UConn Musculoskeletal Institute

The Power of MRI

A UConn Health physician is seen reviewing an MRI brain scan.

A UConn Health physician is seen reviewing an MRI brain scan. At UConn Health, doctors are pioneering ways to use MRI technology to diagnose and monitor a range of conditions affecting many parts of the body Photo: Peter Morenus


Magnetic resonance imaging (MRI) has come a long way since the technique was first used in the U.S. in the late 1970s. UConn Health is now taking this powerful, non-invasive imaging tool to the next level.

UConn Health physicians in a variety of specialties are using the technology — which captures images of the inside of the body using a large magnet rather than radiation — in new ways to detect and monitor illnesses.

Prostate Cancer

Dr. Peter Albertsen, chief of UConn Health’s Division of Urology, currently follows 100 patients with localized prostate cancer, which is slow-growing, using advanced multiple-parametric MRI imaging. The technology has now replaced ultrasound as the imaging method of choice for prostate cancer. The technique yields multiple imaging sequences of the prostate, providing information about the anatomy, cellular density measurement, and vascular supply.

There is growing evidence to support the idea that the best treatment plan for low-grade prostate cancer is “watchful waiting” to monitor its progression, instead of immediate surgery or radiation. Albertsen’s practice of active surveillance, and not intervention, for localized prostate cancer was reinforced by a recent long-term study published in September in the New England Journal of Medicine, on which Albertsen served as a consultant.

The technology is extraordinarily helpful, allowing us to avoid invasive biopsy testing and associated risks of bleeding and infection.

Liver Disease

UConn Health is the first in Greater Hartford to use MRI to measure the stiffness of patients’ livers to reveal disease without the need for biopsy. Its MR elastography technique involves placing a paddle on a patient’s skin over the liver during MRI to create vibrations and measure the velocity of the radio waves penetrating the organ. This can indicate a stiffer liver and help diagnose fibrosis, cirrhosis, a fatty liver, or inflammation associated with hepatitis. The initiative is led by Dr. Marco Molina, radiologist in the Department of Diagnostic Imaging and Therapeutics.

“The technology is extraordinarily helpful, allowing us to avoid invasive biopsy testing and associated risks of bleeding and infection,” Molina says. “Plus, with the obesity epidemic, patients developing nonalcoholic steatohepatitis (NASH), or fatty liver, can receive earlier diagnosis and take action to reverse their disease’s progression with diet and exercise.”

Breast Cancer

The new Women’s Center at UConn Health has opened its state-of-the-art Beekley Imaging Center, featuring advanced breast cancer screening. Dr. Alex Merkulov, associate professor of radiology and section head of women’s imaging, and his team are conducting research to test the effectiveness of using an abbreviated, five-minute MRI scan to confirm or rule out a breast cancer diagnosis. Typically, an MRI test takes 20 minutes, but researchers are seeing that a briefer MRI scan of just a few minutes can help provide a definitive answer to whether an abnormal breast growth is cancer or not — and potentially help women avoid the biopsy process.

Arthritis

The UConn Musculoskeletal Institute is now researching the use of MRI to assess and map the strength, weakness, and underlying makeup of a patient’s cartilage, especially for those with arthritis. The tool can allow orthopedic experts to identify any thinning or loss of cartilage in the body, which signifies moderate to late-stage disease. In early stages of arthritis, MRI can help pinpoint early morphological and subtle biochemical changes in cartilage.

Neurological Disorders

In neuroradiology, UConn Health is using the power of MRI to differentiate brain tumors, to detect strokes, to assess dementia, to diagnose multiple sclerosis, to evaluate traumatic brain injury, to find the source of epilepsy, and to guide brain surgery. In March 2017, leading neuroradiologist Dr. Leo Wolansky joins UConn Health to advance its research and chair the Department of Diagnostic Imaging and Therapeutics. Wolansky’s neuroimaging research has focused on enhancing understanding of MRI and its contrast agents, especially for multiple sclerosis and brain tumors. He also specializes in the hybrid imaging modality PET-MRI.

“Thanks to the power and advancement of MRI, doctors can see early evidence of disease and seize the opportunity to intervene and improve their patients’ health,” Molina says.

