Paraspinal Edema Is the Most Sensitive Feature of Lumbar Spinal Epidural Abscess on Unenhanced MRI.

OBJECTIVE: Spinal epidural abscess (SEA) is a serious infection requiring prompt treatment and potential neurosurgical intervention. Although contrast-enhanced spine MRI is the mainstay for diagnosis of SEA, unenhanced MRI is typically performed for patients with nonspecific symptoms or insufficient clinical information. We evaluated the sensitivity and specificity of imaging features suggestive of SEA at unenhanced spine MRI. MATERIALS AND METHODS: We searched our database for contrast-enhanced lumbar spine MRI examinations from January 1, 2000, through August 1, 2014, with "epidural abscess" in the report. We included 68 patients older than 18 years with an enhancing epidural collection at MRI and surgical (60%), microbiologic (15%), or clinical (25%) confirmation of SEA. Sixty-eight age- and sex-matched control subjects without SEA were also selected. Three readers scored unenhanced MR images on the degree of psoas and paraspinal muscle edema, extent of bone marrow edema, and abnormal disk signal. RESULTS: Paraspinal edema was highly sensitive (97%) for SEA, with lower sensitivities for psoas (54%), bone marrow (65%), and disk edema (66%). Each of these markers was highly significant in univariate analysis (p < 0.001). A multivariate logistic regression model adjusting for age and sex found that paraspinal (p < 0.001) and bone marrow edema (p = 0.006) were significant independent predictors of SEA (odds ratio, 58; p < 0.001), with a trend toward significance for psoas edema and abnormal disk signal. Psoas muscle edema was the most specific (96%) finding for the presence of SEA. CONCLUSION: Paraspinal edema is highly sensitive for SEA. Familiarity with the findings for SEA at unenhanced MRI could help expedite further definitive evaluation when contrast agent is not administered.

A survey of radiology chairpersons' perceptions of the relative importance of education of medical students, residents, and fellows.

OBJECTIVE: The purpose of the study was twofold: to assess radiology chairpersons' perceptions about the value of education of medical students, residents, and fellows with respect to the achievement of department success and to uncover their personal involvement in instructional activities. MATERIALS AND METHODS: A questionnaire was sent to all American members of the Society of Chairmen in Academic Radiology (SCARD) requesting their opinions about 21 putative responsibilities of their job including student, resident, and fellow education. The survey also asked the respondents to list the size of their trainee complement, both residents and fellows. The data were assessed in toto and after disaggregation by program size as indicated by the number of trainees and by the percentage of fellows versus all trainees. RESULTS: Sixty-nine of 108 chairpersons responded with contributory responses for a response rate of 63.9%. Resident training was the fourth most frequently affirmatively cited component of their perceptions of a department's success at 86% positive. Slightly more than half indicated that they were personally involved in resident instruction but less than a third participated in student or in fellow training. Disaggregation by the size of the department with respect to the number of trainees revealed that resident teaching as a critical factor decreased in estimation of importance from 100% to 64% (p < 0.001) as programs increased in size. Fellowship training correspondingly increased from 18% to 45% (p = 0.054) from small to large departments. CONCLUSION: Resident education as a valued activity and as a specific chair function varies inversely with both program size and the percentage of fellows among all trainees.

Aftermath of Ankle Inversion Injuries: Spectrum of MR Imaging Findings.

Acute and chronic ankle inversion injuries are a common source of pain and a diagnostic challenge. Several studies have shown a variety of injury patterns after inversion injury both in acute and chronic settings. Although traditional assessment with clinical examination and radiographs is generally accepted for inversion injuries, MR imaging is a useful tool to detect occult injuries and in patients with chronic symptoms. This article examines a range of MR imaging findings that may be present in patients with lateral ankle pain following an acute or chronic inversion injury.

Accountable Care Organizations: what they mean for the country and for neurointerventionalists.

The Affordable Care Act is celebrating its fifth anniversary and remains one of the most significant attempts to reform healthcare in US history. Prior to the federal legislation, Accountable Care Organizations had largely been part of an academic discussion about how to control rising healthcare costs, but have since become a fixture in our national healthcare landscape. A fundamental shift is underway in the relationship between healthcare delivery and payment models. Some elements of Accountable Care Organizations may remain unfamiliar to most healthcare providers, including neurointerventional specialists. In this paper we review the fundamental concepts behind and the current forms of Accountable Care Organizations, and discuss the challenges and opportunities they present for neurointerventionalists.