AJNR. American journal of neuroradiology最新文献

{"title":"Why 2D Matters: Comparative Evaluation of 2D and 3D T1-Weighted Imaging of the Skull Base and Neck.","authors":"Amy F Juliano, Nathan Huey, Laura V Romo, Hillary R Kelly, Manuel Patino, Yuh-Shin Chang, Paul Couto, Marcela Marsiglia, Jarrel Seah, Sebastian F Juliano, Katherine L Reinshagen","doi":"10.3174/ajnr.A8887","DOIUrl":"https://doi.org/10.3174/ajnr.A8887","url":null,"abstract":"<p><strong>Background and purpose: </strong>3-dimensional (3D) T1-weighted imaging (T1-WI) MR protocols have been proposed as time-efficient alternatives for skull base and neck imaging, but direct comparisons with conventional 2-dimensional (2D) T1-weighted turbo spin echo (TSE) imaging are limited. This study aims to qualitatively and quantitatively compare 2D and 3D T1-WI of the head and neck.</p><p><strong>Materials and methods: </strong>A retrospective review was conducted on 21 patients who underwent both 2D and 3D pre-and post-contrast T1-WI during the same scan session (3T Philips 7700). Seven independent radiologists (4.5-35-years experience) evaluated image quality using Likert scales, categorical ratings (2D better, 3D better, equivalent), and yes/no questions. Quantitative measures included ROI intensity values in buccal fat, masseter muscle, and tumors (if present), as well as percent delineation of two small but relevant muscles, tensor veli palatini and superior pharyngeal constrictor muscles on skull base and neck MR, respectively.</p><p><strong>Results: </strong>Of the 21 MRIs (10 skull base, 11 neck), contrast timing was balanced across sequences. Raters significantly favored 2D T1-weighted TSE for improved fat visualization at skull base foramina, homogeneity of fat signal, and parotid architecture (p<.001). Tumor margins were more clearly defined on 2D neck MR (pre-and post-contrast: p<.001, p=.04), although this was not significantly different at the skull base. 3D sequences showed less pulsation artifact particularly pre-contrast (both p<.001), but more susceptibility artifact (both, p<.001). Quantitatively, 2D images had higher fat-to-muscle (both p<.001) and tumor-to-muscle relative signal intensity ratios (neck: p<.001, skull base: p=.04). Delineation of tensor veli palatini and superior pharyngeal constrictor muscles was significantly better with 2D imaging (both p<.001). Multiplanar reformat capability from 3D imaging did not add diagnostic value in either the neck or skull base (all p<.05).</p><p><strong>Conclusions: </strong>Despite advances in 3D imaging, 2D T1-weighted TSE sequences continue to offer superior soft tissue contrast and delineation in the complex anatomy of the skull base and neck. While 3D sequences reduce pulsation artifacts and provide thinner slices, their overall diagnostic utility remains less favorable due to poorer tissue contrast and increased susceptibility artifacts particularly at tissue interfaces, especially relevant in the head and neck.</p><p><strong>Abbreviations: </strong>TSE=turbo spin echo, TFE= turbo field echo, ROI=region-of-interest, 2D=2-dimension, 3D=3-dimension, mDixon=modified Dixon, T1-WI=T1-weighted image, MPR=multiplanar reformat.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Image-Based Search in Radiology: Identification of Brain Tumor Subtypes within Databases Using MRI-Based Radiomic Features.","authors":"Marc von Reppert, Saahil Chadha, Klara Willms, Arman Avesta, Nazanin Maleki, Tal Zeevi, Jan Lost, Niklas Tillmanns, Leon Jekel, Sara Merkaj, MingDe Lin, Karl-Titus Hoffmann, Sanjay Aneja, Mariam S Aboian","doi":"10.3174/ajnr.A8805","DOIUrl":"10.3174/ajnr.A8805","url":null,"abstract":"<p><strong>Background and purpose: </strong>Existing neuroradiology reference materials do not cover the full range of primary brain tumor presentations, and text-based medical image search engines are limited by the lack of consistent structure in radiology reports. To address this, an image-based search approach is introduced here, leveraging an institutional database to find reference MRIs visually similar to presented query cases.</p><p><strong>Materials and methods: </strong>Two hundred ninety-five patients (mean age and standard deviation, 51 ± 20 years) with primary brain tumors who underwent surgical and/or radiotherapeutic treatment between 2000 and 2021 were included in this retrospective study. Semiautomated convolutional neural network-based tumor segmentation was performed, and radiomic features were extracted. The data set was split into reference and query subsets, and dimensionality reduction was applied to cluster reference cases. Radiomic features extracted from each query case were projected onto the clustered reference cases, and nearest neighbors were retrieved. Retrieval performance was evaluated by using mean average precision at k, and the best-performing dimensionality reduction technique was identified. Expert readers independently rated visual similarity by using a 5-point Likert scale.