Exploring new landmarks: analysis of Twitter usage during the 41st ESNR Annual Meeting.

We analyzed the use of Twitter during the 41st Annual Meeting of the European Society of Neuroradiology (ESNR) held in Rotterdam from 19 to 23 September 2018. The aim was to check the status of the European neuroradiology Twitter community and to discover which topics were discussed most often. The data were compared with a similar analysis performed during the Annual Meeting of the American Society of Neuroradiology (ASNR) in 2014. Even though the analysis demonstrated a low use of Twitter during the ESNR meeting, the platform still generated an important volume of impressions and engagement. This use was noted by the global community because topics of the meeting, such as the value of radiological reporting and advanced imaging, were discussed worldwide. These data, also compared to the American meeting, suggests a need for more prolific use and engagement with ESNR social media accounts in order to draw our members into discussions during meetings and to reinforce the place of European neuroradiology in the debate on key imaging topics as well as promoting society events.

The degenerative spine: pattern recognition and guidelines to image interpretation.

Degenerative disease of the spine, in the form of intervertebral disc degeneration and bony growth, causing osteophytes and impinging upon the spinal canal and neural foramina, is the most frequent disorder affecting the spine. In this chapter we first discuss briefly the indications for computed tomography or magnetic resonance imaging in suspected degenerative spine disease. We then describe changes of disc height, signal intensity, and disc contour with aging and repeated microtrauma, as well as the imaging techniques most appropriate to image them. A grading system for lumbar disc changes is provided. Stenosis of the canal and neural foramina is reviewed next, concluding with a description of degenerative changes affecting the vertebral endplates and bone marrow.

Nine-year-old girl with a respiratory epithelial cyst of the orbit.

OBJECTIVE: Here we describe the clinical and histopathological characteristics of a nine-year-old girl with an intraorbital mass of the left orbit, and review the relevant literature. RESULTS: Imaging data and surgical biopsy revealed an intraconal cystic lesion in the medial-inferior quadrant of the left orbit. The cyst was lined with ciliated pseudostratified epithelium, consistent with a respiratory epithelial cyst of the orbit. Cyst marsupialisation and partial mass removal alleviated symptoms, and no cyst recurrence was observed during follow-up. The literature suggests that this is an uncommon cause of a cystic orbital mass. CONCLUSION: Respiratory epithelial cysts of the orbit should be considered in the differential diagnosis of intraorbital masses. Surgical excision of such a lesion should be limited to avoid damaging orbital structures. Respiratory epithelial cysts of the orbit generally follow a benign course, and recurrence of ocular symptoms is rare.

Pneumosinus dilatans in anterior skull base meningiomas.

INTRODUCTION: Skull base meningiomas are often missed on non-contrast CT or MR examinations due to their close proximity to bone and low lesion to brain contrast. The purpose of this study is to illustrate that pneumosinus dilatans can be an indicator of anterior skull base meningiomas. METHODS: A retrospective search of the radiology information system and picture archiving and computing system database was performed. Search terms were "meningioma" in association with "pneumosinus dilatans." Medical records and imaging studies were reviewed independently by two experienced neuroradiologists and were read in consensus. We recorded the patient age at the time of discovery of the meningioma, main presenting symptom(s), location of the tumor, and imaging characteristics. We also performed a comparative literature search for pneumosinus dilatans and its association with meningiomas. RESULTS: Ten patients (six women; four men) were identified in whom a meningioma of the anterior skull base was associated with a pneumosinus dilatans. Three patients had multiple meningiomas, so a total of 14 intracranial tumors were identified. Mean age at discovery was 59 years with an age range of ± 20years. All meningiomas were diagnosed by MRI and/or CT. CONCLUSION: Pneumosinus dilatans can be a helpful sign to indicate the presence of a meningioma of the anterior skull base.

Trauma of the spine and spinal cord: imaging strategies.

