Malpractice Litigation Related to Diagnosis and Treatment of Intracranial Aneurysms.

BACKGROUND AND PURPOSE: Approaches to management of intracranial aneurysms are inconsistent, in part due to apprehension relating to potential malpractice claims. The purpose of this article was to review the causes of action underlying medical malpractice lawsuits related to the diagnosis and management of intracranial aneurysms and to identify the factors associated and their outcomes. MATERIALS AND METHODS: We consulted 2 large legal databases in the United States to search for cases in which there were jury awards and settlements related to the diagnosis and management of patients with intracranial aneurysms in the United States. Files were screened to include only those cases in which the cause of action involved negligence in the diagnosis and management of a patient with an intracranial aneurysm. RESULTS: Between 2000 and 2020, two hundred eighty-seven published case summaries were identified, of which 133 were eligible for inclusion in the analysis. Radiologists constituted 16% of 159 physicians sued in these lawsuits. Failure to diagnose was the most common medical malpractice claim referenced (100/133 cases), with the most common subgroups being "failure to include cerebral aneurysm as a differential and thus perform adequate work-up" (30 cases), and "failure to correctly interpret aneurysm evidence on CT or MR imaging" (16 cases). Only 6 of these 16 cases were adjudicated at trial, with 2 decided in favor of the plaintiff (awarded $4,000,000 and $43,000,000, respectively). CONCLUSIONS: Incorrect interpretation of imaging is relatively infrequent as a cause of malpractice litigation compared with failure to diagnose aneurysms in the clinical setting by neurosurgeons, emergency physicians, and primary care providers.

Lesion detection on a combined "All-in-One" window compared to conventional window settings in thoracic oncology chest CT examinations.

PURPOSE: The purpose of this study was to investigate if lesion detection using a single "All-in-One" (AIO) window was non-inferior to lesion detection on conventional window settings in thoracic oncology chest computed tomography (CT) examinations. MATERIALS AND METHODS: In a retrospective study, 50 consecutive chest CT examinations of 50 patients (31 men, 19 women; mean age 64±10 [SD] years, range: 35-82 years) containing 417 lesions, were reviewed by 6 radiologists, subdivided into 2 groups of 3 radiologists each, with similar levels of expertise in each group (senior staff member, junior staff member and radiology resident). All examinations were reviewed in conventional or AIO window settings by one of the groups. A 'lesion' was defined as any abnormality seen on the chest CT examination, including both benign and malignant lesions, findings in chest and upper abdomen, and measurable and non-measurable disease. Lesions were listed as 'missed' when they were not seen by at least two out of three observers. F-tests were used to evaluate the significance of the variables of interest within a mixed model framework and kappa statistics to report interobserver agreement. RESULTS: On a reader level, 54/417 lesions (12.9%) were not detected by the senior staff member reading the studies in conventional window settings and 45/417 (10.8%) by the senior staff member reading the AIO images. For the junior staff member and radiology resident this was respectively 55/417 (13.2%) and 67/417 (16.1%) for the conventional window settings and 43/417 (10.3%) and 61/417 (14.6%) for the AIO window. On a lesion level, 68/417 (16.3%) were defined as 'missed' lesions (lesions not detected by at least 2 readers): 21/68 (30.9%) on the AIO-window, 30/68 (44.1%) on conventional views and 17/68 (25.0%) on both views. The use of the AIO window did not result in an increase of missed lesions (P>0.99). Interobserver agreement in both groups was similar (P=0.46). Regarding lesions that were categorized as 'missed' on the AIO window or on conventional window settings, there was no effect of location (chest or upper abdomen) (P=0.35), window (P=0.97) and organ (P=0.98). CONCLUSIONS: A single AIO-window is non-inferior to multiple conventional window settings for lesion detection on chest CT examinations in thoracic oncology patients.

MRI following primary repair of the anterior cruciate ligament.

Primary repair of the anterior cruciate ligament (ACL) is being performed increasingly in the treatment of acute proximal ACL ruptures. Advantages of ACL repair over surgical reconstruction with a tendon graft include preservation of the anatomy and proprioceptive function of the native ACL, and therefore, faster rehabilitation. The addition of an internal brace protects the repair during ACL healing and can increase the success rate of the procedure. Given this evolution of ACL surgical treatment, radiologists should be familiar with the new repair techniques and their appearances on postoperative imaging. In this article, we describe two different surgical techniques for primary ACL repair, dynamic intraligamentary stabilisation and internal brace ligament augmentation, and provide an overview of the normal and abnormal appearances after this type of repair at magnetic resonance imaging (MRI) follow-up.

The degenerative spine: pattern recognition and guidelines to image interpretation.

Degenerative disease of the spine, in the form of intervertebral disc degeneration and bony growth, causing osteophytes and impinging upon the spinal canal and neural foramina, is the most frequent disorder affecting the spine. In this chapter we first discuss briefly the indications for computed tomography or magnetic resonance imaging in suspected degenerative spine disease. We then describe changes of disc height, signal intensity, and disc contour with aging and repeated microtrauma, as well as the imaging techniques most appropriate to image them. A grading system for lumbar disc changes is provided. Stenosis of the canal and neural foramina is reviewed next, concluding with a description of degenerative changes affecting the vertebral endplates and bone marrow.

