Recommendations for Neuroradiology Training during Radiology Residency by the American Society of Neuroradiology Section Chiefs Leadership Group
美国神经放射学会领导小组关于放射科住院医师培训期间神经放射学培训的建议
Wintermark, J. Anderson, V. Gupta, T.A. Kennedy, L.A. Loevner, R.F. Riascos, C. Robson, G. Saigal and C. Glastonbury
American Journal of Neuroradiology February 2021, DOI: https://doi.org/10.3174/ajnr.A6968
Recommendations:
It is strongly recommended that radiology trainees have at least 16–24 weeks of training in neuroradiology under the direction of a neuroradiologist. Additionally, it is recommended that at least 8–12 of those weeks occur during the last 3 years of their training before they start practicing independently.
推荐：
强烈建议放射科培训医师在神经放射学医师的指导下接受至少16-24周的神经放射学的培训。另外，建议在他们独立上班之前，接受住院医师培训的最后3年里，至少接受8-12周的神经放射学培训。
Continued interpretation and education in brain, spine, head & neck, and neurovascular imaging should occur throughout the residency. Although specific numbers of cases are not an indication of competency, a guideline for consideration is that a radiology trainee interpret at least 300 neuroimaging CT scans, 150 Neuroimaging MRI scans, and 50 neurovascular imaging studies (neuro CTAs and neuro MRAs) under the guidance and direction of a neuroradiologist during the last 3 years of their training, before he or she starts practicing independently.
在住院医师培训期间，应对其进行颅脑、脊柱、头颈部以及神经血管成像的培训。尽管具体病例数量并不代表住院医师的胜任能力，但需考虑的培训原则是，在放射科住院医师开始独立上班以前的培训的最后3年，住院医应在神经放射学医师的指导下，至少完成300例神经影像的CT检查、150例神经影像的MRI检查以及50例神经血管影像学检查（神经影像的CTAs、MRAs）的诊断。
It is strongly recommended that competency in Neuroimaging be tested. Resources for evaluation could include competency tests established in the home institution, performance on RadExam (https://www.acr.org/Lifelong-Learning-and-CME/Learning-Activities/RadExam), or similar testing formats.
强烈建议对住院医师的神经影像学诊断能力进行测试。评估的方式包括住院医师在家中的RadExam上完成能力测试评估（https://www.acr.org/Lifelong-Learning-and-CME/Learning-Activities/RadExam), or similar testing formats），或类似的评估方式。
Conclusion:
From a patient safety perspective, radiology trainees graduating on or after June 2021 and joining practice who have not met the recommendations listed above should seriously consider not interpreting even routine neuroradiology studies.
结论
从患者安全的角度出发，2021年6月或之后毕业并开始工作的培训的放射科住院医师，如果未能达到上述要求，应该认真考虑不能够进行常规的神经放射学研究。
For the independent practice and interpretation of ad-vanced neuroradiology (including pediatric neuroradiology, head and neck radiology, and advanced neuroimaging), a formal, ACGME-approved neuroradiology fellowship is strongly recommended. A neuroradiology fellowship will ensure exposure, experience, and competency for both routine and advanced neuroradiology.
关于高级的神经放射学诊断（包括小儿神经放射学、头颈部放射学和高级神经影像学），强烈建议由ACGME批准的正式的神经放射学医师方能独立进行诊断。神经放射学医师需保证其对常规和高级神经放射学诊断的接触、经验和能力。
Spinal Compliance Curves: Preliminary Experience with a New Tool for Evaluating Suspected CSF Venous Fistulas on CT Myelography in Patients with Spontaneous Intracranial Hypotension
脊髓顺应性曲线：使用新工具评估自发性颅内低血压患者在脊髓CT造影检查时怀疑CSF静脉瘘的初步诊断经验
M.T. Caton, B. Laguna, K.A. Soderlund, W.P. Dillon and V.N. Shah
American Journal of Neuroradiology February 2021, DOI: https://doi.org/10.3174/ajnr.A7018
Clinical question:
This study describes a method to estimate craniospinal space compliance using saline infusion during CT myelography and explores the use of craniospinal space compliance and pressure-volume curves in patients with suspected cerebrospinal-venous fistula.
