1
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Benson JC, Trejo-Lopez JA, Cormier JL, Parney IF, Mark IT, Madhavan AA, Kotsenas AL, Rydberg CH, Luetmer PH, Eckel LJ, Johnson DR. Radiology-pathology correlation: Giant tumefactive perivascular spaces. Neuroradiol J 2024:19714009241247459. [PMID: 38613202 DOI: 10.1177/19714009241247459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
Dilated perivascular spaces (PVSs) are common and easily recognized on imaging. However, rarer giant tumefactive PVSs (GTPVSs) can have unusual multilocular cystic configurations, and are often confused for other pathologic entities, including neoplasms, cystic infarctions, and neuroepithelial cysts. Because GTPVSs are scarcely encountered and even more infrequently operated upon, many radiologists are unaware of the imaging and pathologic features of these lesions. Here, a case of a resected GTPVS is presented, highlighting both its radiologic and histologic characteristics, and discussing how such lesions can be differentiated from their closest mimickers on imaging.
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Affiliation(s)
- John C Benson
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Jason L Cormier
- Department of Neurosurgery, Acadiana Neurosurgery, Lafayette, LA, USA
| | - Ian F Parney
- Department of Neurosurgery, Mayo Clinic, Rochester, LA, USA
| | - Ian T Mark
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Amy L Kotsenas
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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2
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Jabal MS, Ramadan D, Ibrahim MK, Duszak R, Kotsenas AL, Brinjikji W, Kallmes D. Influential Radiology Figures and Organizations in Social Media. J Am Coll Radiol 2023; 20:1277-1286. [PMID: 37634801 DOI: 10.1016/j.jacr.2023.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE With social media becoming a vibrant hub for the radiology community, highlighting expert leaders and trustful conduits of information in the virtual field is proving crucial. The aim of this study was to identify and describe the most prominent and influential figures and organizational accounts to follow in radiology. METHODS Influence scores for the topic "radiology" on Twitter (now known as X) were computed using the Right Relevance machine learning service. Top influencers were classified according to gender, geography, physician degree, areas of influence, subspecialization, influence score, title, affiliated institution, dual degree, medical school origin, content type, and research activity. Statistical analysis was performed assessing variable correlations. RESULTS In the top quartile of influential figures, 87% were physicians, 60% men, and 93% located in the United States. Prevalent backgrounds included neuroradiology (21%), abdominal imaging (12%), and artificial intelligence (11%). Of the top 100 figures, 81% were US graduates, 97% held medical degrees, and 28% had dual degrees. Fifty-eight percent provided educational content. A majority held leadership positions (58%) and academic professorship titles (70%). The median h index, publication number, and citation number were 14, 49, and 881, respectively. No significant correlation was noted between influence score and academic rank or research output. CONCLUSIONS Virtual presence is becoming integral to health care professions and academic spheres, unfolding great potential for enhancing the sense of belonging, advocacy, recruitment, and fostering new relationships. Having a core of influential leaders and organizations to follow can serve as a resource for the community members and aspiring students building a positive connected basis for radiology's thriving future.
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Affiliation(s)
- Mohamed Sobhi Jabal
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; Department of Computer and Information Science, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Dina Ramadan
- Department of Radiology, Alexandria University, Alexandria, Egypt. https://twitter.com/Dina_ramadan94
| | - Mohamed K Ibrahim
- Department of Radiology, Mayo Clinic, Rochester, Minnesota. https://twitter.com/khaledorad
| | - Richard Duszak
- Chair, Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi. https://twitter.com/RichDuszak
| | - Amy L Kotsenas
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; Council Speaker, American College of Radiology. https://twitter.com/AmyKotsenas
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota. https://twitter.com/WBrinjikji
| | - David Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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3
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Smith EN, Artunduaga M, Kotsenas AL. Everyday advocacy. Clin Imaging 2023; 101:66-68. [PMID: 37302339 DOI: 10.1016/j.clinimag.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 06/13/2023]
Abstract
When considering advocacy, many people think of the political fundraising form, and assume it is difficult to carry out, or that it requires a big investment of time, energy, or money. However, advocacy comes in many different forms, and can be implemented every day. A more mindful approach and a few small, but critical, steps can take our advocacy to a new, more intentional level; one that we can practice every day. There are many opportunities to use our advocacy skills every day to stand up for something that matters and to make advocacy a habit. It will take all of us working together to rise to the challenge and make a difference in our specialty, for our patients, in our society and in our world.
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Affiliation(s)
- Elainea N Smith
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Maddy Artunduaga
- Department of Radiology, Pediatric Radiology Division, UT Southwestern Medical Center, Dallas, TX, USA
| | - Amy L Kotsenas
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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4
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Siewert B, Bruno MA, Fleishon HB, Hublall R, Slanetz PJ, Jankovic SN, Kotsenas AL, Schwartz ES, Pawley B, Mukherji SK, Bourland JD, Artunduaga M, Saif M, Poussaint TY, Scanlon MH, Kirsch J, Lexa FJ. Summary of the 2022 ACR Intersociety Meeting. J Am Coll Radiol 2023; 20:479-486. [PMID: 37121627 DOI: 10.1016/j.jacr.2023.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 05/02/2023]
Abstract
The ACR Intersociety Committee meeting of 2022 (ISC-2022) was convened around the theme of "Recovering From The Great Resignation, Moral Injury and Other Stressors: Rebuilding Radiology for a Robust Future." Representatives from 29 radiology organizations, including all radiology subspecialties, radiation oncology, and medical physics, as well as academic and private practice radiologists, met for 3 days in early August in Park City, Utah, to search for solutions to the most pressing problems facing the specialty of radiology in 2022. Of these, the mismatch between the clinical workload and the available radiologist workforce was foremost-as many other identifiable problems flowed downstream from this, including high job turnover, lack of time for teaching and research, radiologist burnout, and moral injury.
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Affiliation(s)
- Bettina Siewert
- Associate Professor of Radiology, Harvard Medical School, Boston, Massachusetts, and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Vice Chair of RSNA Quality Improvement Committee.
| | - Michael A Bruno
- Professor of Radiology and Professor of Medicine, Penn State University, University Park, Pennsylvania, and Department of Radiology, Penn State Health, Hershey Medical Center, Hershey, Pennsylvania
| | - Howard B Fleishon
- Associate Professor of Radiology, Department of Radiology and Imaging Sciences, Atlanta, Georgia; President, ACR
| | - Ronald Hublall
- Central Illinois Radiological Associates, East Peoria, Illinois
| | - Priscilla J Slanetz
- Professor of Radiology, Boston University Chobanian & Avedisian School of Medicine and Department of Radiology, Boston Medical Center, Boston, Massachusetts; President-Elect, AUR; Vice Chair of Academic Affairs in the Department of Radiology and Associate Program Director of the Diagnostic Radiology Residency, Boston Medical Center; Subspecialty Chair, ACR Appropriateness Criteria Breast Imaging Panels; Chair, Mentorship Committee, Society of Breast Imaging; Co-Chair, Fellowship Committee and Breast Imaging Committee of the Massachusetts Radiological Society
| | - Stephanie N Jankovic
- Department of Radiology, Oregon Health & Science University Hospital, Portland, Oregon
| | - Amy L Kotsenas
- Professor of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota, and Department of Radiology, Mayo Clinic, Rochester, Minnesota; Board of Chancellors, ACR
| | - Erin S Schwartz
- Professor of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Barbara Pawley
- Associate Professor of Radiology, University of Kentucky, Lexington, Kentucky, and Department of Radiology, UK Albert B. Chandler Hospital, Lexington, Kentucky; Immediate Past-President, American Association for Women Radiologists
| | | | - J Daniel Bourland
- Professor of Radiation Oncology, Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; 2022 President, American Association of Physicists in Medicine, 2023 Chair, Board of Directors, American Association of Physicists in Medicine
| | - Maddy Artunduaga
- Assistant Professor of Radiology, Department of Radiology, Pediatric Radiology Division, UT Southwestern Medical Center, Dallas, Texas
| | - Manal Saif
- Department of Radiology, Penn State Health, Hershey Medical Center, Hershey, Pennsylvania
| | - Tina Y Poussaint
- Lionel W. Young Chair in Radiology, Professor of Radiology, Harvard Medical School, Boston, Massachusetts, and Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, 1st Past President, American Society of Neyruradiology
| | - Mary H Scanlon
- Clinical Professor of Radiology, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, Pennsylvania, and Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, President, Association of Program Directors in Radiology
| | - Jacobo Kirsch
- Chair, Florida Region Imaging Institute, Cleveland Clinic Florida, Weston Hospital, Weston, Florida
| | - Frank J Lexa
- Professor and Vice Chair Faculty Affairs, Department of Radiology, University of Pittsburgh Medical Center International, Pittsburgh, Pennsylvania; Vice President, ACR; Chief Medical Officer, The Radiology Leadership Institute of the ACR
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Choi HH, Kotsenas AL, Chen JV, Bronsky C, Roth CJ, Kohli MD. Multi-institutional Experience with Patient Image Access Through Electronic Health Record Patient Portals. J Digit Imaging 2022; 35:320-326. [PMID: 35022926 PMCID: PMC8921401 DOI: 10.1007/s10278-021-00565-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022] Open
Abstract
The objective is to determine patients' utilization rate of radiology image viewing through an online patient portal and to understand its impact on radiologists. IRB approval was waived. In this two-part, multi-institutional study, patients' image viewing rate was retrospectively assessed, and radiologists were anonymously surveyed for the impact of patient imaging access on their workflow. Patient access to web-based image viewing via electronic patient portals was enabled at 3 institutions (all had open radiology reports) within the past 5 years. The number of exams viewed online was compared against the total number of viewable imaging studies. An anonymized survey was distributed to radiologists at the 3 institutions, and responses were collected over 2 months. Patients viewed 14.2% of available exams - monthly open rate varied from 7.3 to 41.0%. A total of 254 radiologists responded to the survey (response rate 32.8%); 204 were aware that patients could view images. The majority (155/204; 76.0%) felt no impact on their role as radiologists; 11.8% felt negative and 9.3% positive. The majority (63.8%) were never approached by patients. Of the 86 who were contacted, 46.5% were contacted once or twice, 46.5% 3-4 times a year, and 4.7% 3-4 times a month. Free text comments included support for healthcare transparency (71), concern for patient confusion and anxiety (45), and need for attention to radiology reports and image annotations (15). A small proportion of patients viewed their radiology images. Overall, patients' image viewing had minimal impact on radiologists. Radiologists were seldom contacted by patients. While many radiologists feel supportive, some are concerned about causing patient confusion and suggest minor workflow modifications.
