Tim Shepherd

@NatRevNeurol Previous papers also show spinal cord atrophy before lesions or myelitis - for example; pubmed.ncbi.nlm.nih.gov/27144215/

Increased health-care use preceding the first attack supports the idea of a prodromal phase in NMOSD journals.sagepub.com/doi/abs/10.117…

@ecalabr Much of movement disorders imaging is great for board exams but worthless IRL

Anyone able to use this in real practice? No luck here. Willing to admit it could be a skill issue…

@jasondruzgal If time commitment is the same either way… I’d actually rather do LPs than read CTAs any day. The decision fatigue accumulation and tedium is far less?

@jdpereira @portokalh I’m a huge fan of the Haines book or Warner Atlas of Neurosnatomy - the latter was a character and the book is not easy but image quality and the perspectives from the slice orientations can be inspired in the pre-3D MRI era (where you only got one shot at cutting it right)

Hey, neuro Twitter folk: - it is a huge gap in my knowledge the fact I know little about human brain anatomy/function. Like, actual textbook stuff - we didn’t have it in college, and there were no classes during my PhD. I want to fix this. Recommendations on study books?

@Miriam_Peckham Could also be a rugby player?

Sometimes the weirdest tidbits pique my interest in neurorads. For example, seeing this patient’s ears and knowing he’s likely experienced a few fistfights. Also realizing he was likely fighting a right handed individual (left ear shows more chronic damage)- “cauliflower ear”

@seraj25 @teachplaygrub We use this to predict the fMRI…. In the sagittal plane divide the medial frontal gyrus (better name for structure above above cingulate gyrus) by the anterior commissural plane - the motor SMA is 1-cm behind it, the language SMA will be 1-cm in front of it.

@teachplaygrub Nice summary, do you have any recommendations to help identifying the SMA Borders, I found it very confusing, thanks

1/They say form follows function! Brain MRI anatomy is best understood in terms of both form & function. Here’s a thread to help you to remember important functional brain anatomy

@portokalh @northernthrux @nastasiayendiki No real idea - avoided that prep back in the day for this reason - you basically need to gently rehydrate the tissue but this is often what happens during the staining process in some instances so maybe look to that? Don’t start with a previous sample ;)

@northernthrux I do not know of a fixed protocol, but maybe @nastasiayendiki or @tim0shepherd know. I assume steps of going from -80 to -20 to -4 help.

@BrentWeinberg I used to give them my baseball card profiling my idiosyncrasies (eg think Hemingway, not Faulkner… don’t say flow voids are normal in 5-mm axial T2 etc)

@jasondruzgal I would clarify - Friday 507pm when you’re on call, everyone has left and the ED doesn’t stop while PACs is down.

@PhilipRChapman1 @Miriam_Peckham Not enough rads/fluoro time to do them all, but we’re in a doom loop of non-rad MDs losing skill - alternate fixes… 1) most kits have 3.5” cutting needles that are 1” too short for many USA patients especially for 2) train non rads to use paramedian approach

I did an image-guided lumbar puncture recently on a person who was chronically blind from known idiopathic intracranial hypertension. I asked her how many lumbar punctures she had in the past. She answered 28. How many were "horrible"? I asked. She answered 25. I know its all relative. I get it. And I have difficult cases as well sometimes. But it is clear that many who do them have never been trained to do them well. If you think that pain, suffering, multiple failed attempts, and memories of a horrible experience are just part of the lumbar puncture, please consider additional training/instruction .... or maybe not doing them. The idealist in me says it doesn't have to be that way. I wonder what experience has taught others.

@francisdeng Lawyers will always find an expert… some cancer protocols use NECT or CECT in path dependent way - the key original clinical trial used it for decision making etc.

When reading a CT head (wo or w/wo contrast) with a reason of "r/o brain mets" - when would you recommend MRI in the impression? What about CT head for "r/o stroke"? or "r/o septic emboli"?

@EMiddlebrooksMD @TheSENRS Two of my favorite guys - congrats on successful meeting!

Incredibly grateful to serve as @TheSENRS President, a society that has been near and dear to my heart since my very first meeting as a trainee! Thank you to Dr. Murtagh who has been the best Ex Comm partner one could ask for!

@dyousem1 @TheASNR @radresidents The sweetest part will be in a year … when you get more unsolicited email invites from the “association of functional kidney practitioners” citing this paper.

Proud that the final version of our paper is out..... doi.org/10.1067/j.cpra… What an annoyance!#asnr @theasnr @radresidents

@heacockmd You have to be proven amyloid positive by pet or csf to get lecanemab.

@tim0shepherd Is the increase in symptomatic patients or proactive screening? Surprised it’s increased so fast.

We’ve done more clinical Amyloid PET in past 2 weeks than last 2 years…

@heacockmd CMS change for sure

@tim0shepherd CMS change or just coincidence?

@AdiG1993 @PhilipRChapman1 Referral to correct specialists, avoid repetitive wrong workup/treatment, counseling of patient and family, enrollment in therapeutic drug trials….

@tim0shepherd @PhilipRChapman1 How does early dx of MSA help?

Like a lot of Radiologic signs, the Hot Cross Bun Sign is great.....when it works. But keep in mind, it may be absent 50% of the time especially early in the course of Multiple System Atrophy.

@hsairmd Show-off ;)

Once again got down to #zeroinbox, shorter interval than last time. In March, it lasted about 2 weeks. More than anything, it has taught me to attack challenges without trying to make everything perfect. Often, better to move forward with some imperfection; things work out.

@Avkaji @jasondruzgal @drmankad Brain parenchyma appears normal without hemorrhage, extra-axial collections, hydrocephalus, mass effect or CT signs of ischemia/infarct. The visualized soft tissues and bones of the skull and face appear normal. 30 words before the wrapper …

Can AI/ML at least help me decide at 5 PM if the ventricles have gone up or down. Isn’t that basic “enabling”, leave aside the high end genomic predictions! #radiologyfatigue