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  1. Article: Radiographic Findings of Inflammatory Arthritis and Mimics in the Hands.

    Ezzati, Fatemeh / Pezeshk, Parham

    Diagnostics (Basel, Switzerland)

    2022  Volume 12, Issue 9

    Abstract: Clinical presentation could be challenging in patients with arthralgia, and imaging plays an important role in the evaluation of these patients to make the diagnosis or narrow the differential diagnosis. Radiography of the hands is a commonly available ... ...

    Abstract Clinical presentation could be challenging in patients with arthralgia, and imaging plays an important role in the evaluation of these patients to make the diagnosis or narrow the differential diagnosis. Radiography of the hands is a commonly available imaging modality that can provide crucial information with regard to the pattern and pathology of the involved joints. It is important that radiologists and rheumatologists are familiar with the imaging findings of different rheumatic diseases to make the diagnosis in the early stages of disease to initiate treatment.
    Language English
    Publishing date 2022-09-02
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2662336-5
    ISSN 2075-4418
    ISSN 2075-4418
    DOI 10.3390/diagnostics12092134
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  2. Article ; Online: Spectrum of Hand Arthritis: Doppler Ultrasound, Diffusion-Weighted MR Imaging, and Perfusion MR Imaging Evaluation.

    Pezeshk, Parham / Soldatos, Theodoros / Ezzati, Fatemeh / Bhatnagar, Nidhi / Chhabra, Avneesh

    Magnetic resonance imaging clinics of North America

    2023  Volume 31, Issue 2, Page(s) 239–253

    Abstract: Early diagnosis of arthritis is of paramount importance to slow the progression of disease and joint destruction. Because of temporal dissemination of the clinical and laboratory manifestations of the inflammatory arthritis and overlap of the findings, ... ...

    Abstract Early diagnosis of arthritis is of paramount importance to slow the progression of disease and joint destruction. Because of temporal dissemination of the clinical and laboratory manifestations of the inflammatory arthritis and overlap of the findings, diagnosis can be challenging in early stages of the disease. This article highlights the utility of advanced cross-sectional imaging, including color-Doppler ultrasound, diffusion-weighted MR imaging, and perfusion MR imaging in the domain of arthropathy so that the reader can apply these principles and techniques in their practices for timely and accurate diagnosis and improved multidisciplinary communications for better management of such conditions.
    MeSH term(s) Humans ; Magnetic Resonance Imaging/methods ; Arthritis, Rheumatoid/diagnosis ; Diffusion Magnetic Resonance Imaging ; Perfusion ; Ultrasonography, Doppler
    Language English
    Publishing date 2023-02-20
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1196851-5
    ISSN 1557-9786 ; 1064-9689
    ISSN (online) 1557-9786
    ISSN 1064-9689
    DOI 10.1016/j.mric.2023.02.001
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  3. Article ; Online: Extent of bone marrow edema on dual-energy CT aids in differentiation of acute from post-acute fractures of lower legs.

    Haider, Shamrez / Pezeshk, Parham / Xi, Yin / Abdellatif, Waleed / Chhabra, Avneesh

    European radiology

    2023  Volume 33, Issue 6, Page(s) 4094–4102

    Abstract: Objectives: Bone marrow edema (BME) from dual-energy CT is useful to direct attention to radiographically occult fractures. The aim was to characterize utility of BME of lower extremity (LE) fractures with the hypothesis that stabilized and post-acute ... ...

    Abstract Objectives: Bone marrow edema (BME) from dual-energy CT is useful to direct attention to radiographically occult fractures. The aim was to characterize utility of BME of lower extremity (LE) fractures with the hypothesis that stabilized and post-acute fractures exhibit decreased extent and frequency of BME than non-stabilized and acute fractures, respectively.
    Methods: An IRB-approved retrospective review of known LE fractures. A total of 141 cases met inclusion criteria, including 82 fractures without splint/cast stabilization, and 59 cases with stabilization. Two readers independently recorded BME, and its multiplicity and area (mm
    Results: BME was significantly larger in non-stabilized (859.3 mm
    Conclusions: BME evaluation can assist in differentiation of acute versus post-acute fractures. Extent of BME is reduced with splint/cast stabilization, which may limit its accuracy in detection of lower extremity fractures.
    Key points: • Evaluation of bone marrow edema on dual-energy CT aids in differentiation of acute versus post-acute fracture. • Bone marrow edema evaluation is limited in the setting of post-acute or stabilized fractures. • There is decreased frequency and extent of bone marrow edema in post-acute, non-comminuted, and stabilized fractures.
    MeSH term(s) Humans ; Bone Marrow ; Leg ; Tomography, X-Ray Computed/methods ; Fractures, Bone ; Bone Marrow Diseases/diagnostic imaging ; Edema/diagnostic imaging ; Lower Extremity/diagnostic imaging ; Magnetic Resonance Imaging/methods ; Sensitivity and Specificity
    Language English
    Publishing date 2023-01-04
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1085366-2
    ISSN 1432-1084 ; 0938-7994 ; 1613-3749
    ISSN (online) 1432-1084
    ISSN 0938-7994 ; 1613-3749
    DOI 10.1007/s00330-022-09373-3
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  4. Article ; Online: 3D MRI of the Rheumatic Diseases.

