Zehava S Rosenberg, M.D.

The Spring Ligament Recess of the Talocalcaneonavicular Joint: Depiction on MR Images With Cadaveric and Histologic Correlation
Desai, Kapil R; Beltran, Luis S; Bencardino, Jenny T; Rosenberg, Zehava S; Petchprapa, Catherine; Steiner, German
2011 May;196(5):1145-1150, American journal of roentgenology
OBJECTIVE: The objective of this study was to describe the anatomy and MR appearance of the spring ligament recess of the talocalcaneonavicular joint. SUBJECTS AND METHODS: Forty-nine MR examinations of the ankle with a spring ligament recess were prospectively collected. The size of the recess was measured. The presence of the following variables was recorded: talocalcaneonavicular joint effusion, ankle joint effusion, talar head impaction, acute lateral ankle sprain, chronic lateral ankle sprain, spring ligament tear, sinus tarsi ligament tear, talar dome osteochondral injury, and talonavicular osteoarthrosis. The Fisher exact test was performed to quantify the association of the talocalcaneonavicular effusion with the other variables. MR arthrography and dissection with histologic analysis were performed in two cadaveric ankles. RESULTS: Twenty-four men and 25 women (average age, 39 years; range, 21-77 years) were included in the study. The average size of the fluid collection was 0.4 x 0.8 cm (range, 0.2-0.9 x 0.4-1.5 cm). The prevalence of the measured variables was talocalcaneonavicular joint effusion, 67.3%; ankle joint effusion, 61.2%; talar head impaction, 32.7%; acute lateral ankle sprain, 28.6%; chronic lateral ankle sprain, 59.2%; spring ligament tear, 14.3%; sinus tarsi ligament tear, 12.2%; talar dome osteochondral lesion, 20.4%; and talonavicular osteoarthrosis, 18.4%. There was a higher prevalence of talar head impaction among individuals with talocalcaneonavicular joint effusion (p = 0.0522). Cadaveric study revealed communication between the talocalcaneonavicular joint and the spring ligament recess. CONCLUSION: The spring ligament recess is a synovium-lined, fluid-filled space that communicates with the talocalcaneonavicular joint. The recess should be distinguished from a tear of the plantar components of the spring ligament
— id: 131819, year: 2011, vol: 196, page: 1145, stat: Journal Article,

Reply
La Rocca Vieira R.; Bencardino J.T.; Rosenberg Z.S.
2011 ;197(4):1023-1023, American journal of roentgenology
— id: 138724, year: 2011, vol: 197, page: 1023, stat: Journal Article,

MRI features of cortical desmoid in acute knee trauma
La Rocca Vieira, Renata; Bencardino, Jenny T; Rosenberg, Zehava Sadka; Nomikos, George
2011 Feb;196(2):424-428, American journal of roentgenology
OBJECTIVE: The purpose of this study was to describe the MRI features of cortical desmoids associated with acute trauma. CONCLUSION: Marrow edema, periostitis, and adjacent soft-tissue edema can be seen in cases of cortical desmoid associated with acute trauma
— id: 121327, year: 2011, vol: 196, page: 424, stat: Journal Article,

Bone marrow edema patterns in the ankle and hindfoot: distinguishing MRI features
Rios, Adriana Martins; Rosenberg, Zehava Sadka; Bencardino, Jenny Teresa; Rodrigo, Silvia Perez; Theran, Sara Garcia
2011 Oct;197(4):W720-W729, American journal of roentgenology
OBJECTIVE: Many disorders produce similar or overlapping patterns of bone marrow edema in the ankle. Bone marrow edema may present in a few hindfoot bones simultaneously or in a single bone. The purpose of this pictorial essay is to provide guidelines based on clinical history and specific MRI patterns and locations to accurately identify the cause of ankle bone marrow edema. We will first focus on bone marrow edema in general disease categories involving multiple bones, such as reactive processes, trauma, neuroarthropathy, and arthritides. A discussion of bone marrow edema in individual bones of the ankle and hindfoot including the tibia, fibula, talus, and calcaneus will follow. Helpful hints for arriving at the correct diagnosis will be provided in each section. CONCLUSION: After review of this article, radiologists should be able to use their knowledge of clinical history and specific MRI patterns and locations to accurately distinguish between the various causes of bone marrow edema in the ankle and hindfoot
— id: 140048, year: 2011, vol: 197, page: W720, stat: Journal Article,

Bisphosphonate-related complete atypical subtrochanteric femoral fractures: diagnostic utility of radiography
Rosenberg, Zehava Sadka; La Rocca Vieira, Renata; Chan, Sarah S; Babb, James; Akyol, Yakup; Rybak, Leon D; Moore, Sandra; Bencardino, Jenny T; Peck, Valerie; Tejwani, Nirmal C; Egol, Kenneth A
2011 Oct;197(4):954-960, American journal of roentgenology
OBJECTIVE: The objective of our study was to evaluate the diagnostic utility of conventional radiography for diagnosing bisphosphonate-related atypical subtrochanteric femoral fractures. MATERIALS AND METHODS: Retrospective interpretation of 38 radiographs of complete subtrochanteric and diaphyseal femoral fractures in two patient groups-one group being treated with bisphosphonates (19 fractures in 17 patients) and a second group not being treated with bisphosphonates (19 fractures in 19 patients)-was performed by three radiologists. The readers assessed four imaging criteria: focal lateral cortical thickening, transverse fracture, medial femoral spike, and fracture comminution. The odds ratios and the sensitivity, specificity, and accuracy of each imaging criterion as a predictor of bisphosphonate-related fractures were calculated. Similarly, the interobserver agreement and the sensitivity, specificity, and accuracy of diagnosing bisphosphonate-related fractures (i.e., atypical femoral fractures) were determined for the three readers. RESULTS: Among the candidate predictors of bisphosphonate-related fractures, focal lateral cortical thickening and transverse fracture had the highest odds ratios (76.4 and 10.1, respectively). Medial spike and comminution had odd ratios of 3.8 and 0.63, respectively. Focal lateral cortical thickening and transverse fracture were also the most accurate factors for detecting bisphosphonate-related fractures for all readers. The sensitivity, specificity, and overall accuracy for diagnosing bisphosphonate-related fractures were 94.7%, 100%, and 97.4% for reader 1; 94.7%, 68.4%, and 81.6% for reader 2; and 89.5%, 89.5%, and 89.5% for reader 3, respectively. The interobserver agreement was substantial (kappa > 0.61). CONCLUSION: Radiographs are reliable for distinguishing between complete femoral fractures related to bisphosphonate use and those not related to bisphosphonate use. Focal lateral cortical thickening and transverse fracture are the most dependable signs, showing high odds ratios and the highest accuracy for diagnosing these fractures
— id: 137889, year: 2011, vol: 197, page: 954, stat: Journal Article,

Subtrochanteric femoral fractures in patients receiving long-term alendronate therapy: imaging features
Chan, Sarah Shock; Rosenberg, Zehava Sadka; Chan, Keith; Capeci, Craig
2010 Jun;194(6):1581-1586, American journal of roentgenology
OBJECTIVE: A paradoxical association between long-term alendronate therapy and low-energy subtrochanteric femoral fractures has been recently recognized. A retrospective review of 34 such femoral fractures was performed. CONCLUSION: Subtrochanteric femoral fractures associated with long-term alendronate therapy present with minimal trauma, may be chronic, and when incomplete may be missed. The characteristic imaging features include initial involvement and focal thickening of the lateral cortex, transverse orientation, medial beak, and superior displacement and varus angulation at the fracture site
— id: 109798, year: 2010, vol: 194, page: 1581, stat: Journal Article,

MRI of ankle and lateral hindfoot impingement syndromes
Donovan, Andrea; Rosenberg, Zehava Sadka
2010 Sep;195(3):595-604, American journal of roentgenology
OBJECTIVE: The objective of this article is to review the pathophysiology and clinical presentation of impingement syndromes at the ankle joint (anterolateral, anterior, anteromedial, posteromedial, and posterior) and the role of MRI in evaluating impingement at the ankle joint and at extraarticular locations, lateral to the ankle joint (talocalcaneal and calcaneofibular). CONCLUSION: MRI is valuable in assessing both osseous and soft-tissue abnormalities associated with impingement syndromes
— id: 120631, year: 2010, vol: 195, page: 595, stat: Journal Article,

MR imaging of entrapment neuropathies of the lower extremity. Part 2. The knee, leg, ankle, and foot
Donovan, Andrea; Rosenberg, Zehava Sadka; Cavalcanti, Conrado F
2010 Jul-Aug;30(4):1001-1019, Radiographics
Entrapment neuropathies of the knee, leg, ankle, and foot are often underdiagnosed, as the results of clinical examination and electrophysiologic evaluation are not always reliable. The causes of most entrapment neuropathies in the lower extremity may be divided into two major categories: (a) mechanical causes, which occur at fibrous or fibro-osseous tunnels, and (b) dynamic causes related to nerve injury during specific limb positioning. Magnetic resonance (MR) imaging, including high-resolution MR neurography, allows detailed evaluation of the course and morphology of peripheral nerves, as well as accurate delineation of surrounding soft-tissue and osseous structures that may contribute to nerve entrapment. Familiarity with the normal MR imaging anatomy of the nerves in the knee, leg, ankle, and foot is essential for accurate assessment of the presence of peripheral entrapment syndromes. Common entrapment neuropathies in the knee, leg, ankle, and foot include those of the common peroneal nerve, deep peroneal nerve, superficial peroneal nerve, tibial nerve and its branches, and sural nerve
— id: 120632, year: 2010, vol: 30, page: 1001, stat: Journal Article,

Increased MR signal intensity in the pronator quadratus muscle: Does it always indicate anterior interosseous neuropathy?
Gyftopoulos, Soterios; Rosenberg, Zehava Sadka; Petchprapa, Catherine
2010 Feb;194(2):490-493, American journal of roentgenology
OBJECTIVE: The objective of this study was to assess the prevalence of increased signal intensity in the pronator quadratus in the general patient population. Using region-of-interest measurements, we measured the signal intensity of the pronator quadratus and of an adjacent flexor muscle. In addition, we performed independent subjective assessments of the pronator quadratus. CONCLUSION: Increased signal intensity in the pronator quadratus is a frequent normal finding of unclear etiology and is not related to disease. Familiarity with this normal phenomenon is important to avoid overdiagnosis of denervation due to anterior interosseous nerve entrapment
— id: 106371, year: 2010, vol: 194, page: 490, stat: Journal Article,

