Zack Nigogosyan, MD

Can MRI find spinal #CSFleaks that standard imaging misses? A new study used 2-step MRI to identify dural defects in suspected #SIH 🧠 ⬆️leak localization may⬆️targeted treatment 🔗…adachejournal.onlinelibrary.wiley.com/share/5GY7H2NC… @zack4186 @cyrusraji @SherwinAzad @DrJonOh @vellimana #Neurology #Headache

"Nontrauma-Associated Cerebral Fat Embolism Syndrome in Sickle Cell–Related Hemoglobinopathies: A Case Series and Systematic Review" doi.org/10.3174/ajnr.A… #FellowsJournalClub @Rshnzr; @HosseiniHelia; @zack4186

@northwoods1980 Agree- use this during ED shifts frequently.

Medical Coll of Wisconsin literally changed my life after this publication and utilizing their protocol. Before this...fluoro gastrografin exams were common and yielded limited info very often. Still grateful for this publication and work here....pubs.rsna.org/doi/full/10.11…

@northwoods1980 You can do a few things. I assume this is a fresh roast? You can try this extension tube: etsy.com/shop/RazzoRoas… I heard this larger size roaster is great: #nav-specification" target="_blank" rel="nofollow noopener">aliexpress.us/item/325680588… I also heard good things about the aillio bullet roaster (1kg).

I have a new coffee roaster. Just learning. But, looking for a second larger roaster that can roast at least 1 pound of green beans per roast for a reasonable price. Any suggestions?

@francisdeng @Redmond_CA Thin cuts. Ensure it’s a helical acquisition ;)

@Redmond_CA The same people telling you to do thin cuts

@ecalabr Difficult delivery with neck traction resulting in nerve root avulsions and subgaleal hematoma.

Neonate with left arm paralysis. What’s the cause and what scenario led to this?

@dr_cellini You could use CPT code 76140 and create an imaging consult service (many radiology departments have this). Then the clinician gets the benefit of your interpretation and you can charge for that service. Win win.

@northwoods1980 Rishi tea does a good job.

Looking for a new online recommendation for loose tees. High-quality green, Earl Gray and oolong. Any favorites? I've typically used Tea Source.

@ItaniMalak @MIRimaging Great case!

Don't miss this excellent case coauthored by colleagues from @MIRimaging in the new issue of RadioGraphics

@teachplaygrub @IanYMChan Great tutorial! If you want to see catheter angio correlation, read this article: neuroangio.org/sample-page/ne….

1/My hardest thread yet! Are you up for the challenge? How stroke perfusion imaging works! Ever wonder why it’s Tmax & not Tmin? Do you not question the images & let RAPID read the perfusion for you? Not anymore! Here's all you need to understand perfusion imaging!

@Tzvia_P @PennRadiology Congrats!

I am SO excited to join @PennRadiology as a diagnostic radiology resident in the research track!! Philly here I come!!

@northwoods1980 Real finding in the radiograph. Nice catch.

@farkomd I use center line analysis and report based on NASCET criteria

When radiology reads a CTA of the head and neck and they say 60-75 percent stenosis of a carotid , are they measuring or are they eyeballing it? Seems as though I would get an actual measurement

@ecalabr CC fistula. TOF MRI can be helpful or can go direct to angio for definitive characterization and/or treatment depending on preference.

Patient with right eye pain and proptosis. What's going on here and what is the next step in diagnosis and management?

@northwoods1980 Quiet dark cool room. Can’t beat it.

Trying to go back from nights to days. Was planning to try 3 mg melatonin with 50 mg Benadryl going to bed tonight. Any other suggestions?

Looking to update your knowledge of body MRI pulse sequence physics and take a deeper dive into clinically relevant MR physics? Explore our @RadioGraphics Tutorial entitled Body MRI Pulse Sequences: Atlas and User Guide at: pubs.rsna.org/doi/10.1148/rg… @MIRimaging @WUSTLmed

@northwoods1980 I would say our protocols for code strokes immediately connects us with the neurology team. Speaking with neurology real time correlating neuro exam with findings is very helpful.

I wonder how much of this has to do with protocol and software specifics? There's a lot of protocol, quality variability among institutions performing CTA exams I've noticed which would dramatically alter interpretation accuracy I assume. I see this all the time among various different hospitals. Having to do with timing, bolus rate, etc. and software. Not to mention AI capabilities. Of course the distractions, training, expertise, volumes for the interpreting radiologist also matters. Also, I don't work with trainees so this would be me. I also wonder about clinical history, expertise or lack there of when it comes to whoever was ordering this exam. Mid-level, board-certified ER doctor, stroke neurologist, etc. So many factors that make these studies not Super helpful in terms of understanding real world application.

Think of this lawsuit next time you look at the new professional compensation rate for interpreting CTA head and neck. How long until radiologists simply refuse? Also, if AI reads this, who are the attorneys going after if rads refuse in future?

@PhilipRChapman1 How many were image guided?

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.

@GovindMattay @MIRimaging @WUDeptMedicine @AMdmph @vnarra01 @RadiologyACR Very cool! Important topic

Honored to have been selected to speak about my project on communication and follow up of incidental imaging findings at #QSI2023 @MIRimaging @WUDeptMedicine @AMdmph @vnarra01 @RadiologyACR