临床问题
本研究描述了一种在脊髓CT造影过程中输注生理盐水来评估颅脑、脊髓间隙顺应性的方法，并探讨了在可疑脑脊髓静脉瘘的患者中使用颅脑、脊髓间隙顺应性和压力-容积曲线。
What was done:
Patients with suspected cerebrospinal-venous fistula underwent dynamic CT myelography. During the procedure, 1- to 5-mL boluses of saline were infused, and incremental changes in CSF pressure were recorded. These data were used to plot craniospinal space compliance curves.
可疑脑脊髓静脉瘘的患者接受了动态脊髓CT造影检查。检查过程中，注入了1-5 mL的生理盐水，记录CSF压力增加的变化，并使用这些数据绘制颅脑、脊髓间隙顺应性曲线图。
Findings and results:
Thirty-four CT myelograms in 22 patients were analyzed. Eight of 22 (36.4%) patients had confirmed cerebrospinal-venous fistulas. Bolus infusion was well-tolerated with no complications and transient headache in 2/34 (5.8%). Patients with confirmed cerebrospinal-venous fistulas had higher compliance at opening pressure and overall compliance (2.6 versus 1.8 mL/cm H20, P < .01). There was no difference in the pressure volume index (77.5 versus 54.3 mL, P = .13) between groups.
本研究分析了22例患者的34个脊髓CT造影检查。22例患者中有8例（36.4％）已确诊为脑脊髓静脉瘘。静脉输注耐受性良好表现为无并发症、无短暂头痛，占2/34（5.8％）。确诊为脑脊髓静脉瘘的患者在开放压力和总体顺应性方面具有较高的依从性（2.6 vs. 1.8 mL/cm H20，P <0.01）。 两组之间的压力体积指数没有差异（77.5 vs. 54.3 mL，P =0 .13）。
Conclusion:
A method of deriving craniospinal space compliance curves using saline intrathecal infusion is described. Preliminary analysis of craniospinal space compliance curves provides qualitative and quantitative information about pressure-volume dynamics and may serve as a diagnostic tool in patients with known or suspected cerebrospinal-venous fistulas.
本研究描述了一种脑脊髓硬膜内注射生理盐水的方法得出颅脑、脊髓间隙顺应性曲线。颅脑、脊髓间隙顺应曲线的初步分析为压力-体积动态检查提供了定性和定量信息，并可作为患有已知或疑似脑脊髓静脉瘘的患者的诊断工具。
Prediction of Clinical Outcome in Patients with Large-Vessel Acute Ischemic Stroke: Performance of Machine Learning versus SPAN-100
大血管急性缺血性卒中患者的临床结果预测：机器学习 vs SPAN-100性能
Jiang, G. Zhu, Y. Xie, J.J. Heit, H. Chen, Y. Li, V. Ding, A. Eskandari, P. Michel, G. Zaharchuk and M. Wintermark
American Journal of Neuroradiology February 2021, 42 (2) 240-246; DOI: https://doi.org/10.3174/ajnr.A6918
What was done:
A retrospective multicenter cohort of 1431 patients with acute ischemic stroke was subdivided into recanalized and nonrecanalized patients. Extreme Gradient Boosting machine learning models were built to predict the mRS score at 90 days using clinical, imaging, combined, and best-performing features.
本研究为多中心回顾性研究，将1431例急性缺血性卒中患者分为血管再通组和未再通组。采用临床、影像学、综合和具有最佳性能的征象，构建了最大梯度增强的机器学习模型来预测90天的mRS得分。
Findings and results:
In 3 groups of patients, the baseline NIHSS was the most significant predictor of outcome among all the parameters, with relative weights of 0.36∼0.69; ischemic core volume on CTP ranked as the most important imaging biomarker with relative weights of 0.29∼0.47. The model with the best-performing features had a better performance than the other machine learning models. The area under the curve of the model with the best-performing features was higher than SPAN-100 model and reached statistical significance for the total (P < .05) and the nonrecanalized patients (P < .001).
