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Trunz LM, Landy JE, Dodson CC, Cohen SB, Zoga AC, Roedl JB. Effectiveness of Hematoma Aspiration and Platelet-rich Plasma Muscle Injections for the Treatment of Hamstring Strains in Athletes. Med Sci Sports Exerc 2022; 54:12-17. [PMID: 34310495 DOI: 10.1249/mss.0000000000002758] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The effect of platelet-rich plasma (PRP) treatment on recovery in acute hamstring injuries is controversial. Previous study results are inconsistent, and a standardized therapeutic approach has not been established yet. PURPOSE To assess the treatment effect using a combination of hematoma aspiration and muscle strain PRP injection in partial hamstring muscle tears (grade 2 strains) in athletes. METHODS Magnetic resonance imaging of athletes with grade 2 hamstring strains were reviewed from 2013 to 2018. From 2013 to 2015, athletes were treated conservatively, and from 2016 to 2018, with a combination of ultrasound-guided hematoma aspiration and PRP muscle strain injection. The outcome, including return-to-play (in days) and recurrence rate, was compared retrospectively between both groups (conservative vs aspiration/PRP) using ANOVA and Fisher's exact test. There was no significant difference in age, type of sport, and muscle involvement (including injury grade/location, hamstring muscle type, and length/cross-sectional area of the strain). RESULTS Fifty-five athletes (28 treated conservatively, 27 with hematoma aspiration/PRP injection) were included. Average return-to-play time (mean) was 32.4 d in the conservative group and 23.5 d in the aspiration/PRP group (P < 0.001). Recurrence rate of the hamstring strain was 28.6% (8/28) in the conservative treatment group and less than 4% (1/27) in the aspiration/PRP group (P = 0.025). CONCLUSIONS Athletes with grade 2 hamstring strains treated with a combination of hematoma aspiration and PRP injection had a significantly shorter return-to-play and a lower recurrence rate compared with athletes receiving conservative treatment.
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Affiliation(s)
- Lukas M Trunz
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Jeffrey E Landy
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Christopher C Dodson
- Divison of Sports Medicine, Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Rothman Orthopaedic Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Steven B Cohen
- Divison of Sports Medicine, Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Rothman Orthopaedic Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Adam C Zoga
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Johannes B Roedl
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Trunz LM, Eschelman DJ, Gonsalves CF, Adamo RD, Dave JK. Investigation of Radiation Dose Estimates and Image Quality Between Commercially Available Interventional Fluoroscopy Systems for Fluoroscopically Guided Interventional Procedures. Acad Radiol 2021; 28:1559-1569. [PMID: 32224035 DOI: 10.1016/j.acra.2020.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/12/2020] [Accepted: 02/23/2020] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate differences in radiation dose and image quality for single-plane flat-panel-detector based interventional fluoroscopy systems from two vendors using phantom study and clinical procedures. MATERIALS AND METHODS AlluraClarityIQ (Philips) and Artis Q (Siemens-Healthineers) interventional fluoroscopy systems were evaluated. Phantom study included comparison of system-reported air-kerma rates (AKR) for clinical protocols with simulated patient thicknesses (20-40 cm). Differences in system-reported radiation dose estimates, cumulative-air-kerma (CAK) and kerma-area-product (KAP), for different clinical procedures were investigated. Subset analysis investigated differences in CAK, KAP and other factors affecting radiation dose when the same patients underwent repeat embolization procedures performed by the same physician on the two different fluoroscopy systems. Two blinded interventional radiologists reviewed image-quality for these procedures using a five-point scale (1-5; 5-best) for five parameters. RESULTS Phantom study revealed that air-kerma rates was significantly higher for Artis Q system for 30-40cm of simulated patient thicknesses (p < 0.05). Overall data analysis from 4381 clinical cases revealed significant differences in CAK and KAP for certain procedures (p < 0.05); with significantly lower values for AlluraClarityIQ systems (median CAK lower by: 29%-58%). Subset analysis with 40 patients undergoing repeat embolization procedures on both systems revealed that median CAK and KAP were significantly lower for AlluraClarityIQ systems (p < 0.02) by 45% and 31%, respectively. Image quality scores for AlluraClarityIQ systems were significantly greater (mean difference range for five parameters: 1.3-1.6; p < 0.005). CONCLUSION Radiation dose and image quality differences were observed between AlluraClarityIQ and Artis Q systems. AlluraClarityIQ systems showed lower radiation utilization and an increase in subjective perception of image quality.