Hand, Wrist, and Elbow Team Brings Innovation

3 doctors stand together, Dr. Craig Rodner (left), Dr. Joel Ferreira (center), and  Dr. Anthony Parrino (right) Farmington, Southington

Dr. Anthony Parrino (left) – Farmington, Southington
Dr. Craig Rodner (center) – Avon, Farmington
Dr. Joel Ferreira (right) – Farmington, Storrs Center

Photo: Janine Gelineau


Hands, wrists, and elbows are complex and fragile. No matter our age or profession, we are prone to upper extremity injuries throughout our lifetime, along with diseases such as arthritis and tendonitis as we age.

Dr. Craig Rodner and new recruits Dr. Joel Ferreira and Dr. Anthony Parrino, who are both former UConn orthopaedic surgery residents, form the UConn Musculoskeletal Institute’s team, offering patients comprehensive surgical and non-surgical care in this area. All three specialists have completed advanced training during prestigious fellowships in hand, wrist, and elbow orthopedic surgery.

The Hand, Wrist, and Elbow Program at UConn Health offers advanced care for both children and adults for all bone and soft-tissue conditions of the upper extremity. The team cares for people from all walks of life who have pain from repetitive activity, acute trauma, or sports-related injury — from weekend warriors to the elite athletes of the UConn Huskies sports teams. Comprehensive care approaches include patient activity modification, physical therapy, bracing, steroid injections, and, if necessary, surgery.

Innovative surgical interventions are offered for arthritis, carpal tunnel syndrome, fractures, tendon and nerve damage, sports injuries, Dupuytren’s contractures, hand deformities, and more. These interventions include enhanced minimally invasive, arthroscopic, and microscopic surgical techniques leading to faster, less painful recovery.

The expansion of the team this past year to include Ferreira and Parrino brought specialized training in all aspects of elbow surgery, daily access to the hand surgeon experts, as well as expanded patient access to cutting-edge “wide-awake” painless hand surgery for certain conditions. Using a localized numbing medication in “wide-awake” procedures allows patients, if they so choose, to drive to and from the procedure, avoid the use of sedation, and recover more rapidly.

“Our goal at the UConn Musculoskeletal Institute is to get our patients back to functioning where they were before injury or disease affected them,” says Parrino. Ferreira adds: “We offer the absolute highest-quality, personalized care that there is to each and every patient to find the best surgical or non-surgical solution for an individual problem.”

While the number one focus of the hand, wrist, and elbow team is providing the highest possible level of compassionate care to each patient, Rodner, Ferreira, and Parrino are also dedicated to upper extremity research and education and are actively involved in teaching the students at the UConn School of Medicine and the residents of the UConn orthopedic surgery program about all facets of upper extremity care.

Lab Notes – Fall 2016

‘Morrbid’ RNA Could Be Key to Asthma Treatment

No.2 Pencil eraser erasing a piece of an RNA strand

Researchers have discovered a potential therapeutic target for inflammatory disorders that are characterized by abnormal myeloid cell lifespan, such as asthma, Churg-Strauss syndrome, and hypereosinophilic syndrome. Investigators including Adam Williams of UConn Health and The Jackson Laboratory named the novel long non-coding RNA ‘Morrbid’ (Myeloid RNA Regulator of Bim-Induced Death). They discovered that Morrbid tightly controls how long circulating myeloid cells live — which is key to maintaining the balance between fighting infection and exacerbating inflammation — by overriding a signaling mechanism that prevents premature immune cell death. In mice, deleting the gene helped protect them against inflammation and immunopathology. The findings were published online in Nature, Aug. 15, 2016.


Parents Living Longer is Good News for Offspring, Study Says

Father and young son laugh together and hug

A new study led by the University of Exeter and co-authored by the UConn Center on Aging, among other international contributors, shows that how long a person’s parents live can help predict how long the offspring will live, and how healthy the child will be as he or she ages. The study of 186,000 participants, aged 55 to 73 years and followed for up to eight years, is the largest of its kind. It found that a person’s chance of survival increased by 17 percent for each decade that at least one parent lived beyond age 70, and that those with longer-lived parents had lower rates of heart disease and other circulatory conditions, as well as cancer. The study was published in the Journal of the American College of Cardiology, Aug. 15, 2016.


PRP Limits Ill Effects of Osteoarthritis Treatment

red blood cells

Giving platelet-rich plasma (PRP) to patients undergoing treatment for osteoarthritis may limit the negative effects of the drugs used to manage their symptoms, according to a new study led by Dr. Augustus Mazzocca, director of the UConn Musculoskeletal Institute, and the University of Pittsburgh Medical Center. Osteoarthritis is the most common chronic condition of the joints, causing pain, stiffness, and swelling in approximately 27 million Americans. Powerful anti-inflammatory medicines and local anesthetics relieve pain and improve range of motion, but can also lead to tissue degeneration. In the study, published in the August issue of The American Journal of Sports Medicine, researchers found combining PRP with these treatments significantly reduced their toxic effect on the cells and even improved their proliferation.


