No abstract

SUMMARY:Vascular hyperintensities have been noted on FLAIR sequences obtained in the setting of acute stroke and intracranial steno-occlusive disease. The presence of FVHs likely represents disordered blood flow, often from collaterals distal to arterial occlusion or stenosis. As opposed to other vessel signs seen in arterial insufficiency, FVH is unique in that it does not represent thrombus, but rather sluggish or disordered blood flow through vessels. This review will discuss the diagnostic and prognostic value of FVH and its impact on clinical decision-making.ABBREVIATIONS: DWI ϭ diffusion-weighted imaging; FLAIR ϭ fluid-attenuated inversion recovery; FVH ϭ FLAIR vascular hyperintensity; GRE-BA ϭ gradient-echo susceptibility vessel blooming artifacts; HMCAS ϭ hyperdense MCA sign seen on CT; HVS ϭ hyperintense vessel sign; MCA ϭ middle cerebral artery; MRA ϭ MR angiography; MRI ϭ MR imaging; NIHSS ϭ National Institutes of Health Stroke Scale; PWI ϭ perfusion-weighted imaging; rtPA ϭ recombinant tissue plasminogen activator; TOF ϭ time of flight; TIA ϭ transient ischemic attacks A dvances in MR imaging have allowed better characterization of tissue and vessel status in cerebrovascular diseases, including acute stroke. Although the particular MR imaging sequences used for evaluation of stroke vary among institutions, FLAIR sequences are usually obtained. FLAIR sequences have a high sensitivity and specificity for the evaluation of brain parenchyma pathology and the subarachnoid spaces. 1,2One frequently encountered imaging finding in acute ischemic stroke is high signal intensity within blood vessels on FLAIR sequences (Fig 1). We aimed to review the current understanding of the etiology, physiology, and clinical significance of FVH. This underappreciated neuroimaging sign may have important clinical implications.In the past decade, FVHs have been associated with largevessel occlusion 3-7 or stenosis. 8 This finding has been termed "FVH," "hyperintense vessel sign," "hyperintense vessels on FLAIR," and the "ivy sign" (Table). For this review, it will be referred to exclusively as FVH. FVHs are described as focal, tubular, or serpentine hyperintensities seen, often transiently, in the subarachnoid space against the relative hypointensity of CSF. As opposed to other vessel signs seen in arterial insufficiency, FVH is unique in that it does not represent thrombus but rather is a representation of the sluggish or disordered blood flow through vessels, most often leptomeningeal collaterals.9,10 Its presence indicates regions of abnormal blood flow and potentially salvageable brain tissue in acute stroke. This review will discuss the diagnostic and prognostic value of FVH and its impact on clinical decision-making. Identification of FVHThe key to identification of FVH is to be aware of its appearance and of the clinical conditions in which it appears with greater frequency. Although the most frequent location is within the Sylvian fissure, FVH has been noted within distal branches of the anterior, middle, and posteri...

I ntracranial hemorrhage is a potentially life-threatening problem that has many direct and indirect causes. Accuracy in diagnosing the presence and type of intracranial hemorrhage is a critical part of effective treatment. Diagnosis is often an urgent procedure requiring review of medical images by highly trained specialists and sometimes necessitating confirmation through clinical history, vital signs, and laboratory examinations. The process is complicated and requires immediate identification for optimal treatment.Intracranial hemorrhage is a relatively common condition that has many causes, including trauma, stroke, aneurysm, vascular malformation, high blood pressure, illicit drugs, and blood clotting disorders (1). Neurologic consequences can vary extensively from headache to death depending upon the size, type, and location of the hemorrhage. The role of the radiologist is to detect the hemorrhage, characterize the type and cause of the hemorrhage, and to determine if the hemorrhage could be jeopardizing critical areas of the brain that might require immediate surgery.While all acute hemorrhages appear attenuated on CT images, the primary imaging features that help radiologists determine the cause of hemorrhage are the location, shape, and proximity to other structures. Intraparenchymal hemorrhage is blood that is located completely within the brain itself. Intraventricular or subarachnoid hemorrhage is blood that has leaked into the spaces of the brain that normally contain cerebrospinal fluid (the ventricles or subarachnoid cisterns, respectively). Extra-axial hemorrhage is blood that collects in the tissue coverings that surround the brain (eg, subdural or epidural subtypes). It is important to note that patients may exhibit more than one type of cerebral hemorrhage, which may appear on the same image or imaging study. Although small hemorrhages are typically less morbid than large hemorrhages, even a small hemorrhage can lead to death if it is in a critical location. Small hemorrhages also may herald future hemorrhages that could be fatal (eg, ruptured cerebral aneurysm). The presence or absence of hemorrhage may guide specific treatments (eg, stroke).Detection of cerebral hemorrhage with brain CT is a popular clinical use case for machine learning (2-5). Many of these early successful investigations were based upon relatively small datasets (hundreds of examinations) from single institutions. Chilamkurthy et al created a diverse brain CT dataset that was selected from 20 geographically distinct centers in India (more than 21 000 unique examinations). This was used to create smaller randomly selected subsets for validation and testing on common acute brain abnormalities (6). The ability for machine learning algorithms to generalize to "real-world" clinical imaging data from disparate institutions is paramount to successful use in the clinical environment.The intent for this challenge was to provide a large multiinstitutional and multinational dataset to help develop machine learning algorithms that ca...