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Affiliation(s)
- Hailey H Choi
- University of California San Francisco, 505 Parnassus Ave., CA, San Francisco, 94143, USA.
| | - Amy L Kotsenas
- Mayo Clinic Rochester, 200 1st St. SW, Rochester, 55905, MN, USA
| | - Joshua Vic Chen
- University of California San Francisco, 505 Parnassus Ave., CA, San Francisco, 94143, USA
| | - Christina Bronsky
- University of California San Francisco, 505 Parnassus Ave., CA, San Francisco, 94143, USA
| | | | - Marc D Kohli
- University of California San Francisco, 505 Parnassus Ave., CA, San Francisco, 94143, USA
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6
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Madhavan AA, Carr CM, Morris PP, Flanagan EP, Kotsenas AL, Hunt CH, Eckel LJ, Lindell EP, Diehn FE. Imaging Review of Paraneoplastic Neurologic Syndromes. AJNR Am J Neuroradiol 2020; 41:2176-2187. [PMID: 33093137 DOI: 10.3174/ajnr.a6815] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/29/2020] [Indexed: 12/19/2022]
Abstract
Paraneoplastic syndromes are systemic reactions to neoplasms mediated by immunologic or hormonal mechanisms. The most well-recognized paraneoplastic neurologic syndrome, both clinically and on imaging, is limbic encephalitis. However, numerous additional clinically described syndromes affect the brain, spinal cord, and peripheral nerves. Many of these syndromes can have imaging findings that, though less well described, are important in making the correct diagnosis. Moreover, imaging in these syndromes frequently mimics more common pathology, which can be a diagnostic challenge for radiologists. Our goal is to review the imaging findings of paraneoplastic neurologic syndromes, including less well-known entities and atypical presentations of common entities. Specifically, we discuss limbic encephalitis, paraneoplastic cerebellar degeneration, paraneoplastic brain stem encephalitis, cranial neuropathy, myelitis, and polyneuropathy. We also demonstrate common diagnostic pitfalls that can be encountered when imaging these patients.
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Affiliation(s)
- A A Madhavan
- From the Division of Neuroradiology, Department of Radiology (A.A.M., C.M.C., P.P.M., A.L.K., C.H.H., L.J.E., E.P.L., F.E.D.)
| | - C M Carr
- From the Division of Neuroradiology, Department of Radiology (A.A.M., C.M.C., P.P.M., A.L.K., C.H.H., L.J.E., E.P.L., F.E.D.)
| | - P P Morris
- From the Division of Neuroradiology, Department of Radiology (A.A.M., C.M.C., P.P.M., A.L.K., C.H.H., L.J.E., E.P.L., F.E.D.)
| | - E P Flanagan
- Department of Neurology (E.P.F.), Mayo Clinic, Rochester, Minnesota
| | - A L Kotsenas
- From the Division of Neuroradiology, Department of Radiology (A.A.M., C.M.C., P.P.M., A.L.K., C.H.H., L.J.E., E.P.L., F.E.D.)
| | - C H Hunt
- From the Division of Neuroradiology, Department of Radiology (A.A.M., C.M.C., P.P.M., A.L.K., C.H.H., L.J.E., E.P.L., F.E.D.)
| | - L J Eckel
- From the Division of Neuroradiology, Department of Radiology (A.A.M., C.M.C., P.P.M., A.L.K., C.H.H., L.J.E., E.P.L., F.E.D.)
| | - E P Lindell
- From the Division of Neuroradiology, Department of Radiology (A.A.M., C.M.C., P.P.M., A.L.K., C.H.H., L.J.E., E.P.L., F.E.D.)
| | - F E Diehn
- From the Division of Neuroradiology, Department of Radiology (A.A.M., C.M.C., P.P.M., A.L.K., C.H.H., L.J.E., E.P.L., F.E.D.)
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7
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Kotsenas AL. Using Dual-Energy CT to Identify Small Foci of Hemorrhage in the Emergency Setting. Radiology 2020; 294:139-140. [DOI: 10.1148/radiol.2019192258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Amy L. Kotsenas
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55902
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8
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Fletcher JG, DeLone DR, Kotsenas AL, Campeau NG, Lehman VT, Yu L, Leng S, Holmes DR, Edwards PK, Johnson MP, Michalak GJ, Carter RE, McCollough CH. Evaluation of Lower-Dose Spiral Head CT for Detection of Intracranial Findings Causing Neurologic Deficits. AJNR Am J Neuroradiol 2019; 40:1855-1863. [PMID: 31649155 DOI: 10.3174/ajnr.a6251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/21/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Despite the frequent use of unenhanced head CT for the detection of acute neurologic deficit, the radiation dose for this exam varies widely. Our aim was to evaluate the performance of lower-dose head CT for detection of intracranial findings resulting in acute neurologic deficit. MATERIALS AND METHODS Projection data from 83 patients undergoing unenhanced spiral head CT for suspected neurologic deficits were collected. Cases positive for infarction, intra-axial hemorrhage, mass, or extra-axial hemorrhage required confirmation by histopathology, surgery, progression of findings, or corresponding neurologic deficit; cases negative for these target diagnoses required negative assessments by two neuroradiologists and a clinical neurologist. A routine dose head CT was obtained using 250 effective mAs and iterative reconstruction. Lower-dose configurations were reconstructed (25-effective mAs iterative reconstruction, 50-effective mAs filtered back-projection and iterative reconstruction, 100-effective mAs filtered back-projection and iterative reconstruction, 200-effective mAs filtered back-projection). Three neuroradiologists circled findings, indicating diagnosis, confidence (0-100), and image quality. The difference between the jackknife alternative free-response receiver operating characteristic figure of merit at routine and lower-dose configurations was estimated. A lower 95% CI estimate of the difference greater than -0.10 indicated noninferiority. RESULTS Forty-two of 83 patients had 70 intracranial findings (29 infarcts, 25 masses, 10 extra- and 6 intra-axial hemorrhages) at routine head CT (CT dose index = 38.3 mGy). The routine-dose jackknife alternative free-response receiver operating characteristic figure of merit was 0.87 (95% CI, 0.81-0.93). Noninferiority was shown for 100-effective mAs iterative reconstruction (figure of merit difference, -0.04; 95% CI, -0.08 to 0.004) and 200-effective mAs filtered back-projection (-0.02; 95% CI, -0.06 to 0.02) but not for 100-effective mAs filtered back-projection (-0.06; 95% CI, -0.10 to -0.02) or lower-dose levels. Image quality was better at higher-dose levels and with iterative reconstruction (P < .05). CONCLUSIONS Observer performance for dose levels using 100-200 eff mAs was noninferior to that observed at 250 effective mAs with iterative reconstruction, with iterative reconstruction preserving noninferiority at a mean CT dose index of 15.2 mGy.
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Affiliation(s)
- J G Fletcher
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - D R DeLone
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - A L Kotsenas
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - N G Campeau
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - V T Lehman
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - L Yu
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - S Leng
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - D R Holmes
- Biomedical Imaging Resource (D.R.H., P.E.)
| | | | - M P Johnson
- Biomedical Statistics and Informatics (M.P.J.), Mayo Clinic, Rochester, Minnesota
| | - G J Michalak
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - R E Carter
- Health Sciences Research (R.E.C.), Mayo Clinic, Jacksonville, Florida
| | - C H McCollough
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
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D'Anna G, Chen MM, McCarty J, Radmanesh A, Kotsenas AL. Reply. AJNR Am J Neuroradiol 2019; 40:E57. [PMID: 31515209 DOI: 10.3174/ajnr.a6215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- G D'Anna
- Radiology Unit Humanitas Mater Domini Castellanza (Varese), Italy
| | - M M Chen
- Department of Radiology University of Texas MD Anderson Cancer Center Houston, Texas
| | - J McCarty
- Department of Diagnostic and Interventional Imaging University of Texas Health Sciences Center at Houston Houston, Texas
| | - A Radmanesh
- Department of Radiology New York University School of Medicine New York, New York
| | - A L Kotsenas
- Department of Radiology Mayo Clinic Rochester, Minnesota
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Kohli MD, Daye D, Towbin AJ, Kotsenas AL, Heilbrun ME. Social Media Tools for Department and Practice Communication and Branding in the Digital Age. Radiographics 2019; 38:1773-1785. [PMID: 30303796 DOI: 10.1148/rg.2018180090] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
With nearly 70% of adults in the United States using at least one social media platform, a social media presence is increasingly important for departments and practices. Patients, prospective faculty and trainees, and referring physicians look to social media to find information about our organizations. The authors present a stepwise process for planning, executing, and evaluating an organizational social media strategy. This process begins with alignment with a strategic plan to set goals, identification of the target audience(s), selection of appropriate social media channels, tracking effectiveness, and resource allocation. The article concludes with a discussion of advantages and disadvantages of social media through a review of current literature. ©RSNA, 2018.
