Avneesh Chhabra, MD Assistant Professor of Radiology and Orthopedic Surgery MSK Radiology Section

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High Resolution MR Neurography. Evaluation O f Radiculopathy. Avneesh Chhabra, MD Assistant Professor of Radiology and Orthopedic Surgery MSK Radiology Section The Russell H. Morgan Department of Radiology and Radiological Science Johns Hopkins Medical Institutions. Background.
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High Resolution MR NeurographyEvaluation Of RadiculopathyAvneesh Chhabra, MDAssistant Professor of Radiology and Orthopedic SurgeryMSK Radiology SectionThe Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins Medical InstitutionsBackground
  • Radiculopathy (backpain radiating to arms and / or legs) is a major health problem and burden to the society at large.
  • Approximately 15% of all US adults have recurrent low back pain in their lifetime, with at least 5% becoming disabled. Low back injuries lead to an estimated health cares costs totaling more than $ 55 billion/year.
  • RadiculopathyMRI+-Nerve Block6-8 weeks of PhysiotherapyDon’t RespondRespondRespondNerve BlockSurgeryDon’t RespondRespondRadiculopathyMRI-6-8 weeks of PhysiotherapyDon’t RespondRespondNerve BlockMRN- New techniqueRadiculopathyHypothesisIn clinically suspected radiculopathy and MRI equivocal subjects, MRN can predict those who will respond to nerve block.Nerve BlockAims
  • To test whether MRI predicts subjects who respond to nerve block
  • To test whether MRI predicts subjects who fail to respond to physiotherapy
  • STUDY DESIGN
  • A pilot study of 20 subjects with no history of previous surgery, suspected of radiculopathy by history and clinical examination and with non-contributory or indeterminate conventional MRI
  • All subjects receive MRN exam as a research tool. The results of MRN will not be made available to the subjects or the referring physician.
  • STUDY DESIGN
  • Outcome measures, such as
  • LBP intensity (visual analogue scale)
  • Unidimentional QOL thermometer scale
  • Oswestry Disability Index
  • Administered at the time of MRN, after completion of physical therapy and 6-12 weeks following nerve block in patients undergoing such procedure.
  • STUDY DESIGN
  • Reading Procedure-
  • Two readers, blinded to clinical information will be given structured training sessions on evaluation of MRN images demonstrating imaging features of nerve impingement 2 weeks before the formal review of all the images.
  • Each patient’s examination will be read for the assessment of presence or absence of nerve impingement.
  • STUDY DESIGN
  • Statistics-
  • Sensitivity and specificity of MRN interpretation will be calculated with respect to response to physiotherapy and nerve block.
  • Kappa values for interobserver variability in reading MRN exams between the readers will be assessed.
  • Linear and logistic regression models will be used to assess the outcomes adjust for age, sex and race as predicted by MRN.
  • Significance
  • Since, early detection of cervical and lumbosacral nerve impingement is essential for diagnosis, therapeutic intervention, and for planning of follow-up strategies; MRN could make a major impact in radiculopathy diagnosis by improving the diagnostic accuracy and reader confidence in pin pointing the exact site of nerve impingement.
  • These results may translate into overall decreased cost of care by reducing the number of spine interventions and subsequent surgeries.
  • Acknowledgements
  • My team (Sonye, John, Francisco, Zeshaan & Kelly
  • Experts- Steve Sozio and Timothy Pavlik
  • Course directors and teachers
  • Related Search

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