Additional Diagnostic Value of Cone Beam CT Myelography Performed After Digital Subtraction Myelography for Detecting CSF-venous Fistulas.

Background And Purpose: CSF-venous fistulas are a common cause of spontaneous intracranial hypotension. The diagnosis and precise localization of these fistulas hinges on specialized myelographic techniques, which mainly include decubitus digital subtraction myelography and decubitus CT myelography (using either energy integrating or photon counting detector CT). A previous case series showed that cone beam CT myelography, performed as an adjunctive tool with digital subtraction myelography, increased the detection of CSF-venous fistulas.

Successful fusion versus pseudarthrosis after spinal instrumentation: a comprehensive imaging review.

Purpose: Following spinal instrumentation and fusion, differentiating between successful arthrodesis and pseudoarthrosis on imaging can be challenging. Interpretation of such examinations requires understanding both the expected evolution of postoperative findings and the subtle indicators of pseudoarthrosis across multiple imaging modalities. Due to this level of intricacy, many clinicians lack familiarity with the subject beyond the more rudimentary concepts.

The Central Dot Sign : A Specific Post-gadolinium Enhancement Feature of Intramedullary Spinal Cord Metastases.

Purpose: Peripheral enhancement characteristics on magnetic resonance imaging (MRI), namely the rim and flame signs, are specific for intramedullary spinal cord metastases (ISCM) compared to primary cord masses. The study compared the frequency of a novel finding-the central dot sign-in ISCMs versus primary intramedullary masses.

Methods: In this study 45 patients with 64 ISCMs and 64 control patients with 64 primary intramedullary cord masses were investigated and 2 radiologists blinded to lesion type independently evaluated MR images for the presence of a central dot sign: a punctate focus of enhancement in/near the center of an enhancing intramedullary mass.

Dynamic Internal Jugular Vein Compression by Hypertrophic Hyoid Bone: Management and Outcomes.

Extracranial osseous compression of the internal jugular vein (IJV) is exceedingly rare. The clinical manifestations of IJV obstruction are very heterogeneous and subtle, and arriving at a diagnosis can be challenging. We describe a case of dynamic IJV compression in a 40-year-old male with progressive, positional, ill-defined right periorbital and neck pain associated with photosensitivity.

Beyond plaque: A pictorial review of non-atherosclerotic abnormalities of extracranial carotid arteries.

The common carotid artery (CCA) and extracranial internal carotid artery are subject to a wide variety of non-atheromatous pathologies. These entities are often overshadowed in both research and clinical realms by atherosclerotic disease. Nevertheless, non-atherosclerotic disease of the carotid arteries may have profound, even devastating, neurologic consequences.

Synovial Cysts Confounding Access to the Dorsal S1 Neural Foramen in Transforaminal Epidural Steroid Injections.

Objectives: The S1 dorsal foramen is the route for 30% of lumbar transforaminal epidural injections; it is therefore important to identify structures impeding S1 foraminal access. The study objective was to characterize the imaging findings, prevalence, and anatomic origin of synovial cysts presenting within the S1 neural foramen.

Methods: A case series (N = 14) established imaging characteristics of S1 synovial cysts.

Aneurysm morphology in patients with autosomal dominant polycystic kidney disease: A case-control study.

Purpose: Approximately 8% of patients with autosomal dominant polycystic kidney disease (ADPKD) develop intracranial aneurysms. The reason for development of intracranial aneurysms in ADPKD patients might be related to interactions between the presence of hypertension and the basic mechanism underlying the disease, which leads to weakness of the connective tissue. In this study, we aimed to identify differences in aneurysm morphology between ADPKD patients and a location-matched set of controls.

The Impact of Social Media on Negative Online Physician Reviews: an Observational Study in a Large, Academic, Multispecialty Practice.

Background: Online reviews of physicians are becoming increasingly common, however no correlation of these reviews to formal patient satisfaction surveys. With the explosion of social media, it is unknown as to how this form of communication may have a role in potentially managing and addressing the search position of negative online reviews.

Methods: We obtained a list of 102 physicians with negative online reviews between September 2014 and December 2014.

