High Body Mass Index and Change in Cervical Carotid Artery Position on Serial Scans: A Retrospective Study of an Unexplained Phenomenon.

OBJECTIVE: The purpose of this study was to investigate the relationship between increased body mass index (BMI) and abdominal circumference and prevalence of the change of position of common and internal carotid arteries on serial imaging, termed wandering carotid artery. METHODS: We retrospectively reviewed computed tomography/magnetic resonance imaging neck scans and determined whether the common and internal carotid arteries moved in position on serial scans. We correlated patients' demographic and medical information along with abdominal circumference, BMI, location of the aortic arch, and area of soft tissue surrounding the carotid arteries with the prevalence of a wandering carotid artery. RESULTS: Computed tomography/magnetic resonance imaging neck performed on 56 randomly selected patients between 2017 and 2020 were reviewed. A total of 42.9% of the patients had a wandering common or internal carotid artery. The abdominal circumference and BMI were significantly higher in the patients with wandering carotid arteries compared with the patients without (abdominal circumference = 102.9 ± 14.13 vs 91.61 ± 13.9 cm [ P = 0.01] and BMI = 34.27 ± 8.58 [obese] vs 26.21 ± 4.89 [overweight, P = 0.0001]). After adjusting for age, sex, hypertension, diabetes, atherosclerosis grade, and aortic arch location, the odds of wandering carotid artery was 1.23 (95% confidence interval, 1.1-1.44) times higher for every one-unit increase in BMI. CONCLUSIONS: There is a higher prevalence of wandering common and internal carotid arteries in obese patients with large abdominal circumference irrespective of age, sex, diabetes, hypertension, or carotid atherosclerosis.

"Are They Listening, and Do They Find It Useful?"-Evaluation of Mid-Rotation Formative Subjective and Objective Feedback to Radiology Trainees.

BACKGROUND: Residents commonly receive only end-of-rotation evaluations and thus are often unaware of their progress during a rotation. In 2021, our neuroradiology section instituted mid-rotation feedback in which rotating residents received formative subjective and objective feedback. The purpose of this study was to describe our feedback method and to evaluate if residents found it helpful. METHODS: Radiology residents rotate 3-4 times on the neuroradiology service for 1-month blocks. At the midpoint of the rotation (2 weeks), 7-10 neuroradiology attendings discussed the rotating residents' subjective performance. One attending was tasked with facilitating this discussion and taking notes. Objective metrics were obtained from our dictation software. Compiled feedback was relayed to residents via email. A 16-question anonymous survey was sent to 39 radiology residents (R1-R4) to evaluate the perceived value of mid-rotation feedback. Odds ratios and 95% confidence intervals were computed using logistic regression. RESULTS: Sixty-nine percent (27/39) of residents responded to the survey; 92.6% (25/27) of residents reported receiving mid-rotation feedback in ≥50% of neuroradiology rotations; 92.3% (24/26) of residents found the subjective feedback helpful; 88.4% (23/26) of residents reported modifying their performance as suggested (100% R1-R2 vs 70% R3-R4; OR: 15.4 CI:1.26, >30.0);59.1% (13/22) of residents found the objective metrics helpful (75% R1-R2 vs 40% R3-R4; OR: 3.92 CI:0.74, 24.39) and 68.2% (15/22) stated they modified their performance based on these metrics (83.3% R1-R2 vs 50.0% R3-R4; OR:4.2 CI:0.73, 30.55); and 84.6% (22/26) of residents stated that mid-rotation subjective feedback and 45.5% (10/22) stated that mid-rotation objective feedback should be implemented in other sections. CONCLUSIONS: Majority of residents found mid-rotation feedback to be helpful in informing them about their progress and areas for improvement in the neuroradiology rotation, more so for subjective feedback than objective feedback. The majority of residents stated all rotations should provide mid-rotation subjective feedback.

"The Up and Down Approach" to Localize and Exclude Sites of Intraspinal CSF Leaks.

Myelography is a commonly performed procedure to locate cerebrospinal fluid (CSF) leaks in patients with spontaneous intracranial hypotension. Often, the site of leak within the spinal canal cannot be located creating a diagnostic dilemma for clinicians. This technical report describes a novel method to locate and exclude intraspinal CSF leaks in patients with multiple potential sites of CSF leak using a lumbar and cervical approach to inject intrathecal contrast and subsequently performing CT myelography.

Head and neck vessel magnetic resonance angiography appearance and artifacts after therapeutic intravenous ferumoxytol infusion.

Intravenous ferumoxytol infusions are an effective treatment option for iron deficiency anemia. Ferumoxytol contains a superparamagnetic iron oxide core which causes artifacts on multiple MRI brain sequences. However, in our experience, there is not much information on the appearance of intracranial and neck vessels on MR angiography (MRA) after recent therapeutic i.v. administration of ferumoxytol. MRA is an integral part of the work-up for multiple diseases processes including for acute stroke and for detection of aneurysm(s), vasculopathy/vasculitis, vascular malformations, among others and are often performed without the acquisition of MRI brain. Without proper knowledge of the appearance of vessels after administration of i.v. feruomoxytol, radiologists may misinterpret the findings leading to unnecessary further investigation or errant diagnosis. We present the case of a patient who underwent MRI brain and MRA head and neck imaging after recent therapeutic i.v. infusion of ferumoxytol and discuss relevant imaging findings and imaging artifact caused by this medication.

