Our objective was to determine disagreement rates in radiological reports provided by using a double-reading protocol in a national teleradiology company.
From January 2015 to July 2016, 134169 ...radiological exams from 36 French centers, benefited outsourced interpretations by certified radiologists, in both regular and after-hours activities. Of these, 2040 CT and MR-scans (1.5%) were subjected to a second opinion by other radiologists in the field of their anatomical specialty (cerebral, thoracic, abdominal-pelvic, and osteoarticular). A five-point agreement scale graded from 0 to 4 was assigned for each exam. Disagreements were considered as minor if no clinical consequence for patient (scores 1 and 2) and major if potential clinical consequence (score 3 and 4). Independent radiologists performed a retrospective analysis and a stratified statistical analysis.
Double reading was performed on CT-scans (n = 934/2040, 45.8%) and MR-scans (n = 1106/2040, 54.2%) performed in regular (80.1%) and after-hours activities (19.9%). Disagreement scores occurred in 437 exams (21.4%), including major disagreements in 59 (2.9%). Among these, 48/754 were assigned by the thoracic second reader (6.4%), 6/70 by the abdominal-pelvic second reader (8.6%), 3/901 by the osteoarticular second reader (0.3%), and 2/315 by the cerebral second reader (0.6%), with statistical significant difference. No additional disagreement rate was observed in regular and after-hours activities (P = 0.63).
Double-reading of outsourced CT and MRI interpretations yielded 21.4% disagreement rate, with potential clinical consequence for patient in 2,9% of the cases. These results are in accordance with those previously reported and suggests that quality assurance of outsourced interpretations is needed.
Gadolinium-based contrast agents (GBCAs) are used in up to 35% of magnetic resonance imaging (MRI) examinations and are associated with an excellent safety profile. Nevertheless, two main issues have ...arisen in the last two decades: the risk of nephrogenic systemic fibrosis and the risk of gadolinium deposition and retention. As a first step, this article reviews the different categories of GBCAs available in neuroradiology, their issues, and provides updates regarding the use of these agents in routine daily practice. Recent advances in MRI technology, as well as the development of new MRI sequences, have made GBCA injection avoidable in many indications, especially in patients with chronic diseases when iterative MRIs are required and when essential diagnostic information can be obtained without contrast enhancement. These recent advances also lead to changes in recommended MRI protocols. Thus, in a second step, this review focuses on consensus concerning brain MRI protocols in 10 common situations (acute ischemic stroke, intracerebral hemorrhage, cerebral venous thrombosis, multiple sclerosis, chronic headache, intracranial infection, intra- and extra-axial brain tumors, vestibular schwannoma and pituitary adenoma). The latter allowing the standardization of practices in neuroradiology. Recommendations were also made concerning the use of GBCAs in neuroradiology, based on evidence in the literature and/or by consensus between the different coauthors.
Spatial neglect is one of the main predictors of poor functional recovery after stroke. Many therapeutic interventions have been developed to alleviate this condition, but to date the evidence of ...their effectiveness is still scarce.
The purpose of this study was to test whether combining prism adaptation (PA) and methylphenidate (MP) could enhance the recovery of neglect patients at a functional level.
RITAPRISM is a multicentre, randomized, double-blind, placebo-controlled study comparing PA plus placebo (control) versus PA plus MP. 24 patients were prospectively enrolled (10 in the placebo group and 14 in the MP group).
The main result is a long-term functional improvement (on the functional independence measure (FIM) and on Bergego's scale) induced by MP combined with PA. No serious adverse event occurred.
The long-term benefit on activities of daily living (ADL) obtained in this randomized controlled trial set this intervention apart from previous attempts and supports with a high level of evidence the value of combining PA and MP in order to improve the autonomy of neglect patients. Further studies will be needed to clarify the mechanism of this improvement. Although not specifically assessed at this stage, a part of the improvement in ADL might be related to the collateral effect of MP on mood, executive functions or fatigue, and/or the combined effect of PA and MP on motor intentional bias of neglect patients.
This study provides Class I evidence that adding MP to PA improves the functional outcome of neglect patients.
EUCTR2008-000325-20-FR.
Liponeurocytoma of the Cerebellopontine Angle Chiaramonte, Carmela; Rabaste, Sylvain; Jacquesson, Timothee ...
World neurosurgery,
April 2018, 2018-Apr, 2018-04-00, 20180401, 2018-04, Volume:
112
Journal Article
Peer reviewed
Liponeurocytoma is a very rare tumor classified as grade II (neuronal and mixed neuronal-glial tumors) according to 2016 World Health Organization classification of tumors of the central nervous ...system. The median age at detection is 50 years, and the most frequent location is the posterior cranial fossa, especially within the cerebellar hemispheres; liponeurocytomas arising in the cerebellopontine angle (CPA) are exceptional.