Bath Salts 101: Pharmacist Explains Party Drugs

Synthetic party drugs with dangerous hallucinogenic properties, such as those sold commercially as “bath salts,” continue to pose a significant public health risk around the country. C. Michael White — head of the Department of Pharmacy Practice in UConn’s School of Pharmacy — published a comprehensive review of synthetic cathinones in the June 2016 issue of The Journal of Clinical Pharmacology to help clinicians recognize signs of abuse and properly treat patients with adverse events, ranging from psychosis to heart disease, from the drugs. This is the third in a series of articles on drugs including molly/ecstasy and GHB that he wrote to support clinicians. He is currently working on an assessment of synthetic marijuana.

dirty spoon holds 'bath salt' drug

All-Star Athletes to Weekend Warriors: How UConn Health Sports Medicine Keeps Patients Off the Sidelines

By Lauren Woods

Crop of woman's legs in running shoes on a pain splattered lime-green background.


Anthony Giansanti, 27, of Montville, Conn. has been playing baseball practically since he could walk. It’s in his blood. Giansanti’s grandfather and his nine brothers started their own league in Hartford in the 1950s. Giansanti first picked up a bat at age 4, and began playing competitively at 9.

“It’s always been a dream of mine to play professionally,” says Giansanti, who joined the Chicago Cubs organization shortly after graduating from Siena College in Loudonville, N.Y.

But Giansanti, who has played on a variety of Cubs-affiliated minor league teams around the country and is now playing for the Bridgeport Bluefish in the independent Atlantic League, almost didn’t achieve his dream. During his freshman year at Siena, he was running to first base during a game against Tulane when he experienced what he says felt like a gunshot in his upper right leg.

The hamstring injury put Giansanti on the sidelines for two months. He did special pool exercises, underwent ultrasound and muscle-stimulation therapy, and rested every day. But no matter what he did, the injury continued to resurface throughout college and his early professional career, benching him for two to three weeks each time it flared up.

There’s nothing better than seeing a patient walk into my office smiling, saying they were able to do something in physical therapy for the first time in years.

In 2015, Giansanti was running to third for the Triple-A Iowa Cubs when he felt the same warm, intense cramp as he had his freshman year at Siena. Again, he was out for two months.

On the recommendation of other athletes, Giansanti visited UConn Health’s Dr. Cory Edgar, who sees patients at UConn Health Storrs Center and is an orthopaedic team physician for UConn Athletics. Edgar and Dr. Matthew Hall, another Huskies team physician, diagnosed him with a hole in his hamstring, and suggested an advanced, injectable treatment called platelet-rich plasma (PRP), followed by physical therapy and rehabilitation.

For four months, Giansanti practiced eccentric strength training and stretching. He received two PRP injections, six weeks apart.

“I now have absolutely no issues with my hamstring,” says Giansanti. “I am faster and stronger than ever before.”


Bridgeport Bluefish outfielder Anthony Giansanti, 27

Bridgeport Bluefish outfielder Anthony Giansanti, 27, is back in the game after UConn Health sports medicine experts treated his recurring hamstring injury. Courtesy of Bridgeport Bluefish


Treating Athletes and Average Folks

The UConn Health team of nine sports medicine doctors who are trusted with keeping professional athletes like Giansanti, as well as more than 700 UConn Huskies student-athletes, in the game are the same ones who see 26,000 everyday people each year. And they bring the same cutting-edge strategies to the table to prevent and treat injuries for both types of patients.

“UConn’s sports medicine experts apply what keeps their top-performance athlete patients healthy and translate that knowledge to help guide the care of their everyday recreational athlete patients, and the weekend warriors, to keep them moving and doing what they want to do as they age,” says Dr. Robert Arciero, chief of the Division of Sports Medicine at UConn Health, a UConn Athletics team physician, and past president of the American Orthopaedic Society for Sports Medicine.

The cooperation between UConn Health and UConn Athletics benefits both groups — and their patients.

“UConn Health sports medicine experts are phenomenal and an integral part of our UConn Athletics team, as we rely heavily on their expertise to care for our UConn student-athletes,” says UConn’s Head Team Physician, Dr. Deena Casiero, the new director of sports medicine at UConn and an attending physician at UConn Health who completed a fellowship with UConn’s sports medicine team.

