ASNR 2016 Events for Members In-Training and Young Professionals

Please join us at the ASNR 54th Annual Meeting for events with other Members-In-Training and Young Professionals!

Every day

  • Young Professionals Lounge
    • 6:30am – 6:00pm
    • Park 8226 (Lobby Level)
    • This will provide a “home base” for fellows, residents, young professionals & medical students to network and share knowledge and experiences throughout the meeting.

Saturday, May 21st

  • Unofficial Networking/Social Event
    • 9pm onward
    • Stone’s Throw Lobby bar at Marriott Wardman Park
    • Join us for a central location to relax and hang out with friends!

Sunday, May 22nd

  • The Foundation of the ASNR Visionaries and Young Professionals Reception
    • 7:30pm – 8:30pm
    • Stone’s Throw Restaurant (Lobby Level) at the Washington Marriott Wardman Park
    • The leadership of the ASNR and The Foundation of the ASNR will also attend. Enjoy visiting with other trainees, fellows, and recent graduates, as well as with some of the leaders. The evening reception will include beverages and appetizers. We hope to see you there!

Monday, May 23

  • 2C-Young Professional Programming: Adding Value to Your Practice
    • 8:35am – 10:00am
    • Washington 1/2/3 (Exhibition Level)
    • Moderators: Mark Mamlouk, MD, Joshua Hirsch, MD, FACR, FSIR
    • 8:35 AM – 9:00 AM — Radiology’s Role in Value Based Care — Arun Krishnaraj, MD, MPH
    • 9:00 AM – 9:25 AM Where are the Opportunities for Neuroradiologists Within the Threats to Us and Our Practices – Frank Lexa, MD
    • 9:25 AM – 9:50 AM – Utilizing Midlevel Professionals – Falgun Chokshi, MD
    • 9:50 AM – 10:00 AM – Discussion
  • 4B-Young Professional Programming: Practical Post-Treatment Neuroimaging
    • 1:15pm – 2:45pm
    • Washington 4/5/6 (Exhibition Level)
    • Moderators: Patricia Hudgins, MD, Ramon Barajas, Jr., MD
    • 1:15 PM – 1:40 PM — Post Treatment Brain — Soonmee Cha, MD
    • 1:40 PM – 2:05 PM — Post Treatment Neck — Suresh Mukherji, MD, FACR, MBA
    • 2:05 PM – 2:30 PM — Post Treatment Spine —

Pediatric Interventional Radiology

Towbin R, Baskin KM, eds. Pediatric Interventional Radiology. Cambridge University Press; 2015; 493 pp; 692 ill; $175.00

Cover of Pediatric Interventional Radiology, edited by Towbin and BaskinPediatric interventional radiology is a unique subspecialty that bridges pediatric radiology and adult interventional radiology.  Children have a unique set of pathology and challenges when compared to adults; children are not just small adults. Pediatric Interventional Radiology provides a comprehensive overview of this unique subspecialty, perfect for the trainee or radiologist whose practice encounters pediatric patients in need of a procedure.

The first chapter provides a great introduction and approach to pediatric interventional radiology. This section includes many pediatric-specific details, which would be useful for anyone performing pediatric procedures or fluoroscopy, not just the pediatric interventionalists. For example, in the absence of underlying pathology, routine labs are not always required prior to a pediatric procedure. There is a detailed discussion of analgesia and sedation in the pediatric patient, along with the weight-based doses and reversal agents, which is a very useful reference for any practitioner performing pediatric cases with sedation. There are specifics on how to minimize radiation while optimizing imaging, which is always key for pediatric imaging. Also included in the introduction is a thorough list of suggested equipment for a pediatric ready angiography suite, such as smaller French catheters and wires.

The book includes helpful photographs of images demonstrating techniques and devices. However, that being said, some of the images leave something to be desired. Not all of the images are appropriately cropped or windowed, making it difficult to see the finding. On occasion, an arrow was chosen in a color very close the background, making the reader search the image. A few older images appeared grainy and not what you would expect in a publication. The figure captions provided good detail but were not always on the same page …

Journal Scan – This Month in Other Journals, May 2016

  1. Safain MG, Roguski M, Heller RS, Malek AM. Flow Diverter Therapy With the Pipeline Embolization Device Is Associated With an Elevated Rate of Delayed Fluid-Attenuated Inversion Recovery Lesions. Stroke. 2016;47(3):789–97. doi:10.1161/STROKEAHA.115.010522.

