Implementing a rapid cord compression Magnetic Resonance Imaging protocol in the emergency department: Lessons learned.

Background & Purpose: (1) Evaluate efficacy of an abbreviated total spine protocol in triaging emergency department (ED) patients through retrospective evaluation. (2) Describe patient outcomes following implementation of a rapid cord compression protocol.

Methods: (1) All contrast-enhanced total spine magnetic resonance imaging studies (MRIs) performed on ED patients ( = 75) between 10/1-12/31/2022 for evaluation of cord compression were included.

Central Nervous System Complications of Oncologic Therapy.

Traditional and newer agents used to treat cancer can cause significant toxicity to the central nervous system. MRI of the brain and spine is the imaging modality of choice for patients with cancer who develop neurologic symptoms. It is important to be aware of the agents that can cause neurotoxicity and their associated imaging findings so that patients are properly diagnosed and treated.

Stroke risk stratification in acute dizziness presentations: A prospective imaging-based study.

Objective: To estimate the ability of bedside information to risk stratify stroke in acute dizziness presentations.

Methods: Surveillance methods were used to identify patients with acute dizziness and nystagmus or imbalance, excluding those with benign paroxysmal positional vertigo, medical causes, or moderate to severe neurologic deficits. Stroke was defined as acute infarction or intracerebral hemorrhage on a clinical or research MRI performed within 14 days of dizziness onset.

Utility of dual-energy CT virtual keV monochromatic series for the assessment of spinal transpedicular hardware-bone interface.

Objective: Our aim was to evaluate the utility of dual-energy CT (DECT) virtual kilo-electron volt (keV) monochromatic images for the visualization of the transpedicular screw-bone interface after spinal fusion.

Materials And Methods: This retrospective study included postfusion spine CT studies performed from October 2011 through April 2012 on a dual-energy 64-MDCT unit (Discovery CT750 HD). Studies were postprocessed on an Advantage Windows workstation (version 4.

Neuroradiology back to the future: head and neck imaging.

Imaging of the head and neck was initially described within the first year after Roentgen's discovery of the x-ray and was used to localize foreign bodies in the head and neck area, including the orbital, laryngeal, and esophageal regions. Subsequently, x-rays were used to evaluate the air-filled paranasal sinuses, the pneumatized temporal bone, and the upper aerodigestive tract. Special views for evaluating these structures were developed by early investigators.

Applications of magnetic resonance imaging in adult temporal bone disorders.

Magnetic resonance (MR) imaging has new applications in the assessment of temporal bone disorders. This article summarizes current MR imaging applications in evaluating adult temporal bone lesions according to their location, beginning from the most common indication, vestibular schwannoma. Inner ear lesions, petrous lesions, and middle ear lesions are discussed, including the role of diffusion-weighted imaging in cholesteatomas, external ear lesions, and a few systemic conditions.

Neuroradiology back to the future: spine imaging.

Although radiography of the spine began shortly after Roentgen's discovery in 1895, there was little written in the medical literature about spine imaging until nearly 25 years later with the development of myelography, first by using air and then a variety of positive contrast agents. The history of spine imaging before CT and MR imaging is, in large part, a history of the development of contrast agents for intrathecal use. The advent of CT and, more important, MR imaging revolutionized spine imaging.

Neuroradiology back to the future: brain imaging.

The beginning of neuroradiology can be traced to the early 1900s with the use of skull radiographs. Ventriculography and pneumoencephalography were introduced in 1918 and 1919, respectively, and carotid angiography, in 1927. Technical advances were made in these procedures during the next 40 years that lead to improved diagnosis of intracranial pathology.

Cerebral blood flow alterations in pain-processing regions of patients with fibromyalgia using perfusion MR imaging.

Background And Purpose: Widespread pain sensitivity in patients with FM suggests a CNS processing problem. The purpose of this study was to assess alterations in perfusion as measured by DSC in a number of brain regions implicated in pain processing between patients with FM and healthy controls.

Materials And Methods: Twenty-one patients with FM and 27 healthy controls underwent conventional MR imaging and DSC.

Systemic air embolism after transthoracic lung biopsy: A case report and review of literature.

Computed tomography (CT)-guided lung biopsy is a common diagnostic procedure that is associated with various complications, including pneumothorax, hemoptysis and parenchymal hemorrhage. Systemic air embolism is a very rare (0.07%) but potentially life-threatening complication.

Safety of intravenous thrombolytic use in four emergency departments without acute stroke teams.

Objectives: The objective was to evaluate safety of intravenous (IV) tissue plasminogen activator (tPA) delivered without dedicated thrombolytic stroke teams.

Methods: This was a retrospective, observational study of patients treated between 1996 and 2005 at four southeastern Michigan hospital emergency departments (EDs) with a prospectively defined comparison to the National Institute of Neurological Disorders and Stroke (NINDS) tPA stroke study cohort. Main outcome measures were mortality, intracerebral hemorrhage (ICH), systemic hemorrhage, neurologic recovery, and guideline violations.

Feasibility of superficial temporal artery as the input artery for cerebral perfusion CT.

Objective: The purpose of this study was to determine whether the superficial temporal artery as a surrogate arterial input function, compared with the anterior cerebral artery as the arterial input function, generates accurate perfusion CT maps with significant correlates for cerebral blood flow, cerebral blood volume, and mean transit time.