Sciatic nerve injury model in the axolotl: functional, electrophysiological, and radiographic outcomes
Kropf, Nina; Krishnan, Kartik; Chao, Moses; Schweitzer, Mark; Rosenberg, Zehava; Russell, Stephen M
2010 Apr;112(4):880-889, Journal of neurosurgery
OBJECT: The 2 aims of this study were as follows: 1) to establish outcome measures of nerve regeneration in an axolotl model of peripheral nerve injury; and 2) to define the timing and completeness of reinnervation in the axolotl following different types of sciatic nerve injury. METHODS: The sciatic nerves in 36 axolotls were exposed bilaterally in 3 groups containing 12 animals each: Group 1, left side sham, right side crush; Group 2, left side sham, right side nerve resected and proximal stump buried; and Group 3 left side cut and sutured, right side cut and sutured with tibial and peroneal divisions reversed. Outcome measures included the following: 1) an axolotl sciatic functional index (ASFI) derived from video swim analysis; 2) motor latencies; and 3) MR imaging evaluation of nerve and muscle edema. RESULTS: For crush injuries, the ASFI returned to baseline by 2 weeks, as did MR imaging parameters and motor latencies. For buried nerves, the ASFI returned to 20% below baseline by 8 weeks, with motor evoked potentials present. On MR imaging, nerve edema peaked at 3 days postintervention and gradually normalized over 12 weeks, whereas muscle denervation was present until a gradual decrease was seen between 4 and 12 weeks. For cut nerves, the ASFI returned to 20% below baseline by Week 4, where it plateaued. Motor evoked potentials were observed at 2-4 weeks, but with an increased latency until Week 6, and MR imaging analysis revealed muscle denervation for 4 weeks. CONCLUSIONS: Multiple outcome measures in which an axolotl model of peripheral nerve injury is used have been established. Based on historical controls, recovery after nerve injury appears to occur earlier and is more complete than in rodents. Further investigation using this model as a successful 'blueprint' for nerve regeneration in humans is warranted
— id: 120633, year: 2010, vol: 112, page: 880, stat: Journal Article,

MR Imaging of Entrapment Neuropathies of the Lower Extremity: Part 1. The Pelvis and Hip1
Petchprapa, Catherine N; Rosenberg, Zehava Sadka; Sconfienza, Luca Maria; Cavalcanti, Conrado Furtado A; La Rocca Vieira, Renata; Zember, Jonathan S
2010 Jul-Aug;30(4):983-1000, Radiographics
Entrapment neuropathies can manifest with confusing clinical features and therefore are often underrecognized and underdiagnosed at clinical examination. Historically, electrophysiologic evaluation has been considered the mainstay of diagnosis. Today, cross-sectional imaging, particularly magnetic resonance (MR) imaging and specifically MR neurography, plays an increasingly important role in the work-up of entrapment neuropathies. MR imaging is a noninvasive operator-independent technique that allows identification of the underlying cause of injury, differentiation between surgically treatable and untreatable causes, and guidance of selective diagnostic anesthetic nerve blocks. Pathologic conditions affecting the lumbosacral plexus and major motor and mixed nerves of the pelvis and hip include neuropathies of the lumbosacral plexus, femoral nerve, lateral femoral cutaneous nerve, obturator nerve, and sciatic nerve; piriformis muscle syndrome; and injury of the gluteal nerves. Diagnosis of entrapment neuropathies of the pelvis and hip with MR imaging requires familiarity with the normal MR imaging anatomy and awareness of the anatomic and pathologic factors that put peripheral nerves at risk for injury
— id: 110883, year: 2010, vol: 30, page: 983, stat: Journal Article,

Extraarticular lateral hindfoot impingement with posterior tibial tendon tear: MRI correlation
Donovan, Andrea; Rosenberg, Zehava Sadka
2009 Sep;193(3):672-678, American journal of roentgenology
OBJECTIVE: Posterior tibial tendon dysfunction with secondary hindfoot valgus can lead to painful extraarticular, lateral talocalcaneal, and subfibular impingements, often necessitating surgical intervention. The purpose of this study was to correlate findings of lateral hindfoot impingement with grading of posterior tibial tendon tears and severity of hindfoot valgus on MRI. MATERIALS AND METHODS: MR images from 75 patients (45 women and 30 men) with MRI evidence of posterior tibial tendon tears were evaluated for grade of posterior tibial tendon tear, hindfoot valgus angle, osseous contact or opposing marrow signal changes at the talus-calcaneus or fibula-calcaneus, peroneal tendon subluxation-dislocation, and presence of lateral malleolar bursa. Statistical analyses were performed using Cochran-Armitage, Fisher's exact, and Mann-Whitney tests. RESULTS: Twenty-eight cases (37%) of lateral hindfoot impingement were identified, including six talocalcaneal, eight subfibular, and 14 talocalcaneal-subfibular impingements. The prevalence of impingement was significantly increased with greater MRI hindfoot valgus angle (p < 0.001). The prevalence of talocalcaneal-subfibular impingement significantly increased with grading of posterior tibial tendon tear (p = 0.018). Peroneal tendon subluxation was present only with advanced hindfoot valgus (p = 0.010) and impingement (p = 0.004). There was no significant association between the presence of lateral malleolar bursa and hindfoot valgus severity. CONCLUSION: Extraarticular lateral hindfoot impingement is associated with advanced posterior tibial tendon tears and increased MRI hindfoot valgus angle. Peroneal tendon subluxation likely represents an end stage of lateral impingement in patients with posterior tibial tendon dysfunction
— id: 120634, year: 2009, vol: 193, page: 672, stat: Journal Article,

Normal anatomy and strains of the deep musculotendinous junction of the proximal rectus femoris: MRI features
Gyftopoulos, Soterios; Rosenberg, Zehava Sadka; Schweitzer, Mark E; Bordalo-Rodrigues, Marcelo
2008 Mar;190(3):W182-W186, American journal of roentgenology
OBJECTIVE: The MRI features of the proximal rectus femoris musculotendinous junction have scarcely been described in the literature. The purpose of our study, based on a review of 50 asymptomatic and 20 symptomatic MRI studies, was to define the normal MRI anatomy and MRI features of intrasubstance injury of deep musculotendinous tears of the proximal rectus femoris. CONCLUSION: Axial and coronal MR images are optimal for visualizing the direct and indirect heads, the conjoined tendon, and the deep musculotendinous junction of the proximal rectus femoris. Tears of the deep musculotendinous junction are longitudinal, involving a long segment of the muscle. MRI features include a 'bull's-eye' sign, longitudinal scar, retraction, pseudocyst, and hematoma
— id: 111875, year: 2008, vol: 190, page: W182, stat: Journal Article,

MRI features of posterior capitellar impaction injuries
Rosenberg, Zehava Sadka; Blutreich, Salomon I; Schweitzer, Mark E; Zember, Jonathan S; Fillmore, Kevin
2008 Feb;190(2):435-441, American journal of roentgenology
OBJECTIVE: Posterior capitellar injury is a scantly recognized entity in the literature. Furthermore, irregularity of the posterior capitellum, termed the 'pseudodefect' of the capitellum, has been touted as a normal MRI finding, not to be misinterpreted for impaction injury. Our objectives, based on 11 MRI studies, were to report the MRI features of a true posterior capitellar impaction injury and to document associated clinical, osseous, and soft-tissue abnormalities that may shed light on the cause of this injury. CONCLUSION: Traumatic posterior impaction injuries can occur in the capitellum, albeit infrequently. These lesions often present clinically with elbow instability, have a high incidence of lateral ulnar collateral and radial collateral ligament injuries, and show osseous abnormalities typical of elbow dislocation. Thus, MRI evidence of posterior capitellar impaction injuries, to be distinguished from the pseudodefect of the capitellum, should raise the possibility of previous elbow dislocation or posterolateral rotatory instability
— id: 75857, year: 2008, vol: 190, page: 435, stat: Journal Article,

MRI of the distal biceps femoris muscle: normal anatomy, variants, and association with common peroneal entrapment neuropathy
Vieira, Renata La Rocca; Rosenberg, Zehava Sadka; Kiprovski, Kiril
2007 Sep;189(3):549-555, American journal of roentgenology
OBJECTIVE: The objectives of our study were to describe the previously unreported normal MR anatomy of the distal biceps femoris muscle and its relationship with the common peroneal nerve and to present a case in which previously unreported MR evidence of an anatomic variation in the distal biceps femoris muscle was associated with common peroneal entrapment neuropathy. MATERIALS AND METHODS: One hundred consecutive 1.5-T knee MR studies of 97 asymptomatic patients were retrospectively reviewed by two observers in consensus for, first, normal anatomy of the distal biceps femoris muscle; second, anatomic variations of the muscle; and, third, the relationship of the muscle to the common peroneal nerve. Measurements of the distal and posterior extents of the short and long heads of the biceps femoris were performed. An MR study of a symptomatic patient with clinical evidence of common peroneal neuropathy associated with a surgically proven anatomic variation of the distal biceps femoris was reviewed. RESULTS: Two MR anatomic patterns were seen in the asymptomatic patient group: First, in 77 knees (77%), the common peroneal nerve was located within abundant fat posterolateral to the biceps femoris; and, second, in 23 cases (23%), the common peroneal nerve traversed within a narrow fatty tunnel between the biceps femoris and lateral head of the gastrocnemius muscles. There was a positive correlation between the distal and posterior extents of the short head of the biceps femoris muscle and the presence of the tunnel. CONCLUSION: Variations in the posterior and distal extents of the biceps femoris muscle can produce a tunnel in which the common peroneal nerve travels. We also described a case of common peroneal neuropathy secondary to tunnel formation
— id: 73917, year: 2007, vol: 189, page: 549, stat: Journal Article,

Entrapment neuropathies of the shoulder and elbow in the athlete
Bencardino, Jenny T; Rosenberg, Zehava Sadka
2006 Jul;25(3):465-87, vi, Clinics in sports medicine
MRI is a useful diagnostic method for evaluating nerve disease at the shoulder and elbow. MRI can depict the normal anatomy of the nerves, confirm and identify the cause of the neuropathy, identify the site of entrapment based on muscle denervation patterns, and detect unsuspected space-occupying lesions. MRI can also narrow down the differential diagnosis of nerve disease, such as in the case of suprascapular nerve syndrome versus Parsonage-Turner syndrome, or radial tunnel syndrome versus lateral epicondylitis. Large prospective studies with surgical correlation, however, are still necessary to better elucidate MRI's exact role in the assessment of entrapment neuropathies of the upper extremity
— id: 75816, year: 2006, vol: 25, page: 465, stat: Journal Article,

Sports-related injuries of the wrist: an approach to MRI interpretation
Bencardino, Jenny T; Rosenberg, Zehava Sadka
2006 Jul;25(3):409-32, vi, Clinics in sports medicine
Sports-related injuries to the wrist range from minor sprains to severe soft tissue disruption that can pose a risk to the normal function of the upper extremity. It is important to identify the specific nature of such injuries so as to establish an accurate diagnosis and deliver appropriate treatment. MRI of the wrist has greatly benefited from the use of dedicated surface coils, which allow fine depiction of soft tissue and cartilaginous structures. A review of the normal anatomy, MR interpretation pitfalls, and most common abnormalities of the tendons, ligaments, triangular fibrocartilage complex, and nerves of the wrist are presented
— id: 75817, year: 2006, vol: 25, page: 409, stat: Journal Article,