Unusual progression of osmotic demyelination after liver transplantation on MRI brain.

Osmotic demyelination syndrome, comprised of central pontine and extrapontine myelinolysis, is an important and potentially fatal complication primarily related to rapid overcorrection of serum sodium leading to devastating neurological symptoms. While traditionally presenting in the pons, we report the case of a 43-year-old female patient who recently underwent a liver transplant and developed extrapontine myelinolysis and subsequently central pontine myelinolysis resulting in irreversible spastic quadriparesis. This rare case highlights the variability of presentation of osmotic demyelination syndrome on imaging.

Radiology Performed Fluoroscopy-Guided Lumbar Punctures Decrease Volume of Diagnostic Study Interpretation - Impact on Resident Training and Potential Solutions.

OBJECTIVES: Lumbar punctures performed in radiology departments have significantly increased over the last few decades and are typically performed in academic centers by radiology trainees using fluoroscopy guidance. Performing fluoroscopy-guided lumbar punctures (FGLPs) can often constitute a large portion of a trainee's workday and the impact of performing FGLPs on the trainee's clinical productivity (i.e. dictating reports on neuroradiology cross-sectional imaging) has not been studied. The purpose of the study was to evaluate the relationship between the number of FGLPs performed and cross-sectional neuroimaging studies dictated by residents during their neuroradiology rotation (NR). MATERIAL AND METHODS: The number of FGLPs and myelograms performed and neuroimaging studies dictated by radiology residents on our neuroradiology service from July 2008 to December 2017 were retrospectively reviewed. The relationship between the number of FGLPs performed and neuroimaging studies (CT and MRI) dictated per day by residents was examined. RESULTS: Radiology residents (n = 84) performed 3437 FGLPs and myelograms and interpreted 33402 cross-sectional studies. Poisson regression demonstrated an exponential decrease in number of studies dictated daily with a rising number of FGLPs performed (P = 0.0001) and the following formula was derived: Number of expected studies dictated per day assuming no FGLPs × e-0.25 x number of FGLPs = adjusted expected studies dictated for the day. CONCLUSION: We quantified the impact performing FGLPs can have on the number of neuroimaging reports residents dictate on the NR. We described solutions to potentially decrease unnecessary FGLP referrals including establishing departmental guidelines for FGLP referrals and encouraging bedside lumbar punctures attempts before referral. We also emphasized equally distributing the FGLPs among trainees to mitigate procedural burden.

Infrahyoid wandering carotid arteries.

Knowledge of retropharyngeal carotid arteries in patients is important in order to avoid potential catastrophic injuries. Previous studies demonstrated that carotid arteries can change in position at or near the level of the hyoid bone on serial scans. We report the presence of wandering carotid arteries at the level of the cricoid cartilage and superiorly in the neck of a 74-year-old female patient over multiple months. The potential for carotid arteries to randomly change positions in the suprahyoid and infrahyoid neck should be known by clinicians to avoid misdiagnosing occult neck masses and to avoid potential arterial injury during neck surgery. Although the exact etiology for wandering carotid arteries remains uncertain, we propose that reduced axial tension on carotid arteries and increased body mass Index may play a causative role.

Trends in Fluoroscopy Time in Fluoroscopy-Guided Lumbar Punctures Performed by Trainees Over an Academic Year.

RATIONALE AND OBJECTIVES: Fluoroscopy-guided lumbar puncture (FGLP) is an operator-dependent procedure that can contribute to lifetime cumulative radiation dose. Benchmark fluoroscopic times (FTs) have been published for ranges of body mass index (BMI), but trends in FT in FGLPs performed by neuroradiology trainees during their training have not been studied. The purpose of this study was to investigate the trends in FTs in FGLPs performed by neuroradiology fellows in an academic year. MATERIALS AND METHODS: We retrospectively reviewed FGLPs performed at our institution from July 2013 to June 2015 and determined the FT average and standard deviation of residents and non-neuroradiology fellows, neuroradiology fellows, and neuroradiology attendings. We used the Kruskal-Wallis test to evaluate group differences in FT in operator groups and academic quarters and by patient age, BMI, and needle length. Linear and Poisson regression analyses were performed to directly examine the relationship between the number of FGLPs performed and FTs. RESULTS: A total of 776 patients had successful FGLPs; 594 cases (77%) were performed by neuroradiology fellows (n = 14). The average FT and variance for neuroradiology fellows significantly decreased over the year (P = 0.004 and P < 0.001) with an estimated decrease of 0.01 minute of FT per FGLP. BMI, long needle length, and age ≥65 years old significantly affected the average FT (P = 0.03, P < 0.001, and P < 0.001) and FT decreased in all of these subgroups in the academic year. CONCLUSIONS: FT in FGLP cases performed by neuroradiology fellows decreases during the year. Our data can be utilized by radiology training programs and practices as a benchmark to monitor individual operator FT.