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Gujar SK, Manzoor K, Wongsripuemtet J, Wang G, Ryan D, Agarwal S, Lindquist M, Caffo B, Pillai JJ, Sair HI. Identification of the Language Network from Resting-State fMRI in Patients with Brain Tumors: How Accurate Are Experts? AJNR Am J Neuroradiol 2023; 44:274-282. [PMID: 36822828 PMCID: PMC10187806 DOI: 10.3174/ajnr.a7806] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/04/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND AND PURPOSE Resting-state fMRI helps identify neural networks in presurgical patients who may be limited in their ability to undergo task-fMRI. The purpose of this study was to determine the accuracy of identifying the language network from resting-state-fMRI independent component analysis (ICA) maps. MATERIALS AND METHODS Through retrospective analysis, patients who underwent both resting-state-fMRI and task-fMRI were compared by identifying the language network from the resting-state-fMRI data by 3 reviewers. Blinded to task-fMRI maps, these investigators independently reviewed resting-state-fMRI ICA maps to potentially identify the language network. Reviewers ranked up to 3 top choices for the candidate resting-state-fMRI language map. We evaluated associations between the probability of correct identification of the language network and some potential factors. RESULTS Patients included 29 men and 14 women with a mean age of 41 years. Reviewer 1 (with 17 years' experience) demonstrated the highest overall accuracy with 72%; reviewers 2 and 3 (with 2 and 7 years' experience, respectively) had a similar percentage of correct responses (50% and 55%). The highest accuracy used ICA50 and the top 3 choices (81%, 65%, and 60% for reviewers 1, 2, and 3, respectively). The lowest accuracy used ICA50, limiting each reviewer to the top choice (58%, 35%, and 42%). CONCLUSIONS We demonstrate variability in the accuracy of blinded identification of resting-state-fMRI language networks across reviewers with different years of experience.
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Affiliation(s)
- S K Gujar
- From the Division of Neuroradiology (S.K.G., K.M., J.W., D.R., S.A., J.J.P., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - K Manzoor
- From the Division of Neuroradiology (S.K.G., K.M., J.W., D.R., S.A., J.J.P., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - J Wongsripuemtet
- From the Division of Neuroradiology (S.K.G., K.M., J.W., D.R., S.A., J.J.P., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - G Wang
- Department of Biostatistics (G.W., M.L., B.C.)
| | - D Ryan
- From the Division of Neuroradiology (S.K.G., K.M., J.W., D.R., S.A., J.J.P., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - S Agarwal
- From the Division of Neuroradiology (S.K.G., K.M., J.W., D.R., S.A., J.J.P., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - M Lindquist
- Department of Biostatistics (G.W., M.L., B.C.)
| | - B Caffo
- Department of Biostatistics (G.W., M.L., B.C.)
| | - J J Pillai
- From the Division of Neuroradiology (S.K.G., K.M., J.W., D.R., S.A., J.J.P., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Neurosurgery (J.J.P.)
| | - H I Sair
- From the Division of Neuroradiology (S.K.G., K.M., J.W., D.R., S.A., J.J.P., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
- The Malone Center for Engineering in Healthcare (H.I.S.), The Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland
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Blitz AM, Huynh PP, Bonham LW, Gujar SK, Sorte DE, Moghekar A, Luciano MG, Rigamonti D. High-Resolution MRI for Evaluation of Ventriculostomy Tubes: Assessment of Positioning and Proximal Patency. AJNR Am J Neuroradiol 2020; 41:57-63. [PMID: 31924603 PMCID: PMC6975305 DOI: 10.3174/ajnr.a6320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 10/02/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Imaging evaluation of ventriculostomy tubes, despite the frequency of malfunction, has remained inadequate due to the absence of a systematic way of assessing the catheter itself. In this retrospective review, we assessed the utility of high-resolution 3D MR imaging techniques, including CISS and volumetric interpolated breath-hold examination sequences, in the evaluation of ventriculostomy catheters. MATERIALS AND METHODS We performed a retrospective review of 23 clinical MR imaging cases of shunted hydrocephalus spanning a 3-year period, all depicting ventriculostomy catheters. The MR imaging examinations included isotropic CISS and volumetric interpolated breath-hold examination sequences performed with and without contrast. These were independently evaluated by 2 neuroradiologists with respect to the catheter course, side hole position, relationship of the side holes to the ventricles, patency, and the presence or absence of intraluminal debris. RESULTS The catheter tip was best seen on isotropic CISS sequences reformatted in an oblique plane, and side holes were visualized as CSF signal defects along the catheter wall in 10/23 (43%) cases. The relationship of the catheter side holes to the ventricles was seen in 47% of cases and was best visualized on the coronal CISS sequences. Catheter patency was confirmed in 12/23 (52%) cases, while the other 48% were notable for T2 hypointense filling defects compatible with luminal obstruction. Enhancement of some of these filling defects on imaging is suggestive of choroid plexus ingrowth rather than debris. CONCLUSIONS High-resolution 3D MR imaging using isotropic CISS sequences allows systematic evaluation of catheter positioning, patency, and potential etiologic differentiation of filling defects when shunt dysfunction is suspected.
