MRI-based Neuropathy Score Reporting And Data System (NS-RADS): multi-institutional wider-experience usability study of peripheral neuropathy conditions among 32 radiology readers.

OBJECTIVE: To determine the inter-reader reliability and diagnostic performance of classification and severity scales of Neuropathy Score Reporting And Data System (NS-RADS) among readers of differing experience levels after limited teaching of the scoring system. METHODS: This is a multi-institutional, cross-sectional, retrospective study of MRI cases of proven peripheral neuropathy (PN) conditions. Thirty-two radiology readers with varying experience levels were recruited from different institutions. Each reader attended and received a structured presentation that described the NS-RADS classification system containing examples and reviewed published articles on this subject. The readers were then asked to perform NS-RADS scoring with recording of category, subcategory, and most likely diagnosis. Inter-reader agreements were evaluated by Conger's kappa and diagnostic accuracy was calculated for each reader as percent correct diagnosis. A linear mixed model was used to estimate and compare accuracy between trainees and attendings. RESULTS: Across all readers, agreement was good for NS-RADS category and moderate for subcategory. Inter-reader agreement of trainees was comparable to attendings (0.65 vs 0.65). Reader accuracy for attendings was 75% (95% CI 73%, 77%), slightly higher than for trainees (71% (69%, 72%), p = 0.0006) for nerves and comparable for muscles (attendings, 87.5% (95% CI 86.1-88.8%) and trainees, 86.6% (95% CI 85.2-87.9%), p = 0.4). NS-RADS accuracy was also higher than average accuracy for the most plausible diagnosis for attending radiologists at 67% (95% CI 63%, 71%) and for trainees at 65% (95% CI 60%, 69%) (p = 0.036). CONCLUSION: Non-expert radiologists interpreted PN conditions with good accuracy and moderate-to-good inter-reader reliability using the NS-RADS scoring system. CLINICAL RELEVANCE STATEMENT: The Neuropathy Score Reporting And Data System (NS-RADS) is an accurate and reliable MRI-based image scoring system for practical use for the diagnosis and grading of severity of peripheral neuromuscular disorders by both experienced and general radiologists. KEY POINTS: • The Neuropathy Score Reporting And Data System (NS-RADS) can be used effectively by non-expert radiologists to categorize peripheral neuropathy. • Across 32 different experience-level readers, the agreement was good for NS-RADS category and moderate for NS-RADS subcategory. • NS-RADS accuracy was higher than the average accuracy for the most plausible diagnosis for both attending radiologists and trainees (at 75%, 71% and 65%, 65%, respectively).

Utility of balanced steady-state field precession sequence in the evaluation of retinal and subdural hemorrhages in patients with abusive head trauma.

Abusive head trauma is the leading cause of physical child abuse deaths in children under 5 years of age in the United States. To evaluate suspected child abuse, radiologic studies are typically the first to identify hallmark findings of abusive head trauma including intracranial hemorrhage, cerebral edema, and ischemic injury. Prompt evaluation and diagnosis are necessary as findings may change rapidly. Current imaging recommendations include brain magnetic resonance imaging with the addition of a susceptibility weighted imaging (SWI) sequence which can detect additional findings that suggest abusive head trauma including cortical venous injury and retinal hemorrhages. However, SWI is limited due to blooming artifacts and artifacts from the adjacent skull vault or retroorbital fat, which can affect the evaluation of retinal, subdural, and subarachnoid hemorrhages. This work explores the utility of the high-resolution, heavily T2 weighted balanced steady-state field precession (bSSFP) sequence to identify and characterize retinal hemorrhage and cerebral cortical venous injury in children with abusive head trauma. The bSSFP sequence provides distinct anatomical images to improve the identification of retinal hemorrhage and cortical venous injury.

Utility of three-dimensional and reformatted head computed tomography images in the evaluation of pediatric abusive head trauma.

Skull fractures are common in the pediatric population following head trauma and are estimated to occur post head trauma in 11% of children younger than 2 years. A skull fracture indicates potential underlying intracranial injury and might also help explain the mechanism of injury. Multiple primary and accessory sutures complicate the identification of non-depressed fractures in children younger than 2 years. Detection of linear skull fractures can be difficult on two-dimensional (2-D) CT and can be missed, particularly when the fracture is along the plane of image reconstruction. Knowledge of primary and accessory sutures as well as normal anatomical variants is of paramount importance in identifying pediatric skull fractures with a greater degree of confidence. Acute fractures appear as lucent cortical defects that do not have sclerotic borders, in contrast to sutures, which might demonstrate sclerotic margins. Three-dimensional (3-D) CT has increased sensitivity and specificity for detecting skull fractures and is essential in the evaluation of pediatric head CTs for distinguishing subtle fractures from sutural variants, especially in the setting of trauma. In this review, we present our experience of the use of 3-D reformats in head CT and its implications on the interpretation, especially in the setting of accidental or abusive head trauma.

Pediatric interventional radiology workforce in North America: a descriptive analysis of demographics, educational backgrounds and scholarly activities.