Effect of foot and ankle position on tarsal tunnel compartment volume
Bracilovic, Ana; Nihal, Aneel; Houston, Vern L; Beattie, Aaron C; Rosenberg, Zehava S; Trepman, Elly
2006 Jun;27(6):431-437, Foot & ankle international
BACKGROUND: Tarsal tunnel pressure is increased when the foot and ankle are positioned in eversion or inversion from neutral, aggravating symptoms of tarsal tunnel syndrome in some patients. Space-occupying lesions may cause tarsal tunnel syndrome. We hypothesized that positional change of the foot and ankle from neutral to eversion or inversion causes decreased tarsal tunnel compartment volume that may aggravate symptoms of posterior tibial nerve entrapment. METHODS: MRI of 13 ankles in nine healthy subjects in three positions (neutral, eversion, inversion) were obtained with respect to the malleolar-calcaneal plane; this plane was defined by the distal tip of the anterior colliculus of the medial malleolus, the medial tubercle of the posterior calcaneal tuberosity, and the lateral tubercle of the posterior calcaneal tuberosity. The borders of the tarsal tunnel noted on the MRI were traced with a computer digitizing apparatus to determine the cross-sectional area of the tarsal tunnel on each image, and the slice thickness and interspace distance for the seven central images were used to calculate tarsal tunnel volume. RESULTS: The mean tarsal tunnel volume was significantly greater when the foot and ankle were in neutral position (21.5 +/- 0.9 cm(3)) than in either full eversion (18.0 +/- 0.9 cm(3); p = or < 0.001) or inversion (20.3 +/- 1.0 cm(3); p = or < 0.001). CONCLUSIONS: The results support the hypothesis that eversion and inversion of the foot and ankle cause decreased compartment volume of the tarsal tunnel and increased tarsal tunnel pressure that may contribute to symptoms of posterior tibial nerve entrapment in tarsal tunnel syndrome. CLINICAL RELEVANCE: Neutral immobilization of the foot and ankle may relieve symptoms of posterior tibial nerve entrapment in tarsal tunnel syndrome by minimizing pressure on the nerve and maximizing tarsal tunnel compartment volume available for the nerve
— id: 94032, year: 2006, vol: 27, page: 431, stat: Journal Article,

MR imaging features of radial tunnel syndrome: initial experience
Ferdinand, Brett D; Rosenberg, Zehava Sadka; Schweitzer, Mark E; Stuchin, Steven A; Jazrawi, Laith M; Lenzo, Salvatore R; Meislin, Robert J; Kiprovski, Kiril
2006 Jul;240(1):161-168, Radiology
PURPOSE: To retrospectively assess magnetic resonance (MR) imaging features of radial tunnel syndrome. MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was waived for the retrospective HIPAA-compliant study. MR images of 10 asymptomatic volunteers (six men, four women; mean age, 30 years) and 25 patients (11 men, 14 women; mean age, 49 years) clinically suspected of having radial tunnel syndrome were reviewed for morphologic and signal intensity alterations of the posterior interosseous nerve and adjacent soft-tissue structures. MR images of the asymptomatic volunteers were reviewed to establish the normal appearance of the radial tunnel. MR images of the symptomatic patients were evaluated for the following: signal intensity alteration and morphologic alteration of the posterior interosseous nerve; the presence of mass effect on the posterior interosseous nerve such as the presence of bursae, a thickened leading edge of the extensor carpi radialis brevis, or prominent radial recurrent vessels; signal intensity alteration within the depicted forearm musculature such as edema or atrophy; and signal intensity changes at the origin of the common extensor and common flexor tendons, which would suggest a diagnosis of epicondylitis. RESULTS: All images of volunteers demonstrated normal morphology and signal intensity within the posterior interosseous nerve and adjacent soft tissues. Two volunteers had borderline thickening of the leading edge of the extensor carpi radialis brevis. Thirteen patients (52%) had denervation edema or atrophy within muscles (supinator and extensors) innervated by the posterior interosseous nerve. One patient had isolated pronator teres edema. Seven (28%) patients had the following mass effects along the posterior interosseous nerve: thickened leading edge of the extensor carpi radialis brevis (n = 4), prominent radial recurrent vessels (n = 1), schwannoma (n = 1), or bicipitoradial bursa (n = 1). The rest of the patients had either normal MR imaging findings (n = 4) or lateral epicondylitis (n = 2). CONCLUSION: Muscle denervation edema or atrophy along the distribution of the posterior interosseous nerve is the most common MR finding in radial tunnel syndrome
— id: 66465, year: 2006, vol: 240, page: 161, stat: Journal Article,

MR imaging of the proximal rectus femoris musculotendinous unit
Bordalo-Rodrigues, Marcelo; Rosenberg, Zehava Sadka
2005 Nov;13(4):717-725, Magnetic resonance imaging clinics of North America
MR imaging is a useful modality for diagnosing and grading proximal rectus femoris injuries.MR imaging is also valuable in predicting the length of recovery and rehabilitation time of musculotendinous strains and in presurgical planning when resection of a chronic hematoma, deep scar tissue, or a pseudocyst is contemplated
— id: 120635, year: 2005, vol: 13, page: 717, stat: Journal Article,

MR imaging of the hip
Rosenberg ZS
2005 ;13(4):xv-xvi, Magnetic resonance imaging clinics of North America
— id: 59552, year: 2005, vol: 13, page: xv, stat: Journal Article,

MR imaging of iliopsoas musculotendinous injuries
Shabshin, Nogah; Rosenberg, Zehava Sadka; Cavalcanti, Conrado F A
2005 Nov;13(4):705-716, Magnetic resonance imaging clinics of North America
The literature describing iliopsoas compartment injuries is based on case reports and small patient series, mostly in the orthopedic literature.Nevertheless, in recent years, there has been a growing recognition of these injuries. Because many intra-articular and extra-articular bony and soft tissue injuries in the groin may clinically mimic each other, because two or more pathologic entities may coexist, and because athletes are highly motivated to continue with their physical activity, diagnosis of iliopsoas injury is often delayed. Thus, cross-sectional imaging is highly important. MR imaging is most accurate for diagnosing nondynamic diseases of the iliopsoas compartment as well as for ruling out other abnormalities of the hip joint and surrounding structures. When a snapping hip is being investigated or corticosteroid injection is warranted, US can be of help in providing a dynamic study and by guiding the injection
— id: 120636, year: 2005, vol: 13, page: 705, stat: Journal Article,

Normal variants and diseases of the peroneal tendons and superior peroneal retinaculum: MR imaging features
Wang, Xiao-Tian; Rosenberg, Zehava Sadka; Mechlin, Michael B; Schweitzer, Mark E
2005 May-Jun;25(3):587-602, Radiographics
Diseases of the peroneal tendons and superior peroneal retinaculum (SPR) are frequently underdiagnosed causes of lateral ankle pain and instability. Common diseases include tenosynovitis, rupture, and dislocation of the peroneal tendons as well as injuries to the SPR. Many anatomic variants, such as a flat or convex retromalleolar fibular groove, hypertrophy of the peroneal tubercle, an accessory peroneus quartus muscle, a low-lying peroneus brevis muscle belly, or an os peroneum, may be associated with or predispose to lateral ankle disease. Magnetic resonance (MR) imaging is excellent for detecting soft-tissue and bone variants and abnormalities related to the lateral ankle. Knowledge of the MR imaging appearances of these entities aids radiologists in making the precise diagnosis of disorders of the peroneal tendons and SPR. Pitfalls and normal variants of the peroneal tendons, including magic angle phenomenon, pseudosubluxation of the peroneus brevis tendon, a bifurcated or mildly crescentic peroneus brevis tendon, insertion of the peroneus quartus tendon into the peroneus brevis tendon, and the presence of an os peroneum are important to recognize. It is also useful to be familiar with the MR imaging appearances of SPR injuries, which can be an overlooked but treatable cause of lateral ankle pain and instability
— id: 56114, year: 2005, vol: 25, page: 587, stat: Journal Article,

MR imaging of common entrapment neuropathies at the wrist
Bordalo-Rodrigues, Marcelo; Amin, Parinita; Rosenberg, Zehava Sadka
2004 Jun;12(2):265-79, vi, Magnetic resonance imaging clinics of North America
MR imaging is a useful technique in the work-up of compressive neuropathies at the wrist, providing fine anatomical detail and excellent diagnostic accuracy. MR imaging, however, should be reserved for those cases in which the clinical and electrodiagnostic findings are inconclusive, the symptoms are unusually severe, or when a tumor is suspected. This article reviews the normal anatomy and the MR imaging features of the most common compressive neuropathies at the wrist: carpal and ulnar tunnel syndromes
— id: 46036, year: 2004, vol: 12, page: 265, stat: Journal Article,

MR imaging of entrapment neuropathies at the elbow
Bordalo-Rodrigues, Marcelo; Rosenberg, Zehava Sadka
2004 Jun;12(2):247-63, vi, Magnetic resonance imaging clinics of North America
MR imaging has a valuable role in the evaluation of compressive neuropathies at the elbow. Specific MR signs in association with clinical findings can supply an accurate diagnosis. A review of normal anatomy, clinical features, and MR assessment of nerve entrapment syndromes at the elbow is presented
— id: 46037, year: 2004, vol: 12, page: 247, stat: Journal Article,

MRI features of chronic injuries of the superior peroneal retinaculum
Rosenberg, Zehava Sadka; Bencardino, Jenny; Astion, Donna; Schweitzer, Mark E; Rokito, Andrew; Sheskier, Steven
2003 Dec;181(6):1551-1557, American journal of roentgenology
OBJECTIVE: The aims of this study were to assess, grade, and surgically correlate previously unreported MRI features of superior peroneal retinacular injuries in nine surgically proven cases and to record all soft-tissue and bony abnormalities associated with these injuries. CONCLUSION: MRI was found to be a useful tool for detecting and grading superior peroneal retinacular injuries and providing information, important for presurgical planning, regarding common concomitant soft-tissue and osseous abnormalities of the lateral collateral ligaments, peroneal tendons, and fibular groove. Superior peroneal retinacular injuries are frequently associated with MRI evidence of peroneal tendon dislocations and tears. Conversely, routine MRI studies may not depict dislocated peroneal tendon injuries, despite clinical history to that effect
— id: 43808, year: 2003, vol: 181, page: 1551, stat: Journal Article,

Radial nerve entrapment syndromes at the elbow: MR features
Bencardino, JT; Rosenberg, ZS; Hassankhani, A; Thornhill, BA
2002 ;225(2):654-654, Radiology
— id: 114526, year: 2002, vol: 225, page: 654, stat: Journal Article,

Malalignment at the Lisfranc joint: MR features in asymptomatic patients and cadaveric specimens
Delfaut, Emmanuelle M; Rosenberg, Zehava Sadka; Demondion, Xavier
2002 Sep;31(9):499-504, Skeletal radiology
OBJECTIVE: To assess the frequency of malalignment in the 1st, 2nd and 3rd tarso-metatarsal joints (Lisfranc joint) in cadaveric specimen and asymptomatic individuals utilizing oblique axial MR images. DESIGN AND PATIENTS: Four fresh frozen cadaveric feet were dissected in the oblique axial plane at 5 mm slice thickness. Thirty MR studies in 29 patients who had no history of pain, trauma or surgery at the tarso-metatarsal area were included in our study. The 1st to 3rd tarso-metatarsal joints were evaluated on the MR studies and cadaveric slices by two musculoskeletal radiologists for (1) the presence of a medial and/or lateral step-off and (2) articular surface divergence. RESULTS: In the cadaveric dissections there were lateral step-offs in the 1st ( n=3) and in the 2nd ray ( n=3) respectively. No joint incongruity was evidenced. The MR studies in the patients population depicted 28 step-offs (9 medial, 19 lateral) in the 1st ray, 16 (2 medial, 14 lateral) in the 2nd ray and two in the 3rd ray. Joint incongruity was present in the 2nd ray ( n=6) and in the 3rd ray ( n=12). All the above findings were limited to a few images. CONCLUSIONS: Isolated joint malalignment with otherwise normal findings (no ligamentous injury, no fracture and no bone marrow edema) might reflect normal anatomic features at the tarso-metatarsal joints and must be interpreted carefully
— id: 120637, year: 2002, vol: 31, page: 499, stat: Journal Article,

