Eddy Dirk Zandee van Rilland

All Publications

• Myositis and Its Mimics: Guideline Updates, MRI Characteristics, and New Horizons. AJR. American journal of roentgenology Zandee van Rilland, E. D., Yao, L., Stevens, K. J., Chung, L. S., Fiorentino, D. F., Boutin, R. D. 2024

  Abstract

  Myositis is defined as inflammation within skeletal muscle and is a subcategory of myopathy, which is more broadly defined as any disorder affecting skeletal muscle. Myositis may be encountered as a component of autoimmune and connective tissue disease, where it is described as idiopathic inflammatory myopathy. Myositis can also be caused by infections, as well as toxins and drugs, including newer classes of medications. MRI plays an important role in the diagnosis and evaluation of patients with suspected myositis, but many entities may have imaging features similar to myositis and can be considered myositis mimics. These include muscular dystrophies, denervation, deep venous thrombosis, diabetic myonecrosis, muscle injury, heterotopic ossification, and even neoplasms. In patients with suspected myositis, definitive diagnosis may require integrated analysis of imaging findings with clinical, laboratory, and pathology data. The objectives of this article are to review the fundamental features of myositis, including recent updates in terminology and consensus guidelines for idiopathic inflammatory myopathies, the most important MRI differential diagnostic considerations for myositis (i.e., myositis mimics), and new horizons, including the potential importance of artificial intelligence and multimodal integrated diagnostics in the evaluation of patients with muscle disorders.

  View details for DOI 10.2214/AJR.24.31359

  View details for PubMedID 38838235

• Does the presence of macroscopic intralesional fat exclude malignancy? An analysis of 613 histologically proven malignant bone lesions. European radiology Zandee van Rilland, E. D., Yoon, S. Y., Garner, H. W., Ni Mhuircheartaigh, J., Wu, J. S. 2024

  Abstract

  To determine if macroscopic intralesional fat detected in bone lesions on CT by Hounsfield unit (HU) measurement and on MRI by macroscopic assessment excludes malignancy.All consecutive CT-guided core needle biopsies (CNB) of non-spinal bone lesions performed at a tertiary center between December 2005 and September 2021 were reviewed. Demographic and histopathology data were recorded. All cases with malignant histopathology were selected, and imaging studies were reviewed. Two independent readers performed CT HU measurements on all bone lesions using a circular region of interest (ROI) to quantitate intralesional fat density (mean HU < -30). MRI images were reviewed to qualitatively assess for macroscopic intralesional fat signal in a subset of patients. Inter-reader agreement was assessed with Cronbach's alpha and intraclass correlation coefficient.In 613 patients (mean age 62.9 years (range 19-95 years), 47.6% female), CT scans from the CNB of 613 malignant bone lesions were reviewed, and 212 cases had additional MRI images. Only 3 cases (0.5%) demonstrated macroscopic intralesional fat on either CT or MRI. One case demonstrated macroscopic intralesional fat density on CT in a case of metastatic prostate cancer. Two cases demonstrated macroscopic intralesional fat signal on MRI in cases of chondrosarcoma and osteosarcoma. Inter-reader agreement was excellent (Cronbach's alpha, 0.95-0.98; intraclass correlation coefficient, 0.90-0.97).Malignant lesions rarely contain macroscopic intralesional fat on CT or MRI. While CT is effective in detecting macroscopic intralesional fat in primarily lytic lesions, MRI may be better for the assessment of heterogenous and infiltrative lesions with mixed lytic and sclerotic components.Macroscopic intralesional fat is rarely seen in malignant bone tumors and its presence can help to guide the diagnostic workup of bone lesions.• Presence of macroscopic intralesional fat in bone lesions has been widely theorized as a sign of benignity, but there is limited supporting evidence in the literature. • CT and MRI are effective in evaluating for macroscopic intralesional fat in malignant bone lesions with excellent inter-reader agreement. • Macroscopic intralesional fat is rarely seen in malignant bone lesions.