</p><p><strong>Results: </strong>t-Distributed stochastic neighbor embedding with 6 components was the highest-performing dimensionality reduction technique, with mean average precision at 5 ranging from 78%-100% by tumor type. The top 5 retrieved reference cases showed high visual similarity Likert scores with corresponding query cases (76% 'similar' or 'very similar').</p><p><strong>Conclusions: </strong>We introduce an image-based search method for exploring historical MR images of primary brain tumors and fetching reference cases closely resembling queried ones. Assessment involving comparison of tumor types and visual similarity Likert scoring by expert neuroradiologists validates the effectiveness of this method.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Cerebellar Peduncle Morphometry with Hypertrophic Olivary Degeneration: A Pilot Case-Control Study.","authors":"Koustav Ghosal, Sumit Thakar, Sunitha P Kumaran, Saritha Aryan","doi":"10.3174/ajnr.A8888","DOIUrl":"https://doi.org/10.3174/ajnr.A8888","url":null,"abstract":"<p><strong>Background and purpose: </strong>Hypertrophic olivary degeneration (HOD) is a rare neurological condition resulting from disruption of the dentato-rubro-olivary pathway (DROP). Nearly half the HOD cases, however, lack detectable lesions in the DROP, and fewer than 10% of patients develop the condition following surgical resection of posterior fossa tumors. Based on these observations, we hypothesized that inherent anatomical variations in components of the DROP -specifically the inferior cerebellar peduncle (ICP) and superior cerebellar peduncle (SCP) -may predict susceptibility to HOD.</p><p><strong>Materials and methods: </strong>This retrospective pilot case-control study included 12 patients who developed unilateral HOD following maximal safe resection of midline posterior fossa tumors and 24 matched controls who underwent tumor resection via the same standardized surgical approach but did not develop HOD. Morphometric measurements of the ICP and SCP were obtained from T2-weighted MRI and recorded as ratios to brainstem width (ICP/medulla, SCP/midbrain). Group comparisons were performed using independent t-tests, and effect sizes were calculated. Receiver operating characteristic analysis assessed the predictive accuracy of these ratios, while logistic regression and bootstrap resampling (10,000 iterations) were used to assess robustness and reproducibility.</p><p><strong>Results: </strong>The ICP/medulla ratio was significantly lower in HOD cases (0.40 ± 0.04) than in controls (0.47 ± 0.06, p = 0.01), while the SCP/midbrain ratio showed no significant difference (p = 0.78). Effect size analysis indicated a large difference between groups (Cohen's d = -1.14). Receiver operating characteristic analysis demonstrated good predictive accuracy for the ICP/medulla ratio (area under the curve = 0.80, 95% CI, 0.64-0.92). Logistic regression confirmed a significant association between a smaller ICP/medulla ratio and increased HOD risk (p = 0.01). Bootstrap resampling reinforced the reliability of these findings (mean regression coefficient = -30.78, 95% CI: -61.59 to -12.70).</p><p><strong>Conclusions: </strong>This pilot study suggests that smaller ICP/medulla ratios are associated with a higher likelihood of developing HOD following posterior fossa tumor resection. While preliminary, this novel finding highlights the possible role of these measurements in enhancing preoperative risk assessment.</p><p><strong>Abbreviations: </strong>DROP = dentato-rubro-olivary pathway; HOD = hypertrophic olivary degeneration; ICP = inferior cerebellar peduncle; ION = inferior olivary nucleus; SCP = superior cerebellar peduncle.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraplaque Hemorrhage Volume and Ischemic Stroke Risk.","authors":"Shahriar Faghani, Mana Moassefi, Erik Albach, Ajay A Madhavan, Ian T Mark, Girish Bathla, Darya P Shlapak, Carrie M Carr, Bradley J Erickson, John C Benson","doi":"10.3174/ajnr.A8889","DOIUrl":"https://doi.org/10.3174/ajnr.A8889","url":null,"abstract":"<p><strong>Background and purpose: </strong>Intraplaque hemorrhage (IPH) in carotid atherosclerotic plaques is the best-established biomarker of plaque vulnerability. However, the relationship between IPH volume and ischemic neurologic symptoms remains scarcely studied. This study explored the association between carotid IPH volume and ischemic event severity.