From The ViewBox

In this episode, we discuss the imaging of hepatocellular carcinoma and liver transplantation with our guest Dr. Mark Masciocchi, Director of Body MRI. This is the first of a two part series. Key discussion points in this episode include:

- Diagnosis of HCC on imaging, with emphasis on MRI.

- Importance of imaging for considering patients for liver transplantation.

- Common complications after transplantation.

Hosts: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology. Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Guest: Mark Masciocchi, MD. Assistant Professor of Radiology, Division of Abdominal Imaging, UMMS Dept of Radiology.

References:

Catalano OA, Singh AH, Uppot RN, Hahn PF, Ferrone CR, Sahani DV. Vascular and Biliary Variants in the Liver: Implications for Liver Surgery. RadioGraphics. 2008;28(2):359-378. doi:10.1148/rg.282075099

Vascular and Biliary Variants in the Liver: Implications for Liver Surgery | RadioGraphics. Accessed August 24, 2020. https://pubs.rsna.org/doi/full/10.1148/rg.282075099

In this episode we welcome a special guest, Dr. Max Rosen – Chair of Radiology at UMMS. Dr. Rosen provides an overview of the department, including its history and growth. We discuss the organization of the department and introduce the clinical, research and educational missions of the department. Dr. Rosen shares his thoughts on what a prospective trainee or faculty member might want to know about the department.

Hosts: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology. Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Guest: Max P. Rosen, MD, MPH. Professor and Chair, UMMS Dept of Radiology.

References:

UMass Radiology. Message from the Chair. https://www.umassmed.edu/radiology/about-us/message-from-the-chair/

In this episode our guest, Dr. Carolynn Debenedectis rejoins us to discusses BI-RADS classification. This podcast is designed to give junior residents the basics they need to know to understand and use BI-RADS on their breast imaging rotation.

Host: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology. Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Guest: Carolynn Debenedectis, MD. Associate Professor of Radiology, Division of Breast Imaging, UMMS Dept of Radiology.

Resources:

• Rao A, Feneis J, Lalonde C, Ojeda-Fournier, H. A Pictorial Review of Changes in the BI-RADS Fifth Edition. 2016; 36:623-639. https://pubs.rsna.org/doi/10.1148/rg.2016150178

In this episode our guest, Dr. Ryan Tai discusses septic arthritis and the radiologist’s role in its work-up, diagnosis and management. The learning objectives for this podcast include:

1. Describe the pathophysiology of septic arthritis

2. Discuss the clinical manifestations of septic arthritis

3. Understand the role of imaging in the work-up of septic arthritis

4. Understand the role of joint aspiration in the diagnosis of septic arthritis

5. Briefly describe the treatment of septic arthritis

Host: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology. Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Guest: Ryan Tai, MD. Assistant Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology.

Resources:

• Karchevsky, M et al. MRI Findings of Septic Arthritis and Associated Osteomyelitis in Adults. AJR 2004;192:119-122.

• Greenspan, A and Tehransadeh J. Imaging of Infectious Arthritis. Radiology Clinics of North America 2001;39(2):267-276.

In this episode our guest, Dr. Carolynn Debenedectis - Residency Program Director and Vice Chair of Education, will summarize what programs directors are looking for in your application to radiology residency. We will also discuss how COVID is changing the application season this year.

Host: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology. Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Guest: Carolynn Debenedectis, MD. Associate Professor of Radiology, Division of Breast Imaging, UMMS Dept of Radiology.

Resources:

• COVID-19 and the Radiology Match: A Residency Program’s Survival Guide to the Virtual Interview Season. Acad Radiol 2020; July. DOI:10.1016/j.acra.2020.06.023 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340060/

In this episode our guest, Dr. Carolynn Debenedectis, discusses what to do during your first year of radiology to be successful. We will discuss the top 3 things program directors look for in the ideal 1st year radiology resident.

Host: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology. Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Guest: Carolynn Debenedectis, MD. Associate Professor of Radiology, Division of Breast Imaging, UMMS Dept of Radiology.

Resources:

• Getting Started: A Guide to Year One of Radiology Residency. https://www.acr.org/-/media/ACR/Files/RFS/RFS_Guide_Final.pdf

In this episode our guest, Dr. Byron Chen, continues his discussion from Episode 14 on the art of taking a case in radiology. In part 2 of the series, Dr. Chen continues the step-by-step primer based on his approach. This episode includes a discussion of presenting differential diagnosis and management, as well as suggestions and insight for trainees taking cases orally.

