ◽  
Hypertensive Encephalopathy ◽  
Cell Disease ◽  
Acute Infarction ◽  
Cortical Edema

Abstract Cerebrovascular (CVA) accidents are a serious complication of Sickle Cell Disease (SCD). Acute cerebral infarction occurs in approximately 10% of children with SCD under the age of 16 years, with silent infarcts identified in an additional 22%. Children however can present with acute neurologic deterioration mimicking a CVA but demonstrate a picture consistent with hypertensive encephalopathy (HTNE). The incidence of HTNE in children with SCD is unknown with few annedoctal reports available in the literature. We retrospectively identified 83 children with SCD, who received their care at Children’s National Medical Center in Washington, DC, from 1992 to 2005, who presented with neurologic complaints that prompted Magnetic Resonance Imaging (MRI). There were 37 females and 46 males, age 13 months to 17 years, with mean age of 5 years and 8 months. Clinical and neuro-imaging data identified 8 children (7 females and 1 male) with clinical picture compatible with HTNE (BP &gt; 2 std deviation for age), prior to neuroimaging. At the time of the hypertensive episode, the ages ranged from 6 to 16 years and 8 months, with an average of 14 years and 2 months. All patients had Hb SS. Neurologic complaints included seizure, sudden onset headache, confusion, loss of consciousness, and urinary retention. Elevated blood pressures were aggressively treated and all patient received an exchange transfusion. No specific etiology for the hypertension was determined. Initial MRI, obtained within 24–48 hours of presentation, did not show acute or prior infarction in this group. However, there was absence of diffusion restriction on T1 and T2 weighted images, and presence of cerebral cortical edema, which differentiate HTNE from acute infarction. The magnetic resonance angiogram (MRA) did not demonstrate evidence of arteriopathy. The hallmark of HTNE is a complete resolution of abnormalities of both the neurologic exam and the imaging studies at follow up. There was complete resolution of cerebral edema in all patients and mild interval prominence of the cerebral sulci, which can indicate cerebral volume loss, in three out of the 8 patients, in follow up studies obtained 10 days to 4 months later. No recurrences of the symptoms have been reported, with follow up ranging from 5 months to 8 years. None of the patients with HTNE has received chronic transfusions. We conclude that HTNE should be considered in the differential diagnosis of an acute neurologic event in a child with SCD. Accurate recording of vital signs and prompt correction of hypertension is indicated. MRI can accurately distinguish between HTNE and acute infarction, even when clinical symptoms are similar. This distinction helps physicians to establish proper treatment such as chronic transfusion following infarction.

Cost Effectiveness in Low Risk MGUS Patients

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2360-2360
Author(s):  
Tiffany Pompa ◽  
Mark Maddox ◽  
Adonas Woodard ◽  
Jeurkar Chet ◽  
Maelys Amat ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Risk Stratification ◽  
Medical Costs ◽  
Low Risk ◽  
Bone Lesions ◽  
Office Visits ◽  
Excess Cost ◽  
Total Cost ◽  
The Cost