</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted on consecutive patients with suspected carotid atherosclerosis, evaluated from December 2015 to January 2021. Patients underwent carotid plaque MRI using T1-weighted imaging with fat suppression for IPH detection. Included patients had documented neurological symptoms, classified as amaurosis fugax (AF), TIA, and/or stroke. MRI scans were reviewed for presence and volume of IPH, with semi-automated software used for volumetric segmentation. Statistical analyses, including Mann-Whitney U tests and Receiver Operating Characteristic (ROC) curves, were performed to evaluate IPH volume thresholds and their association with symptom severity.</p><p><strong>Results: </strong>The study included 358 patients, of whom 120 had IPH-positive carotid plaques. A higher incidence of ischemic events was noted on the left side, with 28 strokes, 6 AF, and 12 TIAs observed in left-sided events, and 19 strokes, 1 AF, and 3 TIAs in right-sided events. No significant differences in IPH volumes were found across symptom categories or event laterality. ROC analysis identified IPH volume thresholds with AUC values of 0.579 (0.396, 0.748) for left-sided events and 0.618 (0.333, 0.910) for right-sided events, indicating limited discriminatory power for predicting ischemic event severity.</p><p><strong>Conclusions: </strong>While carotid IPH volume is detectable across various neurological symptom categories, our findings indicate that IPH volume alone does not significantly correlate with ischemic event severity. Threshold IPH volumes showed low diagnostic accuracy, suggesting that other plaque characteristics and systemic factors may be more relevant in determining ischemic stroke risk.</p><p><strong>Abbreviations: </strong>IPH＝Intraplaque hemorrhage; AF＝Amaurosis fugax; ROC＝Receiver Operating Characteristic.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of CT-Guided Targeted Epidural Patching For Lateral Dural Tears In Spontaneous Intracranial Hypotension: A Multicenter Retrospective Cohort Study.","authors":"Andrew L Callen, Daniel Montes, Debayan Bhaumik, Peter Lennarson, Mark D Mamlouk, Niklas Lützen, Jürgen Beck, Horst Urbach, Daniel Scoffings, David Butteriss, Lalani Carlton Jones","doi":"10.3174/ajnr.A8886","DOIUrl":"https://doi.org/10.3174/ajnr.A8886","url":null,"abstract":"<p><strong>Background and purpose: </strong>Spontaneous intracranial hypotension (SIH) due to lateral dural tears with spinal longitudinal extradural fluid collections (SLECs) can cause disabling orthostatic headaches. While epidural patching is commonly used as first-line treatment, outcomes specific to lateral dural tears have not been well characterized. We aimed to evaluate clinical and radiologic outcomes following CT-guided patching for lateral dural tears and assess whether anatomic or procedural factors- including presence of a herniated arachnoid pouch, patch volume, material, or approach-influence treatment success.</p><p><strong>Materials and methods: </strong>This was a retrospective multicenter cohort study of patients with lateral dural tears treated with CT-guided epidural patching between December 2013 and March 2025. Demographics, leak characteristics, patching details, and clinical and imaging outcomes were collected. The presence of herniated arachnoid pouches on spine MRI and pre/post-treatment Bern scores were recorded. Associations between clinical resolution, SLEC resolution, and procedural variables were analyzed using univariate methods.</p><p><strong>Results: </strong>Fifty-six patients (mean age 38.7 ± 11.7 years; 80% female) were included. Mean pretreatment Bern score was 6.6 ± 2.3; no patients had superficial siderosis. Clinical resolution occurred in 20/56 (35.7%), and SLEC resolution in 10/40 (25%) on post-patch spine MRI. A herniated arachnoid pouch was present in 69.7% and associated with lower SLEC resolution (30% vs. 80%, p=0.003). Patch type, volume, transforaminal approach, and needle placement into the herniated pouch were not associated with outcomes. Post-patch Bern scores were lower among those with clinical resolution (0.9 ± 1.1 vs. 2.6 ± 2.5, p=0.046). Of 11 patients with complete clinical improvement who had post-patch spine MRI, 5 (45.5%) had persistent SLECs.</p><p><strong>Conclusions: </strong>CT-guided patching led to complete symptom resolution in roughly one-third of patients with lateral dural tears. Herniated arachnoid predicted lower SLEC resolution, while procedural variables were not predictive of outcome. A subset of patients improved clinically despite persistent extradural fluid, emphasizing the need for long-term monitoring.<b>ABBREVIATIONS:</b> SIH＝ spontaneous intracranial hypotension; SLEC = spinal longitudinal extradural fluid collection.