Forty-one consecutive patients undergoing aneurysm treatment with the Pipeline Embolization Device and a comparison group of 78 Neuroform stent-mediated embolizations were studied. Serial magnetic resonance images were assessed for the presence of newly occurring diffusion-weighted imaging and fluid-attenuated inversion recovery (FLAIR) lesions. Pipeline patients were more likely to have new ipsilateral FLAIR lesions at all time points studied, and 34% (14/41) of Pipeline patients experienced a new FLAIR lesion when compared with 10% (8/78) of Neuroform stent-coil patients. No patient in either group developed a new permanent neurological deficit. They conclude that PED is associated with continued new and independent ipsilateral FLAIR signal abnormalities, and that these lesions were independent from any previous DWI or FLAIR lesion, suggesting a persistent delayed and de novo source generation process. This was in stark contrast with Neuroform-stent–assisted coil embolization, which had almost no rat new FLAIR burden.

Worrisome……prudent follow up recommended!

  1. Auriel E, Charidimou A, Gurol ME, et al. Validation of Clinicoradiological Criteria for the Diagnosis of Cerebral Amyloid Angiopathy-Related Inflammation. JAMA Neurol. 2016;73(2):197–202. doi:10.1001/jamaneurol.2015.4078.

They modified the previously proposed clinicoradiological criteria and retrospectively analyzed clinical medical records and FLAIR and gradient-echo scans obtained from individuals with CAA-ri and noninflammatory CAA at two referral centers. Participants included 17 individuals with pathologically confirmed CAA-ri and 37 control group members with pathologically confirmed noninflammatory CAA. In the CAA-ri group, 14 of 17 (82%) met the criteria for both probable and possible CAA-ri. Sensitivity and specificity was 82%and 97%, respectively, for the probable criteria and sensitivity and specificity of 82%and 68%, respectively, for the possible criteria.

Their findings also indicate that small DWI …

Imaging in Endocrine Disorders

Buchfelder M, Guaraldi F, eds. Imaging in Endocrine Disorders. Kargar 2015; 156 pp; 141 ill; $212.00. Frontiers of Hormone Research; vol 45.

Cover of Imaging in Endocrine Disorders, edited by Buchfelder and Guaraldi

Imaging in Endocrine Disorders, edited by Drs. Buchfelder and Guaraldi, with 20 other authors, is a short, informative hardcover (150 pages in length). Most all chapters should be of interest to neuroradiologists because the material deals with structures we evaluate on a daily basis (pituitary, parasella, thyroid, parathyroid) or structures we note when there is spine imaging (adrenal, pancreas, paraspinal). Particularly well done is the chapter on MRI of the pituitary and pituitary tumors. The explanations are succinct and the images are beautiful. The material on the pituitary includes separate chapters on Intraoperative MR for adenomas and molecular imaging (eg, nuclear) of pituitary pathology. While the material on the thyroid is sufficient, the parathyroid section is skimpy and leaves out a number of imaging aspects of that organ and its pathology. Overall, the book gives a summary look at endocrine tumors; certainly the images are worth reviewing.…

Imaging in Neurology

Osborn AG, Digre KB. Imaging in Neurology. Elsevier; 2016; 528 pp; $149.99

osborn_digre_imaging-neurology_coverImaging in Neurology, from Drs. Anne G. Osborn and Kathleen B. Digre, serves as an imaging reference with key radiologic findings “to the most common and important neurological disorders”. The book is a great educational tool, which successfully presents a vast and varying amount of information in a manner that is thorough yet concise. The book begins with a succinct overview of the various imaging modalities used in neuroimaging, with representative images. The remainder, and bulk, of the book provides a comprehensive review of brain and spine anatomy and pathology, broken down into 3 brain sections and 6 spine sections.