Traumatic injuries of the spine and spinal cord are common and potentially devastating lesions. We present a comprehensive overview of the classification of vertebral fractures, based on morphology (e.g., wedge, (bi)concave, or crush fractures) or on the mechanism of injury (flexion-compression, axial compression, flexion-distraction, or rotational fracture-dislocation lesions). The merits and limitations of different imaging techniques are discussed, including plain X-ray films, multi-detector computed tomography (MDCT), and magnetic resonance imaging (MRI) for the detection. There is growing evidence that state-of-the-art imaging techniques provide answers to some of the key questions in the management of patients with spine and spinal cord trauma: is the fracture stable or unstable? Is the fracture recent or old? Is the fracture benign or malignant? In summary, we show that high-quality radiological investigations are essential in the diagnosis and management of patients with spinal trauma.

Functional MRI of the cervical spinal cord on 1.5 T with fingertapping: to what extent is it feasible?

INTRODUCTION: Until recently, functional magnetic resonance imaging (fMRI) with blood oxygen level-dependent (BOLD) contrast, was mainly used to study brain physiology. The activation signal measured with fMRI is based upon the changes in the concentration of deoxyhaemoglobin that arise from an increase in blood flow in the vicinity of neuronal firing. Technical limitations have impeded such research in the human cervical spinal cord. The purpose of this investigation was to determine whether a reliable fMRI signal can be elicited from the cervical spinal cord during fingertapping, a complex motor activity. Furthermore, we wanted to determine whether the fMRI signal could be spatially localized to the particular neuroanatomical location specific for this task. METHODS: A group of 12 right-handed healthy volunteers performed the complex motor task of fingertapping with their right hand. T2*-weighted gradient-echo echo-planar imaging on a 1.5-T clinical unit was used to image the cervical spinal cord. Motion correction was applied. Cord activation was measured in the transverse imaging plane, between the spinal cord levels C5 and T1. RESULTS: In all subjects spinal cord responses were found, and in most of them on the left and the right side. The distribution of the activation response showed important variations between the subjects. While regions of activation were distributed throughout the spinal cord, concentrated activity was found at the anatomical location of expected motor innervation, namely nerve root C8, in 6 of the 12 subjects. CONCLUSION: fMRI of the human cervical spinal cord on an 1.5-T unit detects neuronal activity related to a complex motor task. The location of the neuronal activation (spinal cord segment C5 through T1 with a peak on C8) corresponds to the craniocaudal anatomical location of the neurons that activate the muscles in use.

Influence of user-defined parameters on diffusion tensor tractography of the corticospinal tract.

This study discusses the influence of user-defined parameters on fiber tracking results obtained from a standard deterministic streamline tractography algorithm. Diffusion tensor imaging with fiber tractography was performed in five healthy volunteers. A region of interest was highlighted in the ventral part of the pons at the level of the middle cerebellar peduncle. The parameters studied were angle threshold, fractional anisotropy threshold, step length and number of seed samples per voxel. Changes in fiber tracts were described for increasing values per parameter. Increasing the angle threshold resulted in more and longer fibers. A higher fractional anisotropy threshold resulted in decreased length and fiber tracts that were not representative. Increasing the step length decreased the fiber continuity and altered its position. A higher number of seed samples per voxel resulted in a higher fiber tract density. When interpreting diffusion tensor images, the reader should understand the influence of user-defined settings on the results, and should be aware of the inter-dependency of fiber tracking parameters.

Posterior reversible encephalopathy and Guillain-Barré syndrome in a single patient: coincidence or causative relation?

We report 62-year-old female patient with coincident posterior reversible encephalopathy syndrome (PRES) and Guillain-Barré syndrome (GBS). The first presentation of PRES was a generalised tonic-clonic seizure. A risk factor for PRES was acute arterial hypertension. The diagnosis of PRES was established by MRI (magnetic resonance imaging) and hypertension was treated with labetalol 800mg daily followed by regression of symptoms of PRES. Two days after the seizure the first motor signs of GBS presented with a weakness in both upper arms. The diagnosis of GBS was finally established 6 days after the seizure by clinical evolution, lumbar puncture and electrophysiological findings. After treatment of GBS with intravenous immunoglobulins (IVIg), antihypertensive therapy could be phased out and finally stopped. The patient was discharged after 25 days without any medication. At that time she was completely recovered from PRES and recovering well from GBS. The acute arterial hypertension, the provoking factor of PRES, was probably caused by an autonomic dysfunction in the context of GBS before motor signs of GBS were present but we speculate also that there are other GBS related factors playing a role in PRES. This hypothesis is based on the relatively high coincidence of these two rare syndromes which appears from a review of the literature. One other possible mechanism can be the influence of cytokines, produced in the context of a GBS, on the permeability of blood brain barrier.