Social media for radiologists: an introduction.

UNLABELLED: Social media, which can be defined as dynamic and interactive online communication forums, are becoming increasingly popular, not only for the general public but also for radiologists. In addition to assisting radiologists in finding useful profession-related information and interactive educational material in all kinds of formats, they can also contribute towards improving communication with peers, clinicians, and patients. The growing use of social networking in healthcare also has an impact on the visibility and engagement of radiologists in the online virtual community. Although many radiologists are already using social media, a large number of our colleagues are still unaware of the wide spectrum of useful information and interaction available via social media and of the added value these platforms can bring to daily practice. For many, the risk of mixing professional and private data by using social media creates a feeling of insecurity, which still keeps radiologists from using them. In this overview we aim to provide information on the potential benefits, challenges, and inherent risks of social media for radiologists. We will provide a summary of the different types of social media that can be of value for radiologists, including useful tips on how to use them safely and efficiently. MAIN MESSAGES: • Online social networking enhances communication and collaboration between peers • Social media facilitate access to educational and scientific information • Recommendations and guidelines from policymakers and professional organisations are needed • Applications are desired for efficient and secure exchange of medical images in social media.

The Endovascular Treatment of Epistaxis.

Epistaxis or nosebleed is relatively common in the general population. Depending on the location of the bleeding in the nasal cavity, epistaxis can be divided in two types: anterior or posterior type. The anterior type is far more frequent, often self-limiting and, if needed, is relatively easy treatable. Posterior type epistaxis is rare and more likely to require medical attention. The cornerstone of the conservative therapy of posterior epistaxis is nasal packing. Only in patients with persistent or recurrent epistaxis, endovascular intervention or surgery is indicated. Both treatment options have a similar success and complication rate, but endovascular treatment, if feasible, has several advantages above surgical treatment. The choice of procedure should be made on a patient-to-patient basis, taking several parameters into account. In this pictorial essay we present an overview of the relevant radiological anatomy and a review of various causes of epistaxis, with the emphasis on the endovascular treatment.

Lithium-Induced Nephropathy.

BACKGROUND: A 59-year-old man was referred for CT scan of the abdomen after repair of an eventrated appendectomy wound. The man had a known history of bipolar affective disorder, for which he had been on lithium therapy for many years. As an incidental finding, CT scan showed numerous small hypodense renal lesions. Subsequently a MRI examination was performed to further characterize these renal abnormalities.

Septic Thrombophlebitis of the Right Ovarian Vein.

BACKGROUND: A 26-year-old woman presented at the emergency department with a painful abdomen and fever up to 39°C, despite antibiotics. She had given prematurely birth by caesarian section to a twin 8 days earlier. On clinical examination she had a diffuse painful and tender abdomen, especially on the right side and suprapubic region. Laboratory findings showed an increased c-reactive protein of 24 mg/dL (normal < 0,3) and increased white blood cell count of 13 Å~ 10E9/L (normal 4,3-10 Å~ 10E9/L). There was also a decreased hemoglobin level of 8,4 g/dL (normal 12-15 g/dL). An ultrasonography was performed by the gynecologist and revealed a large heterogeneous fluid collection anteriorly of the uterus.

Bronchial Atresia.

BACKGROUND: A 48-year-old male smoker with no significant previous medical history presented to the emergency department with acute respiratory distress, characterized by dyspnea and nonspecific chest pain. Laboratory findings and electrocardiography (ECG) were normal.

Developmental venous anomaly: MR and angiographic features.

Developmental venous anomaly (DVA) is probably the most common anomaly of the intracranial vasculature. DVAs consist of multiple, radially oriented dilated medullary veins that converge into a transcerebral vein. We describe the imaging findings of this vascular anomaly in different patients and the role of different imaging modalities.

Giant cavernous malformations in young adults: report of two cases, radiological findings and surgical consequences.

Cerebral cavernous malformations, also known as cavernous angioma or cavernoma, are a type of vascular disorder. They consist of abnormally large vascular cavities or sinusoid channels of varying size. The majority of cavernous malformations in the brain are small and do not always present with symptoms. A minority of large cavernous malformations, known as giant cavernous malformations (GCM), can cause neurological symptoms (such as headaches, focal neurologic deficits and seizures), which are probably related to hemorrhage and mass effect. GCM grow steadily in size over time, due to repetitive episodes of bleeding. The purpose of this paper is to document two case reports of patients with GCM, illustrate the radiological appearance, discuss the neurosurgical consequences, and to provide a literature analysis.

Mucocele of the appendix: case report and review of literature.