As its title suggests, the book’s strength lays in its fantastic images. The radiologic pictures and graphics are plentiful and well selected to best depict key imaging features. Image quality and size allow for an easy viewing experience. The images are well annotated, allowing for accurate identification of the depicted findings, even in the presence of multiple findings within the same image. Multiple imaging modalities are represented, with the most pertinent modalities selected for each entity.

Perhaps just as strong as the images is the book’s organization. Brief overviews at the beginning of each section lay the foundation for the collection of cases that follow. Each disorder is then presented on a single page with a concise text and pictorial description. Key facts, including imaging findings, top differential diagnoses and clinical issues, are provided in bulletpoint format, allowing for a quick perusal of information without overwhelming the reader. The arrangement by pathology- and anatomy-based diagnoses allows for quick and convenient referral as well as the ability to compare and contrast diagnoses with just a glance of the eye or flip of the page.

This book would …

Synopsis of Spine Surgery

An HS, Sing K, eds. Synopsis of Spine Surgery. 3rd ed. Thieme; 2016; 384 pp; 313 ill; $89.99

an_singh_synopsis-spin-surg_coverSynopsis of Spine Surgery by Drs. An and Singh is a short, 384-page softcover that highlights key concepts in spine surgery. Material is covered in a bullet-like format and accompanied by drawings and some imaging (CT, MR, plain radiographs). Twenty six chapters cover subjects from the craniovertebral junction to the sacral region. Cartoons also accompany many of the surgical descriptions, making the approaches to the spine, in all areas, more understandable.

Probably of greatest interest to a radiologist would be the chapters on pediatric and adult spine deformities. Here we gain an appreciation of what is felt to be of greatest importance to the surgeon from an imaging point of view. Concepts and measurements of balance lines, pelvic incidence/tilt, and other metrics are shown and discussed. How instrumentation is positioned and the effect of hardware and biologics is instructive.

This book is intended for surgical trainees in orthopedics and has limited utility for neuroradiologists.…

Imaging Psoas Sign in Lumbar Spinal Infections: Evaluation of Diagnostic Accuracy and Comparison with Established Imaging Characteristics

Fellows’ Journal Club

In this retrospective case-control study, the authors evaluated lumbar spine MR imagings during a 30-month period that were requested for the evaluation of discitis-osteomyelitis. Fifty age-matched control patients were compared with 51 biopsy-proved or clinically diagnosed patients with discitis-osteomyelitis. The investigators assessed the randomly organized MR imaging examinations for abnormalities of the psoas musculature, vertebral bodies, discs, and epidural space. Psoas T2 hyperintensity demonstrated high sensitivity (92%), specificity (92%), and positive likelihood ratio (11.5). They conclude that psoas T2 hyperintensity, the imaging psoas sign, is highly correlated with discitis-osteomyelitis.

Abstract

Figure 1 from Ledbetter et al. Imaging Psoas Sign in Lumbar Spinal Infections: Evaluation of Diagnostic Accuracy and Comparison with Established Imaging Characteristics
Click image to enlarge

BACKGROUND AND PURPOSE

Lumbar discitis-osteomyelitis has imaging characteristics than can overlap with noninfectious causes of back pain. Our aim was to determine the added accuracy of psoas musculature T2 hyperintensity (imaging psoas sign) in the MR imaging diagnosis of lumbar discitis-osteomyelitis.

MATERIALS AND METHODS

This retrospective case-control study evaluated lumbar spine MR imaging examinations, during a 30-month period, that were requested for the evaluation of discitis-osteomyelitis. Of this pool, 50 age-matched control patients were compared with 51 biopsy-proved or clinically diagnosed patients with discitis-osteomyelitis. Two reviewers, blinded to the clinical information, assessed the randomly organized MR imaging examinations for abnormalities of the psoas musculature, vertebral bodies, discs, and epidural space.

