Comments for AJNR Blog http://www.ajnrblog.org American Journal of Neuroradiology Tue, 19 Jan 2010 19:43:08 +0000 hourly 1 Comment on Neuro Protocols by mdmarchand http://www.ajnrblog.org/2009/02/02/neuro-protocols/comment-page-1/#comment-632 mdmarchand Tue, 19 Jan 2010 19:43:08 +0000 http://www.ajnrblog.org/?p=314#comment-632 one more point - we use a vibe (siemens) seq w/FS (GE equivalent=FMPSPGR, VIBRANT, FAME or LAVA) pre and post as our workhorse post con imaging ST neck. It is a T1 weighted gradient echo sequence acquired as a slab - very fast acquisition time, very good spatial resolution, can cut into 2 mm images etc. Any experience with this seq or similar seq for neck imaging? I am worried about the contrast detection issue, but images are so detailed it might be worth the tradeoff here one more point – we use a vibe (siemens) seq w/FS (GE equivalent=FMPSPGR, VIBRANT, FAME or LAVA) pre and post as our workhorse post con imaging ST neck. It is a T1 weighted gradient echo sequence acquired as a slab – very fast acquisition time, very good spatial resolution, can cut into 2 mm images etc. Any experience with this seq or similar seq for neck imaging? I am worried about the contrast detection issue, but images are so detailed it might be worth the tradeoff here

]]> Comment on Neuro Protocols by mdmarchand http://www.ajnrblog.org/2009/02/02/neuro-protocols/comment-page-1/#comment-631 mdmarchand Tue, 19 Jan 2010 19:00:32 +0000 http://www.ajnrblog.org/?p=314#comment-631 In general with head and neck imaging, your protocols do not fat sat the pre T1 – several of my partners state they have found pre T1 w/FS to be helpful in the past and they want to keep pre T1 FS images going forward. I like the standard T1 personally, your thoughts on the value of pre T1 w/ FS. Several state a case in the past where they would have called enhancement without the pre FS T1… Also, your CN 5 protocol is fairly short, with no pre con T1 images – is that all you do? Why the MRA as opposed to a CISS/FIESTA? I was taught that sgpr T1 seq do not show enhancement as well as standard T1 seq – your CN 5 includes an spgr seq, your thoughts on less than ideal contrast detection (ucsd does the same seq as you). I see a mix of STIR and T2 with FS in the orbit protocol – what is the rationale for one over the other? We lean toward STIR with head and neck imaging. Lastly, our referring neurology group sees a high volume of MS patients. We have seen STIR imaging of the posterior fossa to be superior to other sequences (including PD) in the detection of wm lesions and now our ms protocol includes an axial stir seq In general with head and neck imaging, your protocols do not fat sat the pre T1 – several of my partners state they have found pre T1 w/FS to be helpful in the past and they want to keep pre T1 FS images going forward. I like the standard T1 personally, your thoughts on the value of pre T1 w/ FS. Several state a case in the past where they would have called enhancement without the pre FS T1…

Also, your CN 5 protocol is fairly short, with no pre con T1 images – is that all you do? Why the MRA as opposed to a CISS/FIESTA?

I was taught that sgpr T1 seq do not show enhancement as well as standard T1 seq – your CN 5 includes an spgr seq, your thoughts on less than ideal contrast detection (ucsd does the same seq as you).

I see a mix of STIR and T2 with FS in the orbit protocol – what is the rationale for one over the other? We lean toward STIR with head and neck imaging.

Lastly, our referring neurology group sees a high volume of MS patients. We have seen STIR imaging of the posterior fossa to be superior to other sequences (including PD) in the detection of wm lesions and now our ms protocol includes an axial stir seq

]]> Comment on Educational Presentation: Branchial Cleft Cysts by jason.johnson http://www.ajnrblog.org/2009/12/28/educational-presentation-branchial-cleft-cysts-2/comment-page-1/#comment-623 jason.johnson Sun, 03 Jan 2010 18:46:51 +0000 http://www.ajnrblog.org/?p=2476#comment-623 Really nicely done. Easy to read and understand. Nice choice of pictures. Here's a link to a poster I showed in Athens with highlights some of the other cystic lesions of the head and neck. http://www.scribd.com/doc/19586968/090809-ESNR-Meeting-Congenital-Cysts-of-the-Head-and-Neck Really nicely done. Easy to read and understand. Nice choice of pictures. Here’s a link to a poster I showed in Athens with highlights some of the other cystic lesions of the head and neck.