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Affiliation(s)
- Marc D Kohli
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143 (M.D.K.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.D.); Department of Radiology, Cincinnati Children's Hospital, Cincinnati, Ohio (A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.L.K.); and Department of Radiology and Imaging Sciences, Emory University Healthcare, Atlanta, Ga (M.E.H.)
| | - Dania Daye
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143 (M.D.K.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.D.); Department of Radiology, Cincinnati Children's Hospital, Cincinnati, Ohio (A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.L.K.); and Department of Radiology and Imaging Sciences, Emory University Healthcare, Atlanta, Ga (M.E.H.)
| | - Alexander J Towbin
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143 (M.D.K.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.D.); Department of Radiology, Cincinnati Children's Hospital, Cincinnati, Ohio (A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.L.K.); and Department of Radiology and Imaging Sciences, Emory University Healthcare, Atlanta, Ga (M.E.H.)
| | - Amy L Kotsenas
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143 (M.D.K.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.D.); Department of Radiology, Cincinnati Children's Hospital, Cincinnati, Ohio (A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.L.K.); and Department of Radiology and Imaging Sciences, Emory University Healthcare, Atlanta, Ga (M.E.H.)
| | - Marta E Heilbrun
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143 (M.D.K.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.D.); Department of Radiology, Cincinnati Children's Hospital, Cincinnati, Ohio (A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.L.K.); and Department of Radiology and Imaging Sciences, Emory University Healthcare, Atlanta, Ga (M.E.H.)
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11
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D'Anna G, Chen MM, McCarty J, Radmanesh A, Kotsenas AL. Reply. AJNR Am J Neuroradiol 2019; 40:E55. [PMID: 31537521 DOI: 10.3174/ajnr.a6214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- G D'Anna
- Radiology Unit Humanitas Mater Domini Castellanza (Varese), Italy
| | - M M Chen
- Department of Radiology University of Texas MD Anderson Cancer Center Houston, Texas
| | - J McCarty
- Department of Diagnostic and Interventional Imaging University of Texas Health Sciences Center at Houston Houston, Texas
| | - A Radmanesh
- Department of Radiology New York University School of Medicine New York, New York
| | - A L Kotsenas
- Department of Radiology Mayo Clinic Rochester, Minnesota
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12
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Affiliation(s)
- Amy L Kotsenas
- 1Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - John D Port
- 1Department of Radiology, Mayo Clinic, Rochester, MN, USA
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D'Anna G, Chen MM, McCarty JL, Radmanesh A, Kotsenas AL. The Continued Rise in Professional Use of Social Media at Scientific Meetings: An Analysis of Twitter Use during the ASNR 2018 Annual Meeting. AJNR Am J Neuroradiol 2019; 40:935-937. [PMID: 31072973 DOI: 10.3174/ajnr.a6064] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 04/04/2019] [Indexed: 12/15/2022]
Abstract
Professional use of social media continues to increase. We analyzed Twitter use of our own American Society of Neuroradiology (ASNR) 2018 annual meeting, reviewing all Twitter posts (3020 tweets from 523 participants) containing the hashtag #ASNR18 from May 21, 2018, to June 12, 2018, extracting the transcripts from Symplur. Then, each tweet was categorized by the role of user, type of tweet, and topic. The dominant user category was neuroradiologist/radiologist (63%). The keynote address, "The Radiology Renaissance: Shaping the Future of Healthcare," presented by Andy DeLao @Cancergeek was the most frequently tweeted topic (10%). Comment on a session was the major type of tweet. When we compared the data with a similar analysis in 2014, our data analysis showed a growth in the use of Twitter in only 4 years.
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Affiliation(s)
- G D'Anna
- From the Neuroradiology Unit (G.D.A.), Azienda Socio Sanitaria Territoriale Monza Ospedale San Gerardo, Monza, Italy
| | - M M Chen
- Department of Radiology (M.M.C.), University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J L McCarty
- Department of Diagnostic and Interventional Imaging (J.L.M.), University of Texas Health Sciences Center at Houston, Houston, Texas
| | - A Radmanesh
- Department of Radiology (A.R.), New York University School of Medicine, New York, New York
| | - A L Kotsenas
- Department of Radiology (A.L.K.), Mayo Clinic, Rochester, Minnesota
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Abstract
Autoimmune epilepsy (AE) is becoming increasingly recognized as a potentially reversible cause of frequent or medically intractable seizures and cognitive deterioration. We describe various presentations of autoimmune encephalopathy which have specifically presented with seizure and describe reported imaging findings. This is organized as a review of the more common autoantibodies which can specifically precipitate seizure according to the intracellular or extracellular location of the targeted antigen. For each antibody, we illustrate their pathophysiology, characteristic clinical presentations with typical effective treatments and prognoses and imaging findings on MRI and PET/CT exams. Parenchymal involvement is variable with the limbic structures typically affected; however, non-limbic cortex, cerebellum, brainstem and basal ganglia can also be involved. In the acute setting, affected regions typically demonstrate T2 hyperintensity with mild mass effect from edema and increased 18F-fludeoxyglucose uptake. Chronically involved parenchyma will often undergo atrophy and demonstrate decreased metabolism; mesial temporal sclerosis is often the end result when the limbic system is involved. Without treatment, long-term effects from AE range from ongoing cognitive dysfunction and refractory seizures to death. Familiarity with AE may prompt appropriate antibody screening, particularly in cases of refractory seizure disorders. Early investigation and proper management of AE cases may help to prevent parenchymal and neurologic deterioration in these patients.
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Affiliation(s)
- Julie Guerin
- 1 Department of Radiology, Mayo Clinic , Rochester, MN , USA
| | - Robert E Watson
- 1 Department of Radiology, Mayo Clinic , Rochester, MN , USA
| | - Carrie M Carr
- 1 Department of Radiology, Mayo Clinic , Rochester, MN , USA
| | - Greta B Liebo
- 1 Department of Radiology, Mayo Clinic , Rochester, MN , USA
| | - Amy L Kotsenas
- 1 Department of Radiology, Mayo Clinic , Rochester, MN , USA
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Rosenkrantz AB, Kotsenas AL, Duszak R. Geographic Variation in Gender Disparities in the US Radiologist Workforce. J Am Coll Radiol 2018; 15:1073-1079. [DOI: 10.1016/j.jacr.2018.04.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/09/2018] [Indexed: 10/16/2022]
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Gregg NM, Osborn TG, Kotsenas AL, Britton J, Cascino GD. S06. A case of linear scleroderma en coup de sabre and epilepsy: Manage the sabre to control the seizures. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Johnson TF, Brinjikji W, Doolittle DA, Nagelschneider AA, Welch BT, Kotsenas AL. Structured Head and Neck CT Angiography Reporting Reduces Resident Revision Rates. Curr Probl Diagn Radiol 2018; 48:114-116. [PMID: 29753407 DOI: 10.1067/j.cpradiol.2018.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/06/2018] [Accepted: 04/09/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE This resident-driven quality improvement project was undertaken to assess the effectiveness of structured reporting to reduce revision rates for afterhours reports dictated by residents. METHODS The first part of the study assessed baseline revision rates for head and neck CT angiography (CTA) examinations dictated by residents during afterhours call. A structured report was subsequently created based on templates on the RSNA informatics reporting website and critical findings that should be assessed for on all CTA examinations. The template was made available to residents through the speech recognition software for all head and neck CTA examinations for a duration of 2 months. Report revision rates were then compared with and without use of the structured template. RESULTS The structured template was found to reduce revision rates by approximately 50% with 10/41 unstructured reports revised and 2/17 structured reports revised. CONCLUSIONS We believe that structured reporting can help reduce reporting errors, particularly in term of typographical errors, train residents to evaluate complex examinations in a systematic fashion, and assist them in recalling critical findings on these examinations.
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Widmer RJ, Maurer MJ, Nayar VR, Aase LA, Wald JT, Kotsenas AL, Timimi FK, Harper CM, Pruthi S. Online Physician Reviews Do Not Reflect Patient Satisfaction Survey Responses. Mayo Clin Proc 2018; 93:453-457. [PMID: 29622095 DOI: 10.1016/j.mayocp.2018.01.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 12/26/2017] [Accepted: 01/23/2018] [Indexed: 10/17/2022]
Abstract
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. Overall, there were 113 unique individuals with negative online reviews from September 1, 2014, to December 31, 2014, with 8 being nonphysicians. We matched 113 physicians in similar departments/divisions. We obtained PG PSS scores of both groups and compared the mean scores of the 2 groups. Press Ganey PSS scores were available for 98 physicians with negative online reviews compared with 82 matched physicians without negative online reviews. The mean raw PG PSS scores were not different between the 2 groups (4.05; 95% CI, 3.99-4.11 vs 4.04; 95% CI, 3.97-4.11; P=.92). We also noted no difference in mean scores on questions related to physician-patient communication and interaction skills between those with poor online reviews and those without (4.38; 95% CI, 4.32-4.43 vs 4.41; 95% CI, 4.35-4.47; P=.42). However, there was a significantly lower non-physician-specific mean in those with negative online reviews (3.91; 95% CI, 3.84-3.97) vs those without negative online reviews (4.01; 95% CI, 3.95-4.09) (P=.02). Here, we provide data indicating that online physician reviews do not correlate to formal institutional PG PSS. Furthermore, physicians with negative online reviews have lower scores on non-physician-specific variables included in the PG PSSs, emphasizing that these discrepancies can negatively affect overall patient experience, online physician reviews, and physician reputation. It is prudent that an improved mechanism for online ratings be implemented to better inform patients about a physician's online reputation.
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Affiliation(s)
- R Jay Widmer
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Matthew J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Veena R Nayar
- Department of Public Affairs, Mayo Clinic, Rochester, MN
| | - Lee A Aase
- Mayo Clinic Center for Social Media, Mayo Clinic, Rochester, MN
| | - John T Wald
- Department of Radiology, Mayo Clinic, Rochester, MN
| | | | - Farris K Timimi
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Mayo Clinic Center for Social Media, Mayo Clinic, Rochester, MN
| | | | - Sandhya Pruthi
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN.
