1/Talk about dangerous liaisons!

Abnormal brain vascular connections like a dural arteriovenous fistula (dural AVF) can be dangerous!

This month’s @theAJNR SCANtastic thread is here to you some durable knowledge about dural AVFs!

ajnr.org/content/45/12/… 2/Dural sinuses sit inside dural leaflets.

Arteries that feed the dura also feed the walls of sinuses, like vasa vasorum.

Arteries in the walls of veins are a natural connection between the veins and arteries—but these connections are usually closed in normal pts.

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/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

1/Controversy in radiology can get tense!

The Mt Fuji sign for tension pnemocephalus is under scrutiny. When should you call it?

A thread about imaging this important neurosurgery complication 2/First, let’s clarify about what the Mt Fuji sign actually is

Most are familiar with the fact that large collections of pneumocephalus can compress the frontal lobes—making them look like the slopes of a mountain

But this isn’t actually enough to call Mt Fuji.

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 road.

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/Time to rupture all your misconceptions about aneurysms!

When you see an aneurysm on imaging, do you know if it’s at high risk of rupture?

This month’s @theAJNR SCANtastic shows you which aneurysms are bursting w/risk!

ajnr.org/content/45/11/… 2/Aneurysm rupture is a devastating even, as it results in subarachnoid hemorrhage & complications such as hydrocephalus, vasospasm, infarcts, & death.

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

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 you see to increase your speed & make sure you never miss a thing! 2/A is for alignment

Look for:
(1) Unstable injuries

(2) Malalignment that causes early degenerative change. Abnormal motion causes spinal elements to abnormally move against each other, like grinding teeth wears down teeth—this wears down the spine

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/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

1/To call it or not to call it? That is the question!

Feeling wacky & wobbly when it comes to normal pressure hydrocephalus?

Don’t want to overcall it, but don’t want to miss it either!

Check out the latest in NPH w/this month’s @theAJNR SCANtastic!

ajnr.org/content/45/10/… 2/NPH was first described in 1965—but, of the original 6 pts, 4 were found to have underlying causes for hydrocephalus.

This begs the question—when do you stop looking & call it idiopathic? When do you suggest it on imaging?

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

1/Time is brain!

So you don’t have time to struggle w/that stroke alert head CT.

If there’s no flow, what are the things you need to know??

Here’s a thread to help you with the five main CT findings in acute stroke. 2/CT in acute stroke has 2 main purposes—(1) exclude intracranial hemorrhage (a contraindication to thrombolysis) & (2) exclude other pathologies mimicking acute stroke.

However, that doesn’t mean you can’t see other findings that can help you diagnosis a stroke.

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/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!

1/Want to TRI to learn something new about the TRIGEMINAL nerve?

If you’re only looking at the skullbase, you are missing a significant part of the trigeminal nucleus!

Let my help you TRI to up your game when it comes to TRIGEMINAL anatomy 2/We normally think of the trigeminal nerve nucleus in the brainstem.

But the trigeminal nucleus actually extends into the spine like a ponytail called the spinal trigeminal nucleus.

1/Having trouble remembering what you should look for in vascular dementia on imaging?

Almost everyone worked up for dementia has infarcts. Which ones are important?

Here’s a thread on the key findings in vascular dementia 2/Vascular cognitive impairment, or its most serious form, vascular dementia, used to be called multi-infarct dementia.

It was thought dementia directly resulted from brain volume loss from infarcts, w/the thought that 50-100cc of infarcted related volume loss caused dementia

1/Ready to seize the day w/epilepsy imaging?

Everyone knows mesial temporal sclerosis (MTS)!

But did you know there are different KINDS of MTS??

Read on for this month's @theAJNR SCANtastic on what YOU need to know in the latest in epilepsy imaging!

ajnr.org/content/45/9/1…
2/The name of the “hippocampus” comes from its shape on gross anatomy.

Early anatomists thought it looked like an upside down seahorse—w/its curved tail resembling the tail of a seahorse.

Hippocampus literally means seahorse.

1/Have MULTIPLE questions about the new criteria for MULTIPLE sclerosis?

ECTRIMS 2024 just came out w/proposed new changes to the McDonald criteria for multiple sclerosis.

The changes are complex, but here is a thread w/the basics that you NEED to know! 2/The 2017 criteria were complex as well, but the basic theme was that they required dissemination in both time & space.

So you needed lesions in multiple locations and of multiple different ages.

1/“Tell me where it hurts.”

How back pain radiates can tell you where the lesion is—if you know where to look!

Do YOU know where to look?

Here’s how to remember the lumbar radicular pain distributions! 2/Why is it important to know the radicular pain distributions?

Most times patients have many POSSIBLE sources of pain--and when you are looking at an MRI, it's your job to decide which finding is the most LIKELY source of pain

These pain distributions can help you do that!

Having trouble visualizing the location of the visual cortex?

Wish you knew where to look for where you see?

Let me open your eyes w/a quick & easy way to find the visual cortex on imaging so that you’re never caught looking! 2/Coronal plane is actually the easiest plane to find the visual cortex because it is directly perpendicular to the Calcarine fissure.

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???

Here’s a thread about 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 get 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?