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Newer classification systems for upper cervical spine trauma now include ligamentous injury in addition to fracture and dislocation patterns. Assessment of associated ligamentous injury, spinal cord injury (SCI), and blunt cerebrovascular injuries (BCVI) in patients with atlanto-occipital distraction injuries (AODI) are critical for management. We aim to determine the incidence of ligamentous injury, SCI, and BCVI in patients with AODI and assess how craniometrics perform in diagnosis of AODI. We performed an IRB-approved retrospective analysis of 35 cases of diagnosed AODI over a period of 8 years. Imaging was analyzed by two experienced neuroradiologists for craniometric measurements, ligamentous injury, SCI, and BCVI. Craniometric measurements were compared to 35 age-matched controls with normal atlanto-occipital joint. Out of 35 patients diagnosed with AODI, 27 were adults and 8 belonged to pediatric age group. The mean age of presentation was 29.4 years with a male/female ratio of 22:13. The basion-dental interval (70.4%) and the combined condylar sum (74.1%) were the most sensitive craniometric measurements for diagnosis of AODI. Alar ligament (83%) and the tectorial membrane (89%) injuries were most commonly injured ligaments. Three adult patients sustained SCI and 10 patients had BCVI. Majority of BCVI involved the internal carotid artery followed by the vertebral artery. The combination of craniometric indices with assessment of ligamentous injuries provides higher diagnostic accuracy for AODI. Alar ligament and tectorial membrane injuries have high association with AODI. There is high association of SCI and BCVI in AODI survivors.

Ischemic strokes in young adults are devastatingly debilitating and increasingly frequent. Stroke remains the leading cause of serious disability in the United States. The consequences of this familiar disease in this atypical age group are especially detrimental and long lasting. Ischemic stroke in young adults is now emerging as a public health issue, one in which radiologists can play a key role. The incidence of ischemic infarction in young adults has risen over the past couple of decades. Increased public awareness, increased use of MRI and angiography, and more accurate diagnosis may in part explain the increased detection of stroke in young adults. The increased prevalence of stroke risk factors in young adults (especially sedentary lifestyle and hypertension) may also contribute. However, compared with older adults, young adults have fewer ischemic infarcts related to the standard cardiovascular risk factors and large- or small-vessel disease. Instead, their infarcts most commonly result from cardioembolic disease and other demonstrated causes (ie, dissection). Thus, radiologists must expand their differential diagnoses to appropriately diagnose ischemic strokes and identify their causes in the young adult population. From the more frequent cardioembolism and dissection to the less common vasculitis, drug-related, CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy), moyamoya, and hypercoagulable state-related infarcts, this article covers a wide breadth of causes and imaging findings of ischemic stroke in young adults. ©RSNA, 2019.

The neuroradiology fellowship match is conducted by the National Resident Matching Program (NRMP) every year. The purpose of this study is to report the trends in neuroradiology match results from 2008 to 2020 in the United States (US) using data available from the NRMP. The fellowship match data was obtained from the NRMP archives. Data specific to programs (number of programs and filled positions) were obtained. Using the NRMP's “Charting Outcomes in the Match: Specialty Matching Service'' report, a detailed analysis of applicant characteristics broken down for each specialty, was also obtained for neuroradiology for the year 2018. Neuroradiology programs in the NRMP Match increased from 71 to 77 and the number of positions increased from 158 to 270 between 2008 and 2020. The fill rate of fellowship spots has remained steady at 75.9% in 2008 and 74.4% in 2020. The proportion of US allopathic medical graduates (US MD) amongst the filled spots decreased from 79.2% (2008) to 64.2% (2020), while the proportion of international medical graduates (IMGs) increased from 11.7% to 25.4%. US MD and IMG fill trends did not reach statistical significance (P = 0.78 and P = 0.92, respectively). US MDs had a higher number of research experiences and publications (23.2 and 26, respectively) when compared to US IMGs (5 and 7) and non-US IMGs (6.8 and 14.2). To conclude, over the last 13 years, the neuroradiology fellowship programs in the US have increased in number and expanded in size, with an almost stable fill rate of around 75%.

Newer classification systems for upper cervical spine trauma now include ligamentous injury in addition to fracture and dislocation patterns. Assessment of associated ligamentous injury, spinal cord injury (SCI), and blunt cerebrovascular injuries (BCVI) in patients with atlanto-occipital distraction injuries (AODI) are critical for management. We aim to determine the incidence of ligamentous injury, SCI, and BCVI in patients with AODI and assess how craniometrics perform in diagnosis of AODI.We performed an IRB-approved retrospective analysis of 35 cases of diagnosed AODI over a period of 8 years. Imaging was analyzed by two experienced neuroradiologists for craniometric measurements, ligamentous injury, SCI, and BCVI. Craniometric measurements were compared to 35 age-matched controls with normal atlanto-occipital joint.Out of 35 patients diagnosed with AODI, 27 were adults and 8 belonged to pediatric age group. The mean age of presentation was 29.4 years with a male/female ratio of 22:13. The basion-dental interval (70.4%) and the combined condylar sum (74.1%) were the most sensitive craniometric measurements for diagnosis of AODI. Alar ligament (83%) and the tectorial membrane (89%) injuries were most commonly injured ligaments. Three adult patients sustained SCI and 10 patients had BCVI. Majority of BCVI involved the internal carotid artery followed by the vertebral artery.The combination of craniometric indices with assessment of ligamentous injuries provides higher diagnostic accuracy for AODI. Alar ligament and tectorial membrane injuries have high association with AODI. There is high association of SCI and BCVI in AODI survivors.

