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Biomedical subjects

Michael E Mulligan

Publications and source records attributed to Michael E Mulligan.

9 recordsLinked to original sources
PubMed2006

Initial experience with Lodox Statscan imaging system for detecting injuries of the pelvis and appendicular skeleton.

The purpose of this study is to assess detection of pelvic and extremity injuries employing a rapid whole-body imaging system (Lodox Statscan). We retrospectively reviewed 37 consecutive cases. The study was approved by our hospital review board and carried out with Health Insurance Portability and Accountability Act (HIPAA) compliance. Anterior-posterior (AP) whole-body Lodox Statscan (LS) exams, obtained in 10-13 s, were reviewed by two musculoskeletal radiologists. Each patient's concurrent computed radiographs (CR) and computed tomographic (CT) studies were reviewed at a later date. There were 23 males and 14 females; ages ranged from 14 to 103 years (average 40 years). Sixteen patients had a total of 73 abnormalities seen on LS, CR or CT. The LS examination identified 47 abnormalities (64.4%) in 15 patients. Twenty-six additional abnormalities were detected with the other modalities (CR, CT) in 11 patients; 8 were evident on LS images in retrospect, with the remaining 18 not identified even retrospectively. Of these retrospectively occult injuries, only one was deemed significant to the acute management of the patient. The LS imaging system seems to be a useful tool for rapid screening of multitrauma patients.

Adolescent↗
PubMed2006

PET/CT and MR imaging in myeloma.

Myeloma is the most common primary bone malignancy. It accounts for 10% of all hematological malignancies and 1% of all cancers. In the United States, there are an estimated 16,000 new cases and over 11,000 deaths yearly due to myeloma. Plasma cell dyscrasias manifest themselves in a variety of forms that range from MGUS (monoclonal gammopathy of undetermined significance) and smoldering myeloma that require no therapy, to the "malignant" form of multiple myeloma. The role of imaging in the management of myeloma includes: an assessment of the extent of intramedullary bone disease, detection of any extramedullary foci, and severity of the disease at presentation; the identification and characterization of complications; subsequent assessment of disease status. This review will focus on the use of PET/CT and MR imaging for myeloma patients at the time of initial diagnosis and for follow-up management, based on current reports in the literature and our practice at the Marlene and Stewart Greenebaum Cancer Center, University of Maryland Medical Center in Baltimore, USA.

Bone Neoplasms↗
PubMed2006

Comparison of imaging with FDG PET/CT with other imaging modalities in myeloma.

OBJECTIVE: To determine the usefulness of FDG PET/CT scanning in the management and staging of myeloma and to assess its strengths and limitations. DESIGN: FDG PET/CT scans and all other available imaging studies were reviewed retrospectively from 16 consecutive patients by two experienced musculoskeletal radiologists and two nuclear medicine physicians working in consensus. PATIENTS: The 16 patients had undergone a total of 19 FDG PET/CT scans. Radiographs were available in all cases, including 13 skeletal surveys; 25 CT scans (16 chest, three abdominal, four pelvic, one spine, one neck) and 22 MR imaging studies (17 spine, three pelvic, two extremity) also were reviewed. Patients' records were examined for relevant clinical information. All focal areas of abnormal FDG uptake were correlated with the other imaging studies to determine clinical significance. FDG PET/CT scans also were reviewed to see if small lesions shown on the other imaging studies could be identified in retrospect. RESULTS: The 12 men and four women had an average age of 58 years (range 30-69 years). All 16 patients had an established diagnosis of multiple myeloma, with average duration of disease, from time of initial diagnosis to review, of 30 months (range 6 months to 11+ years). The FDG PET/CT scans revealed a total of 104 sites (90 in bone, 14 soft tissue) that were suspicious for neoplastic activity based on a standardized uptake value (SUV) greater than 2.5. Fifty-seven of these sites (55%) were new or previously undetected. The other imaging studies (X-ray, CT, MR) and clinical information confirmed the other 47 areas but also revealed 133 other small skeletal lesions. Six of these 133 additional lesions showed mild FDG uptake on re-review of the PET/CT scans. The FDG PET/CT findings led to management changes in 9/16 patients. MR imaging revealed five cases of diffuse bone involvement (four spine, one scapula) that were not evident by FDG PET/CT. CONCLUSION: FDG PET/CT scans are useful for the management and staging of myeloma. However, if PET/CT were the sole imaging study done, it would miss many additional small lytic skeletal lesions and could miss diffuse spine involvement.

Adult↗
PubMed2006

Tunnel convergence in combined anterior cruciate ligament and posterolateral corner reconstruction.

