Radiology & Imaging
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During the COVID-19 crisis the Radiology and Imaging Department mobilized to ensure comprehensive, 24/7 coverage in an ever-shifting landscape of ortho triage and ortho injury centers and expanded inpatient services. We provided additional services to accommodate the transfer of inpatients from NewYork-Presbyterian, performing imaging procedures not normally part of the daily routine, including portable ultrasound and Doppler ultrasound for DVT assessment. We also planned for the expected increase in body imaging-related issues, including chest CT, head/neck CT/CTA, brain MRI and MRCP, as well as arranged for emergency portable ultrasound procedures to be performed at the bedside.
Two of our imaging fellows, Edward McLaughlin, MD, and Shiv Tilwa, MD, who volunteered to cover inpatient care shifts under the direction of the HSS hospitalist team both received the Radiology Fellowship Service and Humanity Award for their service, selflessness, and professionalism in a time of crisis.
As the new head of Interventional Radiology, Edward Yoon, MD, has been working in collaboration with the Spine and Metabolic Bone service lines to introduce techniques in vertebral augmentation and sacroplasty, which are instrumental in decreasing pain, improving quality of life and decreasing progressive spinal deformity.
Through their collaboration with Kevin Koch, MD, at the Medical College of Wisconsin, co-PIs Matthew Koff, MD, and Hollis Potter, MD, developed novel MRI biomarkers that identified the presence of tissue necrosis in patients with symptomatic hip arthroplasty and have a paper accepted using the quantitative imaging technique of T2 mapping to evaluate soft tissue reactions near total hip arthroplasty devices. This work is funded through a National Institutes of Health RO1 grant.
Alissa Burge, MD, of the MRI laboratory has evaluated the diagnostic accuracy for determining the presence of loosening in patients with conventional and newer 3D printed total hip arthroplasty components. These studies emphasize the high sensitivity and specificity of MRI as compared to more traditional radiographs in the detection of implant loosening.
Ryan Breighner, PhD, has also used a novel MRI acquisition called zero time echo (ZTE) imaging to evaluate patients with features of femoroacetabular impingement. The use of this imaging may minimize the need for radiographs, and the associated ionizing radiation, to evaluate bony features. In this way, MRI can generate images with CT-like contrast to evaluate soft tissues, such as ligaments and tendons, and hard tissues, such as bone, within a single imaging examination.
Darryl Sneag, MD, Director of Peripheral Nerve MRI, initiated a two-year NIH-sponsored R21 award in April 2020 to investigate imaging and serologic biomarkers for detection and monitoring of Parsonage-Turner syndrome (PTS), also known as neuralgic amyotrophy.
Dr. Sneag published several studies this past year that helped to redefine PTS as a disease manifesting as intrinsic constrictions of one or more peripheral nerves that may be amenable to surgical neurolysis. Additionally, his collaborative work with the HSS Brachial Plexus & Traumatic Nerve Injury Center has helped debunk the common belief that anterior interosseous syndrome is a compressive neuropathy in the forearm, but instead a subtype of PTS typically involving AIN fascicles of the medial nerve above the elbow.
Ogonna Nwawka, MD, the new Chief of Ultrasound at HSS, has been awarded several grants to support the expansion of musculoskeletal ultrasound (US), which as the result of studies from the American Institute of Ultrasound in Medicine has now been embraced as part of routine imaging evaluation in brachial plexus and peripheral nerve abnormalities at HSS.
We have also characterized biomechanical changes in tendon and muscle using shear wave elastography, a quantitative ultrasound technique, supported by grants by the National Basketball Association, GE Healthcare, and the Radiologic Society of North America.
Ultrasound Imaging of Nerves in the Neck: Correlation to MRI, EMG and Clinical Findings. Casaletto E, Lin B, Wolfe SW, Lee SK, Sneag DB, Feinberg JH, Nwawka OK. Neurol Clin Pract Oct 2020, 10 (5) 415-421.
Quantitative Assessment of Change in Upper Extremity Muscle Stiffness Following Fluid Injection Using Shear Wave Elastography. Nwawka OK, Gutierrez N, Lin B, Ko L, Miller TT. Skel Rad 2020, in press.
Fascicular Constrictions above Elbow Typify Anterior Interosseous Nerve syndrome. Sneag DB, Arányi Z, Zusstone EM, Feinberg JH, Queler SC, Nwawka OK, Lee SK, Wolfe SW. Muscle Nerve. 2020 Mar;61(3):301-310.
Anterior Interosseous Nerve Syndrome Reconsidered: A Critical Analysis Review. Krishnan KR, Sneag DB, Feinberg JH, Wolfe SW. JBJS Rev. 2020 Sep;8(9).
Multivariate Use of MRI Biomarkers to Classify Histologically Confirmed Necrosis in Symptomatic Total Hip Arthroplasty. Sherafati M, Bauer TW, Potter HG, Koff MF, Koch KM. J Orthop Res. 2020 Jul;38(7):1506-1514.
What is the Diagnostic Accuracy of MRI for Component Loosening in THA? Burge AJ, Konin GP, Berkowitz JL, Lin B, Koff MF, Potter HG. Clin Orthop Relat Res. 2019 Sep;477(9):2085-2094.
Evaluation of Osseous Morphology of the Hip Using Zero Echo Time Magnetic Resonance Imaging. Breighner RE, Bogner EA, Lee SC, Koff MF, Potter HG. Am J Sports Med. 2019 Dec;47(14):3460-3468.
The MRI laboratory will have additional submissions for R01 NIH level funding to supplement our existing grants, as well as a submission in collaboration with investigators from the HSS Research Institute of a large grant to the Department of Defense to evaluate the presence and development of fibrosis in the knee.
We will see additional patients participating in research at our satellite campuses and we anticipate greater ability to perform research scanning at these locations. In addition, we continue to build on our relationships with the Department of Biomechanics, to evaluate patients with problematic total knee arthroplasty devices; the Orthopaedic Soft Tissue Research Program, to longitudinally evaluate patients undergoing partial meniscectomy surgery; and the Department of Pathology and Laboratory Medicine, to further correlate MRI synovial patterns to tissue histology.