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Affiliation(s)
- A M Blitz
- From the Department of Radiology (A.M.B.), University Hospitals, Case Western Reserve University
- Departments of Radiology and Radiological Sciences (A.M.B., P.P.H., L.W.B., S.E.G.)
- Neurosurgery (A.M.B., M.G.L., D.R.), Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - P P Huynh
- Departments of Radiology and Radiological Sciences (A.M.B., P.P.H., L.W.B., S.E.G.)
| | - L W Bonham
- Departments of Radiology and Radiological Sciences (A.M.B., P.P.H., L.W.B., S.E.G.)
| | - S K Gujar
- Departments of Radiology and Radiological Sciences (A.M.B., P.P.H., L.W.B., S.E.G.)
| | - D E Sorte
- Department of Radiology (D.E.S.), University of New Mexico, Albuquerque, New Mexico
| | | | - M G Luciano
- Neurosurgery (A.M.B., M.G.L., D.R.), Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - D Rigamonti
- Neurosurgery (A.M.B., M.G.L., D.R.), Johns Hopkins Medical Institutions, Baltimore, Maryland
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Wongsripuemtet J, Tyan AE, Carass A, Agarwal S, Gujar SK, Pillai JJ, Sair HI. Preoperative Mapping of the Supplementary Motor Area in Patients with Brain Tumor Using Resting-State fMRI with Seed-Based Analysis. AJNR Am J Neuroradiol 2018; 39:1493-1498. [PMID: 30002054 DOI: 10.3174/ajnr.a5709] [Citation(s) in RCA: 6] [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: 01/26/2018] [Accepted: 05/08/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The supplementary motor area can be a critical region in the preoperative planning of patients undergoing brain tumor resection because it plays a role in both language and motor function. While primary motor regions have been successfully identified using resting-state fMRI, there is variability in the literature regarding the identification of the supplementary motor area for preoperative planning. The purpose of our study was to compare resting-state fMRI to task-based fMRI for localization of the supplementary motor area in a large cohort of patients with brain tumors presenting for preoperative brain mapping. MATERIALS AND METHODS Sixty-six patients with brain tumors were evaluated with resting-state fMRI using seed-based analysis of hand and orofacial motor regions. Rates of supplementary motor area localization were compared with those in healthy controls and with localization results by task-based fMRI. RESULTS Localization of the supplementary motor area using hand motor seed regions was more effective than seeding using orofacial motor regions for both patients with brain tumor (95.5% versus 34.8%, P < .001) and controls (95.2% versus 45.2%, P < .001). Bilateral hand motor seeding was superior to unilateral hand motor seeding in patients with brain tumor for either side (95.5% versus 75.8%/75.8% for right/left, P < .001). No difference was found in the ability to identify the supplementary motor area between patients with brain tumors and controls. CONCLUSIONS In addition to task-based fMRI, seed-based analysis of resting-state fMRI represents an equally effective method for supplementary motor area localization in patients with brain tumors, with the best results obtained with bilateral hand motor region seeding.
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Affiliation(s)
- J Wongsripuemtet
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (J.W., A.E.T., S.A., S.K.G., J.J.P., H.I.S.).,Department of Radiology (J.W.), Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - A E Tyan
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (J.W., A.E.T., S.A., S.K.G., J.J.P., H.I.S.)
| | - A Carass
- Department of Computer Science and Department of Electrical and Computer Engineering (A.C.), Johns Hopkins University, Baltimore, Maryland
| | - S Agarwal
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (J.W., A.E.T., S.A., S.K.G., J.J.P., H.I.S.)
| | - S K Gujar
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (J.W., A.E.T., S.A., S.K.G., J.J.P., H.I.S.)
| | - J J Pillai
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (J.W., A.E.T., S.A., S.K.G., J.J.P., H.I.S.).,Department of Neurosurgery (J.J.P.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - H I Sair
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (J.W., A.E.T., S.A., S.K.G., J.J.P., H.I.S.)
