1/Reading spine studies with compression fractures is back-breaking work!

Do you just say acute or chronic & move on?

Do you know the key imaging findings? Or how they’re managed?

This week’s SCANtastic covers all YOU need to know from @TheAJNR:

ajnr.org/content/44/11/…
2/Osteoporosis may seem routine & boring, but that's just bc it’s a problem of epidemic proportions

Compression fxs are more common than stroke & Alzheimer’s combined—& have significant morbidity

But bc they are commonplace, we often don’t give them the attention they deserve.

1/Ready for a throw down?!

Everyone knows about MMA fights...

But do you know about the **ORIGINAL** MMA (middle meningeal artery)?

Blood supply to the dura doesn’t get the attention it deserves!

A thread on all the dural vascular anatomy you NEED to know! 2/Everyone knows about the blood supply to the brain.

Circle of Willis anatomy is king & loved by everyone.

But the vascular anatomy of the dural blood supply is the poor, wicked step child of vascular anatomy

Unfortunately, it's is often forgotten

1/Do you feel there’s a back-log of findings in a spine MRI report?

Everyone talks about discs & facets, but not everyone talks about the endplates.

Do you?

Do you need to talk about degenerative changes of the endplates (Modic changes)?

Here’s thread w/all you need to know! 2/Over 30 years ago, Modic et al. found there were 3 types of degenerative endplate changes:

(1) T2 bright changes (indicating edema, Modic 1)
(2) T1 bright changes (indicating fat, Modic 2)
(3) T1 & T2 dark changes (indicating sclerosis, Modic 3)

But what do they mean?

1/The medulla is anything but DULL!

Does seeing an infarct in the medulla cause your heart to skip a beat?

Does medullary anatomy send you into respiratory arrest?

Never fear, here is a thread on the major medullary syndromes! 2/The medulla is like a toll booth.

Everything going down into the cord must pass through the medulla & everything from the cord going back up to the brain must too.

That’s a lot of tracts for a very small territory. Luckily you don’t need to know every tract

1/Are all the screening CT angiograms for trauma becoming a pain in the neck?

Are we over screening for arterial injury?

Let the newest SCANtastic dissect it for you w/the latest @TheAJNR research on trauma screening w/CTA:

ajnr.org/content/early/…
2/Vessel injury can be from direct penetration, but most commonly is from head/neck movement during trauma causing vessel stretching/twisting while the rest of the vessel is fixed.

Just like how your arm breaks if it’s twisted or pulled while the rest of you is fixed!

1/”I LOVE spinal cord syndromes!” is a phrase that has NEVER, EVER been said by anyone.

Do you become paralyzed when you see cord signal abnormality?

Never fear—here is a thread on all the incomplete spinal cord syndromes to get you moving again! 2/Spinal cord anatomy can be complex.

On imaging, we can see the ant & post nerve roots.

We can also see the gray & white matter.

Hidden w/in the white matter, however, are numerous efferent & afferent tracts—enough to make your head spin.

1/Hate it when one radiologist called the stenosis mild, the next one said moderate--but it was unchanged?!

How do you grade it? Do you estimate? Measure? Guess???

Let this thread take the load off your back w/a lumbar grading system that’s easy, reproducible & evidence-based! 2/Lumbar stenosis has always been controversial.

In 2012, they tried to survey spine experts to come to a consensus as to what are the most important criteria for canal & foraminal stenosis.

And the consensus was…that there was no consensus.

So what should you use to call it?

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!

Read this so 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

1/Time to go with the flow!

Hoping no one notices you don’t know the anatomy of internal carotid (ICA)?

Do you say “carotid siphon” & hope no one asks for more detail?

Here’s a thread to help you siphon off some information about ICA anatomy! 2/ICA is like a staircase—winding up through important anatomic regions like a staircase winding up to each floor Lobby is the neck.

First floor is skullbase/carotid canal. Next it stops at the cavernous sinus, before finally reaching the rooftop balcony of the intradural space.

1/Nothing strikes fear into the heart of a radiologist like the question,“Is it safe to do an MRI on this patient w/an implanted device?”

Do questions about pacemakers & MRIs suddenly send your heart racing?

Never fear again! Here’s a thread navigating implanted devices & MRI! 2/MRI & CT are like nuclear & coal power, respectively.
Everyone knows CT is worse for you & usually MRI is very safe & better for your body

But like nuclear power, when things go bad in MRI, they can go horribly wrong. Flying chairs into the magnet wrong. So, people are afraid.

1/AJNR SCANtastic 🧵w/@teachplaygrub!

Has measuring for Chiari 1 malformations become a real headache?