BACKGROUND: Pediatric interventional radiology has grown as an advanced subspecialty with increased demand, number and complexity of cases, and number of pediatric institutions offering a pediatric interventional radiology service. Despite the overall increase in the number of pediatric interventionalists over the past two decades, there is a heterogeneity in their academic backgrounds and a lack of uniform training pathways. OBJECTIVE: To analyze the demographics, academic backgrounds and scholarly activities of pediatric interventionalists across the United States (U.S.) and Canada. MATERIALS AND METHODS: A list of all members of the Society for Pediatric Interventional Radiology was obtained and pediatric interventionalists at academic and private practice institutions in the U.S. and Canada were included. Publicly available online sources were used to gather demographic and educational information about each pediatric interventionalist, which included the online curriculum vitae, the HealthGrades.com and Doximity.com websites, and Elsevier's Scopus database. Demographic and educational data including age, gender, educational background, additional degrees, academic rank, previous leadership positions, and metrics of scholarly activities were recorded. Fellowships in diagnostic pediatric radiology, adult interventional radiology and/or pediatric interventional radiology were recorded. Mann-Whitney U tests and Kruskal-Wallis tests were used to compare differences between groups. RESULTS: One hundred and twenty-five pediatric interventionalists were included, of whom 24 (19.2%) were female. The mean age was 48.6 years (standard deviation [SD]: 10.6, median: 45 years, range: 36-82 years). There was no statistical difference between median age for male versus female pediatric interventionalists (44.5 years vs. 45 years, P=0.89). A majority of pediatric interventionalists were American medical school graduates (96, 76.8%), while 29 (23.2%) were international medical graduates. Eighty-three percent (104) of the pediatric interventionalists completed diagnostic radiology residency training in the U.S., most commonly at the University of Cincinnati in Ohio (6.4%) and Washington University in St. Louis, MO (5.6%). Among fellowship training, pediatric interventionalists completed a pediatric radiology fellowship (61.6%), adult interventional radiology fellowship (40%) and/or a dedicated pediatric interventional radiology fellowship (57.6%). The mean±SD (median) publications, citations and Hirsch index (h-index) for pediatric interventionalists were 32±45 (12), 68±1,317 (120) and 9±10 (5), respectively. There was a statistically higher number of publications, citations and h-index with increasing academic rank at the assistant, associate and professor levels (P<0.001 for all groups). International medical graduate pediatric interventionalists had a higher, but not statistically significant, median publication count (26 vs. 11, P=0.0.25), citation count (236 vs. 93, P=0.36) and h-index (9.0 vs. 5, P=0.24) compared to pediatric interventional radiologists from American medical schools. CONCLUSION: Pediatric interventionalists in North America are predominantly male, with about a quarter having graduated from international medical schools. Pediatric radiology fellowship, followed by pediatric interventional radiology fellowship, was the most frequently pursued training pathway.

Review of the demographic and educational profiles of abdominal imaging fellowship program directors in the United States.

PURPOSE: To evaluate demographics, academic backgrounds, and scholarly activities of Program Directors (PDs) in Abdominal Imaging Fellowships in the United States (US), emphasizing gender representation, international origins, and academic milestones. METHODS: A list of Fellowships in Abdominal Imaging programs in the US was obtained from the Society of Abdominal Radiology. The search was expanded using the Fellowship and Residency Electronic Interactive Database. Data for PDs were sourced from program websites, Healthgrades, Doximity, and Elsevier's Scopus. Metrics such as age, gender, education, academic rank, additional qualifications, prior leadership roles, publications, and h-indices were analyzed using R software. A two-tailed unpaired t-test was used to calculate the difference in means of scholarly activity between male and female PDs. RESULTS: 113 programs were identified: South (36.28%), Northeast (25.66%), Mid-West (20.35%), West (17.69%). Of 107 PDs, 54% male, 41% female, and average age 48 ± 9.4 years. 66.6% were US graduates, 29.2% were international graduates. Most were Assistant Professors (36.28%). 19.46% had degrees like M.P.H. or M.B.A. 45% had prior leadership roles. Average year of residency graduation was 2007. Mean publication count was 54.16, and mean h-index was 14.663. Male PDs had higher publication counts and h-indices than female PDs (p= 0.009 and p= 0.0019 respectively). CONCLUSION: In Abdominal Imaging Fellowship programs in the US, there is an increasing representation of females in Program Director roles. However, research led by female PDs remains less prevalent. The field of Abdominal Imaging values contributions from international graduates and insights from Assistant Professors.

Lumbar vertebral diskitis-osteomyelitis with mycotic abdominal aortic aneurysm caused by Streptococcus mitis.

Vertebral osteomyelitis is a well-documented disease entity in literature with various known etiologies. However, vertebral diskitis-osteomyelitis secondary to an infected aortic aneurysm is an uncommon and life-threatening complication. We present the case of a 65-year-old male patient who presented with chronic low back pain that acutely worsened for 1 to 1.5 months and was diagnosed with vertebral diskitis-osteomyelitis secondary to a contiguous infection from an adjacent mycotic aortic aneurysm. To our knowledge, this is one of the few cases reported of vertebral diskitis-osteomyelitis secondary to mycotic aortic aneurysm. We discuss the findings on CT and MRI, as well as the value of imaging in guiding management.