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Yahyavi-Firouz-Abadi N, Pillai JJ, Lindquist MA, Calhoun VD, Agarwal S, Airan RD, Caffo B, Gujar SK, Sair HI. Presurgical Brain Mapping of the Ventral Somatomotor Network in Patients with Brain Tumors Using Resting-State fMRI. AJNR Am J Neuroradiol 2017; 38:1006-1012. [PMID: 28364005 DOI: 10.3174/ajnr.a5132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 12/25/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Resting-state fMRI readily identifies the dorsal but less consistently the ventral somatomotor network. Our aim was to assess the relative utility of resting-state fMRI in the identification of the ventral somatomotor network via comparison with task-based fMRI in patients with brain tumor. MATERIALS AND METHODS We identified 26 surgically naïve patients referred for presurgical fMRI brain mapping who had undergone both satisfactory ventral motor activation tasks and resting-state fMRI. Following standard preprocessing for task-based fMRI and resting-state fMRI, general linear model analysis of the ventral motor tasks and independent component analysis of resting-state fMRI were performed with the number of components set to 20, 30, 40, and 50. Visual overlap of task-based fMRI and resting-state fMRI at different component levels was assessed and categorized as full match, partial match, or no match. Rest-versus-task-fMRI concordance was calculated with Dice coefficients across varying fMRI thresholds before and after noise removal. Multithresholded Dice coefficient volume under the surface was calculated. RESULTS The ventral somatomotor network was identified in 81% of patients. At the subject level, better matches between resting-state fMRI and task-based fMRI were seen with an increasing order of components (53% of cases for 20 components versus 73% for 50 components). Noise-removed group-mean volume under the surface improved as component numbers increased from 20 to 50, though ANOVA demonstrated no statistically significant difference among the 4 groups. CONCLUSIONS In most patients, the ventral somatomotor network can be identified with an increase in the probability of a better match at a higher component number. There is variable concordance of the ventral somatomotor network at the single-subject level between resting-state and task-based fMRI.
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Affiliation(s)
- N Yahyavi-Firouz-Abadi
- From the Department of Radiology (N.Y.-F.-A.), Mid-Atlantic Permanente Medical Group of Kaiser Permanente, Kensington, Maryland .,Division of Neuroradiology, (N.Y.-F.-A., J.J.P., S.A., R.D.A., S.K.G., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - J J Pillai
- Division of Neuroradiology, (N.Y.-F.-A., J.J.P., S.A., R.D.A., S.K.G., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - M A Lindquist
- Department of Biostatistics (M.A.L., B.C.), Johns Hopkins University, Baltimore, Maryland
| | - V D Calhoun
- The Mind Research Network (S.A., V.D.C.), Departments of Electrical and Computer Engineering, University of New Mexico, Albuquerque, New Mexico
| | - S Agarwal
- Division of Neuroradiology, (N.Y.-F.-A., J.J.P., S.A., R.D.A., S.K.G., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.,The Mind Research Network (S.A., V.D.C.), Departments of Electrical and Computer Engineering, University of New Mexico, Albuquerque, New Mexico
| | - R D Airan
- Division of Neuroradiology, (N.Y.-F.-A., J.J.P., S.A., R.D.A., S.K.G., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - B Caffo
- Department of Biostatistics (M.A.L., B.C.), Johns Hopkins University, Baltimore, Maryland
| | - S K Gujar
- Division of Neuroradiology, (N.Y.-F.-A., J.J.P., S.A., R.D.A., S.K.G., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - H I Sair