Here we report the clinical, radiological, and pathological characteristics of a CPA liponeurocytoma in a 35-year-old woman, as well as a review of the literature. This unusual cisternal location raises the issue of the differential imaging diagnosis with much more common CPA tumors (e.g., meningiomas, vestibular schwannomas, ependymomas, epidermoid cyst, hemangioblastomas, medulloblastomas).
To the best of our knowledge, 59 cases of cerebellar liponeurocytomas have been reported to date, which include only 6 cases of CPA liponeurocytomas. Treatment relies on total removal whenever possible, with an excellent prognosis, but a high MIB-1 index (>10%) and/or incomplete tumor resection are the main adverse prognostic factors.
•Liponeurocytoma is a rare grade II tumor (neuronal and mixed neuronal-glial tumors) that may develop into the cerebellopontine angle.•The pathological differential diagnosis might be difficult particularly with medulloblastoma.•The complete surgical removal represents the only gold standard treatment.
Abstract Prevalence of pituitary incidentaloma is variable: between 1.4% and 27% at autopsy, and between 3.7% and 37% on imaging. Pituitary microincidentalomas (serendipitously discovered adenoma < 1 ...cm in diameter) may increase in size, but only 5% exceed 10 mm. Pituitary macroincidentalomas (serendipitously discovered adenoma > 1 cm in diameter) show increased size in 20–24% and 34–40% of cases at respectively 4 and 8 years’ follow-up. Radiologic differential diagnosis requires MRI centered on the pituitary gland. Initial assessment of nonfunctioning (NF) microincidentaloma is firstly clinical, the endocrinologist looking for signs of hypersecretion (signs of hyperprolactinemia, acromegaly or Cushing's syndrome), followed up by systematic prolactin and IGF-1 assay. Initial assessment of NF macroincidentaloma is clinical, the endocrinologist looking for signs of hormonal hypersecretion or hypopituitarism, followed up by hormonal assay to screen for hypersecretion or hormonal deficiency and by ophthalmologic assessment (visual acuity and visual field) if and only if the lesion is near the optic chiasm (OC). NF microincidentaloma of less than 5 mm requires no surveillance; those of ≥ 5 mm are not operated on but rather monitored on MRI at 6 months and then 2 years. Macroincidentaloma remote from the OC is monitored on MRI at 1 year, with hormonal exploration (for anterior pituitary deficiency), then every 2 years. When macroincidentaloma located near the OC is managed by surveillance rather than surgery, MRI is recommended at 6 months, with hormonal and visual exploration, then annual MRI and hormonal and visual assessment every 6 months. Surgery is indicated in the following cases: evolutive NF microincidentaloma, NF macroincidentaloma associated with hypopituitarism or showing progression, incidentaloma compressing the OC, possible malignancy, non-compliant patient, pregnancy desired in the short-term, or context at risk of apoplexy.
Background:
Sex steroids could explain the course of multiple sclerosis (MS) in pregnancy.
Objective:
To compare the annualized relapse rate (ARR) 12 weeks post-partum in women treated with ...nomegestrol acetate (NOMAc) and 17-beta-estradiol (E2) versus placebo.
Methods:
POPARTMUS is a randomized, proof-of-concept trial in women with MS, receiving oral NOMAc 10 mg/day and transdermal estradiol 75 µg/week, or placebo.
Results:
Recruitment was stopped prematurely due to slow inclusions (n = 202). No treatment effect was observed on ARR after 12 weeks (sex steroids = 0.90 (0.58–1.39), placebo = 0.97 (0.63–1.50) (p = 0.79)).
Conclusion:
POPARTMUS failed showing efficacy of a NOMAc–E2 combination in preventing post-partum relapses.
Purpose
To assess the impact of a different distortion correction (DC) method and patient geometry (sagittal balance) on the quality of spinal cord tractography rendering according to different ...tractography approaches.
Methods
Forty‐four adults free of spinal cord diseases underwent cervical diffusion‐weighted imaging. The phase‐encoding direction was head→foot. Sequence with opposed polarities (foot→head) was acquired to perform DC. Eddy‐current, motion effects, and susceptibility artifact correction methods were used for DC, and two deterministic and one probabilistic tractography approaches were evaluated using MRtrix and DSI Studio tractography software. Fiber length and number of fibers were extracted to evaluate the quality of the tractography rendering. For each subject, cervical lordosis was measured to assess patient geometry. The angle between the main direction of the spinal cord and the orientation of the acquisition box were computed at each spine level to assess acquisition geometry and define an angle threshold for which a tractography of good quality is no longer possible.
Results
There was a significant improvement in tractography quality after performing DC with susceptibility artifact correction using a deterministic approach based on tensor. Before DC, the angle threshold was defined at C6 (15.2°) compared with C7 (21.9°) after corrections, demonstrating the importance of spinal cord angulation for DC.
Conclusion
The impact of DC on tractography quality is greatly impacted by acquisition geometry. To obtain a good‐quality tractography, we propose as a future perspective to adapt the acquisition geometry to that of the patient by automatically adjusting the acquisition box.
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