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Fredriksen JR, Carr CM, Koeller KK, Verdoorn JT, Gadoth A, Pittock SJ, Kotsenas AL. MRI findings in glutamic acid decarboxylase associated autoimmune epilepsy. Neuroradiology 2018; 60:239-245. [PMID: 29353399 DOI: 10.1007/s00234-018-1976-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 01/03/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Glutamic acid decarboxylase (GAD65) has been implicated in a number of autoimmune-associated neurologic syndromes, including autoimmune epilepsy. This study categorizes the spectrum of MRI findings in patients with a clinical diagnosis of autoimmune epilepsy and elevated serum GAD65 autoantibodies. METHODS An institutional database search identified patients with elevated serum GAD65 antibodies and a clinical diagnosis of autoimmune epilepsy who had undergone brain MRI. Imaging studies were reviewed by three board-certified neuroradiologists and one neuroradiology fellow. Studies were evaluated for cortical/subcortical and hippocampal signal abnormality, cerebellar and cerebral volume loss, mesial temporal sclerosis, and parenchymal/leptomeningeal enhancement. The electronic medical record was reviewed for relevant clinical information and laboratory markers. RESULTS A study cohort of 19 patients was identified. The majority of patients were female (84%), with a mean age of onset of 27 years. Serum GAD65 titers ranged from 33 to 4415 nmol/L (normal < 0.02 nmol/L). The most common presentation was medically intractable, complex partial seizures with temporal lobe onset. Parenchymal atrophy was the most common imaging finding (47%), with a subset of patients demonstrating cortical/subcortical parenchymal T2 hyperintensity (37%) or abnormal hippocampal signal (26%). No patients demonstrated abnormal parenchymal/leptomeningeal enhancement. CONCLUSION The most common MRI finding in GAD65-associated autoimmune epilepsy is disproportionate parenchymal atrophy for age, often associated with abnormal cortical/subcortical T2 hyperintensities. Hippocampal abnormalities are seen in a minority of patients. This constellation of findings in a patient with medically intractable epilepsy should raise the possibility of GAD65 autoimmunity.
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Affiliation(s)
- Jason R Fredriksen
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Carrie M Carr
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Kelly K Koeller
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Jared T Verdoorn
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Avi Gadoth
- Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Amy L Kotsenas
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
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20
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Diehn FE, Michalak GJ, DeLone DR, Kotsenas AL, Lindell EP, Campeau NG, Halaweish AF, McCollough CH, Fletcher JG. CT Dental Artifact: Comparison of an Iterative Metal Artifact Reduction Technique with Weighted Filtered Back-Projection. Acta Radiol Open 2017; 6:2058460117743279. [PMID: 29225924 PMCID: PMC5714095 DOI: 10.1177/2058460117743279] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 10/09/2017] [Indexed: 11/16/2022] Open
Abstract
Background Dental hardware produces streak artifacts on computed tomography (CT) images reconstructed with the standard weighted filtered back projection (wFBP) method. Purpose To perform a preliminary evaluation of an iterative metal artifact reduction (IMAR) technique to assess its ability to improve anatomic visualization over wFBP in patients with dental amalgam or other hardware. Material and Methods CT images from patients with dental hardware were reconstructed using wFBP and IMAR software and soft-tissue or bone window/level settings. The anatomy most affected by metal artifacts was identified. Two neuroradiologists determined subjective and objective imaging features, including overall metal artifact score (1 = severe artifacts, 5 = no artifacts), soft-tissue visualization score of the most-compromised structure, and artifact length along the skin surface. CT numbers were used to quantify artifact severity. Results Twenty-four patients were included. IMAR improved overall metal artifact score in 18/24 cases (median =2 ± 0.9 vs. 1 ± 0.6, P < 0.001). Mean CT number in the most-affected anatomical structure significantly improved with IMAR (94.6 vs. 219 HU, P = 0.002) and length of affected skin surface decreased (40.4 mm vs. 118.7 mm, P < 0.001). However, osseous/dental artifactual defects were found in 22/24 cases with IMAR vs. 11/24 with wFBP. Conclusion IMAR software reduced metal artifact both subjectively and objectively and improved visualization of adjacent soft tissues. However, it produced a higher rate of artifactual defects in the teeth and bones than wFBP. Our findings support the use of IMAR as a valuable complement to, but not a replacement for, standard wFBP image reconstruction.
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Affiliation(s)
- Felix E Diehn
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - David R DeLone
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Amy L Kotsenas
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - E Paul Lindell
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Wald JT, Lowery-Schrandt S, Hayes DL, Kotsenas AL. Mayo Clinic Care Network: A Collaborative Health Care Model. J Am Coll Radiol 2017; 15:167-172. [PMID: 29122505 DOI: 10.1016/j.jacr.2017.09.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 09/09/2017] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- John T Wald
- Department of Radiology, Mayo Clinic, Rochester, Minnesota.
| | | | - David L Hayes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Amy L Kotsenas
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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22
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Kotsenas AL, Aase L, Arce M, Timimi FK, Dacy M, Young C, Wald JT. The Social Media DNA of Mayo Clinic-and Health Care. J Am Coll Radiol 2017; 15:162-166. [PMID: 29128500 DOI: 10.1016/j.jacr.2017.09.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 09/09/2017] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Amy L Kotsenas
- Department of Radiology, Mayo Clinic, Rochester, Minnesota.
| | - Lee Aase
- Social Media Network, Mayo Clinic, Rochester, Minnesota
| | - Makala Arce
- Social Media Network, Mayo Clinic, Rochester, Minnesota
| | - Farris K Timimi
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Matthew Dacy
- Department of Development, Mayo Clinic, Rochester, Minnesota
| | - Colleen Young
- Mayo Clinic Connect, Mayo Clinic, Rochester, Minnesota
| | - John T Wald
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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23
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Gadoth A, Pittock SJ, Dubey D, McKeon A, Britton JW, Schmeling JE, Smith A, Kotsenas AL, Watson RE, Lachance DH, Flanagan EP, Lennon VA, Klein CJ. Expanded phenotypes and outcomes among 256 LGI1/CASPR2-IgG-positive patients. Ann Neurol 2017. [PMID: 28628235 DOI: 10.1002/ana.24979] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To describe an expanded phenotypic spectrum and longitudinal outcome in 256 LGI1-IgG-seropositive and/or CASPR2-IgG-seropositive patients. METHODS Patients were identified through service neural autoantibody evaluation. Ninety-five had longitudinal follow-up (7-456 months; median = 35). RESULTS Among 3,910 patients tested, 196 were LGI1-IgG positive, 51 were CASPR2-IgG positive, and 9 were dual positive. Cerebrospinal fluid testing was less sensitive than serum testing, detecting only 24 of 38 (63%) LGI1-IgG-positive and 5 of 6 (83%) CASPR2-IgG-positive patients. LGI1-IgG-positive specimens had higher voltage-gated potassium channel-IgG immunoprecipitation values (0.33nmol/l, range = 0.02-5.14) than CASPR2-IgG-positive specimens (0.10nmol/l, range = 0.00-0.45, p < 0.001). Of patients presenting with pain or peripheral nervous system (PNS) manifestations, 39% were LGI1-IgG seropositive (7% had solely neuropathy or pain). Multivariate analysis identified age as the only significant predictor of central nervous system (CNS) versus PNS involvement (>50 years; odds ratio = 15, p < 0.001). Paroxysmal dizziness spells (PDS), a unique LGI1-IgG accompaniment (14% of patients), frequently delayed the diagnosis. T2-mesiotemporal hyperintensity was more common in LGI1-IgG-positive (41%) than in CASPR2-IgG-positive patients (p = 0.033). T1-bright basal ganglia were confined to LGI1-IgG-positive patients with faciobrachial-dystonic seizures (9 of 39, 31%). Cancer was found in 44% of LGI1-IgG/CASPR2-IgG dual seropositive patients (one-third thymoma). Response to initial immunotherapy was favorable in 97%; mean modified Rankin score was 3 (range = 1-5) at onset and 1.74 (range = 0-6) at last follow-up, with 9% having severe refractory disability, 20% being asymptomatic, 28% receiving immunotherapy, and 58% receiving antiepileptic medication. INTERPRETATION Older age is a strong predictor of CNS involvement in patients seropositive for CASPR2-IgG or LGI1-IgG. Pain, peripheral manifestations, and stereotypic paroxysmal dizziness spells are common with LGI1-IgG. Response to initial immunotherapy is often favorable, but some patients remain severely disabled, requiring long-term immunotherapy and/or antiepileptic medications. Ann Neurol 2017;82:79-92.
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Affiliation(s)
- Avi Gadoth
- Neuroimmunology Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- Neuroimmunology Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN
| | - Divyanshu Dubey
- Neuroimmunology Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN
| | - Andrew McKeon
- Neuroimmunology Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN
| | - Jeff W Britton
- Neuroimmunology Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN
| | - John E Schmeling
- Neuroimmunology Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN
| | - Aurelia Smith
- Neuroimmunology Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN
| | | | | | - Daniel H Lachance
- Neuroimmunology Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN
| | - Eoin P Flanagan
- Neuroimmunology Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN
| | - Vanda A Lennon
- Neuroimmunology Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN
| | - Christopher J Klein
- Neuroimmunology Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN
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McDonald JS, McDonald RJ, Davenport MS, Jaffe TA, Cook TS, Kallmes DF, Kotsenas AL. Gender and Radiology Publication Productivity: An Examination of Academic Faculty From Four Health Systems in the United States. J Am Coll Radiol 2017; 14:1100-1108. [DOI: 10.1016/j.jacr.2017.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/06/2017] [Accepted: 04/11/2017] [Indexed: 11/29/2022]
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25
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Shah V, Kotsenas AL. Social Media Tips to Enhance Medical Education. Acad Radiol 2017; 24:747-752. [PMID: 28222940 DOI: 10.1016/j.acra.2016.12.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/17/2016] [Accepted: 12/17/2016] [Indexed: 10/20/2022]
Abstract
In this article, we describe how social media can supplement traditional education, articulate the advantages and disadvantages of various social media platforms for both teachers and learners, discuss best practices to maintain confidentiality of protected health information, and provide tips for implementing social media-based teaching into the training curriculum.