Invited commentary
Rosenberg, ZS
2002 NOV-DEC ;22(6):1470-1471, Radiographics
— id: 33043, year: 2002, vol: 22, page: 1470, stat: Journal Article,

MR imaging and CT in the assessment of osseous abnormalities of the ankle and foot
Bencardino JT; Rosenberg ZS
2001 Aug;9(3):567-78, xi, Magnetic resonance imaging clinics of North America
This article focuses on the contributions of MR imaging and CT toward the evaluation of painful osseous abnormalities of the foot and ankle. Inconclusive findings on conventional radiographs often mandate further work up with the more advanced cross-sectional imaging techniques. Often, however, the radiologist remains unsure, which modality, CT or MR imaging, should be used. Based on our experience, CT and MR imaging play a complementary role in the assessment of these disorders
— id: 43848, year: 2001, vol: 9, page: 567, stat: Journal Article,

Normal variants and pitfalls in MR imaging of the ankle and foot
Bencardino JT; Rosenberg ZS
2001 Aug;9(3):447-63, x, Magnetic resonance imaging clinics of North America
Normal anatomic variants may erroneously be interpreted as pathologic conditions on MR imaging of the ankle and foot. Therefore, sufficient knowledge of the normal anatomy and its variations is crucial for accurate diagnostic analysis of such images. This article will focus on outlining variants and MR imaging interpretation pitfalls of the tendons, ligaments, muscles, bones, and other miscellaneous structures of the foot and ankle
— id: 43851, year: 2001, vol: 9, page: 447, stat: Journal Article,

MR imaging features of diseases of the peroneal tendons
Bencardino JT; Rosenberg ZS; Serrano LF
2001 Aug;9(3):493-505, x, Magnetic resonance imaging clinics of North America
Injuries of the peroneal tendons including peritendinosis/tenosynovitis, tendinosis, rupture, dislocation are being detected with greater frequency since the advent of MR imaging. This article focuses on the normal as well as pathologic MR features of the peroneal tendons
— id: 43849, year: 2001, vol: 9, page: 493, stat: Journal Article,

MR imaging of tendon abnormalities of the foot and ankle
Bencardino JT; Rosenberg ZS; Serrano LF
2001 Aug;9(3):475-92, x, Magnetic resonance imaging clinics of North America
MR imaging, with its unique soft-tissue contrast resolution, noninvasiveness, and multiplanar capabilities, has been applied to the assessment of tendon abnormalities of the foot and the ankle
— id: 43850, year: 2001, vol: 9, page: 475, stat: Journal Article,

The C sign: more specific for flatfoot deformity than subtalar coalition
Brown RR; Rosenberg ZS; Thornhill BA
2001 Feb;30(2):84-87, Skeletal radiology
OBJECTIVE: To assess the sensitivity and specificity of the C sign, a C-shaped line created by the outline of the talar dome and the inferior margin of the sustentaculum tali on lateral ankle radiographs, for patients with both flatfoot deformity and specifically talocalcaneal (TC) coalition. DESIGN AND PATIENTS: All patients in this retrospective study were under 35 years of age and had a lateral ankle radiograph and follow-up CT scan for a non-traumatic indication. Forty-eight cases over the past 5 years fulfilled these criteria. Two masked musculoskeletal radiologists determined the presence or absence of the C sign for each lateral radiograph by consensus. Each CT study was then assessed by a third musculoskeletal radiologist for the presence of tarsal coalition. Observations were correlated with clinical history regarding presence or absence of flatfoot deformity. RESULTS: Ten cases of TC coalition were diagnosed, four of which demonstrated a C sign (40%). Eight cases with a C sign were encountered, four of which had TC coalition (50%) and four did not. All patients with a positive C sign had a flatfoot clinically (100%), while only eight of 24 flatfooted patients had a C sign (33%). CONCLUSION: The C sign is specific, but not sensitive, for flatfoot deformity, and is neither sensitive nor specific for subtalar coalition
— id: 20731, year: 2001, vol: 30, page: 84, stat: Journal Article,

MR imaging features of tumors of the ankle and foot
Maldjian, C; Rosenberg, Z S
2001 Aug;9(3):639-57, xii, Magnetic resonance imaging clinics of North America
MR imaging is a useful technique in the work-up of neoplasms of the foot and ankle. Certain MR imaging traits may confer a specific diagnosis. For instance, the presence of fat in a homogeneous lesion would indicate a lipoma, while an intraarticular, poorly defined mass with low signal intensity on all pulse sequences is suspicious for pigmented villonodular synovitis. Most neoplasms, however, have no specific trademark MR features. In these cases, MR imaging is useful in imparting information that can assist in treatment and prognosis once a histologic diagnosis is made. For instance, MR imaging may help ascertain the presence and degree of bone marrow involvement, invasion of adjacent anatomical structures, and size of the lesion. MR imaging is an essential and effective modality for the preoperative staging of neoplasms of the foot and ankle
— id: 126568, year: 2001, vol: 9, page: 639, stat: Journal Article,

Update on the ankle and foot: Preface
Rosenberg ZS
2001 ;9(3):xvi-xvi, Magnetic resonance imaging clinics of North America
— id: 26871, year: 2001, vol: 9, page: xvi, stat: Journal Article,

Partial tears of the distal biceps tendon: MR appearance and associated clinical findings
Williams BD; Schweitzer ME; Weishaupt D; Lerman J; Rubenstein DL; Miller LS; Rosenberg ZS
2001 Oct;30(10):560-564, Skeletal radiology
PURPOSE: To describe the magnetic resonance (MR) appearance and associated clinical findings of partial distal biceps tendon tears. DESIGN: Twenty elbow MR images at 1.5 T, performed over a 7 year period, were reviewed for an appearance of partial tears in the distal biceps. These images were assessed by two musculoskeletal radiologists for the extent of: (a) abnormal signal intensity within the tendon, and the presence of (b) bicipitoradial bursitis, and (c) bony microavulsive injury of the radial tuberosity. Medical records for nine of the 20 cases were reviewed for the clinical findings of ecchymosis, trauma, sensation of a 'pop', loss of function, and acuity of onset. RESULTS: Twenty partial distal biceps tendon tears were seen. All displayed an abnormally increased signal in the distal biceps tendon. Three of 20 (15%) showed a 25% to 50% tear, ten of 20 (50%) showed a 50% tear, and seven of 20 (35%) showed a 75% to 90% tear. Bicipitoradial bursitis was seen in 11 of 20 (55%) cases. Bony microavulsive injury of the radial tuberosity was observed in 10 of 20 (50%). Of the nine cases reviewed for associated clinical findings, surprisingly, only three (33%) experienced an acute traumatic episode with an abrupt onset of pain. An insidious onset was reported in four of nine (44%). Sensation of a 'pop' was recorded in only two of nine (22%) cases. Ecchymosis and loss of function were not seen in any of the cases. Finally, surgical conformation was obtained for three cases. CONCLUSION: Partial distal biceps tendon tears have a characteristic MR appearance, demonstrate little functional deficit, and may be attritional in their etiology due to the observation of a low number of patients reporting trauma or an acute onset
— id: 37785, year: 2001, vol: 30, page: 560, stat: Journal Article,

Morton's neuroma: is it always symptomatic?
Bencardino J; Rosenberg ZS; Beltran J; Liu X; Marty-Delfaut E
2000 Sep;175(3):649-653, American journal of roentgenology
OBJECTIVE: We determined the prevalence of clinically silent Morton's neuroma and searched for distinguishing MR imaging features of Morton's neuroma in patients with clinical complaints related to this entity and in patients with clinically silent lesions. MATERIALS AND METHODS: One radiologist who was unaware of clinical findings retrospectively reviewed 85 consecutive foot MR examinations. MR imaging criteria for Morton's neuroma included a low- to intermediate-signal-intensity soft-tissue mass in the intermetatarsal space. The size, location, and signal intensity of each neuroma and the presence of intermetatarsal bursae were recorded. The patients were subdivided into symptomatic or asymptomatic groups on the basis of the patients' answers on a questionnaire documenting the locations and characteristics of symptoms and discussions with each referring physician about clinical findings. Surgical confirmation was available in eight of 25 symptomatic patients. RESULTS: The prevalence of Morton's neuroma in patients with no clinical evidence of this condition was 33% (19/57). Twenty-five patients had symptomatic Morton's neuroma, 19 had Morton's neuroma based on MR imaging findings with no clinical manifestations, and 41 did not have Morton's neuroma. Slightly larger lesions were observed in the symptomatic group, although significant overlap was noted between the two groups. The mean transverse diameter of symptomatic neuromas was 5.3 mm (standard deviation, 2.14) compared with 4.1 mm (standard deviation, 1.75) for asymptomatic neuromas; this difference was marginally significant (p = 0.05). CONCLUSION: The MR imaging diagnosis of Morton's neuroma does not imply symptomatology. Careful correlation between clinical and MR imaging findings is mandatory before Morton's neuroma is considered clinically relevant
— id: 43854, year: 2000, vol: 175, page: 649, stat: Journal Article,

Superior labrum anterior-posterior lesions: diagnosis with MR arthrography of the shoulder
Bencardino JT; Beltran J; Rosenberg ZS; Rokito A; Schmahmann S; Mota J; Mellado JM; Zuckerman J; Cuomo F; Rose D
2000 Jan;214(1):267-271, Radiology
PURPOSE: To determine the accuracy of magnetic resonance (MR) arthrography in the diagnosis of superior labrum anterior-posterior (SLAP) lesions of the shoulder. MATERIALS AND METHODS: From January 1995 to June 1998, MR arthrography of the shoulder was performed in 159 patients with a history of chronic shoulder pain or instability. Fifty-two patients underwent arthroscopy or open surgery 12 days to 5 months after MR arthrography. Diagnostic criteria for SLAP lesion included marked fraying of the articular aspect of the labrum, biceps anchor avulsion, inferiorly displaced bucket handle fragment, and extension of the tear into the biceps tendon fibers. Surgical findings were correlated with those from MR arthrography. RESULTS: SLAP injuries were diagnosed at surgery in 19 of the 52 patients (37%). Six of the 19 lesions (32%) were classified as type I, nine (47%) as type II, one (5%) as type III, and three (16%) as type IV. MR arthrography had a sensitivity of 89% (17 of 19 patients), a specificity of 91% (30 of 33 patients), and an accuracy of 90% (47 of 52 patients). The MR arthrographic classification showed correlation with the arthroscopic or surgical classification in 13 of 17 patients (76%) in whom SLAP lesions were diagnosed at MR arthrography. CONCLUSION: MR arthrography is a useful and accurate technique in the diagnosis of SLAP lesions of the shoulder. MR arthrography provides pertinent preoperative information with regard to the exact location of tears and grade of involvement of the biceps tendon
— id: 27850, year: 2000, vol: 214, page: 267, stat: Journal Article,