- Division of Neuroradiology, (N.Y.-F.-A., J.J.P., S.A., R.D.A., S.K.G., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Etesami M, Hoi Y, Steinman DA, Gujar SK, Nidecker AE, Astor BC, Portanova A, Qiao Y, Abdalla WMA, Wasserman BA. Comparison of carotid plaque ulcer detection using contrast-enhanced and time-of-flight MRA techniques. AJNR Am J Neuroradiol 2012; 34:177-84. [PMID: 22627797 DOI: 10.3174/ajnr.a3132] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [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 Ulceration in carotid plaque is a risk indicator for ischemic stroke. Our aim was to compare plaque ulcer detection by standard TOF and CE-MRA techniques and to identify factors that influence its detection. MATERIALS AND METHODS Carotid MR imaging scans were acquired on 2066 participants in the ARIC study. We studied the 600 thickest plaques. TOF-MRA, CE-MRA, and black-blood MR images were analyzed together to define ulcer presence (plaque surface niche ≥2 mm in depth). Sixty ulcerated arteries were detected. These arteries were randomly assigned, along with 40 nonulcerated plaques from the remaining 540, for evaluation of ulcer presence by 2 neuroradiologists. Associations between ulcer detection and ulcer characteristics, including orientation, location, and size, were determined and explored by CFD modeling. RESULTS One CE-MRA and 3 TOF-MRAs were noninterpretable and excluded. Of 71 ulcers in 56 arteries, readers detected an average of 39 (55%) on both TOF-MRA and CE-MRA, 26.5 (37.5%) only on CE-MRA, and 1 (1.5%) only on TOF-MRA, missing 4.5 (6%) ulcers by both methods. Ulcer detection by TOF-MRA was associated with its orientation (distally pointing versus perpendicular: OR = 5.57 [95% CI, 1.08-28.65]; proximally pointing versus perpendicular: OR = 0.21 [95% CI, 0.14-0.29]); location relative to point of maximum stenosis (distal versus isolevel: OR = 5.17 [95% CI, 2.10-12.70]); and neck-to-depth ratio (OR = 1.96 [95% CI, 1.11-3.45]) after controlling for stenosis and ulcer volume. CONCLUSIONS CE-MRA detects more ulcers than TOF-MRA in carotid plaques. Missed ulcers on TOF-MRA are influenced by ulcer orientation, location relative to point of maximum stenosis, and neck-to-depth ratio.
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Affiliation(s)
- M Etesami
- Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
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Hadjiiski L, Mukherji SK, Gujar SK, Sahiner B, Ibrahim M, Street E, Moyer J, Worden FP, Chan HP. Treatment response assessment of head and neck cancers on CT using computerized volume analysis. AJNR Am J Neuroradiol 2010; 31:1744-51. [PMID: 20595363 DOI: 10.3174/ajnr.a2177] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Head and neck cancer can cause substantial morbidity and mortality. Our aim was to evaluate the potential usefulness of a computerized system for segmenting lesions in head and neck CT scans and for estimation of volume change of head and neck malignant tumors in response to treatment. MATERIALS AND METHODS CT scans from a pretreatment examination and a post 1-cycle chemotherapy examination of 34 patients with 34 head and neck primary-site cancers were collected. The computerized system was developed in our laboratory. It performs 3D segmentation on the basis of a level-set model and uses as input an approximate bounding box for the lesion of interest. The 34 tumors included tongue, tonsil, vallecula, supraglottic, epiglottic, and hard palate carcinomas. As a reference standard, 1 radiologist outlined full 3D contours for each of the 34 primary tumors for both the pre- and posttreatment scans and a second radiologist verified the contours. RESULTS The correlation between the automatic and manual estimates for both the pre- to post-treatment volume change and the percentage volume change for the 34 primary-site tumors was 0.95, with an average error of -2.4 ± 8.5% by automatic segmentation. There was no substantial difference and specific trend in the automatic segmentation accuracy for the different types of primary head and neck tumors, indicating that the computerized segmentation performs relatively robustly for this application. CONCLUSIONS The tumor size change in response to treatment can be accurately estimated by the computerized segmentation system relative to radiologists' manual estimations for different types of head and neck tumors.
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Affiliation(s)
- L Hadjiiski
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5842, USA.