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Kotsenas AL. Re: “Women in Leadership: Why So Few and What to Do About It”. J Am Coll Radiol 2017; 14:450. [DOI: 10.1016/j.jacr.2017.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 11/24/2022]
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Montoya JC, Eckel LJ, DeLone DR, Kotsenas AL, Diehn FE, Yu L, Bartley AC, Carter RE, McCollough CH, Fletcher JG. Low-Dose CT for Craniosynostosis: Preserving Diagnostic Benefit with Substantial Radiation Dose Reduction. AJNR Am J Neuroradiol 2017; 38:672-677. [PMID: 28183836 DOI: 10.3174/ajnr.a5063] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/06/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Given the positive impact of early intervention for craniosynostosis, CT is often performed for evaluation but radiation dosage remains a concern. We evaluated the potential for substantial radiation dose reduction in pediatric patients with suspected craniosynostosis. MATERIALS AND METHODS CT projection data from pediatric patients undergoing head CT for suspected craniosynostosis were archived. Simulated lower-dose CT images corresponding to 25%, 10%, and 2% of the applied dose were created using a validated method. Three neuroradiologists independently interpreted images in a blinded, randomized fashion. All sutures were evaluated by using 3D volume-rendered images alone, and subsequently with 2D and 3D images together. Reference standards were defined by reader agreement by using routine dose and 2D and 3D images. Performance figures of merit were calculated based on reader response and confidence. RESULTS Of 33 pediatric patients, 21 had craniosynostosis (39 positive sutures and 225 negative sutures). The mean volume CT dose index was 15.5 ± 2.3 mGy (range, 9.69-19.38 mGy) for the routine dose examination. Average figures of merit for multireader analysis ranged from 0.92 (95% CI, 0.90-0.95) at routine pediatric dose to 0.86 (95% CI, 0.79-0.94) at 2% dose using 3D images alone. Similarly, pooled reader figures of merit ranged from 0.91 (95% CI, 0.89-0.95) at routine pediatric dose to 0.85 (95% CI, 0.76-0.95) at 2% dose using 2D and 3D images together. At 25% and 10% dose, 95% CI of the difference in figures of merit from routine dose included 0, suggesting similar or noninferior performance. CONCLUSIONS For pediatric head CT for evaluation of craniosynostosis, dose reductions of 75%-90% were possible without compromising observer performance.
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Affiliation(s)
- J C Montoya
- From the Departments of Radiology (J.C.M., L.J.E., D.R.D., A.L.K., F.E.D., L.Y., C.H.M., J.G.F.)
| | - L J Eckel
- From the Departments of Radiology (J.C.M., L.J.E., D.R.D., A.L.K., F.E.D., L.Y., C.H.M., J.G.F.)
| | - D R DeLone
- From the Departments of Radiology (J.C.M., L.J.E., D.R.D., A.L.K., F.E.D., L.Y., C.H.M., J.G.F.)
| | - A L Kotsenas
- From the Departments of Radiology (J.C.M., L.J.E., D.R.D., A.L.K., F.E.D., L.Y., C.H.M., J.G.F.)
| | - F E Diehn
- From the Departments of Radiology (J.C.M., L.J.E., D.R.D., A.L.K., F.E.D., L.Y., C.H.M., J.G.F.)
| | - L Yu
- From the Departments of Radiology (J.C.M., L.J.E., D.R.D., A.L.K., F.E.D., L.Y., C.H.M., J.G.F.)
| | - A C Bartley
- Health Sciences Research (A.C.B., R.E.C.), Mayo Clinic, Rochester, Minnesota
| | - R E Carter
- Health Sciences Research (A.C.B., R.E.C.), Mayo Clinic, Rochester, Minnesota
| | - C H McCollough
- From the Departments of Radiology (J.C.M., L.J.E., D.R.D., A.L.K., F.E.D., L.Y., C.H.M., J.G.F.)
| | - J G Fletcher
- From the Departments of Radiology (J.C.M., L.J.E., D.R.D., A.L.K., F.E.D., L.Y., C.H.M., J.G.F.)
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Li Z, Yu L, Leng S, Williamson EE, Kotsenas AL, DeLone DR, Manduca A, McCollough CH. A robust noise reduction technique for time resolved CT. Med Phys 2016; 43:347. [PMID: 26745928 DOI: 10.1118/1.4938576] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To develop a noise reduction method for time resolved CT data, especially those with significant patient motion. METHODS PArtial TEmporal Nonlocal (PATEN) means is a technique that uses the redundant information in time-resolved CT data to achieve noise reduction. In this method, partial temporal profiles are used to determine the similarity (or weight) between pixels, and the similarity search makes use of both spatial and temporal information, providing robustness to patient motion. The performance of the PATEN filter was qualitatively and quantitatively evaluated with nine cardiac CT patient data sets and five CT brain perfusion patient data sets. In cardiac CT, PATEN was applied to reduce noise primarily in the reduced-dose phases created with electrocardiographic (ECG) pulsing. CT number accuracy and noise reduction were evaluated in both full-dose phases and reduced-dose phases between filtered backprojection images and PATEN filtered images. In CT brain perfusion, simulated quarter dose data were obtained by adding noise to the raw data of a routine dose scan. PATEN was applied to the simulated low-dose images. Image noise, time-intensity profile accuracy, and perfusion parameter maps were compared among low-dose, low-dose+PATEN filter, and full-dose images. The noise reduction performance of PATEN was compared to a previously proposed noise reduction method, time-intensity profile similarity (TIPS) bilateral filtering. RESULTS In 4D cardiac CT, after PATEN filtering, the image noise in the reduced-dose phases was greatly reduced, making anatomical structures easier to identify. The mean decreases in noise values between the original and PATEN images were 11.0% and 53.8% for the full and reduced-dose phases of the cardiac cycle, respectively. TIPS could not achieve effective noise reduction. In CT brain perfusion, PATEN achieved a 55.8%-66.3% decrease in image noise in the low-dose images. The contrast to noise ratio in the axial images was increased and was comparable to the full-dose images. Differentiation of anatomical structure in the PATEN images and corresponding quantitative perfusion parameter maps were preferred by two neuroradiologists compared to the simulated low-dose and TIPS results. The mean perfusion parameters calculated from the PATEN images agreed with those determined from full-dose data to within 12% and 20% for normal and diseased regions. CONCLUSIONS In ECG-gated cardiac CT, where the dose had already been reduced by a factor of 5 in the reduced-dose phases, PATEN achieved a 53.8% noise reduction, which decreased the noise level in the reduced-dose phases close to that of the full-dose phases. In CT brain perfusion, a fourfold dose reduction was demonstrated to be achievable by PATEN filtering, which improved quantitative perfusion analysis. PATEN can be used to effectively reduce image noise to improve image quality, even when significant motion occurred between temporal samples.
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Affiliation(s)
- Zhoubo Li
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905 and Biomedical Engineering and Physiology Graduate Program, Mayo Graduate School, Rochester, Minnesota 55905
| | - Lifeng Yu
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905
| | | | - Amy L Kotsenas
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905
| | - David R DeLone
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905
| | - Armando Manduca
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota 55905
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McGauvran AM, Kotsenas AL. Reply. AJNR Am J Neuroradiol 2016; 37:E67. [PMID: 27492075 DOI: 10.3174/ajnr.a4913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- A M McGauvran
- Department of Radiology Mayo Clinic Rochester, Minnesota
| | - A L Kotsenas
- Department of Radiology Mayo Clinic Rochester, Minnesota
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McGauvran AM, Kotsenas AL, Diehn FE, Wald JT, Carr CM, Morris JM. SAPHO Syndrome: Imaging Findings of Vertebral Involvement. AJNR Am J Neuroradiol 2016; 37:1567-72. [PMID: 27012293 DOI: 10.3174/ajnr.a4736] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/14/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Imaging findings in patients with a combination of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) are often misinterpreted as discitis/osteomyelitis or metastases, resulting in multiple biopsies and delayed diagnosis. We have incidentally noted a semicircular morphology in vertebral body imaging in several cases of SAPHO syndrome with vertebral involvement. Our goal was to evaluate the prevalence of this distinctive morphology in these patients. MATERIALS AND METHODS A retrospective review of patients with SAPHO syndrome diagnosed between July 1998 and August 2013 was conducted. A descriptive analysis of MR imaging, CT, radiography, bone scanning, and PET imaging was performed for the presence and distribution of vertebral body signal intensity or attenuation changes and/or enhancement; contiguous vertebral body involvement; vertebral body collapse; endplate irregularity; disc space, facet, and spinous process involvement; subligamentous thickening; and paraspinal soft-tissue involvement. RESULTS Eighteen patients (16 women [89%]; mean age, 52.9 years) with SAPHO and spine involvement were included. Contiguous involvement of ≥2 vertebral bodies was found in 16 patients (89%), with a curvilinear or "semicircular" pattern involving portions of adjacent vertebral bodies in 10 (63%, P = .14). Most intervertebral discs demonstrated absence of abnormal T2 hyperintensity (73%) and enhancement (89%). Subligamentous thickening was present in 12 (67%). Paraspinal soft-tissue involvement was present in 6 (33%). CONCLUSIONS SAPHO syndrome should be included in the differential diagnosis in a patient with a curvilinear or semicircular pattern of vertebral involvement, contiguous vertebral body involvement, and absence of intervertebral disc edema and enhancement.