New developments in the neuroradiological diagnosis of craniocerebral trauma.

Accurate radiographic diagnosis is a cornerstone of the clinical management and outcome prediction of the head-injured patient. New technological advances, such as multi-detector computed tomography (MDCT) scanning and diffusion-weighted magnetic resonance imaging (MRI) have influenced imaging strategy. In this article we review the impact of these developments on the neuroradiological diagnosis of acute head injury. In the acute phase, multi-detector CT has supplanted plain X-ray films of the skull as the initial imaging study of choice. MRI, including fluid-attenuated inversion recovery, gradient echo T2* and diffusion-weighted sequences, is useful in determining the severity of acute brain tissue injury and may help to predict outcome. The role of MRI in showing diffuse axonal injuries is emphasized. We review the different patterns of primary and secondary extra-axial and intra-axial traumatic brain lesions and integrate new insights. Assessment of intracranial hypertension and cerebral herniation are of major clinical importance in patient management. We discuss the issue of pediatric brain trauma and stress the importance of MRI in non-accidental injury. In summary, new developments in imaging technology have advanced our understanding of the pathophysiology of brain trauma and contribute to improving the survival of patients with craniocerebral injuries.

[Structure and content of the radiological report: an audit of 94 reports from a university education center]. / Structuur en inhoud van het radiologieverslag: een audit van 94 verslagen uit een universitair opleidingscentrum.

Efficient communication between the radiologist and the referring clinician is an essential feature of high quality radiology practice. The written report, the only result of the radiological investigation most clinicians will see, should therefore comply with a number of quality criteria. As far as reporting in Dutch is concerned, these criteria have not been clearly defined. Articles on the radiology report are scarce and mostly focus on reporting in English. We have investigated the quality of radiology reporting in a university hospital in Flanders, the Dutch speaking part of Belgium. A weighed sample of 94 reports of 24 radiologists (staff members and radiologists-in-training) was blinded and evaluated by a qualified radiologist with ten years of experience as a writer and editor-in-chief medical magazines. A scoring system was applied, based on five criteria: comprehensible, problem-oriented, correct Dutch, concise, and direct. This article gives an overview of the results and takes a closer look at three of the 94 reports examined.

3D time-of-flight MR angiography of the intracranial vessels: optimization of the technique with water excitation, parallel acquisition, eight-channel phased-array head coil and low-dose contrast administration.

The aim of this study is three folds: to compare the eight-channel phased-array and standard circularly polarized (CP) head coils in visualisation of the intracranial vessels, to compare the three-dimensional (3D) time-of-flight (TOF) MR angiography (MRA) techniques, and to define the effects of parallel imaging in 3D TOF MRA. Fifteen healthy volunteers underwent 3D TOF MRA of the intracranial vessels using eight-channel phased-array and CP standard head coils. The following MRA techniques were obtained on each volunteer: (1) conventional 3D TOF MRA with magnetization transfer; (2) 3D TOF MRA with water excitation for background suppression; and (3) low-dose (0.5 ml) gadolinium-enhanced 3D TOF MRA with water excitation. Results are demonstrating that water excitation is a valuable background suppression technique, especially when applied with an eight-channel phased-array head coil. For central and proximal portions of the intracranial arteries, unenhanced TOF MRA with water excitation was the best technique. Low-dose contrast enhanced TOF MRA using an eight-channel phased-array head coil is superior in the evaluation of distal branches over the standard CP head coil. Parallel imaging with an acceleration factor of two allows an important time gain without a significant decrease in vessel evaluation. Water excitation allows better background suppression, especially around the orbits and at the periphery, when compared to conventional acquisitions.