Musculoskeletal

The UCSF musculoskeletal imaging section is currently composed of Lynne Steinbach, M.D. (Chief), and Thomas Link, M.D. Dr. Steinbach is a Professor of Clinical Radiology and Orthopaedic Surgery who has been at UCSF for 22 years. She works full time in the musculoskeletal section. Dr. Steinbach is internationally known for her extensive knowledge of musculoskeletal MRI, arthritis and musculoskeletal manifestations of AIDS.Thomas Link, who joined the staff in 2004, is an Associate Professor of Radiology and heads the Clinical Osteoporosis section. He is also the clinical director of the Musculoskeletal Quantitative Imaging Research (MQIR) group. Dr. Link is internationally known for his expertise in osteoporosis and arthritis, and for performing procedures such as osteoid osteoma ablations. Both attendings have written widely on all aspects of these subjects and are highly regarded for their expertise.

There is ample opportunity for scientific investigation in the section. UCSF has state-of-the-art equipment including a 3T research and clinical MRI unit and has always been at the forefront with new imaging techniques. Our residents, fellows, medical students, post-docs, and foreign fellows are able to find new projects in this environment. We also collaborate with investigators from other centers through our broad network of connections. Examples of recent projects that are at the forefront of musculoskeletal imaging include the use of PET imaging for evaluating musculoskeletal sarcomas and myeloma in the spine, various uses of MR arthrography, osteoporosis research, and correlation of osteoarthritic changes on radiographs and MRI with clinical symptoms. All of these projects are enhanced by our excellent rapport with referring clinicians who provide the cases and their follow-up.

The musculoskeletal imaging section also works closely with Sharmila Majumdar, PhD and the MQIR group. This has proved to be a very fruitful and satisfying relationship that is resulting in large NIH grants in the area of musculoskeletal imaging and the formation of a bioengineering research partnership that brings together many related disciplines. Dr. Majumdar has provided her expertise in biophysics and the physics of imaging which has been tremendously helpful in developing state-of-the-art imaging projects. We are getting involved in cutting edge imaging projects in osteoarthritis and cartilage evaluation through this collaboration.

(See article "Morphological and Functional Musculoskeletal Imaging")

Office Telephone: (415) 353-8940 - FAX: (415) 353-2643

UCSF Faculty:

Thomas M. Link, M.D. Professor in Residence Chief, Musculoskeletal Imaging thomas.link@radiology.ucsf.edu

Lynne S. Steinbach, M.D. Professor of Clinical Radiology and Orthopaedic Surgery lynne.steinbach@radiology.ucsf.edu

Clinical Professors, WOS:

• Charles Rennell, M.D.
  
• Mariela Resendes, M.D.
  
• Geoffrey Riley, M.D.

Educational Program:
Clinical Conferences are held monthly. Conferences that trainees may attend include:

• Orthopedic oncology conference- 2 1/2 hours/month
• Rheumatology conference- 1 hour/month
• Hand and wrist imaging correlation conference- 1 hour/month
• Total Joint conference- 1 hour/month
• Sports Medicine imaging correlation conference- 1 hour/month
• Orthopedic spine conference- 1 hour/week
• Neuroradiology spine conference- 1 hour/bimonthly
• Musculoskeletal Journal Club- 1 1/2 hours/month with OARG
• Musculoskeletal Radiology Noon conference- 1 hour/week
• Medical student and orthopedic intern project reports- 1 hour/month

Teaching:

Dr. Steinbach has expended great effort to provide a superior teaching environment for fellows, residents, others who are on the clinical service and referring clinicians. There is extra time spent during readout to review essential concepts. Teaching files are reviewed on a regular basis. Arthrography is taught with up-to-date techniques and great experience on the part of the two attendings. There is an extensive teaching file in the skeletal section (both hard copy and electronic) and in Dr. Steinbach*s own private collection. We have a CD rom that was published by our section and sold by Lippincott that is widely used both on campus and throughout the radiology world. There is also a videotape file that includes lectures on musculoskeletal imaging from previous UCSF post-graduate courses.