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Affiliation(s)
- A M McGauvran
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - A L Kotsenas
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota.
| | - F E Diehn
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - J T Wald
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - C M Carr
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - J M Morris
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Zarrabian MM, Diehn FE, Kotsenas AL, Wald JT, Yu E, Nassr A. Dorsal Lumbar Disc Migrations with Lateral and Ventral Epidural Extension on Axial MRI: A Case Series and Review of the Literature. AJNR Am J Neuroradiol 2016; 37:2171-2177. [PMID: 27390313 DOI: 10.3174/ajnr.a4875] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/15/2016] [Indexed: 11/07/2022]
Abstract
Dorsal epidural migration of lumbar disc extrusion is rare and commonly misdiagnosed. Our purpose was to retrospectively analyze soft-tissue abnormalities on axial MR imaging in both the ventral and lateral epidural space in such dorsal epidural migrations. The presence of each component required complete concordance by 3 independent neuroradiologist readers. In a case series (n = 6) of surgically proved dorsal lumbar disc migrations, in which the radiologist's favored prospective diagnosis had not been correct, each case demonstrated epidural soft-tissue abnormality that had components both laterally and ventrally, abutting the parent disc. Similarly, in previously published cases for which axial MR imaging was available, the lateral component was demonstrated in 23/24 cases (96%). Ventral abutment of the parent disc was evident, in addition, in 17/18 cases (94%) with available disc-level axial images. Both ventral and lateral epidural soft-tissue abnormalities are typically present in dorsal lumbar disc herniations and may help radiologists suggest this rare diagnosis in appropriate cases.
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Affiliation(s)
- M M Zarrabian
- From the Departments of Orthopedic Surgery (M.M.Z., A.N.)
| | - F E Diehn
- Radiology (F.E.D., A.L.K., J.T.W.), Division of Neuroradiology, Mayo Clinic, Rochester, Minnesota
| | - A L Kotsenas
- Radiology (F.E.D., A.L.K., J.T.W.), Division of Neuroradiology, Mayo Clinic, Rochester, Minnesota
| | - J T Wald
- Radiology (F.E.D., A.L.K., J.T.W.), Division of Neuroradiology, Mayo Clinic, Rochester, Minnesota
| | - E Yu
- Department of Orthopaedics (E.Y.), Division of Spine, Ohio State University, Comprehensive Spine Center, Columbus, Ohio
| | - A Nassr
- From the Departments of Orthopedic Surgery (M.M.Z., A.N.)
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Kenney DL, Kelly-Williams KM, Krecke KN, Witte RJ, Watson RE, Kotsenas AL, Wirrell EC, Nickels KC, Wong-Kisiel LC, So E. Usefulness of repeat review of head magnetic resonance images during presurgical epilepsy conferences. Epilepsy Res 2016; 126:106-8. [PMID: 27459547 DOI: 10.1016/j.eplepsyres.2016.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/31/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
Abstract
Surgical epilepsy conferences are an important part of the process of determining whether a patient is a candidate for resective epilepsy surgery. At these conferences, repeat review (re-review) of the magnetic resonance images (MRIs) of the patient's head often occurs. This study assessed how often radiologic re-review at a presurgical epilepsy conference resulted in a changed interpretation of the head MRI. Charts were reviewed for 239 patients who had been presented at presurgical epilepsy conferences between 2008 and 2012. Of the 233 patients whose MRIs were re-reviewed, resective surgery was performed in 94 patients (40.3%). Forty-one patients (17.6%) had a previously undiagnosed finding, and 18 of the 41 (43.9%) underwent resective surgery. For 4 of the 41 patients (9.8%) with a previously undiagnosed pertinent finding, re-review detected abnormalities that were not amenable to surgical resection (autoimmunity or significant bilateral pathology).
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Affiliation(s)
- Daniel L Kenney
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, United States
| | | | - Karl N Krecke
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Robert J Witte
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Robert E Watson
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Amy L Kotsenas
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Elaine C Wirrell
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, United States
| | - Katherine C Nickels
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, United States
| | - Lily C Wong-Kisiel
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, United States
| | - Elson So
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, United States.
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Diehn FE, Maus TP, Morris JM, Carr CM, Kotsenas AL, Luetmer PH, Lehman VT, Thielen KR, Nassr A, Wald JT. Uncommon Manifestations of Intervertebral Disk Pathologic Conditions. Radiographics 2016; 36:801-23. [PMID: 27082664 DOI: 10.1148/rg.2016150223] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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. Examples of atypical pathophysiologic conditions covered are discal cysts, fibrocartilaginous emboli to the spinal cord, tiny calcified disks or disk-level spiculated osteophytes causing spinal cerebrospinal fluid (CSF) leak and intracranial hypotension, and pediatric acute calcific discitis. This broad gamut of disease includes a variety of sizes of disk pathologic conditions, from the tiny (eg, the minuscule calcified disks causing high-flow CSF leaks) to the extremely large (eg, giant calcified thoracic intradural disk herniations causing myelopathy). A spectrum of clinical acuity is represented, from hyperacute fibrocartilaginous emboli causing spinal cord infarct, to acute Schmorl nodes, to chronic intradural herniations. The entities included are characterized by a range of clinical courses, from the typically devastating cord infarct caused by fibrocartilaginous emboli, to the usually spontaneously resolving pediatric acute calcific discitis. Several conditions have important differential diagnostic considerations, and others have relatively diagnostic imaging findings. The pathophysiologic findings are well understood for some of these entities and poorly defined for others. Radiologists' knowledge of this broad scope of unusual disk disease is critical for accurate radiologic diagnoses. Online supplemental material is available for this article. (©)RSNA, 2016.
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Affiliation(s)
- Felix E Diehn
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Timothy P Maus
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Jonathan M Morris
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Carrie M Carr
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Amy L Kotsenas
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Patrick H Luetmer
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Vance T Lehman
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Kent R Thielen
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Ahmad Nassr
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - John T Wald
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Lehman VT, Murphy RC, Schenck LA, Carter RE, Johnson GB, Kotsenas AL, Morris JM, Nathan MA, Wald JT, Maus TP. Comparison of facet joint activity on 99mTc-MDP SPECT/CT with facet joint signal change on MRI with fat suppression. Diagn Interv Radiol 2016; 22:277-83. [PMID: 27035592 DOI: 10.5152/dir.2015.15203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
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. Agreement between the two examination types were determined with the κ and prevalence-adjusted bias-adjusted κ (PABAK) statistics. RESULTS This study included 60 patients (28 male, 47%), with a mean age of 49±19.7 years (range, 12-93 years). The κ value indicated no agreement between 99mTc-MDP SPECT/CT and MRI (κ=-0.026; 95% confidence interval: -0.051, 0.000). The PABAK values were fair to high at each spinal level, which suggests that relatively low disease prevalence lowered the κ values. Together, the κ and PABAK values indicate that there is some degree of intermodality agreement, but that it is not consistent. CONCLUSION Overall, facet joint signal change on fat-suppressed MRI did not always correlate with increased 99mTc-MDP SPECT/CT activity. MRI and 99mTc-MDP SPECT/CT for facet joint evaluation should not be considered interchangeable examinations in clinical practice or research.
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Affiliation(s)
- Vance T Lehman
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
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Flanagan EP, Kotsenas AL, Britton JW, McKeon A, Watson RE, Klein CJ, Boeve BF, Lowe V, Ahlskog JE, Shin C, Boes CJ, Crum BA, Laughlin RS, Pittock SJ. Basal ganglia T1 hyperintensity in LGI1-autoantibody faciobrachial dystonic seizures. Neurol Neuroimmunol Neuroinflamm 2015; 2:e161. [PMID: 26468474 PMCID: PMC4592539 DOI: 10.1212/nxi.0000000000000161] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/10/2015] [Indexed: 01/12/2023]
Abstract
Objective: To characterize the clinical features and MRI abnormalities of leucine-rich glioma-inactivated 1 (LGI1)-autoantibody (Ab) faciobrachial dystonic seizures (FBDS). Methods: Forty-eight patients with LGI1-Ab encephalopathy were retrospectively identified by searching our clinical and serologic database from January 1, 2002, to June 1, 2015. Of these, 26 met inclusion criteria for this case series: LGI1-Ab seropositivity and FBDS. In a separate analysis of all 48 patients initially identified, the MRIs of patients with (n = 26) and without (n = 22) FBDS were compared by 2 neuroradiologists blinded to the clinical details. Results: The median age of the 26 included patients was 62.5 years (range 37–78); 65% were men. FBDS involved arm (26), face (22), and leg (12). Ten were previously diagnosed as psychogenic. Ictal EEGs were normal in 20 of 23 assessed. Basal ganglia T1 and T2 signal abnormalities were detected in 11 patients (42%), with excellent agreement between neuroradiologists (κ scores of 0.86 and 0.93, respectively), and included T1 hyperintensity alone (2), T2 hyperintensity alone (1), or both (8). The T1 hyperintensities persisted longer than the T2 hyperintensities (median 11 weeks vs 1 week, p = 0.02). Improvement with immunotherapy (18/18) was more frequent than with antiepileptic medications (10/24). A separate analysis of all 48 patients initially identified with LGI1-Ab encephalopathy showed that basal ganglia MRI abnormalities were present in 11 of 26 with FBDS but not present in those without FBDS (0/22) (p < 0.001). In contrast, mesial temporal MRI abnormalities were less common among those with FBDS (42%) than those without (91%) (p < 0.001). Conclusions: Basal ganglia T1 hyperintensity is a clinically useful MRI biomarker of LGI1-Ab FBDS and suggests a basal ganglia localization.