Materials And Methods: One hundred perfusion CT examinations performed on 90 patients (51 women and girls, 39 men and boys) were retrospectively reviewed and postprocessed by one investigator using CT perfusion software at a workstation. Color-coded cerebral blood flow, cerebral blood volume, and mean transit time maps were constructed with the superficial temporal artery as a surrogate arterial input function and the anterior cerebral artery as the arterial input function.

Cerebral perfusion imaging.

There are multiple imaging techniques available to assess cerebral perfusion, including positron emission tomography (PET), xenon computed tomography (XeCT), single photon emission computed tomography (SPECT), perfusion-weighted MRI (PWI), and perfusion computed tomography (PCT). Current interest has focused mainly on their use in the setting of acute brain ischemia. Perfusion imaging may be able to distinguish infarcted from salvageable ischemic tissue as a guide to treatment.

Transient neurologic deficit after acetazolamide challenge for computed tomography perfusion imaging.

A case of transient neurologic deficit associated with the acetazolamide challenge conducted in conjunction with dynamic enhanced computed tomography (CT) perfusion imaging for the evaluation of cerebral hemodynamic impairment is reported in a patient with known cerebrovascular steno-occlusive disease. Combining the acetazolamide challenge with dynamic CT perfusion provides a rapid and widely available technique to assess cerebrovascular reactivity; however, one must be cognizant of this serious potential adverse response.

Delineation of lateral tentorial sinus with contrast-enhanced MR imaging and its surgical implications.

Background And Purpose: The lateral tentorial sinus (LTS) has not been well described in the imaging literature. The aim of this study was to investigate the value of MR imaging in assessing the LTS, which may provide guidance for preoperative planning.

Methods: Fifty-five adult patients underwent MR imaging of the brain.

Carotid perfusion CT with balloon occlusion and acetazolamide challenge test: feasibility.

Carotid balloon test occlusion (BTO) is used to assess the collateral circulation and cerebrovascular reserve in patients in whom carotid artery occlusion is contemplated. Eight patients in whom the test was successful were evaluated with perfusion computed tomography (CT) in the resting state and after acetazolamide challenge. Three of the patients showed symmetric blood flow and normal response to acetazolamide.

Cerebral perfusion CT: technique and clinical applications.

Perfusion computed tomography (CT) is a relatively new technique that allows rapid qualitative and quantitative evaluation of cerebral perfusion by generating maps of cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT). The technique is based on the central volume principle (CBF = CBV/MTT) and requires the use of commercially available software employing complex deconvolution algorithms to produce the perfusion maps. Some controversies exist regarding this technique, including which artery to use as input vessel, the accuracy of quantitative results, and the reproducibility of results.

Infantile refsum disease: case report.

Infantile Refsum disease is a rare inborn error of phytanic acid metabolism. It is inherited in an autosomal recessive manner and frequently causes signs and symptoms in the neonate period. The only source of phytanic acid in humans is exogenous, from diet.

Computed tomography perfusion of squamous cell carcinoma of the upper aerodigestive tract. Initial results.

Objective: To define the computed tomography (CT) perfusion characteristics of head and neck squamous cell carcinoma.

Methods: Fourteen consecutive patients with untreated squamous cell cancers of head and neck underwent CT of the head and neck along with CT perfusion imaging through the primary site. For the perfusion studies, CT density changes in blood and tissues were kinetically analyzed using the commercially available CT Perfusion 2 software (General Electric Medical Systems.

Development of a protocol for coronal reconstruction of the maxillofacial region from axial helical CT data.

Using a fresh frozen cadaver head, a series of axial helical CT scans were obtained using varying imaging parameters both before and after traumatizing the head. The appearance of reformatted coronal images was optimized for the lowest radiation dose. A protocol for imaging the maxillofacial region was developed that produced diagnostic coronal reconstructed images from the axial helical CT data.

Diagnostic maxillofacial coronal images reformatted from helically acquired thin-section axial CT data.

Objective: This study was undertaken to determine the sensitivity and specificity of coronal images reformatted from helical thin-section axial CT data obtained for the evaluation of maxillofacial fractures.

Materials And Methods: Multiple fractures were created in nine cadaver heads by blunt trauma and were then evaluated using a late-generation helical CT scanner. Two neuroradiologists then independently evaluated the axial and reformatted coronal maxillofacial images.

MRA in cerebrovascular disease.

Stroke is a major cause of disability and death each year in the United States. Most cases result from atherosclerotic disease at the carotid bifurcations. The risk of such events can be reduced by carotid endarterectomy in both symptomatic and asymptomatic patients with severe occlusive disease documented by imaging studies.

Magnetic resonance imaging of massive bone allografts with histologic correlation.

Objective: The objective of this study was to better understand the MRI appearance of massive bone allografts.

Design: The MRI findings of three massive bone allografts imaged in vivo were correlated with the histologic findings following removal of the allografts. A fourth allograft, never implanted, was imaged and evaluated histologically.

Magnetic resonance imaging in the critical care setting.

Magnetic resonance imaging (MRI) permits noninvasive multiplanar imaging with a large field of view, better soft tissue differentiation than is possible with CT, and assessment of both vascular lumen and wall without administration of contrast media or exposure to x-rays. Patients with renal or cardiac failure or allergy to radiographic contrast agents can be imaged safely. In the critical care setting, MRI is particularly useful in evaluating the major arteries and veins of the trunk, detecting and differentiating masses within skeletal muscle, detecting and characterizing subacute and chronic stroke or intracranial trauma, evaluating the spinal cord, and evaluating suspected CNS infection and CNS complications of AIDS.