RESULTS

Psoas T2 hyperintensity demonstrated a high sensitivity (92.1%; 95% CI, 80%–97.4%) and specificity (92%; 95% CI, 80%–97.4%), high positive likelihood ratio (11.5; 95% CI, 4.5–29.6), low negative likelihood ratio (0.09; 95% CI, 0.03–0.20), and individual area under the receiver operating characteristic curve of 0.92; 95% CI, 0.87–0.97. Identification of psoas T2 abnormality significantly improved (P = .02) the diagnostic accuracy of discitis-osteomyelitis in noncontrast examinations from an area under the receiver operator characteristic curve of the established variables (vertebral body T2 and T1 signal, endplate integrity, disc T2 signal, and disc

Cerebral Blood Flow Improvement after Indirect Revascularization for Pediatric Moyamoya Disease: A Statistical Analysis of Arterial Spin-Labeling MRI

Editor’s Choice

The authors evaluated 15 children treated by indirect cerebral revascularization with multiple burr-holes between 2011–2013. Arterial spin-labeling MR imaging and T1 sequences were analyzed under SPM8 before and after the operation (3 and 12 months). Group analysis showed statistically significant preoperative hypoperfusion in the MCA territory in the Moyamoya hemispheres and a significant increase of cerebral perfusion in the same territory after revascularization. The authors conclude that SPM analysis of arterial spin-labeling MR imaging offers a noninvasive evaluation of preoperative cerebral hemodynamic impairment and an objective assessment of postoperative improvement in children with Moyamoya disease.

Abstract

Click image to enlarge
Click image to enlarge

BACKGROUND AND PURPOSE

The severity of Moyamoya disease is generally scaled with conventional angiography and nuclear medicine. Arterial spin-labeling MR imaging is now acknowledged for the noninvasive quantification of cerebral blood flow. This study aimed to analyze CBF modifications with statistical parametric mapping of arterial spin-labeling MR imaging in children undergoing an operation for Moyamoya disease.

MATERIALS AND METHODS

We included 15 children treated by indirect cerebral revascularization with multiple burr-holes between 2011 and 2013. Arterial spin-labeling MR imaging and T1 sequences were then analyzed under SPM8, according to the general linear model, before and after the operation (3 and 12 months). Voxel-based analysis was performed at the group level, comparing all diseased hemispheres with all normal hemispheres and, at the individual level, comparing each patient with a control group.

RESULTS

Group analysis showed statistically significant preoperative hypoperfusion in the MCA territory in the Moyamoya hemispheres and a significant increase of cerebral perfusion in the same territory after revascularization (P < .05 family-wise error–corrected). Before the operation, individual analysis showed significant hypoperfusion for each patient co-localized with the angiographic defect on DSA. All except 1 patient had improvement of CBF after revascularization, correlated with their clinical status.

Sectional Anatomy by MRI and CT

Anderson MW, Fox MG, eds. Sectional Anatomy by MRI and CT. 4th ed. Elsevier; 2016; 624 pp; 1165 ill; $299.99

anderson-sectional-anatomy-mri-ct-elsevier_coverThis 4th edition of Sectional Anatomy by MRI and CT, written by Drs. Anderson and Fox, is heavily weighted to the musculoskeletal (MSK) system. If one includes the spine and back, MSK composes 85% of the book—no neuroanatomy (brain/head/neck) is included. It would be a satisfactory anatomy reference guide for someone who is in MSK radiology, but not for a neuroradiologist.…

Next AJNR Tweetchat: MACRA Revealed

Our May 2016 Tweetchat moderated by Joshua Hirsch @JoshuaAHirsch, Gregory Nicola @GregoryNNicola, and Robert Barr @rmbxray will discuss MACRA (The Medicare Access and CHIP Reauthorization Act of 2015) and its impact on the field of radiology. Given the impact of the MACRA legislation on all radiologists during this time of transition to value-based models of payment, this is a chat that you won’t want to miss.

Mark you calendars for May 17th at 3 p.m. EST and join Twitter Editor Ryan T. Fitzgerald @ryantfitzgerald for this timely discussion.

Suggested Reading: Sustainable Growth Rate Repealed, MACRA Revealed: Historical Context and Analysis of Recent Changes in Medicare Physician Payment Methodologies by J.A. Hirsch, H.B. Harvey, R.M. Barr, W.D. Donovan, R. Duszak Jr, G.N. Nicola, P.W. Schaefer, and L. Manchikanti. Published online before print November 19, 2015, doi: 10.3174/ajnr.A4522…