http://www.scribd.com/doc/19586968/090809-ESNR-Meeting-Congenital-Cysts-of-the-Head-and-Neck

]]> Comment on CT Still Useful for Retinoblastoma? by galluzzip http://www.ajnrblog.org/2009/07/19/ct-still-useful-for-retinoblastoma/comment-page-1/#comment-496 galluzzip Tue, 13 Oct 2009 13:31:33 +0000 http://www.ajnrblog.org/?p=1610#comment-496 Obviously I agree with Dr. Schwartz in that MRI of the brain and orbits is the 'gold standard' to study retinoblastoma and simulating lesions. My paper tries to show that CT is not indispensable to detect intraocular calcifications (the key element in the diagnosis of retinoblastoma), and stresses the fact that a collaboration with Ophthalmology is essential to reach this target. Dr. Schwartz is right in affirming that the supporting literature is "old" and that is one of my aims in writing this paper: there are articles on the utility of MRI but I could not find articles affirming that CT is not useful in the protocol study of retinoblastoma. Another point of my article is that we are allowed to use radiation only in very selected cases. Obviously I agree with Dr. Schwartz in that MRI of the brain and orbits is the ‘gold standard’ to study retinoblastoma and simulating lesions. My paper tries to show that CT is not indispensable to detect intraocular calcifications (the key element in the diagnosis of retinoblastoma), and stresses the fact that a collaboration with Ophthalmology is essential to reach this target. Dr. Schwartz is right in affirming that the supporting literature is “old” and that is one of my aims in writing this paper: there are articles on the utility of MRI but I could not find articles affirming that CT is not useful in the protocol study of retinoblastoma. Another point of my article is that we are allowed to use radiation only in very selected cases.

]]> Comment on AngioCalc.com by hanleym http://www.ajnrblog.org/2009/05/05/angiocalccom/comment-page-1/#comment-485 hanleym Thu, 24 Sep 2009 19:40:59 +0000 http://www.ajnrblog.org/?p=941#comment-485 We recently updated the www.AngioCalc.com website to include more background information on cerebral aneurysm coiling, more embolization coil products and a detailed comparision of different coil types. We recently updated the http://www.AngioCalc.com website to include more background information on cerebral aneurysm coiling, more embolization coil products and a detailed comparision of different coil types.

]]> Comment on Does the insurance company require the certification of neurointerventionist for payment of the interventional procedure? by tangent http://www.ajnrblog.org/2009/09/21/does-the-insurance-company-require-the-certification-of-neurointerventionist-for-payment-of-the-interventional-procedure/comment-page-1/#comment-484 tangent Wed, 23 Sep 2009 13:28:05 +0000 http://www.ajnrblog.org/?p=1994#comment-484 Thank you for your answer... Thank you for your answer…

]]> Comment on Does the insurance company require the certification of neurointerventionist for payment of the interventional procedure? by MCastillo http://www.ajnrblog.org/2009/09/21/does-the-insurance-company-require-the-certification-of-neurointerventionist-for-payment-of-the-interventional-procedure/comment-page-1/#comment-483 MCastillo Mon, 21 Sep 2009 13:12:40 +0000 http://www.ajnrblog.org/?p=1994#comment-483 Not at our hospital. If the Credentialing Committee grants a person the privilege for performing neurointerventional procedures, basically anyone can do them regardless of the type of board certification they hold and of the specialty. That is why, cardiologists, vascular surgeons, neurologists and neurosurgeons are able to do these procedures in addition to neuroradiologists. What is more troublesome is that despite the multisociety guidelines of training, few of these specialties follow them. Not at our hospital. If the Credentialing Committee grants a person the privilege for performing neurointerventional procedures, basically anyone can do them regardless of the type of board certification they hold and of the specialty. That is why, cardiologists, vascular surgeons, neurologists and neurosurgeons are able to do these procedures in addition to neuroradiologists. What is more troublesome is that despite the multisociety guidelines of training, few of these specialties follow them.