3组患者里，基线NIHSS是所有参数中最显著的预后指标，相对权重为0.36-0.69。CTP的缺血核心体积是最重要的影像学生物标志物，相对权重为0.29-0.47。具有最佳性能的征象的模型比其他机器学习模型具有更好的诊断性能。具有最佳性能的征象的模型的曲线下面积高于SPAN-100模型，并且对所有患者（P <0.05）和未再通组的患者（P <0.001）具有统计学意义。
Conclusion:
Machine learning–based feature selection can identify parameters with higher performance in outcome prediction. Machine learning models with the best-performing features, especially advanced CTP data, had superior performance of the recovery outcome prediction for patients with stroke at admission in comparison with SPAN-100.
基于机器学习的征象选择可以找到结果预测中具有更高性能的参数。与SPAN-100相比，具有最佳诊断性能的征象的机器学习模型（尤其是高级的CTP数据）对预测初入院的卒中患者的恢复情况具有更好的诊断能力。
SPAN: Stroke Prognostication Using Age and National Institutes of Health Stroke Scale
Spinal dural leaks in patients with infratentorial superficial siderosis of the central nervous system—Refinement of a diagnostic algorithm
中枢神经系统幕下表面铁沉积症患者的硬脊膜漏—一种诊断算法的完善
Lucie Friedauer1 | Beata Rezny-Kasprzak2 | Helmuth Steinmetz1 |Richard du Mesnil de Rochemont2 | Christian Foerch1
https://doi.org/10.1111/ene.14611
Clinical question
This study builds on the work of Wilson et al where patients with superficial siderosis were classified into four different sub-types:
(i) Isolated siderosis involving the supratentorial brain;
(ii) Symmetric infratentorial siderosis without a causative intracranial bleeding event in history (iSS type 1 – idiopathic);
(iii) Symmetric infratentorial siderosis with a causative intracranial bleeding event in history (iSS type 2 – this includes both an identified and unidentified cause of hemorrhage);
(iv) Limited (non-symmetric) infratentorial siderosis
这项研究建立在Wilson等的工作基础上，其中中枢神经系统表面铁沉积症患者分为四种不同的亚型：
（i）孤立的幕上铁沉积；
（ii）病史中无颅内出血史引起的幕下对称性铁质沉积（iSS 1型-特发性）；
（iii）病史中有颅内出血史引起的幕下对称性铁质沉积（iSS 2型-包括已确定和未确定的出血原因）；
（iv）局限性（非对称性）幕下铁质沉积
The aim of this study was to determine the frequency of spinal dural CSF leaks amongst patients with symmetric iSS pattern on magnetic resonance imaging (MRI) scans. This included both iSS type 1 patients and also iSS type 2 patients with unidentified cause of hemorrhage.
本研究的目的是探讨磁共振成像（MRI）诊断具有对称性的iSS 模式患者发生硬脊膜漏的发生率。 既包括iSS 1型患者，也包括出血原因不明的iSS 2型患者。
Methods
This was a single center study conducted with a retrospective and a prospective part. The retrospective part was patient identification; all patients with superficial siderosis were identified from the imaging database between 2007 and 2018.
这是一项单中心的研究，包括回顾性和前瞻性两个部分。回顾性研究部分是挑出患者：在2007年至2018年之间从影像数据库中挑出所有患有幕下铁沉积症的患者。
In the second part, all patients with symmetric iSS (infratentorial superficial siderosis) without a causative intracranial bleeding event in history (iSS type 1) were evaluated for the presence of spinal epidural fluid collections with MR imaging of the spinal cord for a potential dural leak.
在第二部分中，对病史中无颅内出血史（iSS type 1）引起的对称性的iSS （幕下铁沉积）的患者进行了评估，通过MR脊髓成像检查评估出现硬脊膜外积液，以明确是否存在潜在的硬脊膜漏 。
Patients with iSS type 2 (i.e., with a causative intracranial bleeding event in history) were also screened for dural CSF leaks if the etiology of the bleeding event could not be determined (intracerebral/subarachnoid hemorrhage of unknown etiology).