  View details for DOI 10.1007/s00330-024-10687-7

  View details for PubMedID 38488967

  View details for PubMedCentralID 4248634

• What is the Value of Radiology Input During a Multidisciplinary Orthopaedic Oncology Conference? Clinical orthopaedics and related research Komarraju, A., Van Rilland, E. Z., Gebhardt, M. C., Anderson, M. E., Heincelman, C., Wu, J. S. 2023; 481 (10): 2005-2013

  Abstract

  Multidisciplinary orthopaedic oncology conferences are important in developing the treatment plan for patients with suspected orthopaedic bone and soft tissue tumors, involving physicians from several services. Past studies have shown the clinical value of these conferences; however, the impact of radiology input on the management plan and time cost for radiology to staff these conferences has not been fully studied.(1) Does radiology input at multidisciplinary conference help guide clinical management and improve clinician confidence? (2) What is the time cost of radiology input for a multidisciplinary conference?This prospective study was conducted from October 2020 to March 2022 at a tertiary academic center with a sarcoma center. A single data questionnaire for each patient was sent to one of three treating orthopaedic oncologists with 41, 19, and 5 years of experience after radiology discussion at a weekly multidisciplinary conference. A data questionnaire was completed by the treating orthopaedic oncologist for 48% (322 of 672) of patients, which refers to the proportion of those three oncologists' patients for which survey data were captured. A musculoskeletal radiology fellow and musculoskeletal fellowship-trained radiology attending physician provided radiology input at each multidisciplinary conference. The clinical plan (leave alone, follow-up imaging, follow-up clinically, recommend different imaging test, core needle biopsy, surgical excision or biopsy or fixation, or other) and change in clinical confidence before and after radiology input were documented. A second weekly data questionnaire was sent to the radiology fellow to estimate the time cost of radiology input for the multidisciplinary conference.In 29% (93 of 322) of patients, there was a change in the clinical plan after radiology input. Biopsy was canceled in 30% (24 of 80) of patients for whom biopsy was initially planned, and surgical excision was canceled in 24% (17 of 72) of patients in whom surgical excision was initially planned. In 21% (68 of 322) of patients, there were unreported imaging findings that affected clinical management; 13% (43 of 322) of patients had a missed finding, and 8% (25 of 322) of patients had imaging findings that were interpreted incorrectly. For confidence in the final treatment plan, 78% (251 of 322) of patients had an increase in clinical confidence by their treating orthopaedic oncologist after the multidisciplinary conference. Radiology fellows and attendings spent a mean of 4.2 and 1.5 hours, respectively, reviewing and presenting at a multidisciplinary conference each week. The annual combined prorated time cost for the radiology attending and fellow was estimated at USD 24,310 based on national median salary data for attendings and internal salary data for fellows.In a study taken at one tertiary-care oncology program, input from radiology attendings and fellows in the setting of a multidisciplinary conference helped to guide the final treatment plan, reduce procedures, and improve clinician confidence in the final treatment plan, at an annual time cost of USD 24,310.Multidisciplinary orthopaedic oncology conferences can lead to changes in management plans, and the time cost to the radiologists should be budgeted for by the radiology department or parent institution.

  View details for DOI 10.1097/CORR.0000000000002626

  View details for PubMedID 36929904

  View details for PubMedCentralID PMC10499106

• MRI of patellar stabilizers: Anatomic visibility, inter-reader reliability, and intra-reader reproducibility of primary and secondary ligament anatomy. Skeletal radiology Zandee van Rilland, E. D., Payne, S. R., Gorbachova, T., Shea, K. G., Sherman, S. L., Boutin, R. D. 2023

  Abstract

  To compare MRI features of medial and lateral patellar stabilizers in patients with and without patellar instability.Retrospective study of 196 patients (mean age, 33.1 ± 18.5 years; 119 women) after diagnosis of patellar instability (cohort-1, acute patellar dislocation; cohort-2, chronic patellar maltracking) or no patellar instability (cohort-3, acute ACL rupture; cohort-4, chronic medial meniscus tear). On MRI, four medial and four lateral stabilizers were evaluated for visibility and injury by three readers independently. Inter- and intra-reader agreement was determined.Medial and lateral patellofemoral ligaments (MPFL and LPFL) were mostly or fully visualized in all cases (100%). Of the secondary patellar stabilizers, the medial patellotibial ligament was mostly or fully visualized in 166 cases (84.7%). Other secondary stabilizers were mostly or fully visualized in only a minority of cases (range, 0.5-32.1%). Injury scores for all four medial stabilizers were higher in patients with acute patellar dislocation than the other 3 cohorts (p < .05). Visibility inter- and intra-reader agreement was good for medial stabilizers (κ 0.61-0.78) and moderate-to-good for lateral stabilizers (κ 0.40-0.72). Injury inter- and intra-reader agreement was moderate-to-excellent for medial stabilizers (κ 0.43-0.90) and poor-to-moderate for lateral stabilizers (κ 0-0.50).The MPFL and LPFL were well visualized on MRI while the secondary stabilizers were less frequently visualized. The secondary stabilizers were more frequently visualized medially than laterally, and patellotibial ligaments were more frequently visualized compared to the other secondary stabilizers. Injury to the medial stabilizers was more common with acute patellar dislocation than with chronic patellar maltracking or other knee injuries.