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reentry Technique for Rescue Recanalization of Carotid Near-Total Occlusion after Subintimal Penetration.","authors":"Dang Khoi Tran, Huu-Thao Nguyen, Chih-Wei Huang, Kai-Chen Chung, Yuang Seng Tsuei","doi":"10.3174/ajnr.A8860","DOIUrl":"10.3174/ajnr.A8860","url":null,"abstract":"<p><p>Carotid stent placement is an effective alternative for stroke prevention in patients with carotid stenosis. However, endovascular recanalization of near-total carotid occlusion remains challenging, with subintimal dissection sometimes unavoidable. We present the case of an adult in their 70s with symptomatic carotid stenosis. During plaque crossing with a microwire, unintentional subintimal dissection occurred. The reentry technique, using a specialized reentry catheter, was performed, followed by carotid stent placement, achieving successful recanalization. The patient made a good clinical recovery. In selected cases, subintimal recanalization of carotid occlusion using the rescue re-entry technique can be performed safely after entry into the false lumen.^1-5.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Location-Specific Net Water Uptake and Malignant Cerebral Edema in Acute Anterior Circulation Occlusion Ischemic Stroke.","authors":"XiaoQing Cheng, Bing Tian, LiJun Huang, Xi Shen, AnYu Liao, ChangSheng Zhou, Quan Hui Liu, HuiMin Pang, JinJing Tang, BaiYan Luo, Xia Tian, YuXi Hou, LuGuang Chen, Qian Chen, WuSheng Zhu, ChengWei Shao, XinDao Yin, GuangMing Lu","doi":"10.3174/ajnr.A8659","DOIUrl":"10.3174/ajnr.A8659","url":null,"abstract":"<p><strong>Background and purpose: </strong>Early identification of malignant cerebral edema (MCE) in patients with acute ischemic stroke is crucial for timely interventions. We aimed to identify regions critically associated with MCE using the ASPECTS to evaluate the association between location-specific net water uptake (NWU) and MCE.</p><p><strong>Materials and methods: </strong>This multicenter, retrospective cohort study included patients with acute ischemic stroke following large anterior circulation occlusion. The ASPECTS was determined by RAPID ASPECTS software. ASPECTS-NWU and Region-NWU were calculated automatically by comparing the Hounsfield unit values in the ischemic and contralateral regions. Critical ASPECTS MCE regions and Region-NWU were evaluated by multivariate logistic regression and the areas under the receiver operating characteristic curves (AUCs).</p><p><strong>Results: </strong>The study included 513 patients. Multivariate analysis showed that the ASPECTS insula (OR = 2.49; 95% CI, 1.44-4.31) and M5 (OR = 1.59; 95% CI, 1.11-3.41) regions were significantly associated with MCE. After adjustment, only the insula (OR = 2.34; 95% CI, 1.23-4.45) was independently associated with MCE. Univariable receiver operating characteristic curve analysis found AUCs for Insula-NWU (AUC, 0.70; 95% CI, 0.65-0.76) and ASPECTS-NWU (AUC, 0.64; 95% CI, 0.58-0.70). The Insula-NWU had better diagnostic power than ASPECTS-NWU (DeLong test; <i>P</i> = .01). A multivariate regression model that combined the NIHSS, ASPECTS, insula involvement, and Insula-NWU had good discriminatory power (AUC = 0.80; 95% CI, 0.74-0.86) and better diagnostic power than Insula-NWU (DeLong test; <i>P</i> < .01).</p><p><strong>Conclusions: </strong>The insula region is critical for MCE, and Insula-NWU has better prediction efficacy than ASPECTS-NWU. This method does not rely on advanced imaging, facilitating rapid assessment in emergencies.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium MRI in Pediatric Brain Tumors.","authors":"Aashim Bhatia, Cassie Kline, Peter J Madsen, Michael J Fisher, Fernando E Boada, Timothy P L Roberts","doi":"10.3174/ajnr.A8642","DOIUrl":"10.3174/ajnr.A8642","url":null,"abstract":"<p><p>Direct sodium MRI (²³Na-MRI) derives its signal from spin-manipulation of the ²³Na nucleus itself and not the more conventional and familiar ¹H-MRI. Although present at much lower concentrations in the human body than the ¹H nuclei in the water molecule H₂O, advances in coil design and pulse sequence development have enabled the feasibility of human in vivo ²³Na-MRI. Additionally, ²³Na-MRI has the potential to offer nuanced physiologic insights not available to conventional MRI; this feature forms the basis of interest in its development and optimism for its novel clinical utility. ²³Na-MRI has the potential to be a useful noninvasive imaging technique to assess biochemical and physiologic cellular changes in tissues, eg, cell integrity and tissue viability. Pathologically, the concentration of total sodium is elevated in tumors relative to normal counterparts due to increased intracellular sodium and/or an increased proportion of extracellular space (reflecting changes in cell morphology and anomalies of homeostasis). Here we review the technological advancements with improved pulse sequences and reconstruction methods that counter the inherent challenges of measuring sodium concentrations in the pediatric brain (in particular, its short-tissue T2 value) and present detailed imaging approaches to quantifying sodium concentrations in the pediatric brain that can be assessed in various CNS pathologies, with the focus on pediatric brain tumors.