Traumatic musculotendinous injuries of the knee: diagnosis with MR imaging
Bencardino JT; Rosenberg ZS; Brown RR; Hassankhani A; Lustrin ES; Beltran J
2000 Oct;20 Spec No(2):S103-S120, Radiographics
Magnetic resonance (MR) imaging is the imaging modality of choice for evaluation of acute traumatic musculotendinous injuries of the knee. Three discrete categories of acute injuries to the musculotendinous unit can be defined: muscle contusion, myotendinous strain, and tendon avulsion. Among the quadriceps muscles, the rectus femoris is the most susceptible to injury at the myotendinous junction due to its superficial location, predominance of type II fibers, eccentric muscle action, and extension across two joints. Among the muscles of the pes anserinus, the sartorius is the most susceptible to strain injury due to its superficial location and biarticular course. The classic fusiform configuration of the semimembranosus along with a propensity for eccentric actions also make it prone to strain injury. MR imaging findings associated with rupture of the iliotibial tract include discontinuity and edema, which are best noted on coronal images. The same mechanism of injury that tears the arcuate ligament from its fibular insertion can also result in avulsion injury of the biceps femoris. The gastrocnemius muscle is prone to strain injury due to its action across two joints and its superficial location. Injuries of the muscle belly and myotendinous junction of the popliteus are far more common than tendinous injuries
— id: 43853, year: 2000, vol: 20 Spec No, page: S103, stat: Journal Article,

Tear of the peroneus longus tendon: MR imaging features in nine patients
Rademaker J; Rosenberg ZS; Delfaut EM; Cheung YY; Schweitzer ME
2000 Mar;214(3):700-704, Radiology
PURPOSE: To determine the magnetic resonance (MR) imaging features that characterize tear of the peroneus longus tendon at the midfoot. MATERIALS AND METHODS: Medical records and MR images in nine patients with a tear of the middle segment of the peroneus longus tendon were retrospectively reviewed. All nine patients had undergone routine ankle MR imaging; three had undergone additional oblique coronal MR imaging. Surgical proof of a tear was available for three patients. RESULTS: Partial tear was present in four patients, and complete tear was present in five. Partial tears were characterized by heterogeneous signal intensity and thickening of the tendon. Complete tears were characterized by discontinuity of the tendon. Additional findings included fluid in the tendon sheath (n = 6), marrow edema of the lateral calcaneal wall (n = 3), enlarged peroneal tubercle (n = 3), and tear of the peroneus brevis tendon (n = 2). The extent of the tear was better assessed with oblique coronal MR images. CONCLUSION: The characteristic MR imaging appearance of complete or partial tear of the middle portion of the peroneus longus tendon includes foci of increased signal intensity in the distal tendon, morphologic alterations, and/or discontinuity of tendon. Bone marrow edema along the lateral calcaneal wall may be suggestive of the diagnosis. Additional oblique coronal midfoot MR images may help in assessment of the extent of the tear
— id: 37817, year: 2000, vol: 214, page: 700, stat: Journal Article,

From the RSNA Refresher Courses. Radiological Society of North America. MR imaging of the ankle and foot
Rosenberg ZS; Beltran J; Bencardino JT
2000 Oct;20 Spec No(2):S153-S179, Radiographics
Magnetic resonance (MR) imaging has opened new horizons in the diagnosis and treatment of many musculoskeletal diseases of the ankle and foot. It demonstrates abnormalities in the bones and soft tissues before they become evident at other imaging modalities. The exquisite soft-tissue contrast resolution, noninvasive nature, and multiplanar capabilities of MR imaging make it especially valuable for the detection and assessment of a variety of soft-tissue disorders of the ligaments (eg, sprain), tendons (tendinosis, peritendinosis, tenosynovitis, entrapment, rupture, dislocation), and other soft-tissue structures (eg, anterolateral impingement syndrome, sinus tarsi syndrome, compressive neuropathies [eg, tarsal tunnel syndrome, Morton neuroma], synovial disorders). MR imaging has also been shown to be highly sensitive in the detection and staging of a number of musculoskeletal infections including cellulitis, soft-tissue abscesses, and osteomyelitis. In addition, MR imaging is excellent for the early detection and assessment of a number of osseous abnormalities such as bone contusions, stress and insufficiency fractures, osteochondral fractures, osteonecrosis, and transient bone marrow edema. MR imaging is increasingly being recognized as the modality of choice for assessment of pathologic conditions of the ankle and foot
— id: 43852, year: 2000, vol: 20 Spec No, page: S153, stat: Journal Article,

MR imaging in sports injuries of the foot and ankle
Bencardino J; Rosenberg ZS; Delfaut E
1999 Feb;7(1):131-49, ix, Magnetic resonance imaging clinics of North America
MR imaging has become the diagnostic modality of choice for the evaluation of traumatic ligamentous and tendinous injures of the foot and ankle, occult bony trauma, and osteochondral lesions of the talus. This article reviews the current applications of MR imaging for the evaluation of sports-related injuries of the foot and ankle, including fractures, sprains, tendon injuries, and heel pain
— id: 43855, year: 1999, vol: 7, page: 131, stat: Journal Article,

Haglund's deformity as a cause of retrocalcaneal bursitis: Evaluation using MR imaging
Bencardino, JT; Rosenberg, ZS
1999 ;213P(1):1536-1536, Radiology
— id: 114529, year: 1999, vol: 213P, page: 1536, stat: Journal Article,

MR imaging of flexor digitorum accessorius longus
Cheung YY; Rosenberg ZS; Colon E; Jahss M
1999 Mar;28(3):130-137, Skeletal radiology
OBJECTIVE: The flexor digitorum accessorius longus muscle (FDAL), an anomalous muscle about the ankle, has recently been implicated in tarsal tunnel syndrome. The purpose of this study is to document the prevalence of the FDAL, its MR appearance and its relation to the neurovascular bundle in the tarsal tunnel. DESIGN AND PATIENTS: The prevalence of the FDAL was determined from 100 ankle MR examinations in asymptomatic individuals. The appearance of the FDAL was summarized from 20 examples of FDAL: six gathered from the asymptomatic group and 14 acquired from a group of randomly collected cases of patients with ankle complaints. RESULTS: The prevalence of the FDAL was 6%, calculated from the group of 100 asymptomatic individuals. Possessing a dominant fleshy component in the tarsal tunnel, the FDAL accompanies the posterior neurovascular bundle as it descends the ankle. CONCLUSION: The FDAL is encountered in 6% of asymptomatic individuals. Its prominent fleshy component in the tarsal tunnel and its close proximity to the posterior tibial neurovascular bundle readily differentiate the FDAL from other medial anomalous muscles on MR imaging
— id: 35506, year: 1999, vol: 28, page: 130, stat: Journal Article,

Central pseudodefect of the talus: a potential ankle MR interpretation pitfall
Rosenberg ZS; Mellado J
1999 Sep-Oct;23(5):718-720, Journal of computer assisted tomography
PURPOSE: The purpose of our study was to outline the MR features of the central pseudodefect of the talus (a normal finding that can simulate an osteochondral lesion on ankle MR studies), assess the prevalence of the central pseudodefect of the talus, and provide insight into the origin of this misleading MR appearance. METHOD: We retrospectively evaluated 31 ankle MR studies in 10 asymptomatic volunteers and 21 consecutive patients for the presence of the central pseudodefect of the talus. None of the patients had a history of trauma to the ankle. The signal, size, and shape of the pseudodefect were documented in each patient. The sagittal images were cross-referenced with the axial and coronal images in all patients in whom the central pseudodefect was identified. RESULTS: Six volunteers (60%) and 13 patients (62%) showed a curvilinear band in the middle third of the talus on far medial sagittal images, consistent with the central pseudodefect of the talus. The band measured 8-15 x 3-8 mm (mean 11 x 4 mm) and was hypointense on T1 and STIR pulse sequences. In two cases, the pseudodefect was subchondral; in the rest, it was found a few millimeters below the articular surface. On cross-referenced axial and coronal images, the band corresponded to the talar insertion site of the deep tibiotalar fibers of the deltoid ligament. CONCLUSION: The central pseudodefect of the talus is a common finding that is produced by the insertion of the tibiotalar fibers of the deltoid ligament into the talus. Familiarity with its appearance is necessary to avoid misinterpreting it as an osteochondral lesion of the talus
— id: 6219, year: 1999, vol: 23, page: 718, stat: Journal Article,

MR imaging of superior peroneal retinacular injuries
Rosenberg, ZS; Bencardino, JT; Cheung, YY; Schweitzer, ME; Astion, D; Rokito, A
1999 ;213P(1):1543-1543, Radiology
— id: 114530, year: 1999, vol: 213P, page: 1543, stat: Journal Article,

Bifocal sclerosing osteosarcoma: unusual presentation and course
Abramovici L; Steiner GC; Rosenberg Z; Kenan S
1998 Aug;27(8):449-452, Skeletal radiology
Multifocal osteosarcoma is uncommon. Long-term survival of an incompletely treated case is exceptional. We report an unusual case of bifocal sclerosing osteosarcoma in a 38-year-old women that involved the left ilium and right proximal femur. The femoral lesion was resected. The tumor in the left ilium was not treated. She did not receive chemotherapy and has been free of metastases for 7 years. Recently, growth of the pelvic osteosarcoma has resulted in vascular compression and edema of the lower extremity. The patient's alkaline phosphatase has been elevated throughout. The tumor was HMB-45 positive, which has not been previously reported in osteosarcoma. The pathogenesis of multifocal osteosarcoma is discussed
— id: 7295, year: 1998, vol: 27, page: 449, stat: Journal Article,

Chondrocalcinosis of the hyaline cartilage of the knee: MRI manifestations
Beltran J; Marty-Delfaut E; Bencardino J; Rosenberg ZS; Steiner G; Aparisi F; Padron M
1998 Jul;27(7):369-374, Skeletal radiology
PURPOSE: To determine the ability of MRI to detect the presence of crystals of calcium pyrophosphate in the articular cartilage of the knee. DESIGN AND PATIENTS: The MR studies of 12 knees (11 cases) were reviewed retrospectively and correlated with radiographs (12 cases) and the findings at arthroscopy (2 cases) and surgery (1 case). A total of 72 articular surfaces were evaluated. Radiographic, surgical or arthroscopic demonstration of chondrocalcinosis was used as the gold standard. Additionally, two fragments of the knee of a patient who underwent total knee replacement and demonstrated extensive chondrocalcinosis were studied with radiography and MRI using spin-echo T1-, T2- and proton-density-weighted images as well as two- and three-dimensional fat saturation (2D and 3D Fat Sat) gradient recalled echo (GRE) and STIR sequences. RESULTS: MRI revealed multiple hypointense foci within the articular cartilage in 34 articular surfaces, better shown on 2D and 3D GRE sequences. Radiographs showed 12 articular surfaces with chondrocalcinosis. In three cases with arthroscopic or surgical correlation, MRI demonstrated more diffuse involvement of the articular cartilage than did the radiographs. The 3D Fat Sat GRE sequences were the best for demonstrating articular calcification in vitro. In no case was meniscal calcification identified with MRI. Hyperintense halos around some of the calcifications were seen on the MR images. CONCLUSION: MRI can depict articular cartilage calcification as hypointense foci using GRE techniques. Differential diagnosis includes loose bodies, post-surgical changes, marginal osteophytes and hemosiderin deposition
— id: 7301, year: 1998, vol: 27, page: 369, stat: Journal Article,