Can’t quite peg when to call a Chiari? Looking for a better way?

Let the new SCANtastic decompress it for you w/new @theAJNR Chiari research: ajnr.org/content/early/…
@TheAJNR 2/Most know that a Chiari 1 malformation (CM) is when the tonsils extend below the foramen magnum (FM).

Classically, it’s bc the posterior fossa is underdeveloped & small, while the cerebellum is normal sized, so it doesn’t fit in the posterior fossa & herniates down.

1/Feeling broken up when it comes to LeFort fractures?

My fellows complained they hate memorizing classifications like LeFort. I thought, “There must be a better way—maybe understanding instead of memorizing.”

A thread so you can understand LeFort & never memorize again! 2/To understand LeFort, you need to understand facial buttresses.

These are not true anatomic structures but a way of understanding facial structure.

Facial bones support facial structures like a table supports food, with legs (vertical buttresses) and table top (horizontal)

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.

1/It’s rare a patient can tell exactly you where their pathology is—but that’s what they’re doing when they have a cranial nerve palsy—you just have to know where to look!

A thread about Six Syndromes of the Sixth Cranial Nerve!

If you know the syndrome, you know the answer! 2/To understand the six syndromes, you must know the anatomy of the 6th nerve

It starts in the brainstem, at the facial colliculus—what looks like the cute baby butt of the brainstem

It then travels anteriorly through the brainstem to exit out the ventral surface of the pons.

1/Raise your hand if you’re confused by the BRACHIAL PLEXUS!

I could never seem to remember or understand it—but now I do & I’ll show you how

A thread so you will never fear brachial plexus anatomy again! 2/Everyone has a mnemonic to remember brachial plexus anatomy.

I’m a radiologist, so I remember one about Rad Techs.

But just remembering the names & their order isn’t enough. That is just the starting point--let’s really understand it

1/Does your ability to remember temporal lobe anatomy seem, well, temporary?

Are you feeling temporally challenged when it comes to this complex region?

Here’s a thread to help you remember the structures of the temporal lobe! 2/Temporal lobe can be divided centrally & peripherally.

Centrally is the hippocampus.

It’s a very old part of the brain & is relatively well preserved going all the way back to rats. Its main function is memory—getting both rats & us through mazes—including the maze of life

1/They say form follows function!

Brain MRI anatomy is best understood in terms of both form & function.

Here’s a short thread to help you to remember important functional brain anatomy--so you truly can clinically correlate! 2/Let’s start at the top. At the vertex is the superior frontal gyrus. This is easy to remember, bc it’s at the top—and being at the top is superior. It’s like the superior king at the top of the vertex.

1/Need help reading spine imaging? I’ve got your back!

It’s as easy as ABC!

A thread about an easy mnemonic you can use on every single spine study to increase your speed & make sure you never miss a thing! 2/A is for alignment.

Normal spinal alignment is perfectly in balance, resulting in the minimal energy needed for erect posture.

Even subtle changes in alignment need compensatory changes to maintain posture, resulting in more work/energy expenditure & pain.

1/Time to rupture all your misconceptions about aneurysms!

When you see an aneurysm on imaging, do you know its risk of rupture?

Do you know which features make one aneurysm more likely to rupture?

Here’s a short thread to teach you which aneurysms are bursting with risk! 2/Aneurysm rupture is a devastating even, as it results in subarachnoid hemorrhage, which can then result in complications such as hydrocephalus, vasospasm, infarcts, and death

Preventing it by treating aneurysms before they rupture is key. But you also don’t want to over treat

1/Are you FISHING for a way to better evaluate subarachnoid hemorrhage?

Are you hungry for a way to classify these patients?

DONUT you worry!

Here’s a short thread to help you remember the modified Fisher scale for classifying subarachnoid hemorrhage. 2/Just think of the brain as a donut.

Like a donut, it’s a bunch of stuff around a hole in the middle. Ventricles are the hole in the middle of the brain just like there’s a hole in the middle of the dough in a donut.

Just don’t quote me to your neuroanatomy professor….

1/Do you feel like you are drowning in an alphabet soup of stroke trials?

Want to ESCAPE the confusion about stroke treatment?

Let this #tweetorial DEFUSE the situation—w/an update on #stroke treatment from the July issue @TheAJNR

#medtwitter #meded #neurotwitter #FOAMed 2/Stroke treatment began w/the discovery that the thrombolytic tPA could help improve outcomes in acute ischemic stroke.

tPA works on a clot in your artery like a drain cleaner does for a clog in your pipes—enzymatically breaking it down to relieve the obstruction