    Ezzati, Fatemeh / Chalian, Majid / Pezeshk, Parham

    Seminars in musculoskeletal radiology

    2021  Volume 25, Issue 3, Page(s) 425–432

    Abstract: Magnetic resonance imaging (MRI) is commonly used to evaluate musculoskeletal pathologies due to its high spatial resolution and excellent tissue contrast. The diagnosis of rheumatic diseases can often be challenging. Investigation with conventional two- ... ...

    Abstract Magnetic resonance imaging (MRI) is commonly used to evaluate musculoskeletal pathologies due to its high spatial resolution and excellent tissue contrast. The diagnosis of rheumatic diseases can often be challenging. Investigation with conventional two-dimensional MRI is helpful for diagnosis and monitoring treatment. In the past few years, three-dimensional (3D) MRI has been more commonly used to assess joint pathologies including inflammatory and rheumatic diseases. This review discusses the techniques and protocols of 3D MRI and its diagnostic yield in the assessment of rheumatic diseases, along with different examples.
    MeSH term(s) Humans ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging ; Rheumatic Diseases/diagnostic imaging
    Language English
    Publishing date 2021-09-21
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1360919-1
    ISSN 1098-898X ; 1089-7860
    ISSN (online) 1098-898X
    ISSN 1089-7860
    DOI 10.1055/s-0041-1731058
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  5. Article ; Online: Diffusion weighted imaging of extremity bone tumors-inter-reader analysis and incremental value over conventional MR imaging.

    Guirguis, Mina / Gupta, Anurag / Thakur, Uma / Pezeshk, Parham / Weatherall, Paul / Sharan, Gaurav / Xi, Yin / Chhabra, Avneesh

    The British journal of radiology

    2023  Volume 96, Issue 1151, Page(s) 20230352

    Abstract: Objective: To determine whether the addition of diffusion-weighted imaging (DWI) to conventional MRI improves diagnostic accuracy of bone tumor characterization with the hypothesis that the DWI has incremental value in the diagnosis of osseous tumors.!## ...

    Abstract Objective: To determine whether the addition of diffusion-weighted imaging (DWI) to conventional MRI improves diagnostic accuracy of bone tumor characterization with the hypothesis that the DWI has incremental value in the diagnosis of osseous tumors.
    Methods: In this multireader cross-sectional validation study, four musculoskeletal radiologists evaluated osseous tumors blinded to final diagnosis in two rounds-first without DWI or apparent diffusion coefficient (ADC) maps, then months later with these available. Each reader recorded a binary result as to whether the lesion is benign or malignant. Intraclass correlation (ICC) and Conger's κ were used. Diagnostic performance measures including area under the receiver operating curve (AUC) were reported.
    Results: 133 osseous tumors of the extremities (76 benign, 57 malignant) were tested. Blinded to DWI, average reader sensitivity, specificity, positive-predictive value, and negative-predictive value were 0.83, 0.92, 0.94, and 0.82, respectively. With DWI, the values were 0.85, 0.92, 0.94, and 0.83, respectively. Interreader agreement was good for both rounds (0.67 and 0.71, respectively,
    Conclusion: DWI and ADC show statistically significantly different values of benign from malignant osseous tumors and mildly increased radiologist confidence with similar interreader reliability. However, given similar diagnostic accuracy, conventional MR imaging is adequate for bone tumor characterization and incremental value of DWI is limited.
    Advances in knowledge: This paper is the first of its kind to report the use of DWI/ADC ratio for the diagnosis of bone tumors.
    MeSH term(s) Humans ; Reproducibility of Results ; Cross-Sectional Studies ; Sensitivity and Specificity ; Magnetic Resonance Imaging ; Diffusion Magnetic Resonance Imaging/methods ; Diagnosis, Differential ; Bone Neoplasms/diagnostic imaging ; Retrospective Studies
    Language English
    Publishing date 2023-07-26
    Publishing country England
    Document type Journal Article
    ZDB-ID 2982-8
    ISSN 1748-880X ; 0007-1285
    ISSN (online) 1748-880X
    ISSN 0007-1285
    DOI 10.1259/bjr.20230352
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  6. Article ; Online: Incremental value of diffusion weighted imaging over conventional MRI for the diagnosis of osteomyelitis of extremities.