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Affiliation(s)
- Eoin P Flanagan
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Amy L Kotsenas
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Jeffrey W Britton
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Andrew McKeon
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Robert E Watson
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Christopher J Klein
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Bradley F Boeve
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Val Lowe
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - J Eric Ahlskog
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Cheolsu Shin
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Christopher J Boes
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Brian A Crum
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Ruple S Laughlin
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
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Kotsenas AL, Michalak GJ, DeLone DR, Diehn FE, Grant K, Halaweish AF, Krauss A, Raupach R, Schmidt B, McCollough CH, Fletcher JG. CT Metal Artifact Reduction in the Spine: Can an Iterative Reconstruction Technique Improve Visualization? AJNR Am J Neuroradiol 2015; 36:2184-90. [PMID: 26251433 DOI: 10.3174/ajnr.a4416] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/11/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Metal-related artifacts from spine instrumentation can obscure relevant anatomy and pathology. We evaluated the ability of CT images reconstructed with and without iterative metal artifact reduction to visualize critical anatomic structures in postoperative spines and assessed the potential for implementation into clinical practice. MATERIALS AND METHODS We archived CT projection data in patients with instrumented spinal fusion. CT images were reconstructed by using weighted filtered back-projection and iterative metal artifact reduction. Two neuroradiologists evaluated images in the region of spinal hardware and assigned a score for the visualization of critical anatomic structures by using soft-tissue and bone windows (critical structures totally obscured, n = 0; anatomic recognition with high diagnostic confidence, n = 5). Using bone windows, we measured the length of the most pronounced linear artifacts. For each patient, neuroradiologists made recommendations regarding the optimal use of iterative metal artifact reduction and its impact on diagnostic confidence. RESULTS Sixty-eight patients met the inclusion criteria. Visualization of critical soft-tissue anatomic structures was significantly improved by using iterative metal artifact reduction compared with weighted filtered back-projection (median, 1 ± 1.5 versus 3 ± 1.3, P < .001), with improvement in the worst visualized anatomic structure in 88% (60/68) of patients. There was not significant improvement in visualization of critical osseous structures. Linear metal artifacts were reduced from 29 to 11 mm (P < .001). In 87% of patients, neuroradiologists recommended reconstructing iterative metal artifact reduction images instead of weighted filtered back-projection images, with definite improvement in diagnostic confidence in 32% (22/68). CONCLUSIONS Iterative metal artifact reduction improves visualization of critical soft-tissue structures in patients with spinal hardware. Routine generation of these images in addition to routine weighted filtered back-projection is recommended.
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Affiliation(s)
- A L Kotsenas
- From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota
| | - G J Michalak
- From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota
| | - D R DeLone
- From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota
| | - F E Diehn
- From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota
| | - K Grant
- Siemens Medical Solutions (K.G., A.F.H.), Malvern, Pennsylvania
| | - A F Halaweish
- Siemens Medical Solutions (K.G., A.F.H.), Malvern, Pennsylvania
| | - A Krauss
- Siemens Healthcare (A.K., R.R., B.S.), Forchheim, Germany
| | - R Raupach
- Siemens Healthcare (A.K., R.R., B.S.), Forchheim, Germany
| | - B Schmidt
- Siemens Healthcare (A.K., R.R., B.S.), Forchheim, Germany
| | - C H McCollough
- From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota
| | - J G Fletcher
- From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota
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Gu CN, Carr CM, Kaufmann TJ, Kotsenas AL, Hunt CH, Wood CP. MRI Findings in Nonlesional Hypertrophic Olivary Degeneration. J Neuroimaging 2015; 25:813-7. [DOI: 10.1111/jon.12267] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/04/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Chris N. Gu
- Department of Radiology; Mayo Clinic; Rochester MN
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Radmanesh A, Kotsenas AL. Social Media and Scientific Meetings: An Analysis of Twitter Use at the Annual Meeting of the American Society of Neuroradiology. AJNR Am J Neuroradiol 2014; 37:25-7. [PMID: 25430857 DOI: 10.3174/ajnr.a4168] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- A Radmanesh
- From the Department of Radiology and Biomedical Imaging (A.R.), University of California, San Francisco, San Francisco, California
| | - A L Kotsenas
- Department of Radiology (A.L.K.), Mayo Clinic, Rochester, Minnesota
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Carr CM, Hunt CH, Kaufmann TJ, Kotsenas AL, Krecke KN, Wood CP. Frequency of bilateral hypertrophic olivary degeneration in a large retrospective cohort. J Neuroimaging 2014; 25:289-295. [PMID: 24716899 DOI: 10.1111/jon.12118] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/10/2014] [Accepted: 01/18/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND PURPOSE Hypertrophic olivary degeneration (HOD) is an uncommon type of transneuronal degeneration. Case reports and case series described in the literature provide a foundation of our current knowledge of HOD. These reports have described HOD most frequently to be unilateral and occurring in association with lesions in the dentato-rubro-olivary pathway. Our purpose was to evaluate the rate of bilateral versus unilateral HOD in a large case series. METHODS A retrospective review was performed to identify patients in which the phrase "hypertrophic olivary degeneration" occurred in the radiology report. A diagnosis of HOD was confirmed on imaging if there was focal hyperintensity on T2-weighted images confined to either or both inferior olivary nuclei. RESULTS A total of 102 patients had findings consistent with HOD. Of these, 76% had findings bilaterally. In 44%, a lesion could not be identified to explain HOD. Bilateral HOD was common in both lesional and nonlesional group, though more common in the nonlesional group. CONCLUSION This study demonstrates that HOD is frequently bilateral. In slightly over 50% of patients with HOD, a lesion can be identified. In just under 50% patients with HOD, a lesion could not be identified and in these cases HOD was present bilaterally in the majority.
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Affiliation(s)
- Carrie M Carr
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
| | - Christopher H Hunt
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
| | - Timothy J Kaufmann
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
| | - Amy L Kotsenas
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
| | - Karl N Krecke
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
| | - Christopher P Wood
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
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Diehn FE, Hunt CH, Lehman VT, Schwartz KM, Eckel LJ, Black DF, Wood CP, Kotsenas AL, Wald JT, Hocker SE. Vertebral Body Infarct and Ventral Cauda Equina Enhancement: Two Confirmatory Findings of Acute Spinal Cord Infarct. J Neuroimaging 2013; 25:133-5. [DOI: 10.1111/jon.12058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/03/2013] [Accepted: 08/03/2013] [Indexed: 12/01/2022] Open
Affiliation(s)
- Felix E. Diehn
- Division of Neuroradiology; Department of Radiology; Mayo Clinic; Rochester MN
| | - Christopher H. Hunt
- Division of Neuroradiology; Department of Radiology; Mayo Clinic; Rochester MN
| | - Vance T. Lehman
- Division of Neuroradiology; Department of Radiology; Mayo Clinic; Rochester MN
| | - Kara M. Schwartz
- Division of Neuroradiology; Department of Radiology; Mayo Clinic; Rochester MN
| | - Laurence J. Eckel
- Division of Neuroradiology; Department of Radiology; Mayo Clinic; Rochester MN
| | - David F. Black
- Division of Neuroradiology; Department of Radiology; Mayo Clinic; Rochester MN
| | - Christopher P. Wood
- Division of Neuroradiology; Department of Radiology; Mayo Clinic; Rochester MN
| | - Amy L. Kotsenas
- Division of Neuroradiology; Department of Radiology; Mayo Clinic; Rochester MN
| | - John T. Wald
- Division of Neuroradiology; Department of Radiology; Mayo Clinic; Rochester MN
| | - Sara E. Hocker
- Division of Critical Care Neurology; Department of Neurology; Mayo Clinic; Rochester MN
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Kotsenas AL, Watson RE, Pittock SJ, Britton JW, Hoye SL, Quek AML, Shin C, Klein CJ. MRI findings in autoimmune voltage-gated potassium channel complex encephalitis with seizures: one potential etiology for mesial temporal sclerosis. AJNR Am J Neuroradiol 2013; 35:84-9. [PMID: 23868165 DOI: 10.3174/ajnr.a3633] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Autoimmune voltage-gated potassium channel complex encephalitis is a common form of autoimmune encephalitis. Patients with seizures due to this form of encephalitis commonly have medically intractable epilepsy and may require immunotherapy to control seizures. It is important that radiologists recognize imaging characteristics of this type of autoimmune encephalitis and suggest it in the differential diagnosis because this seizure etiology is likely under-recognized. Our purpose was to characterize MR imaging findings in this patient population. MATERIALS AND METHODS MR imaging in 42 retrospectively identified patients (22 males; median age, 56 years; age range, 8-79 years) with seizures and voltage-gated potassium channel complex autoantibody seropositivity was evaluated for mesial and extratemporal swelling and/or atrophy, T2 hyperintensity, restricted diffusion, and enhancement. Statistical analysis was performed. RESULTS Thirty-three of 42 patients (78.6%) demonstrated enlargement and T2 hyperintensity of mesial temporal lobe structures at some time point. Mesial temporal sclerosis was commonly identified (16/33, 48.5%) at follow-up imaging. Six of 9 patients (66.7%, P = .11) initially demonstrating hippocampal enhancement and 8/13 (61.5%, P = .013) showing hippocampal restricted diffusion progressed to mesial temporal sclerosis. Conversely, in 6 of 33 patients, abnormal imaging findings resolved. CONCLUSIONS Autoimmune voltage-gated potassium channel complex encephalitis is frequently manifested as enlargement, T2 hyperintensity, enhancement, and restricted diffusion of the mesial temporal lobe structures in the acute phase. Recognition of these typical imaging findings may help prompt serologic diagnosis, preventing unnecessary invasive procedures and facilitating early institution of immunotherapy. Serial MR imaging may demonstrate resolution or progression of radiologic changes, including development of changes involving the contralateral side and frequent development of mesial temporal sclerosis.