Nerve Entrapment
Beltran J; Rosenberg ZS
1998 ;2(2):175-184, Seminars in musculoskeletal radiology
Entrapment and compressive neuropathies are frequent clinical conditions occurring about the elbow. In most instances clinical and electromyograhic evaluation are adequate for patient management, but in some cases further evaluation with imaging techniques is required. Magnetic resonance imaging (MRI) has been shown to be useful in the evaluation of these conditions, especially to detect space occupying lesions. In this article, compressive neuropathies involving the ulnar, median, and radial nerves are discussed, with emphasis on the normal anatomy and the MRI depiction of pathologic findings
— id: 120638, year: 1998, vol: 2, page: 175, stat: Journal Article,

Magnetic resonance imaging of the peroneal tendons
Mota J; Rosenberg ZS
1998 Oct;9(5):273-285, Topics in magnetic resonance imaging
Injuries of the peroneal tendons include tendinosis, tenosynovitis, tears, and dislocation. These injuries are being detected with greater frequency since the advent of MRI. After a review of the normal MRI anatomy of the peroneal tendons, this article will focus on the MR features of peroneal tendon disorders in the foot and ankle
— id: 57057, year: 1998, vol: 9, page: 273, stat: Journal Article,

MRI of Normal Variants and Interpretation Pitfalls of the Elbow
Rosenberg ZS; Bencardino J; Beltran J
1998 ;2(2):141-155, Seminars in musculoskeletal radiology
One of the fundamental principles of MR imaging interpretation is the ability to distinguish normal anatomical landmarks from true disease. The radiologist is thus compelled to accumulate a comprehensive knowledge of normal structures, variants, and potential MRI diagnostic pitfalls.1-5 In this article we will focus on a number of normal bony, ligamentous, and tendinous structures that can simulate disease at the elbow. We discuss the particular anatomy responsible for the appearance of each of these interpretation pitfalls as well as the distinguishing features between these normal variants and true disease
— id: 57576, year: 1998, vol: 2, page: 141, stat: Journal Article,

Normal variants and pitfalls in magnetic resonance imaging of the ankle and foot
Rosenberg ZS; Bencardino J; Mellado JM
1998 Oct;9(5):262-272, Topics in magnetic resonance imaging
Distinction of normal from disease is one of the principal tenets in magnetic resonance imaging (MRI) interpretation of the foot and ankle. Therefore, familiarity with normal anatomic variants and pitfalls in the foot and ankle is crucial for accurate diagnostic analysis of MR images. This article will focus on outlining variants and MRI interpretation pitfalls of the tendons, muscles, bones, ligaments, and other miscellaneous structures of the foot and ankle
— id: 57069, year: 1998, vol: 9, page: 262, stat: Journal Article,

Peroneus brevis tendon in normal subjects: MR morphology and its relationship to longitudinal tears
Rosenberg ZS; Rademaker J; Beltran J; Colon E
1998 Mar-Apr;22(2):262-264, Journal of computer assisted tomography
PURPOSE: The most prevalent, yet unproven, theory for the development of longitudinal splits of the peroneus brevis tendon is the compression of the peroneus brevis tendon by the peroneus longus tendon in dorsiflexion. The goal of our study was to provide insight into this pathomechanism by evaluating the shape of the peroneus brevis tendon and its relationship to the adjacent structures in the fibular groove during plantarflexion and dorsiflexion. METHOD: The MR images of 13 ankles in asymptomatic adult volunteers were performed in full dorsiflexion and plantarflexion. The axial MR images were assessed for the shape of the peroneus brevis tendon and its relationship to the peroneus longus tendon and posterior cortex of the fibula in both plantarflexion and dorsiflexion. RESULTS: In 12 of the 13 volunteers, the peroneus brevis tendon was located anterior or anteromedial to the peroneus longus tendon in the fibular groove. In those volunteers the peroneus brevis tendon was more flattened and compressed against the fibular groove by the overlying peroneus longus tendon in dorsiflexion than plantarflexion. Fat planes were noted in plantarflexion between the peroneal tendons as well as between the peroneus brevis tendon and the fibular groove. These were obliterated in dorsiflexion. CONCLUSION: The changes in configuration of the tendon of the peroneus brevis tendon in dorsiflexion compared with plantarflexion provide support to our present understanding of the pathomechanism of longitudinal tears of the peroneus brevis tendon
— id: 7768, year: 1998, vol: 22, page: 262, stat: Journal Article,

MR arthrography of the shoulder: variants and pitfalls
Beltran J; Bencardino J; Mellado J; Rosenberg ZS; Irish RD
1997 Nov-Dec;17(6):1403-1412, Radiographics
Use of magnetic resonance arthrography to evaluate pathologic conditions of the shoulder is becoming widespread. However, normal anatomy or anatomic variations can cause interpretive errors. The most common variations occur at the origins of the glenohumeral ligaments (GHLs) and the insertion of the joint capsule. Among the GHL variants, common origin of the superior and middle ligaments is the most frequent followed by thinning, thickening, or absence of a ligament, most often the middle one. Absence or thinning of one ligament is sometimes associated with thickening of another or changes in the size and shape of the anterior capsular recesses. Common normal variants of the labrum include foramen sublabrum (detachment of the anterosuperior labrum from the glenoid margin) and the Buford complex (absence of the anterosuperior labrum in association with a thick middle GHL). Pitfalls related to the arthrographic technique include (a) visualization of a deep sulcus between the insertion of the long head of the biceps tendon and the superior labrum and (b) an apparent type III capsular insertion due to overdistention of the capsule by injected contrast material
— id: 43856, year: 1997, vol: 17, page: 1403, stat: Journal Article,

MR imaging of pediatric elbow fractures
Beltran J; Rosenberg ZS
1997 Aug;5(3):567-578, Magnetic resonance imaging clinics of North America
Pediatric elbow fractures are elusive to radiographic detection and more sophisticated imaging techniques are often required to assess the presence and extension of the fracture line to make appropriate treatment decisions. Arthrography is the current method of choice, but ultrasonography and, more recently, MR imaging have been proposed as alternative modalities, although further experience is necessary to validate their usefulness. We believe that MR imaging offers significant benefits because of its exquisite spatial and contrast resolution
— id: 56925, year: 1997, vol: 5, page: 567, stat: Journal Article,

Glenohumeral instability: evaluation with MR arthrography
Beltran J; Rosenberg ZS; Chandnani VP; Cuomo F; Beltran S; Rokito A
1997 May-Jun;17(3):657-673, Radiographics
Magnetic resonance arthrography is superior to other imaging techniques in evaluation of the glenohumeral joint. Normal variants that can be diagnostic pitfalls include the anterosuperior sublabral foramen, the Buford complex, and hyaline cartilage under the labrum. Anteroinferior dislocation is the most frequent cause of anterior glenohumeral instability and produces a constellation of lesions (anteroinferior labral tear, classic and osseous Bankart lesions, Hill-Sachs lesion). Variants of anteroinferior labral tears include anterior labroligamentous periosteal sleeve avulsion and glenoid labral articular disruption. Anterior glenohumeral instability can also involve tears of the anterior or anterosuperior labrum or the glenohumeral ligaments. Posterior glenohumeral instability can involve a posterior labral tear, posterior capsular stripping or laxity; fracture, erosion, or sclerosis and ectopic ossification of the posterior glenoid fossa; reverse Hill-Sachs lesion; McLaughlin fracture; or posterosuperior glenoid impingement. Superior labral anterior and posterior lesions involve the superior labrum with varying degrees of biceps tendon involvement
— id: 8094, year: 1997, vol: 17, page: 657, stat: Journal Article,

MR imaging of dislocation of the posterior tibial tendon
Bencardino J; Rosenberg ZS; Beltran J; Broker M; Cheung Y; Rosemberg LA; Schweitzer M; Hamilton W
1997 Oct;169(4):1109-1112, American journal of roentgenology
OBJECTIVE: The purpose of this article is to describe the MR imaging appearance of seven cases of posterior tibial tendon dislocation and subluxation. CONCLUSION: Posterior tibial tendon dislocation is a rare but important entity usually related to a previous traumatic event. The clinical diagnosis is often missed because of its rarity. MR imaging provides important clues to the diagnosis and preoperative evaluation of this condition
— id: 7110, year: 1997, vol: 169, page: 1109, stat: Journal Article,

Os sustentaculi: depiction on MR images
Bencardino J; Rosenberg ZS; Beltran J; Sheskier S
1997 Aug;26(8):505-506, Skeletal radiology
We describe a 14-year old patient with pain in the medial ankle. The MR study depicted a rare accessory ossicle called the os sustentaculi. This accessory bone should not be confused with a fracture of the sustentaculum tali of the calcaneus
— id: 7111, year: 1997, vol: 26, page: 505, stat: Journal Article,

Peroneus quartus muscle: MR imaging features
Cheung YY; Rosenberg ZS; Ramsinghani R; Beltran J; Jahss MH
1997 Mar;202(3):745-750, Radiology
PURPOSE: To determine the prevalence of the peroneus quartus (PQ) muscle, to demonstrate the morphology of this accessory muscle on magnetic resonance (MR) images, and to reassess the reported association of the PQ muscle with a hypertrophic peroneal tubercle. MATERIALS AND METHODS: A retrospective review was performed of 136 consecutive ankle MR imaging studies. The origins, insertions, and variations in size of the muscle and the dimensions of the peroneal tubercle and retrotrochlear eminence were recorded. RESULTS: The prevalence of the PQ muscle was 10% (14 of 136 cases). The accessory muscle and tendon unit descended medial and posterior to the peroneal tendons. The site of insertion was variable and included the calcaneus, peroneus longus tendon, peroneus brevis tendon; and cuboid bone. The calcaneus was the insertion site in 11 cases. The accessory tendon attached to the retrotrochlear eminence of the calcaneus. In the group with the PQ muscle, the retrotrochlear eminence was significantly taller (P < .01) than in the group without the PQ muscle. CONCLUSION: Contrary to previous reports, the peroneocalcaneal variant of the PQ muscle appears to insert in the retrotrochlear eminence of the calcaneus rather than the peroneal tubercle. The presence of the PQ muscle is associated with a prominent retrotrochlear eminence but not with an enlarged peroneal tubercle
— id: 35507, year: 1997, vol: 202, page: 745, stat: Journal Article,

The role of MR imaging in the management of elbow problems
Eshman SJ; Posner MA; Hochwald N; Rosenberg ZS
1997 Aug;5(3):443-450, Magnetic resonance imaging clinics of North America
In the past several years, the role of MR imaging in diagnosing pathologic conditions of the elbow has dramatically increased. Aside from imaging soft-tissue tumors, it can accurately visualize partial and complete tears of tendons and ligaments, as well as displacement of epiphyseal fractures in children. Its role in identifying loose bodies, particularly when they are nonosseous, and areas of osteochondritis dissecans has also increased. The use of MR imaging for diagnosing neuropathies, particularly when electrodiagnostic studies are negative, offers exciting possibilities as additional technical improvements are developed
— id: 56942, year: 1997, vol: 5, page: 443, stat: Journal Article,

