Imaging Biomarkers and Prevalence of Complex Aortic Plaque in Cryptogenic Stroke: A Systematic Review.

BACKGROUND: Complex aortic plaque (CAP) is a potential embolic source in patients with cryptogenic stroke (CS). We review CAP imaging criteria for transesophageal echocardiogram (TEE), computed tomography angiography (CTA), and magnetic resonance imaging and calculate CAP prevalence in patients with acute CS. METHODS AND RESULTS: PubMed and EMBASE databases were searched up to December 2022 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Two independent reviewers extracted data on study design, imaging techniques, CAP criteria, and prevalence. The Cochrane Collaboration tool and Guideline for Reporting Reliability and Agreement Studies were used to assess risk of bias and reporting completeness, respectively. From 2293 studies, 45 were reviewed for CAP imaging biomarker criteria in patients with acute CS (N=37 TEE; N=9 CTA; N=6 magnetic resonance imaging). Most studies (74%) used ≥4 mm plaque thickness as the imaging criterion for CAP although ≥1 mm (N=1, CTA), ≥5 mm (N=5, TEE), and ≥6 mm (N=2, CTA) were also reported. Additional features included mobility, ulceration, thrombus, protrusions, and assessment of plaque composition. From 23 prospective studies, CAP was detected in 960 of 2778 patients with CS (0.32 [95% CI, 0.24-0.41], I2=94%). By modality, prevalence estimates were 0.29 (95% CI, 0.20-0.40; I2=95%) for TEE; 0.23 (95% CI, 0.15-0.34; I2=87%) for CTA and 0.22 (95% CI, 0.06-0.54; I2=92%) for magnetic resonance imaging. CONCLUSIONS: TEE was commonly used to assess CAP in patients with CS. The most common CAP imaging biomarker was ≥4 mm plaque thickness. CAP was observed in one-third of patients with acute CS. However, high study heterogeneity suggests a need for reproducible imaging methods.

RadRemind!-an Automated Paging System for Reminding Radiology Residents of Their Roles and Responsibilities.

Tasks which are scheduled at irregular intervals afford greater scheduling flexibility but are also more difficult to remember. Difficulty remembering clinical tasks not only create potential inefficiencies in patient care but were also identified as a source of anxiety among our residents. We implemented RadRemind! an automated system of pager notifications in order to improve patient care and reduce residents' anxiety. RadRemind! utilizes only an external shared APACHE, MySQL, PHP server. A set of CRON jobs activate a PHP script which pulls information from our resident schedule as JSON data. It then identifies the appropriate residents to notify and then sends a cURL request to a web-based paging service to trigger notifications to residents' pagers. Each activation of the script was logged in an SQL database. An anonymous survey assessing multiple aspects of efficacy was sent to residents after 3 months of implementation. Seventeen of 29 residents responded to the survey. Residents reported a mean of 2 successful reminders (defined as responsibilities which had been otherwise forgotten prior to the page notification) in the last month which was found to be statistically significant via one-sample t test (t = 3.3, p < 0.01). Paired t test showed a statistically significant (t = 2.9, p = 0.01) decrease of 2 points in reported anxiety. Repeated measures analysis of variance found a statistically significant variation in reported utility (F(3,16) = 15.9, p < 0.01)) by type of reminder such that reminders for interventional radiology call were found to be more useful than reminders for other tasks. Use of an automated paging system is an effective method of reminding residents of irregularly scheduled responsibilities and is associated with reduced scheduling related anxiety.

Learning from Gamers: Integrating Alternative Input Devices and AutoHotkey Scripts to Simplify Repetitive Tasks and Improve Workflow.

Radiologists rely heavily on the digital radiology workstation. They spend most of their time interacting with software applications that use multiple input devices, including mice, keyboards, and microphones. The efficiency of this relationship depends on the interface of the different software applications, their interoperability, and input device effectiveness. Because of the repetition of a radiologic workflow, even small inefficiencies can accumulate into significant losses of time and productivity and contribute to user fatigue. Alternative input devices (AIDs) with onboard memory can be used as ergonomic human-computer interfaces. These devices can also be coupled with AutoHotkey scripts to complete complex tasks in one keystroke. Radiologists can use modern AIDs and simple scripts to minimize frustration, improve and personalize their routines, and streamline interactions with the workstation. The authors discuss hardware and software features that do not require support from information technology professionals and can be implemented with any software that relies on user input.Online supplemental material is available for this article.©RSNA, 2020.

Spontaneous intracranial hypotension in a patient with systemic lupus erythematosus.

Spontaneous intracranial hypotension (SIH) associated with cerebrospinal fluid leak classically presents with postural headache. It is most commonly caused by the spontaneous dehiscence of a meningeal diverticulum or as a consequence of dural tears. The association between connective tissue disease and SIH is well known. However, the occurrence of SIH associated with systemic lupus erythematosus has rarely been reported. We present a 53 years old female with a history of systemic lupus erythematosus who was diagnosed with SIH. The patient was worked up with Magnetic resonance imaging and Computed tomographic myelography, and successfully treated with a nontargeted epidural blood patch. Furthermore, we review the current literature and focus on the various imaging techniques that can be used in the workup of a cerebrospinal fluid leak.

A ventriculoperitoneal shunt incidentally found in the stomach.

We report a case of a ventriculoperitoneal shunt incidentally found within the stomach while the patient was undergoing a percutaneous endoscopic gastrostomy (PEG) tube placement. Among the complications of ventriculoperitoneal shunt placement, bowel perforation is rare a complication found in 0.01%-0.07% of cases, and typically occurs in premature infants and neonates [1]. To date, less than 100 such cases have been recorded of which only a few have appeared in the radiological literature. Here we discuss the current literature, the radiological features, clinical presentations and the management.

Superficial siderosis: Chronic sequelae following brain hemorrhage.

Superficial siderosis is a rare disease of the central nervous system. It is caused by hemosiderin deposition usually following subarachnoid hemorrhage. We report a 67-year-old man with history of motor vehicle accident in 1974 who presents with tremors, worsening ataxia, and impaired auditory, olfactory, and gustatory sensation. The patient was evaluated with magnetic resonance imaging of the brain that showed areas of superficial low T2 signal throughout the posterior fossa, ventricles, sulci, and cisterns, most conspicuous on the gradient-recalled echo T2* susceptibility-weighted sequence. These findings are compatible with old blood products (hemosiderin) and the diagnosis of superficial siderosis.