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Schwartz KM, Luetmer PH, Hunt CH, Kotsenas AL, Diehn FE, Eckel LJ, Black DF, Lehman VT, Lindell EP. Position-related variability of CSF opening pressure measurements. AJNR Am J Neuroradiol 2013; 34:904-7. [PMID: 23064593 DOI: 10.3174/ajnr.a3313] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Normative data for CSF OP have previously been established with patients in the LD position. During fluoroscopically guided LP procedures, radiologists frequently obtain these OP measurements with patients prone. In this prospective study, our goal was to determine the variability of OP measurements as a function of patient positioning and to assess whether there is a relationship with patient BMI. MATERIALS AND METHODS Consecutive patients reporting for fluoroscopically guided LP or myelography were enrolled. OP was measured with the patient in 3 positions, with the order of the technique randomized: prone with table flat, prone with table tilted until the hub of the needle was at the level of the right atrium, and LD with the needle hub at the level of the spinal canal. The BMI of each patient was calculated. The Wilcoxon signed-rank test and linear regression analysis with bivariate fit of difference were used for analysis. RESULTS OP measurements with the patient in the prone position were significantly elevated compared with those in the LD position, with mean differences of 2.7 (P<.001) and 1.6 cm H2O, (P=.017) for prone flat and prone tilted, respectively. There was no significant difference in OP measurements for the prone flat versus prone tilted positions (P=.20). There was no correlation between BMI and observed differences (LD-flat: R2=0.00028; LD-tilt: R2=0.00038; prone-tilt: R2=0.00000020). CONCLUSIONS Measuring OP with the patient in the prone position may result in overestimation of CSF pressure. Table tilt did not significantly impact mean prone OP. Radiologists should specify exact patient positioning when reporting OP measurements.
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Affiliation(s)
- K M Schwartz
- Department of Radiology, Division of Neuroradiology, Mayo Clinic, Rochester, Minnesota 55901, USA.
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Quek AML, Britton JW, McKeon A, So E, Lennon VA, Shin C, Klein C, Watson RE, Kotsenas AL, Lagerlund TD, Cascino GD, Worrell GA, Wirrell EC, Nickels KC, Aksamit AJ, Noe KH, Pittock SJ. Autoimmune epilepsy: clinical characteristics and response to immunotherapy. ACTA ACUST UNITED AC 2012; 69:582-93. [PMID: 22451162 DOI: 10.1001/archneurol.2011.2985] [Citation(s) in RCA: 228] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To describe clinical characteristics and immunotherapy responses in patients with autoimmune epilepsy. DESIGN Observational, retrospective case series. SETTING Mayo Clinic Health System. PATIENTS Thirty-two patients with an exclusive (n=11) or predominant (n=21) seizure presentation in whom an autoimmune etiology was suspected (on the basis of neural autoantibody [91%], inflammatory cerebrospinal fluid [31%], or magnetic resonance imaging suggesting inflammation [63%]) were studied. All had partial seizures: 81% had failed treatment with 2 or more antiepileptic drugs and had daily seizures and 38% had seizure semiologies that were multifocal or changed with time. Head magnetic resonance imaging was normal in 15 (47%) at onset. Electroencephalogram abnormalities included interictal epileptiform discharges in 20; electrographic seizures in 15; and focal slowing in 13. Neural autoantibodies included voltage-gated potassium channel complex in 56% (leucine-rich, glioma-inactivated 1 specific, 14; contactin-associated proteinlike 2 specific, 1); glutamic acid decarboxylase 65 in 22%; collapsin response- mediator protein 5 in 6%; and Ma2, N-methyl-D-aspartate receptor, and ganglionic acetylcholine receptor in 1 patient each. INTERVENTION Immunotherapy with intravenous methylprednisolone; intravenous immune globulin; and combinations of intravenous methylprednisolone, intravenous immune globulin, plasmapheresis, or cyclophosphamide. MAIN OUTCOME MEASURE Seizure frequency. RESULTS After a median interval of 17 months (range, 3-72 months), 22 of 27 (81%) reported improvement postimmunotherapy; 18 were seizure free. The median time from seizure onset to initiating immunotherapy was 4 months for responders and 22 months for nonresponders (P<.05). All voltage-gated potassium channel complex antibody-positive patients reported initial or lasting benefit (P<.05). One voltage-gated potassium channel complex antibody-positive patient was seizure free after thyroid cancer resection; another responded to antiepileptic drug change alone. CONCLUSION When clinical and serological clues suggest an autoimmune basis for medically intractable epilepsy, early-initiated immunotherapy may improve seizure outcome.
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Affiliation(s)
- Amy M L Quek
- Department of Laboratory Medicine and Pathology, Mayo Clinic, College of Medicine, Rochester, MN 55905, USA
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Lehman VT, Luetmer PH, Sorenson EJ, Carter RE, Gupta V, Fletcher GP, Hu LS, Kotsenas AL. Cervical spine MR imaging findings of patients with Hirayama disease in North America: a multisite study. AJNR Am J Neuroradiol 2012; 34:451-6. [PMID: 22878010 DOI: 10.3174/ajnr.a3277] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Most studies of HD have been conducted in Asia, particularly Japan. To characterize the MR imaging findings of North American patients with HD, we reviewed neutral and flexion cervical MR imaging examinations performed for possible HD at 3 academic medical centers located in the Southeastern, Southwestern, and Midwestern regions of the United States. MATERIALS AND METHODS Three neuroradiologists assessed the MR imaging examinations in a blinded fashion and reached a consensus rating for LOA of the posterior dura to the spine, lower spinal cord atrophy, spinal cord T2 hyperintensity, loss of cervical lordosis, anterior dural shift with flexion, and confidence of imaging diagnosis. Final reference diagnosis was established separately with a retrospective chart review by a neurologist. RESULTS Twenty-one patients met the criteria for HD, all were North American males and all who reported their race were white. Seventeen patients did not meet the criteria and served as controls. Four imaging attributes, LOA, dural shift with flexion, consensus diagnosis of neutral images, and consensus diagnosis of combined neutral and flexion images were all able to discriminate the group with HD from the group without HD (P < .05 for each). Findings of HD were often present on neutral images, but the addition of flexion images increased diagnostic confidence. CONCLUSIONS MR imaging findings in white North American patients with HD include LOA on neutral images and forward displacement of the dura with flexion. Findings are often present on neutral MR images and, in the appropriate clinical scenario, should prompt flexion MR imaging to evaluate anterior dural shift.
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Affiliation(s)
- V T Lehman
- Division of Neuroradiology, Department of Radiology, Mayo Clinic College of Graduate Medical Education, Rochester, Minnesota 55905, USA.
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Abstract
Cerebral amyloid angiopathy (CAA) is an important but underrecognized cause of cerebrovascular disorders that predominantly affect elderly patients. CAA results from deposition of beta-amyloid protein in cortical, subcortical, and leptomeningeal vessels. This deposition is responsible for the wide spectrum of clinical symptoms and neuroimaging findings. Many cases of CAA are asymptomatic. However, when cases are symptomatic, patients can present with transient neurologic events, progressive cognitive decline, or potentially devastating intracranial hemorrhage. Computed tomography is the imaging study of choice for evaluation of suspected acute cortical hemorrhage, which may be accompanied by subarachnoid, subdural, or intraventricular hemorrhage. Magnetic resonance imaging is best suited for identification of small or chronic cortical hemorrhages and ischemic sequelae of this disease, exclusion of other causes of acute cortical-subcortical hemorrhage, and assessment of disease progression. Accurate recognition of imaging findings is important in guiding clinical decision making in patients with CAA.
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Affiliation(s)
- Christine P Chao
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
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Warren HG, Kotsenas AL, Czervionke LF. Trigeminal and concurrent glossopharyngeal neuralgia secondary to lateral medullary infarction. AJNR Am J Neuroradiol 2006; 27:705-7. [PMID: 16552020 PMCID: PMC7976982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
A 69-year-old woman developed acute pain in the left trigeminal and glossopharyngeal nerve distributions. MR imaging demonstrated a left lateral medullary infarction (LMI) involving the left spinotrigeminal nucleus and tract, nucleus ambiguus, and solitary nucleus. Most patients presenting with trigeminal neuralgia will have disease involving the trigeminal nerve or ganglion or the primary sensory nucleus in the pons. We discuss the unusual finding of LMI associated with concurrent trigeminal and glossopharyngeal neuralgia.
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Affiliation(s)
- H G Warren
- Department of Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla 32224, USA
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Abstract
Spontaneous cerebrospinal fluid (CSF) leak has been called "spontaneous intracranial hypotension," emphasizing the intracranial symptoms and imaging findings. We present a patient with spontaneous CSF leak whose initial spinal magnetic resonance imaging (MRI) findings were thought to represent epidural tumor or infection. Subsequent MRI examinations showed an improvement of both intracranial and spinal CSF hypotension findings coinciding with clinical symptom resolution. We propose the term "spontaneous craniospinal hypotension" to better emphasize this syndrome's unifying intracranial and spinal pathophysiology and imaging findings.
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Walker DA, Broderick DF, Kotsenas AL, Rubino FA. Routine Use of Gradient-Echo MRI to Screen for Cerebral Amyloid Angiopathy in Elderly Patients. AJR Am J Roentgenol 2004; 182:1547-50. [PMID: 15150006 DOI: 10.2214/ajr.182.6.1821547] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the routine use of gradient-refocused echo MRI sequences in the detection of cortical cerebral microbleeding suggestive of cerebral amyloid angiopathy in elderly patients (> 70 years old). CONCLUSION The addition of gradient-refocused echo sequences to routine brain MRI resulted in the identification of cerebral amyloid angiopathy-related microbleeding in 15.5% of elderly patients. In most (86.7%) of these patients with positive findings, cerebral amyloid angiopathy was not suspected clinically, and 46.7% of these patients were undergoing anticoagulant or aspirin therapy, placing them at an increased risk of recurrent intracranial hemorrhage and catastrophic stroke.
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Affiliation(s)
- D A Walker
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224-1865, USA
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