    Guirguis, Mina / Pezeshk, Parham / Ashikyan, Oganes / Gowda, Prajwal / Archer, Holden / Hoang, Diana / Xi, Yin / Chhabra, Avneesh

    Skeletal radiology

    2023  Volume 52, Issue 9, Page(s) 1669–1682

    Abstract: Objective: To determine the incremental value of diffusion weighted imaging (DWI) over conventional MR imaging in diagnosing extremity osteomyelitis (OM).: Materials and methods: In this cross-sectional study, three experienced musculoskeletal ... ...

    Abstract Objective: To determine the incremental value of diffusion weighted imaging (DWI) over conventional MR imaging in diagnosing extremity osteomyelitis (OM).
    Materials and methods: In this cross-sectional study, three experienced musculoskeletal radiologists evaluated clinically suspected cases of extremity OM in two rounds-first on conventional MR imaging, and then conventional MR imaging combined with DWI 4-6 weeks later. The readers recorded a result of the presence or absence of OM and their diagnostic confidence on a 1-5 scale. Mean and minimum apparent diffusion coefficient (ADC) were measured. Pathology diagnosis served as the reference standard. Statistical analysis utilized intraclass correlation (ICC) and Conger's kappa.
    Results: A total of 213 scans of suspected OM were reviewed by three musculoskeletal radiologists with no significant changes in sensitivity (0.97, 0.97), specificity (0.97, 0.94), positive predictive value (0.91, 0.87), or negative predictive value (0.98, 0.98) between conventional MR imaging and MR imaging combined with DWI, respectively. Reader confidence did not significantly change with the addition of DWI (4.55 and 4.70, respectively). A high inter-reader agreement was observed for the diagnosis of OM, soft tissue abscess, and intraosseous abscess in both rounds. A higher mean (1.46+/-0.43 × 10
    Conclusion: DWI-derived ADC increase is associated with OM. The use of DWI slightly increases reader confidence in the diagnosis of OM; however, no significant incremental value over conventional MR imaging is seen for the final diagnosis of OM.
    MeSH term(s) Humans ; Abscess ; Cross-Sectional Studies ; Diffusion Magnetic Resonance Imaging/methods ; Magnetic Resonance Imaging ; Osteomyelitis/diagnostic imaging ; Extremities ; Sensitivity and Specificity ; Retrospective Studies
    Language English
    Publishing date 2023-04-01
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 527592-1
    ISSN 1432-2161 ; 0364-2348
    ISSN (online) 1432-2161
    ISSN 0364-2348
    DOI 10.1007/s00256-023-04331-6
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  7. Article ; Online: Predictive Value of Radiographic and Magnetic Resonance Imaging Characteristics on Patient Outcomes in Confirmed Acute Osteomyelitis of the Extremities.

    Archer, Holden / Ashikyan, Oganes / Pezeshk, Parham / Guirguis, Mina / Gowda, Prajwal / Hoang, Diana / Xi, Yin / Chhabra, Avneesh

    Journal of computer assisted tomography

    2023  Volume 47, Issue 5, Page(s) 759–765

    Abstract: Objective: The aim of this study was to determine whether imaging characteristics on plain radiography, magnetic resonance imaging (MRI), and diffusion-weighted imaging are predictive of patient outcomes in cases of confirmed osteomyelitis (OM).: ... ...