PURPOSE: To examine the geometric relationship between tunnels created in the lateral femoral condyle in reconstruction of the anterior cruciate ligament (ACL) and the posterolateral structures. METHODS: The geometric relationship between a standard ACL tunnel and 11 lateral femoral tunnel variations in synthetic femur specimens was examined. Tunnel collision frequency and tunnel separation were measured radiographically. Subsequent evaluation was performed on 7 paired cadaveric specimens (14 knees) to access the efficacy of 2 configurations. RESULTS: Phase I-Tunnel collision frequency was 0% and 58% for 25-mm and 30-mm tunnel depths, respectively. Axial angles greater than 40 degrees and coronal angles > or =20 degrees resulted in unsafe configurations. The safest position for lateral tunnel placement was straight lateral approach (0 degrees in the coronal plane) with increased axial plane orientation (hand dropped toward the floor 40 degrees). The safe zone for lateral tunnel configuration was determined to be between [0,0] and [0,40] ([coronal, axial]). Phase II--Control group ([0,0]) collision frequencies were 43% and 86% for the 25-mm 30-mm tunnels, respectively. Experimental group ([0,40]) collision frequencies were 29% and 43% for the 25-mm and 30-mm tunnel, respectively. In femoral condyles measuring <35 mm, collision rates were 100% versus 0% in the control group ([0,0]) versus the experimental group ([0,40]). In specimens where no collision was seen, tunnel separation distance was 4.5 +/- 4.4 mm and 5.8 +/- 2.2 mm for the control and experimental groups, respectively (P = .39). CONCLUSIONS: Tunnel collision occurred often. Tunnel collision is dependent on femoral condyle geometry, tunnel depth, and tunnel configuration. To minimize the potential for tunnel collision, the surgeon should maintain a neutral alignment in the coronal plane, limit lateral tunnel depth to < or =25 mm, and direct the lateral tunnel anteriorly in the axial plane to a maximum of 40 degrees. CLINICAL RELEVANCE: This study describes guidelines for tunnel placement to prevent tunnel collision when performing combined ACL and posterolateral corner reconstruction.

Anterior Cruciate Ligament↗
PubMed2002

Grading articular cartilage of the knee using fast spin-echo proton density-weighted MR imaging without fat suppression.

OBJECTIVE: The objective of this work was to determine the accuracy of fast spin-echo proton density-weighted MR imaging in the evaluation of the articular cartilage of the knee using arthroscopy as a gold standard. MATERIALS AND METHODS: We retrospectively reviewed MR images of the knee in 54 patients for whom arthroscopic results were available. All MR imaging studies included fast spin-echo proton density-weighted coronal and axial sequences as part of our routine protocol. Evaluation of the articular surfaces was performed by three independent observers who were unaware of the arthroscopic results. The cartilage surfaces were graded using a 3-point system, and results were compared with arthroscopic findings. RESULTS: Of 324 cartilage surfaces evaluated, arthroscopy showed 241 surfaces as normal, 56 as containing partial-thickness defects, and 27 as containing full-thickness defects. Compared with arthroscopic data, sensitivity of MR imaging for the three reviewers was 59-73.5%; specificity, 86.7-90.5%; positive predictive value, 60.5-72.6%; negative predictive value, 86.0-90.8%; and accuracy, 79.6-86.1%. Interobserver variability for the presence of disease, which was measured using the kappa statistic, was 0.63. CONCLUSION: Fast spin-echo proton density-weighted MR imaging sequences can be used to evaluate the cartilage of the knee with accuracy comparable to that of previously reported cartilage-specific sequences.

Adolescent↗
PubMedDate not supplied

From the archives of the AFIP. Radiologic spectrum of Paget disease of bone and its complications with pathologic correlation.

Paget disease of bone is a common disorder affecting approximately 3%-4% of the population over 40 years of age. The pathologic abnormality in Paget disease is excessive and abnormal remodeling of bone. Three pathologic phases have been described: the lytic phase (incipient-active), in which osteoclasts predominate; the mixed phase (active), in which osteoblasts cause repair superimposed on the resorption; and the blastic phase (late-inactive) in which osteoblasts predominate. Radiographic appearance of Paget disease reflects these pathologic changes and is often characteristic. Initially, there is osteolysis, particularly affecting the skull (osteoporosis circumscripta) and subchondral long bones, with subsequent development of trabecular and cortical thickening and enlargement of bone in the mixed phase of the disease. Finally, areas of sclerosis may develop in the blastic phase. Frequent sites of involvement include the skull (25%-65% of cases), spine (30%-75%), pelvis (30%-75%), and proximal long bones (25%-30%). Bone scintigraphy typically demonstrates marked increased uptake of radionuclide in all phases of Paget disease. Computed tomography and magnetic resonance imaging often show changes similar to those seen radiographically in noncomplicated Paget disease with maintenance of yellow marrow. Complications of Paget disease include the effects of osseous weakening (deformity and fracture), arthritis, neurologic symptoms, and neoplastic involvement. Sarcomatous transformation is the most feared complication, occurring in approximately 1% of cases, and is seen on images as focal bone destruction extending through the cortex with an associated soft-tissue mass. Recognition of the radiologic spectrum of the appearances of Paget disease usually allows prospective diagnosis and differentiation of its associated complications, which helps guide therapy and improve patient management.

Diagnostic Imaging↗