In addition to treating thousands of past and present UConn Huskies, UConn’s doctors have lent their expertise to such organizations as USA Hockey, the Hartford Whalers, the U.S. Open Tennis Championships, and the New York Islanders as team docs. What’s more, they are also all professors in the UConn School of Medicine’s Department of Orthopaedic Surgery, and all perform research that is leading the charge in preventing and treating sports injuries.

While proper rehabilitation, rest, and physical therapy form the bedrock of quality sports medicine and can fix many common injuries, such as stress fractures or shoulder dislocations, UConn’s research is taking treatment a step further.

“Our mission is to provide all aspects of musculoskeletal medicine for patient care, while advancing basic science and research, teaching and training doctors, and educating researchers around the world,” says Dr. Augustus D. Mazzocca, chair of the Department of Orthopaedic Surgery, director of the UConn Musculoskeletal Institute, and an orthopaedic team physician.

Much of the work centers on using a patient’s own tissues, including PRP or stem cells, to help heal injuries. One particularly ambitious undertaking is the HEAL (Hartford Engineering A Limb) Project, a global initiative led by UConn Health’s Dr. Cato T. Laurencin that aims to regenerate a human knee within seven years and an entire human limb by 2030.

Edgar, who treated Anthony Giansanti with PRP injections, studies how stem cell injections aid healing in tendon, bone, and rotator cuff injuries, as well as meniscus transplants.

“Our use of a patient’s own stem cells can expedite tissue healing, reduce the risk of repeat surgery, and speed a patient’s return to daily life,” Edgar says.

And ensuring patients can get back to doing what they love — be it dancing in the kitchen with their spouses or playing on the court in front of thousands — is the primary goal.

Giving Patients New Hope

Mazzocca is using stem cells to treat a particularly tricky type of injury. Athletes and average Joes alike struggle with stubborn rotator cuff injuries, which can occur while playing sports or from overuse, but sometimes happen for unknown reasons. In addition to being common, torn rotator cuff tendons — which hold the shoulder in place and allow for its movement — don’t always heal, leaving patients unable to lift or move their arms, and doctors don’t always know why.

Mazzocca and his team are working on both physical therapy and biological methods to change that.

“The patient with a bad outcome is the patient that drives us,” he says.

Part of Mazzocca’s team is conducting tests on cadavers to find out how much strain it takes for a newly repaired rotator cuff tendon to fail. The goal is to determine how much strength patients are likely to have post-surgery, giving doctors an idea of when they can tell patients to start rehab work. Another group is testing different physical therapy regimens to see which ones help patients recover fastest and most completely.

Despite the best efforts of surgeons and physical therapists, about 15 percent of rotator cuff patients just don’t heal — and the team suspects a biological reason. For those patients, Mazzocca says he is trying to “use the body’s own natural resources to precisely target and directly repair injured tissue.”

To do so, Mazzocca harvests the patient’s own stem cells during surgery, then spins them down in a centrifuge to concentrate them and inject them back into the repair site to advance healing. These adult stem cells, harvested from bone marrow within the patient’s humeral bone, have the potential to turn into bone, tendon, or cartilage.

“Someone who hasn’t used his or her arm in 10 to 15 years and you’re able to return that function to them — that’s the big thrill,” Mazzocca says.

That’s also the goal of the sports medicine team as a whole.

“There’s nothing better than seeing a patient walk into my office smiling, saying ‘Doc, look what I can do now,’ or saying they were able to do something in physical therapy for the first time in years,” says Edgar.

Precise Instruments: Better Spine Surgery with Robots

By Lauren Woods
Photography by Janine Gelineau

Close up of Mazor Robotic Piece


For 30 years, Frank Ditaranto worked in the construction field. But a sudden back injury changed that, leaving Ditaranto unable to carry on his normal life.

“Two years ago, my back went out and it stayed that way,” says Ditaranto, a 50-year-old Terryville, Conn. resident. “Ever since, I have been bent over like I was 90, with shooting pain down my left leg to my toes, and I was unable to even straighten my leg.”

Daily life and even walking became difficult for Ditaranto. He tried pain medicine, physical therapy, aqua therapy, and epidurals, but there was no relief in sight — until now.