Mucocele of the appendix is a descriptive term of a distended, mucus-filled appendix caused by various conditions, both benign and malignant. Computed tomography is the imaging modality of choice. Correct pre-operative diagnosis is important because of the possibility of peroperative rupture and subsequent development of pseudomyxoma) peritonei. It is the task of the radiologist to alert the clinician and surgeon to the presence of this entity, the potential associated complications and possible signs of malignancy.

Update in non small-cell lung cancer staging.

Significant progress has been made with the introduction of the TNM-7 staging system for non-small cell lung cancer (NSCLC). Constituting the first major revision in 12 years, the seventh edition of NSCLC TNM (TNM-7) is based on the recommendations from the International Association for the Study of Lung Cancer (IASLC) Lung Cancer Staging Project of 2007. This new TNM iteration includes a subset analysis on SCLC and carcinoid tumors. A thorough understanding of its principles by the radiologist is helpful to increase efficiency and to improve communication with the referring clinicians.

Regional gray matter volume differences and sex-hormone correlations as a function of menstrual cycle phase and hormonal contraceptives use.

During the menstrual cycle, hormone-driven functional and morphological changes occur in the female brain. The influence of hormonal contraceptives on these changes has received only little attention in the medical literature. The purpose of our study is to measure regional gray matter volume changes as a function of the cycle phase and use of hormonal contraceptives, in relation to blood concentrations of sex hormones. We performed a prospective study in 30 healthy young women; 15 women had a natural menstrual cycle and 15 were using monophasic combined hormonal contraceptives. MRI examinations were acquired at 2 specific time-points in the cycle (follicular and luteal phase). MRI studies included a T1-weighted, isotropic, high-resolution 3-D gradient echo acquisition, for the purpose of performing voxel based morphometry. Peripheral venous blood samples were obtained to determine concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, and progesterone. We found a highly significant negative correlation of regional gray matter volume in the anterior cingulate cortex with estradiol concentrations. To the best of our knowledge, this result has not been described before, and was only present in the natural cycle group, not in women using hormonal contraceptives. The anterior cingulate cortex is involved in emotion processing and there is literature describing behavioral alternations with changing hormone levels. Our findings provide a structural, morphological basis to support these data. Therefore, we advise neuroscientists to take into account the menstrual cycle phase and use of hormonal contraceptives, in order to avoid obtaining heterogeneous data sets, leading to a significant loss of accuracy and precision.

Impaired coronary flow reserve after a recent myocardial infarction: correlation with infarct size and extent of microvascular obstruction.

BACKGROUND: The exact relationship between the coronary flow reserve (CFR) and infarct size remains unknown. In this prospective study the relationship between the CFR both in the infarcted and remote myocardium and infarct size was investigated. Furthermore, the diagnostic value of the CFR to predict the extent of microvascular obstruction (MO) was evaluated. METHODS: In thirty patients the CFR was measured with a Doppler guide wire 6 ± 3 days after a first myocardial infarction (MI) in the infarct related and in a reference coronary artery. MO and infarct size were determined with magnetic resonance imaging. RESULTS: The CFR was inversely related to infarct size in the infarcted and remote myocardium (respectively, r=-0.60, p<0.01 and r=-0.62, p<0.01). In the infarcted myocardium the extent of MO was strongly related to the infarct size and was in a multivariate analysis the single significant determinant of the CFR and the hyperaemic flow. In the remote myocardium no relationship was present between infarct size and hyperaemic flow, but the baseline flow increased as the infarct size became larger (r=0.58, p<0.01). In a receiver operator characteristic (ROC) analysis, a CFR value ≤ 2 in the infarct related coronary artery offered the best sensitivity (65%) and specificity (71%) to detect the presence of MO (p<0.05). CONCLUSIONS: After MI, the CFR both in the infarcted and remote myocardium is inversely related to infarct size. In the infarcted myocardium, a CFR value ≤ 2 predicts the presence of MO with moderate sensitivity and specificity.

Pneumosinus dilatans in anterior skull base meningiomas.

INTRODUCTION: Skull base meningiomas are often missed on non-contrast CT or MR examinations due to their close proximity to bone and low lesion to brain contrast. The purpose of this study is to illustrate that pneumosinus dilatans can be an indicator of anterior skull base meningiomas. METHODS: A retrospective search of the radiology information system and picture archiving and computing system database was performed. Search terms were "meningioma" in association with "pneumosinus dilatans." Medical records and imaging studies were reviewed independently by two experienced neuroradiologists and were read in consensus. We recorded the patient age at the time of discovery of the meningioma, main presenting symptom(s), location of the tumor, and imaging characteristics. We also performed a comparative literature search for pneumosinus dilatans and its association with meningiomas. RESULTS: Ten patients (six women; four men) were identified in whom a meningioma of the anterior skull base was associated with a pneumosinus dilatans. Three patients had multiple meningiomas, so a total of 14 intracranial tumors were identified. Mean age at discovery was 59 years with an age range of ± 20years. All meningiomas were diagnosed by MRI and/or CT. CONCLUSION: Pneumosinus dilatans can be a helpful sign to indicate the presence of a meningioma of the anterior skull base.