Online Physician Reviews Do Not Reflect Patient Satisfaction Survey Responses.

Online physician reviews have become increasingly prevalent and are a common means by which patients explore medical options online. Currently, there are no data comparing physicians with negative online reviews and those without negative reviews. We sought to compare industry-vetted patient satisfaction surveys (PSSs), such as Press Ganey (PG) PSSs, between those physicians with negative online reviews and those without negative reviews.

Hemodynamic characteristics of stable and unstable vertebrobasilar dolichoectatic and fusiform aneurysms.

Background And Purpose: Vertebrobasilar dolichoectatic and fusiform aneurysms (VBDAs) are known to have a poor natural history, with high rates of growth, rupture, and stroke. The purpose of this study was to identify hemodynamic characteristics that differ between VBDAs associated with growth, rupture, and stroke.

Materials And Methods: VBDAs with CT angiography or MR angiography followed longitudinally without treatment were studied.

Prevalence of hyperdense paraspinal vein sign in patients with spontaneous intracranial hypotension without dural CSF leak on standard CT myelography.

Purpose: A recently identified and treatable cause of spontaneous intracranial hypotension (SIH) is cerebrospinal fluid (CSF)-venous fistula, and a recently described computed tomography myelogram (CTM) finding highly compatible with but not diagnostic of this entity is the hyperdense paraspinal vein sign. We aimed to retrospectively measure the prevalence of the hyperdense paraspinal vein sign on CTMs in SIH patients without dural CSF leak, in comparison with control groups.

Methods: Three CTM groups were identified: 1) SIH study group, which included dural CSF leak-negative standard CTMs performed for SIH, with early and delayed imaging; 2) Early control CTMs, which were performed for indications other than SIH, with imaging shortly after intrathecal contrast administration; 3) Delayed control CTMs, which included delayed imaging.

The Strategic Imperative for the Use of Social Media in Health Care.

Although health care lags behind many other industries in adopting social media as part of a business strategy, the Mayo Clinic recognized the importance of these applications more than a decade ago. In addition to typical media relations and marketing tactics, the Mayo Clinic has successfully used social media as part of an overall program to support the strategic imperatives of the institution.

The Social Media DNA of Mayo Clinic-and Health Care.

Hippocrates' admonition and the medical community's aversion to risk have caused many physicians and institutions to resist participation in modern social media sites such as Facebook (Facebook, Inc, Menlo Park, California, USA), Twitter (Twitter Inc, San Francisco, California, USA), and YouTube (San Mateo, California, USA). However, because Mayo Clinic's founders were champions of analog social networking, it was among the earliest hospitals worldwide to create official accounts on these digital platforms. A proper understanding of the traditional mechanisms of knowledge diffusion in medicine and of the nature of social media sites should help professionals see and embrace the opportunities for positive engagement in social media.

Mayo Clinic Care Network: A Collaborative Health Care Model.

By leveraging its experience and expertise as a consultative clinical partner, the Mayo Clinic developed an innovative, scalable care model to accomplish several strategic goals: (1) create and sustain high-value relationships that benefit patients and providers, (2) foster relationships with like-minded partners to act as a strategy against the development of narrow health care networks, and (3) increase national and international brand awareness of Mayo Clinic. The result was the Mayo Clinic Care Network.

Prevalence of cerebral cavernous malformations associated with developmental venous anomalies increases with age.

Background And Purpose: To test the hypothesis that the prevalence of cerebral cavernous malformation (CCM) associated with developmental venous anomalies (DVAs) increases with age, we studied the age-related prevalence of DVA-associated CCM among patients with DVAs.

Materials And Methods: Patients with DVAs on contrast-enhanced MRI exams performed over a 2-year period were included in this study. A single neuroradiologist reviewed all imaging exams for the presence of CCMs.

Imaging Appearance of Advanced Chronic Adhesive Arachnoiditis: A Retrospective Review.

Objective: Chronic adhesive arachnoiditis (CAA) is rare and has potentially devastating clinical consequences. The objective of this article is to review the clinical features of CAA and describe its appearance on imaging, to increase radiologists' awareness of this challenging diagnosis.

