RESUMEN
There has been extensive growth in both the technical development and the clinical applications of MRI, establishing this modality as one of the most powerful diagnostic imaging tools. However, long examination and image interpretation times still limit the application of MRI, especially in emergent clinical settings. Rapid and abbreviated MRI protocols have been developed as alternatives to standard MRI, with reduced imaging times, and in some cases limited numbers of sequences, to more efficiently answer specific clinical questions. A group of rapid MRI protocols used at the authors' institution, referred to as FAST (focused abbreviated survey techniques), are designed to include or exclude emergent or urgent conditions or screen for specific entities. These FAST protocols provide adequate diagnostic image quality with use of accelerated approaches to produce imaging studies faster than traditional methods. FAST protocols have become critical diagnostic screening tools at the authors' institution, allowing confident and efficient confirmation or exclusion of actionable findings. The techniques commonly used to reduce imaging times, the imaging protocols used at the authors' institution, and future directions in FAST imaging are reviewed to provide a practical and comprehensive overview of FAST MRI for practicing neuroradiologists. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
Asunto(s)
Imagen por Resonancia Magnética , Columna Vertebral , Humanos , Imagen por Resonancia Magnética/métodos , Columna Vertebral/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Literatura de Revisión como AsuntoAsunto(s)
Hipertensión Intracraneal , Papiledema , Seudotumor Cerebral , Humanos , Seudotumor Cerebral/complicaciones , Seudotumor Cerebral/diagnóstico por imagen , Papiledema/diagnóstico por imagen , Papiledema/complicaciones , Prevalencia , Hipertensión Intracraneal/complicaciones , Imagen por Resonancia MagnéticaAsunto(s)
Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Malformaciones Arteriovenosas Intracraneales/patología , Edema Encefálico/complicaciones , Humanos , Aumento de la Imagen , Malformaciones Arteriovenosas Intracraneales/complicaciones , Imagen por Resonancia Magnética , Trombosis/complicacionesAsunto(s)
Trastornos Neurológicos de la Marcha/etiología , Sistema Glinfático/patología , Infecciones por VIH/líquido cefalorraquídeo , Infecciones por VIH/complicaciones , VIH-1 , ARN Viral/líquido cefalorraquídeo , Sustancia Blanca/patología , Progresión de la Enfermedad , Sistema Glinfático/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Sustancia Blanca/diagnóstico por imagenAsunto(s)
Angiografía Cerebral/métodos , Uso Excesivo de los Servicios de Salud/prevención & control , Accidente Cerebrovascular/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Triaje/métodos , Encéfalo/diagnóstico por imagen , Encéfalo/cirugía , Angiografía por Tomografía Computarizada , Humanos , Reproducibilidad de los Resultados , Accidente Cerebrovascular/cirugía , Trombectomía/métodos , TiempoRESUMEN
Three types of cardiac outpouchings are encountered on cardiovascular imaging: diverticula, aneurysms and pseudoaneurysms. The underlying physiology, imaging findings, risk of rupture, and optimal treatment varies for each and a correct diagnosis is critical. We report a case of a rare, incidentally discovered right ventricular aneurysm that was characterized by transthoracic echocardiogram, computed tomography, and cardiac MRI. The types of cardiac outpouchings are reviewed, and we discuss the selection of imaging modality, keys to distinguishing the outpouchings, and management strategies.
Asunto(s)
Mejoramiento de la Calidad , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/tratamiento farmacológico , Tiempo de Tratamiento/normas , Activador de Tejido Plasminógeno/uso terapéutico , Tomografía Computarizada por Rayos X/normas , Humanos , Joint Commission on Accreditation of Healthcare Organizations , Estudios de Casos Organizacionales , Estudios Retrospectivos , Estados UnidosRESUMEN
Background The diagnosis and treatment of acute stroke requires timed and coordinated effort across multiple clinical teams. Purpose To analyze the frequency and temporal distribution of emergent stroke evaluations (ESEs) to identify potential contributory workflow factors that may delay the initiation and subsequent evaluation of emergency department stroke patients. Material and Methods A total of 719 sentinel ESEs with concurrent neuroimaging were identified over a 22-month retrospective time period. Frequency data were tabulated and odds ratios calculated. Results Of all ESEs, 5% occur between 01:00 and 07:00. ESEs were most frequent during the late morning and early afternoon hours (10:00-14:00). Unexpectedly, there was a statistically significant decline in the frequency of ESEs that occur at the 14:00 time point. Conclusion Temporal analysis of ESEs in the emergency department allowed us to identify an unexpected decrease in ESEs and through process improvement methodologies (Lean and Six Sigma) and identify potential workflow elements contributing to this observation.