Canadian Association of Radiologists Head and Neck Imaging Referral Guideline.

The Canadian Association of Radiologists (CAR) Head and Neck Expert Panel consists of radiologists, a laryngologist and laryngeal surgeon, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 11 clinical/diagnostic scenarios, a systematic rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 17 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop 26 recommendation statements across the 11 scenarios. This guideline presents the methods of development and the referral recommendations for sinus disease, tinnitus, thyroid and parathyroid disease, neck mass of unknown origin, acute sialadenitis, chronic salivary conditions, and temporomandibular joint dysfunction.

Direct Puncture of the Superficial Temporal Artery in Embolization of a Scalp Arteriovenous Fistula: A Case Report.

We describe a minimally invasive endovascular approach to treat an arteriovenous fistula of the scalp. We performed a direct puncture of the lesion through the patient's scalp for liquid embolic agent injection along with external compression of the superficial temporal artery to perform a "manual pressure-cooker technique." The combination of these minimally invasive techniques resulted in an excellent clinical and radiographic outcome.

Association between vascular calcification in intracranial vertebrobasilar circulation and luminal stenosis.

INTRODUCTION: The study aims to assess the correlation and association between calcium burden and luminal stenosis in the vertebrobasilar circulation. METHODS: We evaluated 166 patients [mean age, 79.8 ± 8.8 (SD) with 93 males] with stroke symptoms. The calcification patterns were assessed on non-contrast CT (NCCT); quantitative calcium burden [Agatston-Janowitz (AJ) calcium score, volume, and mass] on the initial non-contrast phase of CT perfusion (CTP); and the qualitative and quantitative luminal stenosis on CT angiography (CTA) studies. We calculated the correlation coefficient and association between measures of calcium burden and luminal stenosis. RESULTS: Two hundred twenty-eight of 498 arteries (45.8%) had detectable calcification on NCCT and measurable stenosis in 169 of 498 arteries (33.9%) on CTA. We found a moderate correlation between qualitative calcium burden and qualitative (0.51 for R1 and 0.62 for R2, p < 0.01) as well as quantitative luminal stenosis (0.67 for R1 and 0.69 for R2, p < 0.01). There was a moderate correlation of AJ score (0.66), volume (0.68), and mass of calcification (0.60, p < 0.01) with luminal stenosis measurements. The quantitative calcium burden and luminal stenosis showed statistically significant differences between different qualitative categories of calcium burden (p < 0.001 in both readers). However, severe stenosis was not seen even with the advanced circumferential wall calcification (mean stenosis of 35.3-40.7%). CONCLUSION: Our study showed a moderate correlation between higher burden of vascular calcification and the degree of luminal stenosis. However, higher calcium burden and circumferential wall calcification were not associated with severe luminal stenosis.

Diagnostic Radiology Residency Assessment Tools: A Scoping Review.

PURPOSE: The multifaceted nature of learning in diagnostic radiology residency requires a variety of assessment methods. However, the scope and quality of assessment tools has not been formally examined. A scoping review was performed to identify assessment tools available for radiology resident training and to evaluate the validity of these tools. METHODS: A literature search was conducted through multiple databases and on-line resources. Inclusion criteria were defined as any tool used in assessment of radiology resident competence. Data regarding residents, evaluators and specifics of each tool was extracted. Each tool was subjected through a validation process with a customized rating scale using the 5 categories of validity: content, response process, internal structure, relations to other variables, and consequences. RESULTS: The initial search returned 447 articles; 35 were included. The most evaluated competency being overall knowledge (31%), most common published journal was Academic Radiology (24%); evaluations were most commonly set in the United States (57%). In terms of validation, we found low adherence to modern integrated validity, with 34% of studies including a definition of validity. When specifically examining the 5 domains of validation evidence presented, most were either absent or of low rigor (70%). Only one study presented a modern definition of validation (3%, 1/35). CONCLUSION: We identified 35 evaluation tools covering a variety of competency areas. However, few of these tools have been validated. Development of new validated assessment tools or validation of existing tools is essential for the ongoing transition to a competency-based curriculum.

Reversible sulcal FLAIR hyperintensity on MRI in a migraine patient with aura.

Reversible sulcal fluid-attenuated inversion recovery (FLAIR) hyperintensity is a rare imaging finding that could be seen on magnetic resonance imaging (MRI), in patients with migraine with aura. Herein, we present a patient who was admitted to the emergency department with severe headaches, numbness on the right side of the body, and visual changes. MRI showed sulcal FLAIR hyperintensity in the occipital lobes, with no other abnormality. The patient was diagnosed with migraine with aura by neurology and the follow up MRI showed resolution of the finding, supporting the diagnosis. Sulcal hyperintensity on FLAIR is a nonspecific imaging finding that can occur with or without cerebral spinal fluid (CSF) abnormality. Although, clinical correlation and CSF analysis may be required, radiologists may often be able to suggest the cause of abnormal CSF signal depending on the distribution of sulcal FLAIR hyperintensity, and the presence of additional imaging findings.

Up-Regulation of Interleukin-9 and the Interleukin-9-Associated Calcium-Activated Chloride Channel hCLCA1 in Nasal Mucosa Following In Vivo Allergen Challenge.

: Interleukin (IL)-9 is a pleiotropic T helper 2-type cytokine that has been shown to be up-regulated in allergic airway disease, including asthma. IL-9 has been demonstrated to be a potent stimulus for the production and secretion of mucus from airway epithelial cells via induction of a calcium-activated chloride channel, hCLCA1. The objective of this study was to investigate the expression of IL-9 and hCLCA1 following allergen challenge in the nasal mucosa of allergic rhinitis patients. Nasal biopsies were obtained from allergic rhinitis patients out of allergen season both before (baseline) and after local antigen challenge with either ragweed or diluent (control). Immunohistochemistry and in situ hybridization were used to assess IL-9 protein and hCLCA1 messenger ribonucleic acid. Eosinophils and T cells were detected using immunohistochemistry. IL-9 and hCLCA1 were very low at baseline, and expression was significantly up-regulated following ragweed challenge. Whereas the number of eosinophils increased after allergen challenge, T-cell counts did not change significantly. The results of this study demonstrate the relationship between specific allergen challenge and expression of both IL-9 and hCLCA1, suggesting a possible mechanism for the increased production of mucus from airway epithelial cells in allergic rhinitis.