As a result of the coronavirus disease 2019 (COVID-19) pandemic, faculty members in medicine shifted their academic work to the home environment. Simultaneously, schools and childcare facilities closed, resulting in increased responsibilities and competing demands on working parents. Before the pandemic, women in academic medicine reported spending 8.5 more hours per week on domestic tasks and childcare than their partners and were more likely to take time off because of childcare needs if their partners worked full-time [1]. The disruptions created by the COVID-19 pandemic may amplify gender differences, resulting in a loss of academic productivity among women with consequences to their career advancement [2].Our study objective was to review peer-reviewed journal scholarly activity among male and female contributors to JACR during the first 7 months of the COVID-19 pandemic and to compare it with scholarly journal activity during the comparable months in the year prior. We hypothesized that the proportion of female contributors both submitting manuscripts and accepting peer review invitations decreased during the COVID-19affected months of 2020 compared with the same months in 2019.

IntroductionMedical imaging now accounts for most of the US population's exposure to ionizing radiation. A substantial proportion of this medical imaging is ordered in the emergency setting. We aim to provide a general overview of radiation dose from medical imaging with a focus on computed tomography, as well as a literature review of recent efforts to decrease unnecessary radiation exposure to patients in the emergency department setting.MethodsWe conducted a literature review through calendar year 2010 for all published articles pertaining to the emergency department and radiation exposure.ResultsThe benefits of imaging usually outweigh the risks of eventual radiation-induced cancer in most clinical scenarios encountered by emergency physicians. However, our literature review identified 3 specific clinical situations in the general adult population in which the lifetime risks of cancer may outweigh the benefits to the patient: rule out pulmonary embolism, flank pain, and recurrent abdominal pain in inflammatory bowel disease. For these specific clinical scenarios, a physician-patient discussion about such risks and benefits may be warranted.ConclusionEmergency physicians, now at the front line of patients' exposure to ionizing radiation, should have a general understanding of the magnitude of radiation dose from advanced medical imaging procedures and their associated risks. Future areas of research should include the development of protocols and guidelines that limit unnecessary patient radiation exposure.

Conventional contrast-enhanced MR imaging is the current standard technique for the diagnosis and treatment evaluation of gliomas and other brain neoplasms. However, this method is quite limited in its ability to characterize the complex biology of gliomas and so there is a need to develop more quantitative imaging methods. Perfusion and permeability MR imaging are two such techniques that have shown promise in this regard. This review will highlight the underlying principles, applications, and pitfalls of these evolving advanced MRI methods.

Rationale and Objectives: Our objectives were (1) to determine the extent to which gender discrimination and sexual harassment are experienced by female radiologists and trainees; (2) to examine whether experiencing harassment or discrimination influences perceptions of gender parity; and (3) to explore whether the existence of either formal institutional policies or the number of women in the workplace and/or in leadership positions influences perceptions of having achieved gender equity.Materials and Methods: An online anonymous questionnaire, developed through an Association of University Radiologists (AUR) À affiliated 2019À2020 Task Force, was used to assess participant demographics, perceptions of gender parity, and experiences of gender discrimination and sexual harassment.Results: A total of 375 complete responses were collected. All respondents were female with most practices consisting of fewer than 25% female radiologists. The majority of respondents reported having been a victim of sexual harassment (n = 226, 60.3%) and gender discrimination (n = 318, 84.8%) in the workplace. Approximately 87.5% of participants believed workplace gender parity would take longer than 10 years to achieve; 26.9% responded that it will never happen. Experiencing gender discrimination or harassment in the workplace was significantly associated with a negative outlook on achieving gender parity. Conversely, the presence and number of adequate formal institutional policies to address workplace gender equity and harassment were significantly associated with optimistic views on achieving gender parity. Higher percentages of women in one's practice as well as number of women in leadership positions were also significantly associated with more optimistic expectations. Conclusion:Gender discrimination and sexual harassment are common in the field of radiology and influence victims' outlook on achieving gender parity in the workplace. Perceptions can be improved by implementing adequate institutional training policies on harassment and increasing the representation of female radiologists.

BACKGROUND AND PURPOSE: MMD has been shown to result in impairment of executive functioning in adults. The purpose of this study was to correlate presurgical neuropsychological assessments with the severity of primary MMD as measured by CBF and CVR and with secondary damage from MMD as estimated by cortical stroke and WMD.