Research Directions:

• MR-Arthrography at 3 Tesla
• Cartilage imaging, sequence optimization at 3 Tesla
• In vitro and in vivo comparison of cartilage imaging at 1.5T and 3T
• Imaging of osteoarthritis related changes in the longitudinal follow-up
• Contrast enhanced Multislice Spiral CT for assessment of bone density and structure
• Assessment of the symptomatic intervertebral disc using advanced imaging techniques
• MR imaging of mosaicplasty in the longitudinal follow-up
• Applications of wrist MR arthrography
• MRI histopathologic correlation of sacroiliitis in ankylosing spondylitis
• Comparison of 1.5T with 3T MRI for evaluation of smaller joints
• PET correlation with musculoskeletal pathology
• Correlation of MRI with hip arthroscopy
• MRI for hip impingement
• Evaluation of insufficiency fractures of the pelvis

Honors and awards:

Thomas Link
Musculoskeletal Section Editor for European Radiology

Lynne Steinbach
Invited to present the "Sante Lecture" St Louis University
RSNA Research and Education Foundation Study Section
NIH Progress Review Group for Sarcoma Research

Recent Key References:

Anderson SE, Steinbach LS, Martin M, Tschering-Vogel D, Nagy L. MR imaging of avascular scaphoid nonunion after vascularized bone grafting. Skeletal Radiology 2005; 34:314-20.

Beer A, Saar B, Zantl N, Link TM, Roggel R, Hwang SL, Schwaibold H, Rummeny EJ. MR cystography for bladder tumor detection. Eur Radiol 2004 Dec; 14(12):2311-9.

Blumenkrantz G, Lindsey CT, Dunn TC, Jin H, Ries MD, Link TM, Steinbach LS, Majumdar S. A pilot, two-year longitudinal study of the interrelationship between trabecular bone and articular cartilage in the osteoarthritic knee. Osteoarthritis Cartilage 2004; 12:997-1005.

Bredella M, Steinbach LS, Hawkins R, Caputo G, Segall G. Value of 2-[F-18] 2-fluoro deoxy-D-glucose positron emission tomography in the assessment of patients with multiple myeloma. AJR Am J Roentgenol 2005; 184:1199-1204.

Brugel M, Link TM, Rummeny EJ, Lange P, Theisen J, Dobritz M. Assessment of vascular invasion in pancreatic head cancer with multislice spiral CT: value of multiplanar reconstructions. Eur Radiol 2004 Jul; 14(7):1188-95.

Chung C, Chew F, Steinbach LS. MR Imaging of tendon abnormalities of the elbow. Magn Reson Imaging Clin N Am 2004; 12:233-45.

Daldrup-Link HE, Rudelius M, Piontek G, Metz S, Brauer R, Debus G, Corot C, Schlegel J, Link TM, Peschel C, Rummeny EJ, Oostendorp RA. Migration of iron oxide-labeled human hematopoietic progenitor cells in a mouse model: in vivo monitoring with 1.5-T MR imaging equipment. Radiology 2005 Jan; 234:197-205.

Eckstein F, Fischbeck M, Kuhn V, Link TM, Priemel M, Lochmuller EM. Determinants and heterogeneity of mechanical competence throughout the thoracolumbar spine of elderly women and men. Bone 2004; 35(2):364-74.

King KB, Lindsey CT, Dunn TC, Ries MD, Steinbach LS, Majumdar S. A study of the relationship between molecular biomarkers of joint degeneration and the magnetic resonance-measured characteristics of cartilage in 16 symptomatic knees. Magn Reson Imaging 2004; 22:1117-23.

Lee KY, Dunn TC, Steinbach LS, Ozhinsky E, Ries, MD, Majumdar S. Computer aided quantification of focal cartilage lesions of osteoarthritic knee using MRI. Magn Reson Imaging 2004; 22:1105-15.

Lee KY, Masi JN, Sell CA, Schier R, Link TM, Steinbach LS, Safran M, Ma B, Majumdar S. Computer-aided quantification of focal cartilage lesions using MRI: Accuracy and initial arthroscopic comparison. Osteoarthritis Cartilage 2005 Aug; 13(8):728-37.