]]> Comment on Aunt Mickeys (they look the same until you undress them). Internal capsule infarct or something else? by MCastillo http://www.ajnrblog.org/2009/07/29/aunt-mickeys-they-look-the-same-until-you-undress-them-internal-capsule-infarct-or-something-else/comment-page-1/#comment-448 MCastillo Wed, 19 Aug 2009 15:30:45 +0000 http://www.ajnrblog.org/?p=1657#comment-448 Here are some nice images to complement the Aunt Mickey case above. In this instance it was also a young female who presented with left-sided weakness of a few days duration. The DWI and ADC studies show a rounded lesion in the posterior right periventricular region with restricted diffusion. However, the FLAIR image shows multiple lesions in the periventricular regions compatible with MS. This patient was proven to meet clinical criteria for MS. <img src="http://www.ajnrblog.org/wp-content/uploads/CastilloAuntMickeysComment.jpg" alt="" /> Here are some nice images to complement the Aunt Mickey case above. In this instance it was also a young female who presented with left-sided weakness of a few days duration. The DWI and ADC studies show a rounded lesion in the posterior right periventricular region with restricted diffusion. However, the FLAIR image shows multiple lesions in the periventricular regions compatible with MS. This patient was proven to meet clinical criteria for MS.

]]> Comment on Giant Capillary Telangiectasias by Charles Laurent http://www.ajnrblog.org/2009/02/03/giant-capillary-telangiectasias/comment-page-1/#comment-359 Charles Laurent Sat, 18 Jul 2009 07:18:22 +0000 http://www.ajnrblog.org/?p=346#comment-359 I saw a similar case in the pons & gt; 1cm: moderately hyperintense on T2WI, hypointense on T2*GRE (but not profoundly), normal on FLAIR, T1WI and diffusion, with brush-like enhancement. I can send you pictures if you want me to. charleslaurent1@hotmail.com I saw a similar case in the pons & gt; 1cm: moderately hyperintense on T2WI, hypointense on T2*GRE (but not profoundly), normal on FLAIR, T1WI and diffusion, with
brush-like enhancement.

I can send you pictures if you want me to.

charleslaurent1@hotmail.com

]]> Comment on Exercise and Healthy Brains by J. Keith Smith http://www.ajnrblog.org/2009/07/14/exercise-and-healthy-brains/comment-page-1/#comment-352 J. Keith Smith Fri, 17 Jul 2009 14:04:10 +0000 http://www.ajnrblog.org/?p=1605#comment-352 Dr. Quencer points to the clear next step of relating this observed vascular difference to cognitive function. We are in the process of analyzing cognitive function measures on these subjects- results soon I hope. Any fMRI comparison between active and sedentary subjects would have to be very carefully controlled to exclude any effect of differences in vascular reactivity. It is quite likely that the sedentary subjects have reduced vascular compliance and reduced vascular reactivity. This does bring up one interesting side note- one difficulty we had with this study was finding enough sedentary, but otherwise healthy, elderly subjects in our population. This emphasizes the interaction between physical activity and many disease processes. Dr. James Levine, a Mayo Clinic obesity researcher http://www.usatoday.com/tech/news/2005-06-07-office-fit_x.htm has taken Dr. Quencers final suggestion to its natural extreme with a treadmill attached to a work desk with computer. It would be a simple matter to extend this to a full PACs station on a treadmill. Assuming that one is thinking while reading cases, this would provide the simultaneous physical and mental exercise Dr. Quencer prescribes for his aging neuroradiology colleagues. Dr. Quencer points to the clear next step of relating this observed vascular difference to cognitive function. We are in the process of analyzing cognitive function measures on these subjects- results soon I hope.

Any fMRI comparison between active and sedentary subjects would have to be very carefully controlled to exclude any effect of differences in vascular reactivity. It is quite likely that the sedentary subjects have reduced vascular compliance and reduced vascular reactivity.

This does bring up one interesting side note- one difficulty we had with this study was finding enough sedentary, but otherwise healthy, elderly subjects in our population. This emphasizes the interaction between physical activity and many disease processes.

Dr. James Levine, a Mayo Clinic obesity researcher http://www.usatoday.com/tech/news/2005-06-07-office-fit_x.htm
has taken Dr. Quencers final suggestion to its natural extreme with a treadmill attached to a work desk with computer. It would be a simple matter to extend this to a full PACs station on a treadmill. Assuming that one is thinking while reading cases, this would provide the simultaneous physical and mental exercise Dr. Quencer prescribes for his aging neuroradiology colleagues.

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