The peroneocalcaneus internus muscle: MR imaging features
Mellado JM; Rosenberg ZS; Beltran J; Colon E
1997 Aug;169(2):585-588, American journal of roentgenology
OBJECTIVE: The peroneocalcaneus internus muscle is a rare muscle of the posterior calf that to our knowledge has not been reported in the radiology literature. The purpose of our study was to describe the normal anatomy and MR characteristics of this muscle in eight patients in whom the muscle was identified. CONCLUSION: The peroneocalcaneus internus muscle is a rare muscle that originates from the inner aspect of the distal fibula, descends within the tarsal tunnel, and inserts on a small tubercle in the calcaneus, just distal to the sustentaculum tali. The muscle may displace the flexor hallucis longus muscle medially and thus indirectly encroach on the neurovascular bundle
— id: 7216, year: 1997, vol: 169, page: 585, stat: Journal Article,

MR features of nerve disorders at the elbow
Rosenberg ZS; Bencardino J; Beltran J
1997 Aug;5(3):545-565, Magnetic resonance imaging clinics of North America
MR imaging is a useful method for evaluating nerve disease. It can portray the normal anatomy and identify unsuspected space-occupying masses. Severe intrinsic nerve disease can be depicted. This article outlines the normal anatomy of the three major nerves that traverse the elbow joint: the ulnar nerve, the median nerve, and the radial nerve. Entrapment and compression neuropathies of each nerve are discussed in detail. Finally, the role of MR imaging in delineating each nerve abnormality is examined
— id: 12301, year: 1997, vol: 5, page: 545, stat: Journal Article,

MR imaging of normal variants and interpretation pitfalls of the elbow
Rosenberg ZS; Bencardino J; Beltran J
1997 Aug;5(3):481-499, Magnetic resonance imaging clinics of North America
Discrimination of normal anatomic landmarks from true disease is one of the fundamental tenets of adept MR imaging. The radiologist is thus compelled to accumulate a comprehensive knowledge of normal structures, variants, and potential MR imaging interpretation pitfalls. In this article the authors focus on a number of normal, bony, ligamentous, and tendinous structures that can simulate disease at the elbow. A discussion of the particular anatomy responsible for the appearance of each of these interpretation pitfalls is provided. In addition, ways to distinguish these pitfalls from true elbow disease are discussed
— id: 12302, year: 1997, vol: 5, page: 481, stat: Journal Article,

Anterior horn of the lateral meniscus: another potential pitfall in MR imaging of the knee
Shankman S; Beltran J; Melamed E; Rosenberg ZS
1997 Jul;204(1):181-184, Radiology
PURPOSE: To demonstrate that speckled increased signal intensity at the anterior horn of the lateral meniscus near its central attachment site on sagittal magnetic resonance (MR) images of the knee is a normal finding. MATERIALS AND METHODS: In 22 patients (17 male and five female patients; age range, 13-74 years; mean, 38 years) who underwent arthroscopy after MR imaging, knee MR images that showed speckled increased signal intensity at the anterior horn of the lateral meniscus near its central attachment site on two consecutive sagittal proton-density-weighted images were selected for retrospective review. In addition, a review of 11 knee MR examinations of nine healthy volunteers (five men and four women; age range, 27-43 years; mean, 34 years) was performed. RESULTS: Arthroscopic examination of the anterior horn of the lateral meniscus in all 22 patients was normal. Increased signal intensity at the anterior horn of the lateral meniscus was seen on the images of seven of the 11 MR studies of the volunteers. CONCLUSION: Increased signal intensity at the anterior horn of the lateral meniscus near its central attachment site on knee MR images does not represent a meniscal tear
— id: 7258, year: 1997, vol: 204, page: 181, stat: Journal Article,

Posterior intermalleolar ligament of the ankle: normal anatomy and MR imaging features
Rosenberg ZS; Cheung YY; Beltran J; Sheskier S; Leong M; Jahss M
1995 Aug;165(2):387-390, American journal of roentgenology
OBJECTIVE. The purposes of this study were to delineate the normal anatomy and MR imaging features of the posterior intermalleolar ligament--a normal ligamentous variant of the posterior portion of the ankle--and to identify normal anatomic characteristics that may account for the role of the ligament in the development of posterior impingement syndrome. MATERIALS AND METHODS. The prevalence, size, and shape of the posterior intermalleolar ligament were documented in 36 cadaveric ankles and in 97 MR studies of the ankle in patients with and without symptoms. RESULTS. The posterior intermalleolar ligament was identified in 20 (56%) of the 36 cadaveric feet. It was 1-8 mm wide, and its diameter (anterior to posterior) was 5-8 mm. The ligament often resembled a meniscus, and in one case its anterior lip herniated into the ankle joint. The posterior intermalleolar ligament was detected in 18 (19%) of the 97 MR studies of the ankle. It was visualized on coronal T1- or T2-weighted images as a distinct, hypointense band traversing between the posterior talofibular ligament and the inferior transverse ligament. CONCLUSION. The posterior intermalleolar ligament is a normal variant of the posterior ligaments of the ankle and is present in a significant number of persons. It is best seen on coronal T1- and T2-weighted MR images. Its meniscuslike shape and occasional extension into the ankle joint may account for the development of posterior impingement syndrome in susceptible persons
— id: 35508, year: 1995, vol: 165, page: 387, stat: Journal Article,

Pseudodefect of the capitellum: potential MR imaging pitfall
Rosenberg ZS; Beltran J; Cheung YY
1994 Jun;191(3):821-823, Radiology
PURPOSE: To describe the pseudodefect of the distal humerus at the junction of the capitellum and lateral epicondyle, which may simulate an osteochondral lesion on axial and coronal magnetic resonance (MR) images. MATERIALS AND METHODS: MR imaging studies of the elbow in 32 patients and 22 asymptomatic volunteers were retrospectively reviewed. Thirty-two human humeri were also examined for normal anatomy of the junction of the capitellum and distal humerus. RESULTS: Twenty-two of the clinical MR examinations and 14 of the studies on volunteers revealed the presence of the pseudodefect. A groove at the junction and the overhanging lateral edges of the capitellum account for the appearance of this pseudolesion. CONCLUSION: Familiarity with the characteristic appearance and location of this pseudodefect will prevent its misinterpretation as an osteochondral fracture of the distal humerus
— id: 62339, year: 1994, vol: 191, page: 821, stat: Journal Article,

The elbow: MR features of nerve disorders
Rosenberg ZS; Beltran J; Cheung YY; Ro SY; Green SM; Lenzo SR
1993 Jul;188(1):235-240, Radiology
The authors retrospectively reviewed 15 magnetic resonance (MR) studies of elbows with radiographic evidence of nerve disorders. These 15 cases were selected from 55 MR studies of the elbow in patients referred for various complaints. MR images of the elbow of 10 healthy volunteers were also reviewed. Ulnar nerve disorders were seen in 11 cases. Three patients had median nerve disease, and one patient had a pathologic condition of the radial nerve. The following nerve abnormalities were detected: focal or diffuse nerve thickening, increased signal intensity on T2-weighted images, and course deviation due to either mass effect or spontaneous subluxation. Six of seven patients with nerve thickening, two of two patients with increased nerve signal intensity, and five of eight patients with nerve displacement complained of neurologic symptoms. Four of the patients underwent surgery; in each, surgical results confirmed the findings at MR. These results suggest that MR imaging has a potential role in the detection of nerve disorders at the elbow and in the guidance of treatment
— id: 25255, year: 1993, vol: 188, page: 235, stat: Journal Article,

MRI of anterior cruciate ligament reconstruction
Cheung, Y; Magee, T H; Rosenberg, Z S; Rose, D J
1992 Jan-Feb;16(1):134-137, Journal of computer assisted tomography
Eleven asymptomatic patients 1-9 months after arthroscopic assisted anterior cruciate ligament (ACL) reconstruction with autogenous semitendinosus and gracilis tendons as a 'neoligament' were studied by MR. Each neoligament was clinically intact. Examinations were performed at 1.5 T with T1- and T2-weighted sagittal and oblique spin echo images in the plane of ACL repair. On MR in 9 of the 11 patients (82%) the ACL neoligament appeared as a smooth well-defined band of low signal intensity along its entire course. In two patients (18%) the integrity of the neoligament could not be determined by MR. Ligaments in which integrity could not be determined demonstrated irregularity or a wavy contour, high signal intensity change within the ligament, or discontinuity of the ligament. We conclude that, contrary to previous reports, MR can demonstrate an intact ACL reconstruction
— id: 138455, year: 1992, vol: 16, page: 134, stat: Journal Article,

Spectrum of salivary gland disease in HIV-infected patients: characterization with Ga-67 citrate imaging
Rosenberg, Z S; Joffe, S A; Itescu, S
1992 Sep;184(3):761-764, Radiology
The authors retrospectively reviewed 45 gallium-67 citrate scans of 28 patients infected with the human immunodeficiency virus (HIV). Abnormal salivary gland radiotracer activity was seen in 13 patients with diffuse infiltrative lymphocytosis syndrome (DILS), five patients with undifferentiated salivary gland disease (USD), and 10 patients with acquired immunodeficiency syndrome (AIDS). More DILS patients (54%) had intense gallium uptake than did the AIDS and USD patients combined (13%) (P less than .05). DILS patients had markedly elevated CD8 cell counts and moderately reduced CD4 cell counts, while AIDS patients had normal CD8 cell counts and markedly reduced CD4 cell counts. These differences were statistically significant (P less than .05). The authors recommend that DILS be considered in the differential diagnosis when abnormal, particularly intense, bilateral salivary gland gallium uptake occurs in HIV-infected patients. This disease is more likely to occur when circulating CD8 lymphocytosis is present, while AIDS is the more likely diagnosis when the patient has a normal CD8 cell count and a markedly depressed CD4 cell count
— id: 133338, year: 1992, vol: 184, page: 761, stat: Journal Article,

Rapid destructive osteoarthritis: clinical, radiographic, and pathologic features
Rosenberg, Z S; Shankman, S; Steiner, G C; Kastenbaum, D K; Norman, A; Lazansky, M G
1992 Jan;182(1):213-216, Radiology
Twenty-seven cases of an unusual, poorly recognized destructive hip arthropathy with radiographic findings of rapid severe joint destruction are presented. Radiographic findings mimicked those of other disorders such as septic arthritis, rheumatoid and seronegative arthritis, primary osteonecrosis with secondary osteoarthritis, or neuropathic osteoarthropathy, but none of the patients had clinical, pathologic, or laboratory evidence of these entities. All patients underwent hip arthroplasty, and osteoarthritis was confirmed at pathologic examination. Rapid progression of hip pain and disability was a consistent clinical feature. The average duration of symptoms was 1.4 years. Radiographs obtained at various intervals before surgery (average, 18 months) in nine patients documented rapid hip destruction. Involvement was unilateral in 89% (24 of 27 cases). Twenty patients (83%) were elderly women. The authors postulate that these cases represent an uncommon, rapidly destructive subset of osteoarthritis
— id: 131506, year: 1992, vol: 182, page: 213, stat: Journal Article,