  View details for DOI 10.1007/s00256-023-04432-2

  View details for PubMedID 37704830

  View details for PubMedCentralID 7723147

• Virtual Residency Interviews- A Survival Guide and Lessons Learnt. Current problems in diagnostic radiology Komarraju, A., Van Rilland, E. Z., Gill, R. R. 2023; 52 (5): 336-339

  Abstract

  With the outbreak of Coronavirus Disease 2019 (COVID-19) pandemic, the residency programs were required to conduct virtual/online interviews for recruitment of candidates for their residency programs. While both programs and the candidates had challenges, with the abrupt transition of interviews to online platform, there were some perceived benefits by the applicants. This paper will further review the pros and cons, the challenges and the changes brought about by the online transformation of residency interviews and conclude with tips to the residency applicants and lessons learnt from this transition. Although, residency programs are considering going back to in-person interviews, they may continue to offer virtual interview as well to the candidates in the future.

  View details for DOI 10.1067/j.cpradiol.2023.05.006

  View details for PubMedID 37321883

  View details for PubMedCentralID PMC10188369

• Troubleshooting Challenging Musculoskeletal Tumor Biopsies: Tricks of the Trade. Seminars in roentgenology Zandee van Rilland, E., Wu, J., Deshmukh, S. 2022; 57 (3): 275-290

  Abstract

  Image-guided core needle biopsy of musculoskeletal lesions can be challenging due to a variety of technical, patient-related, and lesion-related factors. Poor preprocedural planning can result in low diagnostic yield, misdiagnosis, delay in care, and the need for additional procedures. Furthermore, suboptimal procedural technique may place the patient at an increased risk of iatrogenic complications. Optimizing pre-procedural planning by considering potential complications is important in ensuring a safe and successful procedure. We provide a review of strategies for troubleshooting challenging image-guided musculoskeletal tumor biopsies.

  View details for DOI 10.1053/j.ro.2022.01.002

  View details for PubMedID 35842247

• Distant migration of gluteal augmentation fat presenting as a soft tissue knee mass. Skeletal radiology Zandee van Rilland, E. D., Wu, J. S., Tompkins, C. M., Kelly, S. P., Anderson, M. E. 2022; 51 (5): 1093-1098

  Abstract

  Gluteal augmentation with autologous fat grafting is an increasingly popular procedure. While complication rates are low, the clinical and imaging evaluation of the various complications can be challenging. We report a case of distal migration of a failed gluteal fat graft in a young female patient presenting as a soft tissue mass in the knee, mimicking a soft tissue sarcoma. Surgical resection of the migrated fat graft confirmed the diagnosis. The diagnosis was challenging as the patient was initially reluctant to disclose her surgical history due to perceived negative social stigmas related to cosmetic contouring procedures. This case highlights the imaging findings of a rare complication following autologous fat grafting for gluteal augmentation and the importance of obtaining a thorough medical history.

  View details for DOI 10.1007/s00256-021-03931-4

  View details for PubMedID 34618183

• Association of aspirin and other non-steroidal anti-inflammatory drugs with bleeding complications in image-guided musculoskeletal biopsies. Skeletal radiology Zandee van Rilland, E., Kim, S., Ni Mhuircheartaigh, J., Shif, Y., Kung, J., Wu, J. S. 2020; 49 (11): 1849-1854

