1/Remembering spinal fracture classifications is back breaking work!

A thread to review the scoring system for thoracic & lumbar fractures—“TLICS” to the cool kids! 2/TLICS scores a fx on (1) morphology & (2) posterior ligamentous complex injury

Let's start w/morphology

TLICS scores severity like the steps to make & eat a pizza:

Mild compression (kneading), strong compression (rolling), rotation (tossing), & distraction (tearing in)

1/The 90s called & wants its carotid imaging back!

It’s been 30 years--why are you still just quoting NASCET?

Do you feel vulnerable when it comes to identifying plaque vulnerability?

Here’s a thread to help you identify high risk plaques with carotid plaque imaging 2/Everyone knows the NASCET criteria:

If the patient is symptomatic & the greatest stenosis from the plaque is >70% of the diameter of normal distal lumen, patient will likely benefit from carotid endarterectomy.

But that doesn’t mean the remaining patients are just fine!

1/Do you know all the aspects of, well, ASPECTS?

Many know the anterior circulation stroke scoring system—but posterior circulation (pc) ASPECTS is often left behind

25% of infarcts are posterior circulation

Do you know pc-ASPECTS?!

Here’s how to remember pc-ASPECTS! 2/Many know anterior circulation ASPECTS.

It uses a 10-point scoring system to semi-quantitation the amount of the MCA territory infarcted on non-contrast head CT

If you need a review: here’s my thread on ASPECTS:

https://x.com/teachplaygrub/status/1587472264764657664

1/I always say you can tell a bad read on a spine MR if it doesn’t talk about lateral recesses.

What will I think when I see your read? Do you rate lateral recess stenosis?

Here’s a thread on lateral recess anatomy & a grading system for lateral recess stenosis 2/First anatomy.

Thecal sac is like a highway, carrying the nerve roots down the lumbar spine.

Lateral recess is part of the lateral lumbar canal, which is essentially the exit for spinal nerve roots to get off the thecal sac highway & head out into the rest of the body

1/Does PTERYGOPALATINE FOSSA anatomy feel as confusing as its spelling?

Does it seem to have as many openings as letters in its name?

Are you pterrified of the pterygopalatine fossa (PPF)?

Let this thread on PPF anatomy help you out. 2/The PPF is a crossroads between the skullbase & the extracranial head and neck

There are 4 main regions that meet here:

(1) Skullbase itself posteriorly, (2) nasal cavity medially, (3) infratemporal fossa laterally, and (4) orbit anteriorly.

1/Feel like a fish out of water when it comes to water on the brain?

Read on for this month’s @Radiographics summary of what you need to know about hydrocephalus!!



@cookyscan1 @RadG_editor #RGphx doi.org/10.1148/rg.240… 2/To understand hydrocephalus, think of CSF like the flow of traffic

3 main ways traffic backs up:

(1) Obstruction on the road:
For hydrocephalus, this is an obstruction along CSF in the ventricle

1/Do scans for dizziness make your head spin?

Need to know what to look for?

Just hear me out!

This month’s @theAJNR SCANtastic will show what to look for:

ajnr.org/content/46/2/3… 2/I always remember the rhyme of the big three for dizz-ee!

First, are vestibular schwannomas

These give an ice cream cone shape in the internal auditory canal! So scoop up that finding!

1/Time is brain! But what time is it?

If you don’t know the time of stroke onset, are you able to deduce it from imaging?

Here’s a thread to help you date a stroke on MRI! 2/Strokes evolve, or grow old, the same way people evolve or grow old

The appearance of stroke on imaging mirrors the life stages of a person—you just have to change days for a stroke into years for a person

So 15 day old stroke has features of a 15 year old person, etc.

1/My hardest thread yet! Are you up for the challenge?

How stroke perfusion imaging works!

Ever wonder why it’s Tmax & not Tmin?

Do you not question & let RAPID read the perfusion for you? Not anymore! 2/Perfusion imaging is based on one principle: When you inject CT or MR intravenous contrast, the contrast flows w/blood & so contrast can be a surrogate marker for blood.

This is key, b/c we can track contrast—it changes CT density or MR signal so we can see where it goes.

1/”That’s a ninja turtle looking at me!” I exclaimed. My fellow rolled his eyes at me, “Why do I feel I’m going to see this a thread on this soon…”

He was right! A thread about one of my favorite imaging findings & pathology behind it 2/Now the ninja turtle isn’t an actual sign—yet!

But I am hoping to make it go viral as one. To understand what this ninja turtle is, you have to know the anatomy.

I have always thought the medulla looks like a 3 leaf clover in this region.

The most medial bump of the clover is the medullary pyramid (motor fibers).

Next to it is the inferior olivary nucleus (ION), & finally, the last largest leaf is the inferior cerebellar peduncle.

Now you can see that the ninja turtle eyes correspond to the ION.

1/They say form follows function!

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

Here’s a thread to help you to remember important functional brain anatomy! 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/”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/To be or not 2b?? That is the question!

Do you have questions about how to remember cervical lymph node anatomy & levels?

Here’s a SUPERBOWL thread to show you how! 2/Google cervical lymph node anatomy & you always get this anatomic picture w/the head flung back like a model posing.

But unless you live in LA, your patients don’t look like this & understanding anatomy from this image is difficult

1/Can’t remember what to look for on scans for memory loss?

New Alzheimer’s treatments are changing these scans!

Read on for the latest @theAJNR SCANtastic on imaging in AD:

… ajnr.org/content/early/ 2/Current hypothesis in Alzheimer’s disease (AD) is that accumulation of amyloid beta (AB) protein result sin inflammation & neuronal death

Thus, new treatments in AD are focused on anti-AB antibodies that remove this protein in AD patients.

1/Can’t remember what to look for on scans for memory loss?

New Alzheimer’s treatments are changing the way we look at these scans!

Read on to get up to date w/the latest @theAJNR SCANtastic on imaging for Alzheimer’s Disease:

ajnr.org/content/early/… @TheAJNR 2/Current hypothesis in Alzheimer’s disease (AD) is that accumulation of amyloid beta (AB) protein result sin inflammation & neuronal death

Thus, new treatments in AD are focused on anti-AB antibodies that remove this protein in AD patients.

1/Does trying to figure out cochlear anatomy cause your head to spiral?

Hungry for some help?

Here’s a thread to help you untwist cochlear CT anatomy w/food analogies! 2/On axial temporal bone CT, you cannot see the whole cochlea at once. So let’s start at the bottom.

The first thing you come to is the basal turn of the cochlea (makes sense, basal=bottom). On axial images, it looks like a banana. I remember both Basal and Banana start w/B.

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