On Jan. 7, Dr. Isaac Moss, assistant professor of orthopaedic surgery and neurosurgery at the Comprehensive Spine Center at the UConn Musculoskeletal Institute, was the first surgeon in New England to use the new Mazor Robotics Renaissance Guidance System to assist him during spine surgery. Ditaranto was his first patient.

To relieve Ditaranto’s severe lower-back and leg pain, Moss successfully removed and fused Ditaranto’s deteriorated L4-5 spinal discs using minimally invasive techniques.

“Thanks to the robotic technology, we were able to place screws in the patient’s spine with extremely high accuracy, small incisions, and minimal intraoperative radiation,” says Moss.

UConn Health is the first institution in New England to offer patients this pioneering and more precise robotic guided spine surgery.

A day after the surgery, Ditaranto said he already felt truly transformed: “For the first time I was able to stand up straight and not have pain shooting down my left leg.”

“I am too young to have to live like that,” says Ditaranto. “I now have new discs and hardware in my spine and I am good to go.”

Ditaranto says he feels “great” and looks forward to simply living life pain-free. Perhaps most importantly, as a single dad of a 16-year-old daughter, he most anticipates playing volleyball with her again.

Most spinal procedures like Ditaranto’s involve the attachment of screws and other implants to the spine. Spine surgery has little room for error. Spinal fixations, such as screws, are typically just millimeters away from sensitive spinal nerves, the spinal cord, the aorta, and other critical vessels.

The new technology’s software allows surgeons to plan a patient’s spine surgery virtually, using a 3-D simulation of the spinal anatomy based upon the patient’s most recent CT scan.

“It’s so important to plan in advance of spine surgery,” says Moss. “The Mazor Renaissance technology allows a surgeon to closely review the anatomy of each patient in depth, and get to know the specifics, to make a more precise surgical plan, and eventually execute a smoother operation.”

Once inside the operating room, the Mazor technology matches, in real time, the surgeon’s pre-operative 3-D plan with intra-operative X-ray imaging of the patient’s spine. During the procedure, the technology guides its robotic arm, which is about the size of a soda can, along the spine to help the surgeon pinpoint the precise location to place his tools to ensure the greatest accuracy and safe placement of screws and other hardware into the spine.


Doctors of the UConn Musculoskeletal Institute’s Comprehensive Spine Center use the Mazor Robotics Renaissance Guidance System to perform spine surgery in January.

Doctors of the UConn Musculoskeletal Institute's Comprehensive Spine Center use the Mazor Robotics Renaissance Guidance System to perform spine surgery in January. Janine Gelineau/UConn Health Photo

Dr. Isaac Moss of the UConn Musculoskeletal Institute will be New England’s and Connecticut’s first surgeon to use pioneering robotic guidance technology to assist him during spine surgery at UConn John Dempsey Hospital

Mazor robotic software images- which will help him pinpoint the most precise spot to place screws and other hardware into a patient’s spine.

Orthopaedic surgeon Dr. Isaac Moss uses the Mazor Robotics Renaissance Guidance System to perform spine surgery in January.


UConn Health is using the robotic-guidance technology for a wide range of spinal procedures including biopsies, thoracic and lumbar spinal fusion, and reconstruction for a wide variety of conditions such as scoliosis (abnormal curves in the spinal column), spondylolisthesis (when one vertebra slips forward onto the vertebra below it), tumors, and trauma, among others.

“Using this advanced technology puts UConn Health at the forefront of spinal surgery,” Moss says. “This technology allows us to perform both traditional and minimally invasive spine surgeries more effectively and safely.”

Other potential benefits of the robotic guidance technology include smaller incisions, shorter operative times, shorter hospitalization and recovery, less pain for patients, and less exposure to fluoroscopy X-ray radiation for both a patient and the surgical team.

To refer a patient to a UConn Health surgeon, call 860.679.5555.

Research shows that compared to freehand spine surgery, the robotic guidance technology can increase the accuracy of screws and other hardware placement by 1.5 mm. This increased accuracy may also reduce the potential for neurologic risks to patients, which may include future nerve pain, tingling, or tissue numbness.

Two other UConn Health surgeons in addition to Moss — Dr. Hilary Onyiuke, director of the Comprehensive Spine Center at the UConn Musculoskeletal Institute and chief of the Division of Neurosurgery, and Dr. Ryan Zengou, assistant professor in the Department of Surgery’s Division of Neurosurgery and the Department of Orthopaedic Surgery — plan to use the system.

“I look forward to using this technology to help patients with spinal pathology by performing complex procedures with optimal precision and the best outcomes possible,” Moss says.