    Abstract Objective: The aim of this study was to determine whether imaging characteristics on plain radiography, magnetic resonance imaging (MRI), and diffusion-weighted imaging are predictive of patient outcomes in cases of confirmed osteomyelitis (OM).
    Materials and methods: In this cross-sectional study, 3 experienced musculoskeletal radiologists evaluated pathologically proven cases of acute extremity OM and recorded imaging characteristics on plain radiographs, MRI, and diffusion-weighted imaging. These characteristics were then compared with the patient outcomes after a 3-year follow-up using length of stay, amputation-free survival, readmission-free survival, and overall survival using multivariate Cox regression analysis. Hazard ratio and corresponding 95% confidence intervals are reported. False discovery rate-adjusted P values were reported.
    Results: For the 75 consecutive cases of OM in this study, multivariate Cox regression analysis adjusting for sex, race, age, body mass index, erythrocyte sedimentation rate, C-reactive protein, and white blood cell count showed no correlation among any of the recorded characteristics on imaging and patient outcomes. Despite the high sensitivity and specificity of MRI for diagnosing OM, there was no correlation between MRI characteristics and patient outcomes. Furthermore, patients with coexistent abscess of the soft tissue or bone with OM had comparable outcomes using the previously mentioned metrics of length of stay, amputation-free survival, readmission-free survival, and overall survival.
    Conclusion: Neither radiography nor MRI features predict patient outcomes in extremity OM.
    MeSH term(s) Humans ; Cross-Sectional Studies ; Retrospective Studies ; Magnetic Resonance Imaging/methods ; Osteomyelitis/diagnostic imaging ; Osteomyelitis/complications ; Extremities/diagnostic imaging
    Language English
    Publishing date 2023-06-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80392-3
    ISSN 1532-3145 ; 0363-8715
    ISSN (online) 1532-3145
    ISSN 0363-8715
    DOI 10.1097/RCT.0000000000001483
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  8. Article ; Online: Diagnostic performance comparison of conventional radiography to magnetic resonance imaging for suspected osteomyelitis of the extremities: a multi-reader study.

    Gowda, Prajwal / Ashikyan, Oganes / Pezeshk, Parham / Guirguis, Mina / Archer, Holden / Hoang, Diana / Xi, Yin / Chhabra, Avneesh

    European radiology

    2023  Volume 33, Issue 11, Page(s) 8300–8309

    Abstract: Objective: To determine whether MRI provides improved diagnostic accuracy compared to radiography for the diagnosis of extremity osteomyelitis (OM) with multi-reader analysis.: Methods: In this cross-sectional study, three musculoskeletal fellowship- ... ...

    Abstract Objective: To determine whether MRI provides improved diagnostic accuracy compared to radiography for the diagnosis of extremity osteomyelitis (OM) with multi-reader analysis.
    Methods: In this cross-sectional study, three musculoskeletal fellowship-trained expert radiologists evaluated cases of suspected OM in two rounds-first using radiographs (XR), then with conventional MRI. Radiologic features consistent with OM were recorded. Each reader recorded individual findings on both modalities and rendered a binary diagnosis along with certainty of final diagnosis on a confidence scale of 1-5. This was compared with the pathology-proven diagnosis of OM to determine diagnostic performance. Intraclass correlation (ICC) and Conger's Kappa were used for statistics.
    Results: XR and MRIs of 213 pathology proven cases (51.5 years ± 14.0 years, mean ± St.Dev.) were included in this study, with 79 tested positive for OM and 98 were positive for a soft tissue abscess, with 78 patients being negative for both. In total, 139 were males and 74 females with bones of interest in the upper and lower extremities in 29 and 184 cases, respectively. MRI showed significantly higher sensitivity and negative predictive value than XR (p < 0.001 for both metrics). Conger's Kappa for OM diagnosis were 0.62 and 0.74 on XR and MRI, respectively. Reader confidence improved slightly from 4.54 to 4.57 when MRI was used.
    Conclusions: MRI is a diagnostically more effective imaging modality than XR for finding extremity osteomyelitis with better inter-reader reliability.
    Clinical relevance statement: This study validates the diagnosis of OM with MRI over XR but adds novelty because it is the largest study of its kind with a clear reference standard to guide clinician decision making.
    Key points: • Radiography is the first-line imaging modality for musculoskeletal pathology but MRI can add value for infections. • MRI shows greater sensitivity for the diagnosis of osteomyelitis of the extremities than radiography. • This improved diagnostic accuracy makes MRI a better imaging modality for patients with suspected osteomyelitis.
    MeSH term(s) Male ; Female ; Humans ; Reproducibility of Results ; Cross-Sectional Studies ; Radiography ; Magnetic Resonance Imaging/methods ; Osteomyelitis/diagnostic imaging ; Lower Extremity ; Retrospective Studies
    Language English
    Publishing date 2023-05-13
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1085366-2
    ISSN 1432-1084 ; 0938-7994 ; 1613-3749
    ISSN (online) 1432-1084
    ISSN 0938-7994 ; 1613-3749
    DOI 10.1007/s00330-023-09734-6
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  9. Article ; Online: Osseous-Tissue Tumor Reporting and Data System With Diffusion-Weighted Imaging of Bone Tumors-An Interreader Analysis and Whether It Adds Incremental Value on Tumor Grading Over Conventional Magnetic Resonance Imaging.

