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More from @teachplaygrub

Lea Alhilali, MD

@teachplaygrub

May 6

1/Have disagreements between radiologists on the degree of cervical canal stenosis become a pain in the neck?

Worried about sticking your neck out & calling severe cervical stenosis?

This month’s @theAJNR SCANtastic has the latest about Cspine MRI!

ajnr.org/content/46/4/7…

@TheAJNR 2/In the lumbar spine, it is all about the degree of canal narrowing & room for nerve roots.

In the cervical spine, we have another factor to think about—the cord.

Cord integrity is key. No matter the degree of stenosis, if the cord isn’t happy, the patient won’t be either

@TheAJNR 3/Cord flattening, even w/o canal stenosis, can cause myelopathy.

No one is quite sure why.

Some say it’s b/c mass effect on static imaging may be much worse dynamically, some say repetitive microtrauma, & some say micro-ischemia from compression of perforators

Read 16 tweets

Lea Alhilali, MD

@teachplaygrub

May 2

1/Do radiologists sound like they are speaking a different language when they talk about MRI?

T1 shortening what? T2 prolongation who?

Here’s a translation w/an introductory thread to MRI.

2/Let’s start w/T1—it is #1 after all! T1 is for anatomy

Since it’s anatomic, brain structures will reflect the same color as real life

So gray matter is gray on T1 & white matter is white on T1

So if you see an image where gray is gray & white is white—you know it’s a T1

3/T1 is also for contrast

Contrast material helps us to see masses

Contrast can’t get into normal brain & spine bc of the blood brain barrier—but masses don’t have a blood brain barrier, so when you give contrast, masses will take it up & light up, making them easier to see.

Read 20 tweets

Lea Alhilali, MD

@teachplaygrub

Apr 28

1/Asking “How old are you?” can be dicey—both in real life & on MRI! Do you know how to tell the age of blood on MRI?

Here’s a thread on how to date blood on MRI so that the next time you see a hemorrhage, your guess on when it happened will always be in the right vein!

2/If you ask someone how to date blood on MRI, they’ll spit out a crazy mnemonic about babies that tells you what signal blood should be on T1 & T2 imaging by age.

But mnemonics are crutch—they help you memorize, but not understand. If you understand, you don’t need to memorize

3/If you look at the mnemonic, you will notice one thing—the T1 signal is all you need to tell if blood is acute, subacute or chronic.

T2 signal will tell if it is early or late in each of those time periods—but that type of detail isn’t needed in real life

So let’s look at T1

Read 20 tweets

Lea Alhilali, MD

@teachplaygrub

Apr 25

1/Radiologist not answering the phone?

Just want a quick read on that stat head CT?

Here's a little help on how to do it yourself w/a thread on how to read a head CT!

2/In bread & butter neuroimaging—CT is the bread—maybe a little bland, not super exciting—but necessary & you can get a lot of nutrition out of it

MRI is like the butter—everyone loves it, it makes everything better, & it packs a lot of calories. Today, we start w/the bread!

3/The most important thing to look for on a head CT is blood.

Blood is Bright on a head CT—both start w/B.

Blood is bright bc for all it’s Nobel prizes, all CT is is a density measurement—and blood is denser (thicker) than water & denser things are brighter on CT

Read 20 tweets

Lea Alhilali, MD

@teachplaygrub

Apr 23

1/Time to FESS up! Do you understand functional endoscopic sinus surgery (FESS)?

If you read sinus CTs, you better know what the surgeon is doing or you won’t know what you’re doing!

Here’s a thread to make sure you always make the important findings!

2/The first step is to insert the endoscope into the nasal cavity.

The first two structures encountered are the nasal septum and the inferior turbinate.

3/So on every sinus CT you read, the first question is whether there is enough room to insert the scope.

Will it go in smoothly or will it be a tight fit?

Read 19 tweets

Lea Alhilali, MD

@teachplaygrub

Apr 21

1/Ready for a throw down?

MMA fights get a lot of attention, but MMA (middle meningeal art) & dural blood supply doesn’t get the attention it deserves.

A thread on dural vascular anatomy!

2/Everyone knows about the blood supply to the brain.

Circle of Willis anatomy is king and loved by everyone, while the vascular anatomy of the blood supply to the dura is the poor, wicked step child of vascular anatomy that is often forgotten

3/But dural vascular anatomy & supply are important, especially now that MMA embolizations are commonly for chronic recurrent subdurals.

It also important for understanding dural arteriovenous fistulas as well.

Read 17 tweets

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Lea Alhilali, MD

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Lea Alhilali, MD

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