  Abstract

  To evaluate the safety of continuing aspirin and other non-steroidal anti-inflammatory drugs (NSAID) in patients undergoing image-guided musculoskeletal biopsies.Prior to October 2017, patients undergoing image-guided musculoskeletal biopsy had aspirin and NSAIDs withheld for the preceding 5-7 days. The policy changed in October 2017 based on new guidelines from the Society of Interventional Radiology such that aspirin and other NSAIDs were not withheld. A retrospective review of patient records was performed for all biopsies prior to and after the policy change to assess for differences in biopsy-related bleeding complications. Additional clinical and biopsy factors including age, gender, liver disease, coagulopathy, biopsy tissue type, and histological diagnosis were assessed.In the pre-policy change group, there were 1853 total biopsies with 43 biopsy-related bleeding complications (2.3%). Within this group, 362 patients were on aspirin with 7 bleeding complications (1.9%) and 260 patients were on NSAIDs with 5 bleeding complications (1.9%). There were 409 total biopsies in the post-policy change group and 7 bleeding complications (1.7%). Within this group, 71 patients were on aspirin with 1 bleeding complication (1.4%). No bleeding complications were recorded in patients on NSAIDs (0%). There was no significant difference in bleeding complication between the pre- and post-policy change groups overall (p = 0.58) and in patients on aspirin (p = 1.00) or other NSAIDs (p = 1.00).Bleeding complications for musculoskeletal biopsies are rare. Leaving patients on aspirin or other NSAIDs during a musculoskeletal biopsy does not increase the incidence of bleeding complications.

  View details for DOI 10.1007/s00256-020-03510-z

  View details for PubMedID 32535773

• Estimating Sex Using Metric Analysis of the Scapula by Postmortem Computed Tomography. Journal of forensic sciences Ali, Z., Cox, C., Stock, M. K., Zandee vanRilland, E. E., Rubio, A., Fowler, D. R. 2018; 63 (5): 1346-1349

  Abstract

  Postmortem computed tomography (CT) has been extensively used in the last decade for identification purposes and in various anthropologic studies. Postmortem CT measurements of scapulae, analyzed using logistic discriminant function developed in this study, showed 94.5% accuracy in estimating sex. Data analyzed using the Dabbs and Moore-Jansen (2010) discriminant function and the discriminant function generated in this study provided nearly identical results with disagreement in only one case. Height and weight were not statically significant in sex prediction. The results of this study show that data obtained from volume rendered postmortem CT images can be considered reliable and treated as a practical option to standard anthropological methods, especially in mass fatalities as a rapid triage tool for sex determination.

  View details for DOI 10.1111/1556-4029.13751

  View details for PubMedID 29464685

• A Minimum 2-Year Follow-up Using Modular Trabecular Metal Tibial Components in Total Knee Arthroplasty Reconstructive Review Zandee van Rilland, E. D., Varcadipane, J. C., Geling, O., Murai Kuba, M., Nakasone, C. K. 2015; 5(3): 23-8
• Assessment of Injuries During Brazilian Jiu-Jitsu Competition. Orthopaedic journal of sports medicine Scoggin, J. F., Brusovanik, G., Izuka, B. H., Zandee van Rilland, E., Geling, O., Tokumura, S. 2014; 2 (2): 2325967114522184

  Abstract

  Brazilian jiu-jitsu (BJJ) is a unique style of martial arts with rapid growth in the United States and internationally. Although studies have examined injuries in other martial arts and combat sports, to date, no published medical study has examined injuries in BJJ competitions.(1) To estimate the incidence of injuries in BJJ competitions and (2) to identify and describe the types and mechanisms of injuries associated with competitive BJJ.Descriptive epidemiology study.Injury data were obtained from records of on-site medical coverage at 8 statewide BJJ tournaments in Hawaii, USA, between 2005 and 2011.The identified injury incidence on the day of matches was 9.2 per 1000 exposures (46 injuries out of 5022 exposures, ie, match participations). Orthopaedic injuries were the most common and accounted for 78% of all injuries (n = 36), followed by costochondral or rib injuries (n = 7) and lacerations requiring medical care (n = 3). The elbow was found to be the joint most commonly injured during BJJ competitions, with the arm bar being the most common mechanism. We propose that this BJJ-specific injury mechanism, the "arm bar," be recognized as another mechanism of hyperextension injury to the elbow in sports.Comparison of the BJJ injury data with injury data reported for judo, taekwondo, wrestling, and mixed martial arts showed that BJJ competitors were at substantially lower risk of injury compared with these other sports. With orthopaedic injuries being most common and the elbow being the area most vulnerable to injury in BJJ, it is important that participants, referees, and physicians be properly educated about the unique mechanisms of injury that can occur, particularly to the elbow.

  View details for DOI 10.1177/2325967114522184

  View details for PubMedID 26535299

  View details for PubMedCentralID PMC4555620