    Guirguis, Mina / Gupta, Anurag / Thakur, Uma / Pezeshk, Parham / Weatherall, Paul / Sharan, Gaurav / Xi, Yin / Chhabra, Avneesh

    Journal of computer assisted tomography

    2023  Volume 47, Issue 2, Page(s) 255–263

    Abstract: Objective: The aim of the study is to determine whether the use of diffusion-weighted imaging (DWI) provides incremental increase in performance in the osseous-tissue tumor reporting and data system (OT-RADS) with the hypothesis that use of DWI improves ...

    Abstract Objective: The aim of the study is to determine whether the use of diffusion-weighted imaging (DWI) provides incremental increase in performance in the osseous-tissue tumor reporting and data system (OT-RADS) with the hypothesis that use of DWI improves interreader agreement and diagnostic accuracy.
    Methods: In this multireader cross-sectional validation study, multiple musculoskeletal radiologists reviewed osseous tumors with DW images and apparent diffusion coefficient maps. Four blinded readers categorized each lesion using the OT-RADS categorizations. Intraclass correlation (ICC) and Conger κ were used. Diagnostic performance measures including area under the receiver operating curve were reported. These measures were then compared with the previously published work that validated OT-RADS but did not include incremental value assessment of DWI.
    Results: One hundred thirty-three osseous tumors of the upper and lower extremities (76 benign, 57 malignant) were tested. Interreader agreement for OT-RADS with DWI (ICC = 0.69) was slightly lower (not statistically different) from the previously published work that did not incorporate DWI (ICC = 0.78, P > 0.05). The mean sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve including DWI of the 4 readers were 0.80, 0.95, 0.96, 0.79, and 0.91, respectively. In the previously published work without DWI, the mean values of the readers were 0.96, 0.79, 0.78, 0.96, and 0.94, respectively.
    Conclusions: The addition of DWI to the OT-RADS system does not allow significantly improved area under the curve diagnostic performance measure. Conventional magnetic resonance imaging can be prudently used for OT-RADS for reliable and accurate characterization of bone tumors.
    MeSH term(s) Humans ; Bone Neoplasms/diagnostic imaging ; Contrast Media ; Cross-Sectional Studies ; Diffusion Magnetic Resonance Imaging/methods ; Magnetic Resonance Imaging/methods ; Neoplasm Grading ; Retrospective Studies ; Sensitivity and Specificity ; Reproducibility of Results
    Chemical Substances Contrast Media
    Language English
    Publishing date 2023-03-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80392-3
    ISSN 1532-3145 ; 0363-8715
    ISSN (online) 1532-3145
    ISSN 0363-8715
    DOI 10.1097/RCT.0000000000001415
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  10. Article: 3D MRI of the Rheumatic Diseases

    Ezzati, Fatemeh / Chalian, Majid / Pezeshk, Parham

    Seminars in Musculoskeletal Radiology

    (3D MRI of the Musculoskeletal System)

    2021  Volume 25, Issue 03, Page(s) 425–432

    Abstract: Magnetic resonance imaging (MRI) is commonly used to evaluate musculoskeletal pathologies due to its high spatial resolution and excellent tissue contrast. The diagnosis of rheumatic diseases can often be challenging. Investigation with conventional two- ... ...

    Series title 3D MRI of the Musculoskeletal System
    Abstract Magnetic resonance imaging (MRI) is commonly used to evaluate musculoskeletal pathologies due to its high spatial resolution and excellent tissue contrast. The diagnosis of rheumatic diseases can often be challenging. Investigation with conventional two-dimensional MRI is helpful for diagnosis and monitoring treatment. In the past few years, three-dimensional (3D) MRI has been more commonly used to assess joint pathologies including inflammatory and rheumatic diseases. This review discusses the techniques and protocols of 3D MRI and its diagnostic yield in the assessment of rheumatic diseases, along with different examples.
    Keywords 3D isotropic ; magnetic resonance imaging ; rheumatoid diseases ; rheumatoid arthritis ; spondyloarthritis
    Language English
    Publishing date 2021-06-01
    Publisher Thieme Medical Publishers, Inc.
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 1360919-1
    ISSN 1098-898X ; 1089-7860
    ISSN (online) 1098-898X
    ISSN 1089-7860
    DOI 10.1055/s-0041-1731058
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