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Trunz LM, Lee P, Lange SM, Pomeranz CL, Needleman L, Ford RW, Karambelkar A, Sundaram B. Imaging approach to COVID-19 associated pulmonary embolism. Int J Clin Pract 2021; 75:e14340. [PMID: 33966326 PMCID: PMC8237008 DOI: 10.1111/ijcp.14340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/04/2021] [Indexed: 12/21/2022] Open
Abstract
The novel coronavirus disease-2019 (COVID-19) illness and deaths, caused by the severe acute respiratory syndrome coronavirus-2, continue to increase. Multiple reports highlight the thromboembolic complications, such as pulmonary embolism (PE), in COVID-19. Imaging plays an essential role in the diagnosis and management of COVID-19 patients with PE. There continues to be a rapid evolution of knowledge related to COVID-19 associated PE. This review summarises the current understanding of prevalence, pathophysiology, role of diagnostic imaging modalities, and management, including catheter-directed therapy for COVID-19 associated PE. It also describes infection control considerations for the radiology department while providing care for patients with COVID-19 associated PE.
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Affiliation(s)
- Lukas M. Trunz
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Patrick Lee
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Steven M. Lange
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | | | | | - Robert W. Ford
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Ajit Karambelkar
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
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Trunz LM, Guglielmo FF, Selvarajan SK, Naringrekar HV, Alturki A, Dave JK, Mitchell DG. Biliary excretion of gadobenate dimeglumine causing degradation of magnetic resonance cholangiopancreatography (MRCP). Abdom Radiol (NY) 2021; 46:562-569. [PMID: 32743690 DOI: 10.1007/s00261-020-02686-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/21/2020] [Accepted: 07/25/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the effect of gadobenate dimeglumine on magnetic resonance cholangiopancreatography (MRCP) and determine an appropriate time frame for performing MRCP sequences. MATERIALS AND METHODS 2D MRCP sequences obtained after intravenous administration of gadobenate dimeglumine or gadobutrol over 14 months were reviewed retrospectively in randomized order by five abdominal radiologists, using a 3-point scale to rate biliary and pancreatic duct clarity (1 = no-, 2 = limited-, 3 = good visualization). Intraclass correlation coefficients were computed and mean scores were compared for both agents. For gadobenate dimeglumine exams, time delays between arterial phase and MRCP acquisition times were analyzed concerning duct clarity. For gadobutrol, only exams with delays ≥ 15 min were included. RESULTS 134 exams (107 gadobenate dimeglumine, 27 gadobutrol) were included. Moderate reliability for pancreatic duct visualization and excellent reliability for visualization of intrahepatic bile ducts and upper and lower extrahepatic bile ducts were noted. No difference in mean scores was noted for pancreatic duct visualization (p = 0.66). Bile duct segment scores were lower with gadobenate dimeglumine (mean: 2.1-2.6) compared with gadobutrol (mean: 2.8-2.9) (p ≤ 0.006). For gadobenate dimeglumine, visualization scores varied depending on the delay between the arterial phase and MRCP acquisition (p ≤ 0.047). Good visualization for all bile duct segments was noted with delays of 7.2-9.4 min (95% confidence interval; mean 8.3 min). CONCLUSION Bile duct clarity degraded on MRCP images with an increasing delay following gadobenate dimeglumine injection. 2D MRCP, thus, should be performed within 7.2 min after obtaining the arterial phase sequence to ensure good visualization of the entire biliary system.
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Affiliation(s)
- Lukas M Trunz
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA.
| | - Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA
| | - Santosh K Selvarajan
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA
| | - Haresh V Naringrekar
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA
| | - Abdullah Alturki
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA
| | - Jaydev K Dave
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA
| | - Donald G Mitchell
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA
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Trunz LM, Gandhi AV, Karambelkar AD, Lange SM, Rao VM, Flanders AE. National Trends in Lumbar Puncture from 2010 to 2018: A Shift Reversal from the Emergency Department to the Hospital Setting for Radiologists and Advanced Practice Providers. AJNR Am J Neuroradiol 2021; 42:206-210. [PMID: 33184070 DOI: 10.3174/ajnr.a6870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/11/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Prior research has shown substantial shifts in procedure shares between specialty groups providing lumbar punctures. Our aim was to analyze national trends in lumbar punctures among the Medicare population from 2010 to 2018. MATERIALS AND METHODS Medicare Part B Physician/Supplier Procedure Summary Master Files from 2010 to 2018 were analyzed for all Current Procedural Terminology, Version 4 codes related to lumbar punctures (62270 and 62272). Lumbar puncture procedure volume and utilization rates were assessed and stratified by place of service and specialty background of the providers. RESULTS From 2010 to 2018, the overall number of lumbar puncture procedures essentially has not changed (92,579 versus 92,533). Radiologists hold the largest and an increasing procedure share of diagnostic and overall lumbar punctures (overall share, 45.7% in 2010 [n = 42,296] versus 52.3% in 2018 [n = 48,414]). Advanced practice providers have increased their procedure share (3.7% in 2010 [n = 3388] versus 8.4% in 2018 [n = 7785], + 129.8% procedure volume). Emergency medicine physicians and neurologists have a decreasing procedure share (21.8% versus 15.3% and 12.5% versus 8.8%, respectively). The inpatient hospital setting remains the largest place of service for lumbar punctures, recording a 5.3% increase in procedure share. The emergency department lumbar puncture volume has declined, with a 7.4% decrease in the overall procedure share. Similarly, the hospital outpatient department procedure volume has increased (+4%), while the private office volume has decreased (-1.7%). CONCLUSIONS During the past decade, lumbar puncture procedures among the Medicare population have remained stable, with a shift in procedure volume from the emergency department and private offices to the hospital setting, which has mainly affected radiologists and advanced practice providers.
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Affiliation(s)
- L M Trunz
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - A V Gandhi
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - A D Karambelkar
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - S M Lange
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - V M Rao
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - A E Flanders
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Trunz LM, Talekar KS, Stein A, Karambelkar A. Hyperacute intracranial hemorrhage with extensive contrast extravasation and rapid hematoma expansion imaged at onset with magnetic resonance imaging. Neuroradiol J 2020; 34:253-256. [PMID: 33307961 DOI: 10.1177/1971400920980151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Evaluation for intracranial hemorrhage is a common indication when performing imaging of the head in the emergency setting. We present a rare case of active, spontaneous extravasation of blood into the brain parenchyma, which evolved during a magnetic resonance imaging examination. A 70-year-old woman who had no previous history of hypertension or trauma underwent magnetic resonance imaging of the brain for confusion and dysarthria. Initial imaging sequences did not demonstrate an acute cerebral hemorrhage; however, subsequent fluid-attenuated inversion recovery, T2- and T1-weighted sequences demonstrated a progressively enlarging signal abnormality. Extravasation of contrast was noted after the administration of gadolinium-based contrast, indicating active intraparenchymal hemorrhage. A computed tomography scan was performed after magnetic resonance imaging to confirm the findings.
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Affiliation(s)
- Lukas M Trunz
- Department of Radiology, 23217Thomas Jefferson University Hospital, USA
| | - Kiran S Talekar
- Department of Radiology, 23217Thomas Jefferson University Hospital, USA
| | - Asher Stein
- Department of Radiology, 23217Thomas Jefferson University Hospital, USA
| | - Ajit Karambelkar
- Department of Radiology, 23217Thomas Jefferson University Hospital, USA
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Trunz LM, Faro SH, Gorniak RJ. Osteoblastoma in the occipital bone: A case report of a rare tumor in the calvarium. Radiol Case Rep 2020; 15:610-614. [PMID: 32215163 PMCID: PMC7090311 DOI: 10.1016/j.radcr.2020.02.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/22/2020] [Accepted: 02/23/2020] [Indexed: 11/24/2022] Open
Abstract
Osteoblastomas infrequently occur in the calvarium, displaying a preference for temporal and frontal bones when it does. We present an unusual case of a large, expansile osteoblastoma in the occipital bone of a 23-year-old man who presented with a nontender lump at the back of his head. Initial computed tomography scan showed a large occipital bone mass, and after additional imaging, a gross total resection was performed. Histopathological examination revealed an osteoblastoma. Although these tumors are benign, overlapping imaging characteristics of lesions affecting the calvarium often present a diagnostic dilemma. This case emphasizes the importance of imaging in the management and work-up of these patients to decrease the risk of complications and assists surgeons in their preoperative planning.
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Affiliation(s)
- Lukas M Trunz
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Scott H Faro
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Richard J Gorniak
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
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