Direct percutaneous puncture versus transarterial embolization for head and neck paragangliomas: A systematic review and meta-analysis.

INTRODUCTION: Embolization of head and neck paragangliomas (HNPs) is a well-established treatment strategy and adjunctive therapy. However, the optimal mode of intervention, whether by direct percutaneous puncture (DP) or via transarterial embolization (TAE), remains unclear. METHODS: The aim of this study was to complete a systematic literature review and meta-analysis to compare the safety and efficacy of DP versus TAE for HNP embolization. The Cochrane Library and MEDLINE databases were used to identify studies describing the clinical outcomes of either DP or TAE for HNP embolization. Outcome measures included: complete angiographic devascularization, major complications, and minor complications. Pooled rates were calculated for each variable which were then compared with meta-regression using a random effects model. RESULTS: Thirty-one retrospective studies met inclusion criteria, detailing 394 patients with 411 HNPs. Overall, DP was associated with a higher rate of complete devascularization (91.5%, 95% confidence interval [CI]: 85.6% to 97.4%; I2 = 0%) when compared to TAE technique (40.1%, CI: 27.2% to 58.9%; I2 = 93%). However, there was no difference regarding major complication rates between DP (6%, CI:1.3% to 10.8%; I2 = 0%) and TAE for HNP embolization (3.3%, CI: 1.4% to 5.3%; I2 = 0%) (p = 0.370), nor in minor complications between the techniques (p = 0.211). Subgroup analysis of TAE embolic agents revealed that particle embolics were associated with a significantly lower rate of major complications (2.5%; 0.4% to 4.6%; I2 = 0%) when compared to liquid embolics (10.6%, CI:4% to 17.3%; I2 = 48%; p = 0.022). CONCLUSIONS: A DP approach for HNP embolization results in a higher rate of complete devascularization and with a similar complication profile when compared to TAE. These findings also suggest that particle embolics are associated with fewer major complications compared to liquid embolics when TAE is utilized.

A pictorial review of imaging findings associated with upper cervical trauma.

The diagnosis of cervical spine injury in the emergency department remains a critical skill of emergency room physicians as well as radiologists. Such diagnoses are often associated with high morbidity and mortality unless readily identified and treated appropriately. Both computed tomography (CT) and magnetic resonance imaging (MRI) often are crucial in the workup of spinal injury and play a key role in arriving at a diagnosis. Unfortunately, missed cervical spine injuries are not necessarily uncommon and often precede detrimental neurologic sequalae. With the increase in whole-body imaging ordered from the emergency department, it is critical for radiologists to be acutely aware of key imaging features associated with upper cervical trauma, possible mimics, and radiographic clues suggesting potential high-risk patient populations. This pictorial review will cover key imaging features from several different imaging modalities associated with upper cervical spine trauma, explore patient epidemiology, mechanism, and presentation, as well as identify confounding radiographic signs to aid in confident and accurate diagnoses.

Confirmation of Intracranial Neuroendocrine Metastasis Using 68Ga-DOTATATE PET/CT.

Neuroendocrine tumors (NETs) are rare neoplasms with an exceedingly low incidence of intracranial metastasis. We present a 79-y-old woman with a biopsy-proven pulmonary neuroendocrine tumor who presented with an intracranial mass in the posterior fossa that was avid on 68Ga-DOTATATE PET/CT, facilitating the rare diagnosis of intracranial NET metastasis. The case highlights the utility of advanced imaging techniques in differentiating intracranial NET metastasis from other etiologies.

Declining Medicare Reimbursement for Diagnostic Radiology: A 10-Year Analysis Across 50 Imaging Studies.

INTRODUCTION: The aim of this study was to investigate trends in Medicare reimbursement from 2011 to 2021 for common diagnostic imaging studies, both at the individual study level and stratified by imaging modality. METHODS: The 50 most common imaging studies in diagnostic radiology were identified and the global reimbursement data from the Center of Medicare and Medicaid Services for each study was extracted from 2011 to 2021. The reimbursement rates were adjusted for inflation and assessed as a function of time for each individual study and by imaging modality. RESULTS: There was a combined mean reduction of inflation adjusted payments of 44.4% across all included imaging studies from 2011 to 2021. Only 3 out of 50 studies saw an increase in adjusted reimbursement during this time. Linear regression analysis revealed that the total mean adjusted reimbursement overall has significantly declined over time (R2 = 0.78, P = 0.0003). The pooled adjusted yearly percent change was also investigated, and an increase in reimbursement was only seen from 2016 to 2017 (+ 0.2%). The period with the steepest decline was in 2013 to 2014 (-16%). The overall yearly percent change was -5.5%. Lastly, reimbursement was stratified by imaging modality. MRI (-60.6%), CT (-44.4%), ultrasound (-31.3%), and radiographs (-6.2%) all experienced a mean decline in reimbursement, though at significantly different severities (P <0.0001). An evaluation of wRVUs during the study period revealed a decline from a mean value of 0.79 to 0.78 wRVUs (-1.3%). CONCLUSION: Diagnostic radiology has experienced significant reimbursement cuts over the past decade, most severely among cross sectional modalities. This data further characterizes reimbursement trends for the field and suggests the need for sustainable future reimbursement schedules.

Multifocal Meningiomas Mimicking Dural-Based Intracranial Metastases at 18F-Fluciclovine PET/CT.

A 78-year-old man with biochemically recurrent prostate adenocarcinoma (prostate-specific antigen, 2.3 ng/mL) but without detectable disease in the chest, abdomen, or pelvis at conventional CT imaging or in the bones at Tc-MDP scintigraphy underwent F-fluciclovine (anti-1-amino-3-F-fluorocyclobutane-1-carboxylic acid) PET/CT to evaluate for occult recurrent or metastatic disease. Imaging identified intense radiotracer uptake within 3 dural-based lesions along the left cerebral convexity. Subsequent MRI and biopsy confirmed multifocal World Health Organization grade 2 atypical meningiomas. Focal intracranial radiotracer uptake at F-fluciclovine PET/CT may create a diagnostic dilemma as incidental meningiomas can mimic intracranial metastases.

Inadvertent Injection of a Breast Implant During Lymphoscintigraphy.

A 34-year-old woman with history of bilateral saline implants, invasive ductal carcinoma of the right breast, and suspicious left breast calcifications was referred for left breast lymphoscintigraphy before bilateral mastectomy. A total of 3.2 mCi of Tc-filtered sulfur colloid was administered with 3 subdermal injections in the superior, lateral, and inferior periareolar left breast in the late afternoon preceding the day of surgery. Imaging identified radiotracer uptake within a dense, circular area deep to the injection sites within the left breast, compatible with implant puncture and radiotracer administration within the indwelling breast implant.