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CPT Codes for MRI Safety-A User's Guide.","authors":"Colin M Segovis, Jacob W Ormsby, Cindy X Yuan, Matthew J Goette, Melissa M Chen, Heidi A Edmonson","doi":"10.3174/ajnr.A8661","DOIUrl":"10.3174/ajnr.A8661","url":null,"abstract":"<p><p>The magnetic fields of the MR environment present unique safety challenges. Medical implants and retained foreign bodies can prevent patients from undergoing MR imaging due to interactions between the magnetic fields of the MR environment and the implant or foreign body. These hazards can be addressed through careful MR safety screening and MR examination customization, often allowing these patients with implants to undergo management-altering MR imaging. However, mitigating these risks takes additional time, expertise, and effort. Effective in 2025, this additional work is formally acknowledged with a new series of Current Procedural Terminology codes to report the work of assessing and addressing safety concerns associated with implants and foreign bodies in the MR environment. This user guide provides guidance on how to report these codes so physician-led MR safety teams can be appropriately reimbursed for the additional work performed in preparing patients with implants or foreign bodies for MR imaging.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiologist, Trainee, and Logistical Factors Impacting the Timeliness of CTA Head and Neck Reporting in Stroke Code Activations.","authors":"Omar A Zaree, Jeffers K Nguyen, Irene Dixe de Oliveira Santo, Ahmed E Kertam, Saeed Rahmani, Jason Johnson, Long H Tu","doi":"10.3174/ajnr.A8660","DOIUrl":"10.3174/ajnr.A8660","url":null,"abstract":"<p><strong>Background and purpose: </strong>Timely reporting of CTA examinations impacts management of acute vascular pathology such as large vessel occlusions, arterial dissection, and ruptured aneurysms, as well as a variety of acute nonvascular pathologies. In this study, we examine potential modifiable factors impacting the timeliness of CTA reporting performed in stroke code activations.</p><p><strong>Materials and methods: </strong>This is an observational study of stroke code CTA head and neck examinations performed at a single health system (3 emergency departments, 1550 inpatient beds) during 4 years (January 1, 2019, to December 31, 2023). Patient age, patient sex, care setting, time of year, shift type, trainee/attending radiologist characteristics, report factors, and number of CTAs performed within the preceding hour were considered potential factors impacting the turnaround time (TAT) of stroke code CTAs. Descriptive statistics, univariate regression, and multivariate regression were used to estimate the impact on reporting TAT.</p><p><strong>Results: </strong>We performed 8422 stroke code CTA examinations. Median TAT was 29 minutes (interquartile range [IQR] 18-48). Median TAT by individual attending radiologists varied from 15 to 40 minutes (median of medians, 29 minutes [IQR 26-34.5]). Univariate regression analyses found younger patient age, emergency department setting, time later in the academic year, nonbusiness hours, specific individual radiologists/trainees, solo reporting by attending radiologists, use of preliminary reports, and fewer stroke codes within the preceding hour to all be associated with shorter TATs (all <i>P</i> < .05). After adjusting for patient-, logistical-, and radiologist-level factors in a multivariate regression model, the greatest impact on TAT was seen with variation in individual attending radiologists (adjusted coefficients, -11.9 to +29.4 minutes) and trainees (-40.1 to +95.7 minutes); reporting CTAs without a trainee and release of preliminary reports before final sign were associated with faster TATs (-19.9 and -26.9 minutes, respectively). Each stroke CTA within the preceding hour was associated with only a 2.8-minute increase in TAT. Secondary analyses suggested that previewing of cases during active scanning and use of \"structured\" reports correlate with a favorable impact on TAT among attending radiologists (both <i>P</i> < .05).</p><p><strong>Conclusions: </strong>Radiologist and trainee-level timeliness in stroke CTA reporting varies widely. Interventions aimed at improving workflow efficiency for both trainees and attending radiologists could improve timeliness of reporting.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}