Abstract Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant disorder characterized by the asymptomatic presence of a monoclonal protein. It is defined by an M protein < 3 gm/dl, less than 10% clonal plasma cells in the bone marrow, and the absence of anemia, hypercalcemia, renal insufficiency and bone lesions. In 2010 the International Myeloma Working Group (IMWG) advocated for MGUS patients to be stratified into low risk disease, which carries a 5% risk of progression to multiple myeloma at 20 years, and high risk disease, which represents a 20% risk at 20 years. This stratification model categorizes patients as low risk if they have an IgG paraprotein with an M-component < 1.5 g/dl and a normal free light chain (FLC) ratio. As such, it is suggested that the initial workup be comprised of a serum protein electrophoresis (SPEP), an immunofixation (IFE), and a FLC ratio. A bone marrow biopsy (BM) and bone survey should only be performed if anemia, hypercalcemia or an elevated creatinine of unclear etiology is noted. If these studies place a patient into the low risk, it is suggested the patient follow up at 6-months with only an SPEP. If the SPEP is stable, the next follow-up is recommended to occur at 2 to 3 year intervals unless symptoms arise suggestive of a plasma cell dyscrasia. The risk stratification of MGUS patients was validated in 2013 by Turesson et al. in a Swedish cohort (Blood, 2014; 123:338-345). Nevertheless, the risk model is not universally accepted and unnecessary office visits along with laboratory studies are performed on low risk patients. The purpose of this study was to perform an internal retrospective review of our patients diagnosed with low risk MGUS, evaluating excess medical costs incurred when patients were not risk stratified by the IMWG recommendations. Methods: MGUS patients seen in the Hematology Oncology Division of Drexel University between 2014 and 2016 were retrospectively categorized into high and low risk based on the IMWG criteria. Those determined to be low risk were evaluated over two years for extra costs incurred outside the IMWG recommendations. Extra cost was tallied based on initial workup and surveillance studies performed up to two years from diagnosis. Costs per test and follow up visits were based on our office appointment pricing and BM biopsy charges. Laboratory costs were obtained based on pricing from ACCU reference lab. Cost per test (varies by lab/provider) SPEP $67 UPEP $130 Serum IFE $200 Urine IFE $72 IgA $27 IgG $27 IgM $27 K/L ratio $120 B2 microglobulin $42 Office Visit $40 - $100 Bone Survey $500 - $1200 BM biopsy $500- $1000 Results: Sixty patients seen between 2014 and 2016 met the criteria for MGUS. Twenty-eight patients were determined to have low risk disease. Of the 28 patients, five were diagnosed prior to 2010 and were excluded. In the remaining 23 patients, four followed up at exactly six months from diagnosis and only one had an SPEP. The most common test ordered was quantitative immunoglobulins (QI) aside from a CBC and CMP. The total number of excess office visits was 49. Three patients had unnecessary BM biopsies (total cost $1,000 - $2,000), and 11 had unnecessary bone surveys (Total $5,500 - $13,200). The total cost of unnecessary lab tests within 2 years was $6,024 and the total cost of unnecessary office visits within 2 years was $1960 - $4900. Thus, the average excess spent per patient was $630 - $1135, for a total excess cost for the 23 patients of $14,484 - $26,124. Conclusion: This internal review highlights the excess medical costs incurred when patients are not risk stratified by the IMWG recommendations. Ideally, no further health care dollars should be spent for low risk MGUS patients who have a stable SPEP at the 6-month visit until the 2 or 3 year follow up visit. The actual excess amount spent in our office in 2 years for these patients was $14,484 - $26,124 beyond the cost of the standard of care recommended by the IMWG guidelines. Additionally, these values did not include excess basic labs such as a CBC or CMP and it did not include extension of our investigation out to three years which would result in further unnecessary costs. One patient was noted to accumulate excess cost due to his co-morbid condition of prostate cancer, which led to increased surveillance for his low risk MGUS. The risk stratification model allows physicians to offer patients a better understanding of their disease, decrease the patient's burden and reduce the cost on healthcare. Disclosures No relevant conflicts of interest to declare.

scholarly journals Incidence and Evaluation of Incidental Abnormal Bone Marrow Signal on Magnetic Resonance Imaging

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Gunjan L. Shah ◽  
Aaron S. Rosenberg ◽  
Jamie Jarboe ◽  
Andreas Klein ◽  
Furha Cossor
Keyword(s):  
Magnetic Resonance Imaging ◽  
Bone Marrow ◽  
Magnetic Resonance ◽  
Complete Blood Count ◽  
Medical Center ◽  
Resonance Imaging ◽  
Bone Marrow Signal ◽  
Abnormal Bone Marrow ◽  
Marrow Signal

Purpose. The increased use of magnetic resonance imaging (MRI) has resulted in reports of incidental abnormal bone marrow (BM) signal. Our goal was to determine the evaluation of an incidental abnormal BM signal on MRI and the prevalence of a subsequent oncologic diagnosis.Methods. We conducted a retrospective cohort study of patients over age 18 undergoing MRI between May 2005 and October 2010 at Tufts Medical Center (TMC) with follow-up through November 2013. The electronic medical record was queried to determine imaging site, reason for scan, evaluation following radiology report, and final diagnosis.Results. 49,678 MRIs were done with 110 patients meeting inclusion criteria. Twenty two percent underwent some evaluation, most commonly a complete blood count, serum protein electrophoresis, or bone scan. With median follow-up of 41 months, 6% of patients were diagnosed with malignancies including multiple myeloma, non-Hodgkins lymphoma, metastatic non-small cell lung cancer, and metastatic adenocarcinoma. One patient who had not undergone evaluation developed breast cancer 24 months after the MRI.Conclusions. Incidentally noted abnormal or heterogeneous bone marrow signal on MRI was not inconsequential and should prompt further evaluation.

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