Materials And Methods: Twenty-nine cases of advanced CAA seen at our institution over 18 years (1995-2013) were retrospectively reviewed.

Prevalence of Developmental Venous Anomalies Increases With Age.

Background And Purpose: To test the hypothesis that developmental venous anomalies (DVAs) may develop in the postnatal period, we studied the age-related prevalence of DVAs on contrast-enhanced magnetic resonance imaging.

Methods: Reports from a consecutive series of head magnetic resonance images with intravenous contrast performed over a 2-year period at our institution were reviewed. Studies reporting the presence of a DVA were retrieved and reviewed by a neuroradiologist.

Penetrating Osseous Spicules Causing High-Flow Ventral CSF Leaks in the Setting of Relatively Low BMI : A Preliminary Study.

Objective/background: We have anecdotally observed patients with high-flow ventral cerebrospinal fluid (CSF) leaks resulting from penetrating osseous spicules or calcified discs to be relatively thin. The purpose of this study was to explore the validity of this observation and determine if a potential association exists between low body mass index (BMI) and high-flow spinal ventral CSF leaks resulting from such dura-penetrating lesions.

Methods: Sixteen consecutive patients with precisely localized high-flow ventral spinal CSF leaks on dynamic myelography were identified.

Imaging Determinants of Clinical Effectiveness of Lumbar Transforaminal Epidural Steroid Injections.

Objective: To examine associations between imaging characteristics of compressive lesions and patient outcomes after lumbar transforaminal epidural steroid injections (TFESIs) stratified by steroid formulation (solution versus suspension).

Design/subjects: Retrospective observational study, academic radiology practice. A 516-patient sample was selected from 2,634 consecutive patients receiving lumbar TFESI for radicular pain.

Uncommon Manifestations of Intervertebral Disk Pathologic Conditions.

Beyond the familiar disk herniations with typical clinical features, intervertebral disk pathologic conditions can have a wide spectrum of imaging and clinical manifestations. The goal of this review is to illustrate and discuss unusual manifestations of intervertebral disk pathologic conditions that radiologists may encounter, including disk herniations in unusual locations, those with atypical imaging features, and those with uncommon pathophysiologic findings. Examples of atypical disk herniations presented include dorsal epidural, intradural, symptomatic thoracic (including giant calcified), extreme lateral (retroperitoneal), fluorine 18 fluorodeoxyglucose-avid, acute intravertebral (Schmorl node), and massive lumbar disk herniations.

Comparison of facet joint activity on 99mTc-MDP SPECT/CT with facet joint signal change on MRI with fat suppression.

Purpose: We compared signal change on magnetic resonance imaging (MRI) with fat suppression and bone scan activity of lumbar facet joints to determine if these two imaging findings are correlated.

Methods: We retrospectively identified all patients who underwent imaging of the lumbar spine for pain evaluation using both technetium-99m methylene disphosphonate single-photon emission computed tomography/computed tomography (99mTc-MDP SPECT/CT) and MRI with at least one fat-suppressed T2- or T1-weighted sequence with gadolinium enhancement within a 180-day interval, at our institution between 1 January 2008 and 19 February 2013. Facet joint activity on 99mTc-MDP SPECT/CT and peri-facet signal change on MRI were rated as normal or increased.

Association between imaging findings and microbiological findings for image‑guided biopsies for spine infections.

Background: In the evaluation of spondylodiscitis, a number of factors are thought to contribute to the positive‑predictive‑value of spine biopsy including biopsy technique and equipment, number of sample obtained, timing of antibiotics, imaging findings and lab values. The purpose of this study was to examine which technical, magnetic resonance imaging (MRI), laboratory and clinical findings are most frequently associated with positive cultures or histopathology among patients receiving spine biopsies with a focus on the association of imaging findings and positive cultures/histopathology.

Methods: Following International Review Board approval, we retrospectively reviewed a consecutive series of spine biopsies performed at our institution over a 28-month period in patients who received spine biopsies for radiographically and clinically suspicious spondylodiscitis.