Arthritis associated with HIV infection: radiographic manifestations
Rosenberg ZS; Norman A; Solomon G
1989 Oct;173(1):171-176, Radiology
Radiographs of symptomatic joints were retrospectively evaluated in 24 patients with inflammatory arthritis and human immunodeficiency virus (HIV) infection. Clinically, 20 patients had a seronegative arthritis including Reiter syndrome (54%), psoriatic arthritis (17%), and undifferentiated forms of spondyloarthropathy (13%). These patients were indistinguishable radiographically from patients with typical seronegative disorders except for the predominance of lower-extremity abnormalities. Four patients (17%) had a rheumatoidlike arthritis defined as acute symmetric polyarthritis (ASP). With the exception of extensive proliferative periostitis, ASP simulated classic rheumatoid arthritis. HIV-associated arthritis was manifest during various stages of HIV infection. It preceded acquired immunodeficiency syndrome in 64% of patients with stage IV HIV infection. Awareness of the coexistence of HIV infection in patients with the above-mentioned arthritides is important, since immunosuppressive therapy, commonly used in the treatment of arthritis, can have detrimental effects in patients with HIV infection
— id: 67357, year: 1989, vol: 173, page: 171, stat: Journal Article,

Computed tomography scan and magnetic resonance imaging of ankle tendons: an overview
Rosenberg ZS; Cheung Y; Jahss MH
1988 Jun;8(6):297-307, Foot & ankle
CT and MRI are both effective in the diagnosis of ankle tendon injuries. MRI is the preferred study, however, because of its superior soft tissue contrast resolution, multiplanar capabilities, lack of beam hardening artifacts, and lack of ionizing radiation. CT can serve as an excellent substitute when financial considerations and availability preclude the use of MRI. CT is also superior in evaluating bony abnormalities associated with tendon injuries
— id: 35521, year: 1988, vol: 8, page: 297, stat: Journal Article,

Rupture of posterior tibial tendon: CT and MR imaging with surgical correlation
Rosenberg ZS; Cheung Y; Jahss MH; Noto AM; Norman A; Leeds NE
1988 Oct;169(1):229-235, Radiology
Computed tomography (CT) and magnetic resonance (MR) imaging were performed in 32 cases of clinically suspected chronic tears of the posterior tibial tendon. Surgery was performed in 22 patients (69%). Each case was classified radiographically and surgically as normal or a type 1, type 2, or type 3 rupture. The sensitivity and specificity of CT were 90% and 100%, respectively, while those of MR imaging were 95% and 100%. The accuracy in detecting ruptures was 91% for CT and 96% for MR imaging. The overall accuracy, which reflected the percentage of cases correctly diagnosed as well as those correctly classified, was 59% for CT and 73% for MR imaging. Although the differences between the CT and MR imaging parameters were not statistically significant (possibly due to the small population), the results suggest that MR imaging is the method of choice for detecting ruptures of the posterior tibial tendon. MR imaging provided greater definition of tendon outline, vertical splits, synovial fluid, edema, and degenerated tissue. CT was superior to MR imaging in showing associated bone abnormalities such as periostitis, subtalar osteoarthritis, and subtalar dislocation
— id: 35520, year: 1988, vol: 169, page: 229, stat: Journal Article,

Rupture of the posterior tibial tendon: CT and surgical findings
Rosenberg ZS; Jahss MH; Noto AM; Shereff MJ; Cheung Y; Frey CC; Norman A
1988 May;167(2):489-493, Radiology
Computed tomography (CT) was performed in 42 patients with 49 clinically suspected tears of the posterior tibial tendon. Twenty-eight of the 49 suspected tears were subsequently surgically explored and repaired. Three patterns of tendon abnormalities were recognized on CT scans: type I-intact, hypertrophied, heterogeneous tendon; type II-attenuated tendon; and type III-absence of a portion of a tendon. Types I and II correlated with partial rupture seen during surgery, and type III correlated with complete rupture of the tendon. CT findings were accurate in 96% of the patients who underwent surgery. In four cases (14%), tendon rupture was seen on CT scans, but the extent of the injury was underestimated and the rupture was misclassified. Reactive periostitis of the distal tibia was seen in 71% of diseased tendons and may represent an important factor in the diagnosis of tendon rupture
— id: 35522, year: 1988, vol: 167, page: 489, stat: Journal Article,

Ankle tendons: evaluation with CT
Rosenberg, Z S; Feldman, F; Singson, R D; Kane, R
1988 Jan;166(1 Pt 1):221-226, Radiology
Computed tomographic (CT) analysis of 21 clinically suspected ankle tendon injuries was performed in 18 patients. In six of the 21 ankles surgical exploration was done, and in one ankle evaluation was done while the patient was under anesthesia. In all seven cases the CT findings were confirmed and in three the clinical diagnosis was disproved. CT provided additional information and helped guide treatment in the majority of patients studied. Thus CT is an accurate, noninvasive modality for assessing ankle tendon injuries
— id: 68495, year: 1988, vol: 166, page: 221, stat: Journal Article,

Distal tibial triplane fractures: diagnosis with CT
Feldman, F; Singson, R D; Rosenberg, Z S; Berdon, W E; Amodio, J; Abramson, S J
1987 Aug;164(2):429-435, Radiology
Distal tibial triplane features, which constitute 6%-10% of epiphyseal injuries, are most accurately delineated and analyzed with computed tomography (CT). This is directly related to the special geometry of these fractures that have important transverse components. CT, with its transaxial orientation, is the only radiographic technique that directly images the otherwise inaccessible, horizontally oriented tibial plafond, the integrity of which largely determines the prognosis. CT is the method of choice for preoperative and postoperative evaluation of these injuries
— id: 68497, year: 1987, vol: 164, page: 429, stat: Journal Article,

Intra-articular calcaneal fractures: computed tomographic analysis
Rosenberg, Z S; Feldman, F; Singson, R D
1987 ;16(2):105-113, Skeletal radiology
Computed tomography (CT) analysis of 21 intra-articular calcaneal fractures categorized according to the Essex-Lopresti classification revealed the following distribution: joint depression-type 57%, comminuted type 43%, tongue-type 0%. The posterior calcaneal facet was fractured and/or depressed in 100% of the cases while the medial facet was involved in only 25% of the cases. CT proved superior to plain films by consistently demonstrating additional fracture components within each major category suggesting subclassifications which have potential prognostic value. CT allowed more expeditious handling of acutely injured patients, and improved preoperative planning, postoperative follow-up, and detailed analysis of causes for chronic residual pain. CT further identified significant soft tissue injuries such as peroneal tendon displacement which cannot be delineated on plain films
— id: 68501, year: 1987, vol: 16, page: 105, stat: Journal Article,

Peroneal tendon injury associated with calcaneal fractures: CT findings
Rosenberg, Z S; Feldman, F; Singson, R D; Price, G J
1987 Jul;149(1):125-129, American journal of roentgenology
Injury to the peroneal tendons is one of the major long-term complications of intraarticular calcaneal fractures and heretofore has been difficult to diagnose by noninvasive radiography. Retrospective review of CT scans of 24 intraarticular calcaneal fractures, obtained shortly after injury, identified 22 cases (92%) of acute peroneal tendon abnormalities. In most of these cases, multiple findings were present. These included lateral displacement in 14 (58%) of 24, impingement by bony fragments in eight (33%), subluxation or dislocation in six (25%), soft-tissue masses around the tendons representing hematomas or early scar tissue in five (21%), and entrapment of the tendons in three (13%). In 10 cases with long-term follow-up, impingement on the tendons by bony fragments correlated well with the subsequent development of peroneal tenosynovitis, while hematoma around the tendons or lateral displacement of the tendons was clinically insignificant. Thus, CT in the immediate postfracture period, can be used to detect and categorize acute peroneal tendon injuries as well as possibly to predict the likelihood and nature of subsequent development of peroneal tenosynovitis
— id: 68499, year: 1987, vol: 149, page: 125, stat: Journal Article,

Recurrent shoulder dislocation after surgical repair: double-contrast CT arthrography. Work in progress
Singson, R D; Feldman, F; Bigliani, L U; Rosenberg, Z S
1987 Aug;164(2):425-428, Radiology
Nine cases of recurrent postoperative shoulder instability, resulting from failed surgical repair, were studied with double-contrast computed tomography (CT) arthrography. Repeat operations in seven cases showed excellent correlation between CT and surgical anatomic findings. CT arthrography was useful in confirming the direction of instability, particularly of the posterior and multidirectional types. Capsular laxity, subscapularis muscle and tendon abnormalities, and Bankart lesions that were either recurrent or not identified during previous operations were the most common causes of recurrent dislocations. The precise identification of the soft-tissue and bone abnormalities responsible for shoulder instability augmented clinical evaluation and aided preoperative planning
— id: 68498, year: 1987, vol: 164, page: 425, stat: Journal Article,

Postamputation neuromas and other symptomatic stump abnormalities: detection with CT
Singson, R D; Feldman, F; Slipman, C W; Gonzalez, E; Rosenberg, Z S; Kiernan, H
1987 Mar;162(3):743-745, Radiology
One of the potentially troublesome sequelae of limb amputations is the development of stump neuromas at the severed ends of major nerves. The ability to define them and to distinguish them from other causes of stump pain is of considerable clinical significance. Computed tomography was performed on ten lower limb amputees with stump pain. Five patients had neuromas that were manifest as focal or generalized alteration in the caliber, size, or contour of the nerve trunk in the affected stump. The remaining five patients each had an abnormality detected; these abnormalities included heterotopic bone formation, popliteal artery aneurysm, lipoma, scar tissue, and abscess in the contralateral limb
— id: 68500, year: 1987, vol: 162, page: 743, stat: Journal Article,

Peroneal tendon injuries: CT analysis
Rosenberg, Z S; Feldman, F; Singson, R D
1986 Dec;161(3):743-748, Radiology
Computed tomographic (CT) evaluation of the peroneal tendons was obtained in 25 normal ankles and 30 abnormal ankles studied for trauma. The tendons and associated soft-tissue and bony structures, such as the calcaneofibular ligament, superior and inferior peroneal retinacula, fibular groove, and peroneal tubercle, which have heretofore evaded documentation on routine radiographs, are illustrated and discussed. Special attention is given to normal variations such as convex fibular tip and enlarged peroneal tubercle, which predispose the peroneal tendons to abnormal mechanical stresses. Examples of CT-established peroneal tendon abnormalities in the 30 cases examined are also demonstrated. These abnormalities include subluxation, dislocation, entrapment, and tenosynovitis of the peroneal tendons. The authors believe CT has proved to be an extremely useful and relatively noninvasive imaging tool for the evaluation of peroneal tendon injuries
— id: 68502, year: 1986, vol: 161, page: 743, stat: Journal Article,

Elbow joint: assessment with double-contrast CT arthrography
Singson, R D; Feldman, F; Rosenberg, Z S
1986 Jul;160(1):167-173, Radiology
The elbow joint was evaluated by means of computed tomography (CT) immediately following double-contrast arthrography. Normal baseline anatomy and representative abnormal studies are illustrated. Intraarticular abnormalities, such as osteocartilaginous bodies, hyperplastic synovium, fracture fragments, and osteophytes, were identified and precisely located on postarthrography CT scans. This technique, which enabled such abnormalities to be seen, has provided an anatomic and mechanical basis for seemingly idiopathic instances of limited elbow motion
— id: 68504, year: 1986, vol: 160, page: 167, stat: Journal Article,