Professional use of social media continues to increase. We analyzed Twitter use of our own American Society of Neuroradiology (ASNR) 2018 annual meeting, reviewing all Twitter posts (3020 tweets from 523 participants) containing the hashtag #ASNR18 from May 21, 2018, to June 12, 2018, extracting the transcripts from Symplur. Then, each tweet was categorized by the role of user, type of tweet, and topic. The dominant user category was neuroradiologist/radiologist (63%). The keynote address, “The Radiology Renaissance: Shaping the Future of Healthcare,” presented by Andy DeLao @Cancergeek was the most frequently tweeted topic (10%). Comment on a session was the major type of tweet. When we compared the data with a similar analysis in 2014, our data analysis showed a growth in the use of Twitter in only 4 years.

Social media use by professional organizations has increased as a platform to disseminate information, affording an alternative avenue to engage membership and the public. The American Journal of Neuroradiology (AJNR) posts cases and articles, hosts Tweet chats, advertises podcasts, and more on its Twitter account (@TheAJNR). The objective of this study was to determine whether user engagement is underestimated on the basis of publicly available metrics and to assess the engagement rate. This study demonstrated that engagement extends beyond visible metrics, suggesting an AJNR "silent" following beyond what is readily apparent. Median engagement rates from the @TheAJNR account from 2017 to 2019 appear stable since last reported in 2016 and are comparable with those reported in other professional medical journals.

Routine non-contrast material-enhanced head CT is one of the most frequently ordered studies in the emergency department. Skull base-related pathologic entities, often depicted on the first or last images of a routine head CT study, can be easily overlooked in the emergency setting if not incorporated in the interpreting radiologist's search pattern, as the findings can be incompletely imaged. Delayed diagnosis, misdiagnosis, or lack of recognition of skull base pathologic entities can negatively impact patient care. This article reviews and illustrates the essential skull base anatomy and common blind spots that are important to radiologists who interpret nonenhanced head CT images in the acute setting. The imaging characteristics of important "do not miss" lesions are emphasized and categorized by their cause and location within the skull base, and the potential differential diagnoses are discussed. An interpretation checklist to improve diagnostic accuracy is provided. ©RSNA, 2019.

Background and purpose Dental and periodontal diseases represent important but often overlooked causes of acute sinusitis. Our goal was to examine the prevalence of potential odontogenic sources of acute maxillary sinusitis according to immune status and their associations with sinusitis. Materials and methods A retrospective review of maxillofacial computed tomography studies from 2013 to 2014 was performed. Each maxillary sinus and its ipsilateral dentition were evaluated for findings of acute sinusitis and dental/periodontal disease. Results Eighty-four patients (24 immunocompetent, 60 immunocompromised) had 171 maxillary sinuses that met inclusion criteria for acute maxillary sinusitis. Inspection of dentition revealed oroantral fistula in 1%, periapical lucencies in 16%, and projecting tooth root(s) in 71% of cases. Immunocompromised patients were more likely to have bilateral sinusitis than immunocompetent patients (67% vs 33%, P = 0.005). A paired case-control analysis in a subset of patients with unilateral maxillary sinusitis (n = 39) showed a higher prevalence of periapical lucency in association with sinuses that had an air fluid level-29% of sinuses with a fluid level had periapical lucency compared with 12% without sinus fluid (P = 0.033). Conclusions Potential odontogenic sources of acute maxillary sinusitis are highly prevalent in both immunocompetent and immunocompromised patients, although the 2 patient populations demonstrate no difference in the prevalence of these potential odontogenic sources. Periapical lucencies were found to be associated with an ipsilateral sinus fluid level. Increased awareness of the importance of dental and periodontal diseases as key components of maxillofacial computed tomography interpretation would facilitate a more appropriate and timely treatment.

The adage "a picture is worth a thousand words" holds true in medicine, especially so in radiology. Although the images radiologists interpret are highly detailed, there often is no substitute for a concise diagrammatic illustration. Medical illustrations can help to clarify anatomy, pathology, and procedures-relaying complex information in a simple and easily understandable format. Medical illustrations have become ubiquitous in medical education and sought after for publications. Unfortunately, existing best-fit illustrations are not always available to complement discussion points. Thus, academicians are well served by the ability to produce their own illustrations. Although creating medical illustrations may seem unachievable to amateur artists, this is not necessarily the case. Digital illustration does not require the typical artistic skills needed for drawing with pen and paper or painting on a canvas. Radiologists of all skill levels, including those who do not view themselves as artistically inclined, can create their own high-quality original diagrams. Whether drawn freehand with a stylus or traced with a mouse, simple and complex digital works are within reach. However, the utility of illustration programs for radiologists is not inherently obvious, and discussion of useful features in the radiology literature is lacking. Digital illustration programs are accessible to most radiologists, and the process can be simplified to an easily approachable level, with illustration complexity left to the artist's discretion. Online supplemental material is available for this article. ©RSNA, 2018.

Head and neck surgical reconstruction is complex, and postoperative imaging interpretation is challenging. Surgeons now use microvascular free tissue transfer, also known as free flaps, more frequently in head and neck reconstruction than ever before. Thus, an understanding of free flaps, their expected appearance on cross-sectional imaging, and their associated complications (including tumor recurrence) is crucial for the interpreting radiologist. Despite the complexity and increasing frequency of free flap reconstruction, there is no comprehensive head and neck resource intended for the radiologist. We hope that this image-rich review will fill that void and serve as a go to reference for radiologists interpreting imaging of surgical free flaps in head and neck reconstruction.

SUMMARY: The use of social media by medical professionals and organizations is increasing, with Twitter receiving the most attention. User engagement is an important goal of social media activity, and engagement metrics represent a viable gauge of value in social media. No thorough analysis of tweet characteristics that increase academic user engagement has yet been published. In this study, the authors analyzed the American Journal of Neuroradiology Twitter feed to determine the tweet characteristics that were associated with higher engagement rates.