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Anwar Z, Zan E, Gujar SK, Sciubba DM, Riley LH, Gokaslan ZL, Yousem DM. Adult lumbar scoliosis: underreported on lumbar MR scans. AJNR Am J Neuroradiol 2010; 31:832-7. [PMID: 20053808 DOI: 10.3174/ajnr.a1962] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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 Adult lumbar scoliosis is an increasingly recognized entity that may contribute to back pain. We investigated the epidemiology of lumbar scoliosis and the rate at which it is unreported on lumbar MR images. MATERIALS AND METHODS The coronal and sagittal sequences of lumbar spine MR imaging scans of 1299 adult patients, seeking care for low back pain, were reviewed to assess for and measure the degree of scoliosis and spondylolisthesis. Findings were compared with previously transcribed reports by subspecialty trained neuroradiologists. Inter- and intraobserver reliability was calculated. RESULTS The prevalence of adult lumbar scoliosis on MR imaging was 19.9%, with higher rates in ages >60 years (38.9%, P < .001) and in females (22.6%, P = .002). Of scoliotic cases, 66.9% went unreported, particularly when the scoliotic angle was <20 degrees (73.9%, P < .001); 10.5% of moderate to severe cases were not reported. Spondylolisthesis was present in 15.3% (199/1299) of cases, demonstrating increased rates in scoliotic patients (32.4%, P < .001), and it was reported in 99.5% of cases. CONCLUSIONS Adult lumbar scoliosis is a prevalent condition with particularly higher rates among older individuals and females but is underreported on spine MR images. This can possibly result in delayed 1) identification of a potential cause of low back pain, 2) referral to specialized professionals for targeted evaluation and management, and 3) provision of health care. The coronal "scout images" should be reviewed as part of the complete lumbar spine evaluation if dedicated coronal sequences are not already part of the spine protocol.
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Affiliation(s)
- Z Anwar
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland 21287-2182, USA
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Abstract
BACKGROUND AND PURPOSE Recently, the performance of C1-2 punctures for cervical myelography was challenged in a medicolegal proceeding as being below the standard of care. We sought to examine current neuroradiologic practices and opinions on the technique. MATERIALS AND METHODS An 11-question survey was sent to 120 program directors of neuroradiology via e-mail links regarding cervical myelography using a C1-2 puncture. Reminders were sent during a 2-month period before data were finalized. RESULTS Eighty-five of 120 (71%) surveys were returned. In the previous year, 14.3% (12/85) of institutions had not performed a C1-2 puncture. Thirty-eight percent (32/85) had performed >or=6 in the same period. Seventy-nine percent (54/68 responding) favored a lumbar approach to cervical myelography, with 6% (4/68) having a predilection for a C1-2 puncture. Ninety-five percent (76/80 responding) thought that performing a C1-2 puncture for cervical myelography reflected the standard of care. Every institution except 1 had staff with expertise to perform C1-2 punctures, and 73% of the institutions teach their fellows the procedure. Ninety-three percent (78/84) of programs would perform a C1-2 puncture for thoracolumbar pathology if MR imaging was contraindicated and there was a contraindication such as a local wound infection precluding a lumbar puncture. Indications for a C1-2 approach included severe lumbar spinal stenosis, infection in the lumbar region, upper limit of the block to be delineated, technical issues preventing lumbar puncture, and the best assessment of the cervical region for myelographic films. CONCLUSIONS C1-2 puncture for cervical myelography, though currently not the most frequently performed method at most institutions, continues to be practiced and is considered within the standard of care by most neuroradiology programs across the country.
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Affiliation(s)
- D M Yousem
- Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
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Abstract
Interventional neuroradiology procedures are a valuable asset in the diagnosis, treatment, and surgical management of various disorders affecting the extracranial head and neck. A detailed understanding of cross-sectional and vascular anatomy and an awareness of potential collateral pathways between extracranial and intracranial vessels are essential for ensuring safe and successful procedures. With the use of high-quality imaging and a meticulous technique, the incidence of major complications is extremely low.
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Affiliation(s)
- D Gandhi
- Division of Interventional Neuroradiology, University of Michigan Health System, Ann Arbor, Mich, USA.
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Joshi VM, Shetty PG, Shroff MM, Gujar SK. Intercostal lung herniation--depiction on spiral CT. J Assoc Physicians India 2001; 49:470-2. [PMID: 11762621] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Computed tomography (CT) is the imaging modality of choice for the demonstration of intercostal lung herniation. The use of forced expiration and Valsalva's manouevre during CT scanning has been recommended in selected cases. We report a case of intercostal lung herniation, demonstrated only on coughing on spiral CT.
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Affiliation(s)
- V M Joshi
- Department of Imaging, PD Hinduja National Hospital and Medical Research Centre, Mumbai
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