如果无法确定出血事件的病因（病因不明的脑内/蛛网膜下腔出血），则应该筛查iSS 2型（有颅内出血事件病史）的患者是否存在硬脑膜漏。
Relative frequencies for siderosis groups for both the dataset from Wilson et al and our dataset were calculated and compared by chi-squared test statistics for significant differences
计算了Wilson等和我们数据的铁沉积症组的相对频率，并通过卡方检验进行了显著差异性比较。
Findings and results:
There were 97,733 MRI brains in the study period from which 93 patients with superficial siderosis were recruited. Of the 93 included cases of siderosis, 42 had isolated supratentorial siderosis, 4 had iSS type 1 (i.e., iSS without history of a causative intracranial bleeding event), 26 had iSS type 2 (i.e., iSS with history of a causative intracranial bleeding event), and another 21 patients had limited infratentorial siderosis.
研究的过程中，共有97733例颅脑MRI检查，从中招募了93例幕下表面铁沉积症的患者。 在93例表面铁沉积症的病例中，有42例为孤立性幕上铁质沉积， 4例为iSS 1型（既往无颅内出血史），26例为iSS 2型（既往有颅内出血史的iSS ），另有21例患者为局限性幕下铁沉积。
These corresponds to relative frequencies of 0.4 per 1,000 brain MRI scans for symmetric iSS (i.e., iSS types 1 and 2) (95% CI 0.256–0.541) and of 0.05 per 1,000 scans for iSS type 1 (95% CI 0.014–0.129).
每1000次颅脑MRI扫描出现对称性的iSS（即1型和2型的iSS）的相对频率为0.4（95％CI 0.256-0.541），每1000次扫描出现1型iSS的相对频率为0.05（95％CI 0.014-0.129）。
The predominant causes in iSS type 2 patients were aneurysmatic subarachnoid hemorrhage and brain tumors.
iSS 2型患者的主要病因是动脉瘤性蛛网膜下腔出血和脑肿瘤。
In the next step, the 4 patients with iSS type 1 were prospectively evaluated for the presence of spinal dural CSF leaks which was positive in all cases (100%).
All patients classified as iSS type 2 who had an unknown etiology of the bleeding event despite routine diagnostic workup (n = 4) were reclassified as iSS type 1. 1 was lost to follow up and in 1 other patient a spinal dural CSF leak was identified. Thus, in five of seven (71%) patients with modified iSS type 1 a spinal dural CSF leak could be identified.
在下一步中，前瞻性评估了4例iSS 1型患者的硬脊膜CSF渗漏情况，所有病例均为阳性（100％）。
所有iSS 2型、在常规诊断检查时出血事件病因未知的患者（n = 4）被重新分类为iSS 1型。其中，1例患者失访，另外1例患者出现硬脊膜CSF漏。 因此，在七名改良后iSS 1型的患者中，有五名（71％）发现硬脊膜CSF漏。
Conclusion
Persisting spinal dural CSF leaks can frequently be identified in patients with symmetric infratentorial superficial siderosis pattern. Diagnostic workup in these cases should include magnetic resonance imaging of the whole spine.
患有对称性的幕下表面铁沉积症患者常常发现硬脊膜CSF漏。 因此诊断检查应包括整个脊柱的磁共振成像。
Implications
In cases of symmetric infratentorial superficial siderosis pattern without bleed / identifiable cause for bleeding, diagnostic workup should include magnetic resonance imaging of the whole spine.
如果对称性的幕下表面铁沉积症既往没有出血史/未能明确出血原因，诊断检查应包括全脊柱的磁共振成像。
Senior editor comments:
This study highlights the importance of considering CSF leaks (and not only vascular malformations) as a cause for superficial siderosis. Notably, frequency estimates of siderosis were quite low in this study, however the numbers of studies having T2* vs SWI were not reported, and the prevalence is likely to be higher if SWI is routinely incorporated into neuroimaging protocols.
高级编辑评论：这项研究强调了将CSF漏（不仅是血管畸形）作为中枢神经系统表面铁沉积症的原因的重要性。 值得注意的是，这项研究中表面铁沉积症的频率估计值较低，而且没有报道T2 * vs SWI的研究数量，如果将SWI纳入常规神经影像学检查方案中，检出率可能会更高。
References