HIV-vacuolar myelopathy: an unusual early presentation in HIV.

Human immunodeficiency virus (HIV)-vacuolar myelopathy is a late presentation of HIV infection and rarely the presenting symptom. Treatment of HIV-vacuolar myelopathy involves anti-retroviral therapy, but neurological deficits are devastating if diagnosis is delayed. We present a rare case of a patient who presented with HIV-vacuolar myelopathy as the initial presentation in a case of newly diagnosed HIV. The case emphasizes the importance of a high index of suspicion and diagnosis for better outcomes in HIV-vacuolar myelopathy.

Critical Evaluation of Interventional Neuroradiology Fellowship Program Websites in North America.

OBJECTIVE: To investigate the accessibility and content of interventional neuroradiology (INR) fellowship program websites in North America. METHODS: We obtained a list of INR/endovascular surgical neuroradiology (ESN) fellowship programs from the Accreditation Council for Graduate Medical Education, the Committee on Advanced Subspecialty Training, the Society of NeuroInterventional Surgery, and the Neurosurgical Fellowship Training Program Directory websites. Individual program websites were evaluated for 27 different fellow recruitment and education criteria. U.S. programs were grouped based on census region and national ranking, and differences between these groups with regard to fellow recruitment and education characteristics were analyzed using nonparametric statistics. RESULTS: A total of 79 INR/ESN fellowship websites were evaluated for presence of fellow recruitment and education features. Approximately one third of all features pertinent to recruitment (32.11%) and approximately 1 in 5 features regarding education (19.11%) were described in these websites. Program description (69.6%), program coordinator/administrator contact e-mail (59.5%), program director's name (59.5%), program eligibility requirements (51.9%), research opportunities (40.5%), and faculty listing (39.2%) were among the most frequently described features, whereas details about parking (1.3%), interview day itinerary (1.3%), meal allowance (2.5%), retirement and benefits (3.8%), and call schedule (5.1%) were the least frequently described features. There was no significant difference between surveyed features and programs when stratified by U.S. census region, neurosurgery/neurology hospital rankings, or accreditation status. CONCLUSIONS: INR/ESN fellowship website content is variable across North America and there is room for improvement to develop and enhance comprehensiveness of program website content.

Imaging in Vaping-associated Lung Injury: Beyond the Haze.

E-cigarette or vaping, product associated lung injury is a rampant public health issue with a total of 2807 reported hospitalized patients in the United States as of February 18, 2020. Limited data, non-specific symptoms, non-responsiveness to antibiotics, and the lack of a specific biomarker, make it a diagnosis of exclusion. Overlap of clinical and imaging findings with other ongoing respiratory illness (MERS, SARS and COVID-19) poses a challenge in accurate diagnosis. We compiled 3 cases of patients hospitalized with confirmed vaping-associated lung injury and analyzed their imaging patterns, which revealed bilateral consolidation, ground-glass opacities and pleural effusions. We also reviewed the available literature on pathophysiology, imaging findings of EVALI and other respiratory illness.

Diagnostic Radiology Residency Program Director Workforce in the United States: A Descriptive Analysis.

PURPOSE: To investigate and describe the demographics, academic background, and scholarly activity of Diagnostic Radiology (DR) residency program directors in the United States. METHODS: A list of all DR residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and corresponding program directors (PD) was obtained from ACGME website. Information about each PD was obtained from publicly available sources including program websites, Healthgrades and Doximity. Demographic and academic data including age, sex, educational background, subspecialty, tenure, interval between residency completion and appointment as PD, terms served, additional degrees, academic rank, prior leadership positions and metrics of scholarly activity were recorded. Nonparametric statistics including Mann-Whitney U and Kruskal-Wallis tests were applied to compare differences between groups. Results are considered statistically significant at p < 0.05. RESULTS: A total of 197 PDs were included in the study of which 139 (70.6%) were male. Average age of PDs was 47.56 years (SD 8.29, median 45, range 35-77). There was no significant difference in median age of male vs female PDs (45 vs 44.5, p = 0.655). Majority of PDs attended American medical schools (181/197, 91.9%), and 16/197 attended international medical schools. Nine PDs received DO degrees (9/197, 4.6%). Academic rank was available for 137 PDs, of which 4 (2.9%) were instructors, 63 (46.0%) were assistant professors, 47 (34.3%) were associate professors and 23 (16.8%) were professors. Fellowship information was available for 183 PDs, of which the most common subspecialties were neuroradiology (24.5%), musculoskeletal radiology (15.8%), abdominal radiology (10.3%), and interventional radiology (9.8%). Female PDs had a significantly higher median publications (13.5 vs 6.0, p = 0.003), median citations (133 vs 37, p = 0.19) and median h-index compared to male PDs (6 ± 3, p = 0.005). CONCLUSION: Radiology PDs are mostly males who graduated from US allopathic medical schools. Female PDs had significantly higher scholarly metrics compared to male PDs. Twenty three percent PDs were appointed in the last 1 year.