Link TM, Bauer J, Kollstedt A, Stumpf I, Hudelmaier M, Settles M, Majumdar S, LochmŸller EM, Eckstein F. Trabecular bone structure of the distal radius, the calcaneus and the spine - Which site predicts fracture status of the spine best? Invest Radiol 2004; 39:487-97.

Link TM, Guglielmi G, van Kuijk C, Adams JE. Radiologic assessment of osteoporotic vertebral fractures: diagnostic and prognostic implications. Eur Radiol 2005 Aug; 15(8):1521-32.

Nagele E, Kuhn V, Vogt H, Link TM, Muller R, Lochmuller EM, Eckstein F. Technical considerations for microstructural analysis of human trabecular bone from specimens excised fromvarious skeletal sites. Calcif Tissue Int 2004; 75(1):15-22.

Magarelli N, Guglielmi G, Savastano M, Toro V, Sborgia M, Fioritoni G, Mattei PA, Steinbach LS, Bonomo L. Superficial inflammatory and primary neoplastic lymphadenopathy: diagnostic accuracy of power-doppler sonography. Eur J Radiol 2004; 52:257-63.

Masi J, Newitt D, Sell C, Daldrup-Link HE, Steinbach L, Majumdar S, Link, TM. MR Arthrography at 3 Tesla - Optimization of Gadodiamide concentration. AJR Am J Roentgenol 2005; 184(6):1754-61.

Masi J, Sell C, Phan C, Han E, Newitt D, Steinbach L, Majumdar S Link, TM. Cartilage imaging at 3 Tesla versus 1.5 Tesla - preliminary results in an animal model. Radiology 2005; 236(1):140-50.

Metz S, Damoser P, Hollweck R, Roggel R, Engelke C, Woertler K, Renger B, Rummeny EJ, Link TM. Chest radiography with a digital flat-panel detector: experimental receiver operating characteristic analysis. Radiology 2005; 234(3):776-84.

Patel PV, Prevrhal S, Bauer JS, Phan C, Eckstein F, LochmŸller EM, Majumdar S, Link TM. Trabecular bone structure obtained from multislice spiral CT of the calcaneus predicts osteoporotic vertebral deformities. J Comput Assist Tomogr 2005; 29(2):246-53.

Schindera ST, Streit M, Kaelin U, Stauffer E, Steinbach LS, Anderson SE. Stewart--Treves syndrome: MR imaging of a postmastectomy upper-limb chronic lymphedema with angiosarcoma. Skeletal Radiology 2005; 34(3):156-60.

Schindera ST, Triller J, Steinbach LS, Zimmermann H, Takala J, Anderson SE. Spectrum of injuries from glacial sports. Wilderness Environ Med 2005; 16:33-7.

Simon G, Link TM, Wortler K, Doebereiner F, Schulte-Frohlinde E, Daldrup-Link H, Settles M, Rummeny EJ. Detection of hepatocellular carcinoma: comparison of Gd-DTPA- and ferumoxides-enhanced MR imaging. Eur Radiol 2005; 15(5):895-903.

Steinbach LS. Magnetic resonance imaging of glenohumeral joint instability. Semin Musculoskeletal Radiol 2005; 9:44-55.

Tshering DW, Vogel  I, Steinbach LS, Hertel R, Bernhard J, Stauffer E, Anderson S. Acromioclavicular joint cyst: nine cases of a pseudotumor of the shoulder. Skeletal Radiol 2005; 34:260-5.

Tshering-Vogel D, Wldherr C, Schindera ST, Steinbach LS, Stauffer E, Anderson SE. Adductor insertion avulsion syndrome, "thigh splints": relevance of radiological follow-up. Skeletal Radiol 2005; 34:355-8.

Waldt S, Bruegel M, Ganter K, Kuhn V, Link TM, Rummeny,EJ, Woertler K. Comparison of multislice CT arthrography and MR arthrography for the detection of articular cartilage lesions of the elbow. Eur Radiol 2005; 15(4):784-91.