Guest: Byron Chen, MD. Assistant Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Host: Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Resources:

• Gunderman, Richard B., and Henry Y. Chou. The future of radiology consultation. Radiology (2016): 6-9. https://doi.org/10.1148/radiol.2016152781

• Currie, S., et al. How confident are general practitioners in interpreting neuroradiology reports? Clinical radiology 73.11 (2018): 944-950. https://doi.org/10.1016/j.crad.2018.06.013

In this episode our guest, Dr. Byron Chen, discusses the art of taking a case in radiology, starting with the historical perspective. He gives us a step-by-step primer based on his approach, filled with many do’s and don’ts. Finally, we discuss the past, present and future of consultative radiology. This is the first of a two-part series.

Guest: Byron Chen, MD. Assistant Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Host: Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Resources:

• Gunderman, Richard B., and Henry Y. Chou. The future of radiology consultation. Radiology (2016): 6-9. https://doi.org/10.1148/radiol.2016152781

• Currie, S., et al. How confident are general practitioners in interpreting neuroradiology reports? Clinical radiology 73.11 (2018): 944-950. https://doi.org/10.1016/j.crad.2018.06.013

Eponyms in radiology have historically been used to describe many types of imaging findings. In this episode, Dr. Watts will discuss with us why we use eponyms and present a list of MSK eponym “categories”. Selected eponyms used in MSK imaging will be presented.

Guest: George (Chip) Watts, MD. Assistant Professor of Radiology, Divisions of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology.

Hosts: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology.

Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Outline of the Eponyms reviewed in today’s podcast is included:

MSK eponym ‘categories’

• Fractures and traumatic injury patterns

• Tumors

• Tumor-like lesions

• Classification/grading systems

• Congenital/metabolic/syndromic

Upper extremity fractures and traumatic injury patterns

• Shoulder

-Hill-Sachs

-Bankart

• Elbow/Forearm

-Essex-Lopresti

-Galleazi

-Monteggia

• Wrist

-Colles

-Smith

-Barton

• Hand

-Bennett

-Rolando

Lower extremity fractures and traumatic injury patterns

• Knee

-Segond

-Pellegrini-Stieda

• Lower leg/Ankle

-Maisonneuve

-Tillaux

-Weber

• Foot

-Lisfranc

-Jones

• **Deferred - Head/Neck/Spine/Pelvis trauma

• Tumors

-Askin Tumor

-Ewing Sarcoma

-Evans Tumor

-Kaposi Sarcoma

-Mafucci Syndrome

-Ollier Disease

-Morton Neuroma

Hunter TB, Peltier LF, Lund PJ. Musculoskeletal Eponyms: Who Are Those Guys? RadioGraphics. 2000; 20: 819-836. DOI: 10.1148/radiographics.20.3.g00ma20819

Hwang S., Schneider, R. Eponyms of Tumors and Tumorlike Lesions in the Musculoskeletal System: Who Were the People and What Are the Lesions? Pictorial Review. AJR 2010; 195: S50–S61. DOI: 10.2214/AJR.07.7137

Dr. Sereni returns to continue his discussion on meniscal injuries. In this podcast Dr. Sereni discusses the evolution of previously discussed basic tears into complex and displaced tears.

Guest: Christopher Sereni, MD. Assistant Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology.

Host: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology.

Review

•Abnormal signal or abnormal morphology

•Three basic types of tears

-Longitudinal vertical (aka the can-opener)

-Horizontal (pita bread)

-Radial (pizza slicer)

-Complex tear - nonstandard combination of basic tear types

Tears in the setting of an ACL injury - a frequently overlooked setting

•Mensicocapsular separation

•Wrisberg rip

-ACL tear allows tibia to translate anteriorly

-Ligament of Wrisberg causes traction on posterior horn of the lateral meniscus, causing vertical longitudinal tear

Displaced tears

•Longitudinal vertical --> bucket handle tear

-central migration of inner portion with or without flipping

-signs - not the be-all end-all

-fragment in the notch

-double anterior horn

-double PCL

-Small posterior horn/body

•Horizontal tear --> flap tear

-inferior flap tear could potentially go unnoticed on arthroscopy

-boomerang sign

-common displaced tear

•Radial oblique tear --> Parrot beak tear

-Displaced flap

-Parrot beak appearance on axial sequence

Resources:

• Saad SS, Gorbachova T, Saing M (2015) Meniscal tears: scanned, scoped, and sculpted. Radiographics 35(4):1138–1139

• De Smet AA. How I diagnose meniscal tears on knee MRI. AJR Am J Roentgenol 2012;199(3):481–499.