American Journal Of Neuroradiology Research Articles

Optimizing GPT-4 Turbo Diagnostic Accuracy in Neuroradiology through Prompt Engineering and Confidence Thresholds.

Integrating large language models (LLMs) such as GPT-4 Turbo into diagnostic imaging faces a significant challenge, with current misdiagnosis rates ranging from 30-50%. This study evaluates how prompt engineering and confidence thresholds can improve diagnostic accuracy in neuroradiology. We analyze 751 neuroradiology cases from the American Journal of Neuroradiology using GPT-4 Turbo with customized prompts to improve diagnostic precision. Initially, GPT-4 Turbo achieved a baseline diagnostic accuracy of 55.1%. By reformatting responses to list five diagnostic candidates and applying a 90% confidence threshold, the highest precision of the diagnosis increased to 72.9%, with the candidate list providing the correct diagnosis at 85.9%, reducing the misdiagnosis rate to 14.1%. However, this threshold reduced the number of cases that responded. Strategic prompt engineering and high confidence thresholds significantly reduce misdiagnoses and improve the precision of the LLM diagnostic in neuroradiology. More research is needed to optimize these approaches for broader clinical implementation, balancing accuracy and utility.

P.074 Assessing the emergence and evolution of artificial intelligence and machine learning research in neuroradiology

Background: Interest in artificial intelligence (AI) and machine learning (ML) has been growing in neuroradiology, but there is limited knowledge on how this interest has manifested into research and the field’s trends, challenges, and future directions. Methods: The American Journal of Neuroradiology was queried for original research articles published since inception (Jan. 1, 1980) to Sept. 19, 2022 that contained any of the following key terms: “machine learning”, “artificial intelligence”, or “radiomics”. Articles were screened, categorized into Statistical Modelling (Type 1), AI/ML Development (Type 2), or End-user Application (Type 3) and then bibliometrically analyzed. Results: A total of 124 articles were identified with 85% being non-integration focused (Type 1 n = 41, Type 2 n = 65) and the remaining (n = 18) being Type 3. The total number of articles published grew two-fold in the last five years, with Type 2 articles mainly driving this growth. While most (66%) Type 2 articles were led by a radiologist with 55% possessing a postgraduate degree, a minority of Type 2 articles addressed bias (15%) and explainability (20%). Conclusions: The results of this study highlight areas for improvement but also strengths that stakeholders can consider when promoting the shift towards integrating practical AI/ML solutions in neuroradiology.

Assessing the Emergence and Evolution of Artificial Intelligence and Machine Learning Research in Neuroradiology.

Interest in artificial intelligence (AI) and machine learning (ML) has been growing in neuroradiology, but there is limited knowledge on how this interest has manifested into research and specifically, its qualities and characteristics. This study aims to characterize the emergence and evolution of AI/ML articles within neuroradiology and provide a comprehensive overview of the trends, challenges, and future directions of the field. We performed a bibliometric analysis of the American Journal of Neuroradiology; the journal was queried for original research articles published since inception (January 1, 1980) to December 3, 2022 that contained any of the following key terms: "machine learning," "artificial intelligence," "radiomics," "deep learning," "neural network," "generative adversarial network," "object detection," or "natural language processing." Articles were screened by 2 independent reviewers, and categorized into statistical modeling (type 1), AI/ML development (type 2), both representing developmental research work but without a direct clinical integration, or end-user application (type 3), which is the closest surrogate of potential AI/ML integration into day-to-day practice. To better understand the limiting factors to type 3 articles being published, we analyzed type 2 articles as they should represent the precursor work leading to type 3. A total of 182 articles were identified with 79% being nonintegration focused (type 1 n = 53, type 2 n = 90) and 21% (n = 39) being type 3. The total number of articles published grew roughly 5-fold in the last 5 years, with the nonintegration focused articles mainly driving this growth. Additionally, a minority of type 2 articles addressed bias (22%) and explainability (16%). These articles were primarily led by radiologists (63%), with most (60%) having additional postgraduate degrees. AI/ML publications have been rapidly increasing in neuroradiology with only a minority of this growth being attributable to end-user application. Areas identified for improvement include enhancing the quality of type 2 articles, namely external validation, and addressing both bias and explainability. These results ultimately provide authors, editors, clinicians, and policymakers important insights to promote a shift toward integrating practical AI/ML solutions in neuroradiology.

Accuracy of ChatGPT generated diagnosis from patient's medical history and imaging findings in neuroradiology cases.

The noteworthy performance of Chat Generative Pre-trained Transformer (ChatGPT), an artificial intelligence text generation model based on the GPT-4 architecture, has been demonstrated in various fields; however, its potential applications in neuroradiology remain unexplored. This study aimed to evaluate the diagnostic performance of GPT-4 based ChatGPT in neuroradiology. We collected 100 consecutive "Case of the Week" cases from the American Journal of Neuroradiology between October 2021 and September 2023. ChatGPT generated a diagnosis from patient's medical history and imaging findings for each case. Then the diagnostic accuracy rate was determined using the published ground truth. Each case was categorized by anatomical location (brain, spine, and head & neck), and brain cases were further divided into central nervous system (CNS) tumor and non-CNS tumor groups. Fisher's exact test was conducted to compare the accuracy rates among the three anatomical locations, as well as between the CNS tumor and non-CNS tumor groups. ChatGPT achieved a diagnostic accuracy rate of 50% (50/100 cases). There were no significant differences between the accuracy rates of the three anatomical locations (p = 0.89). The accuracy rate was significantly lower for the CNS tumor group compared to the non-CNS tumor group in the brain cases (16% [3/19] vs. 62% [36/58], p < 0.001). This study demonstrated the diagnostic performance of ChatGPT in neuroradiology. ChatGPT's diagnostic accuracy varied depending on disease etiologies, and its diagnostic accuracy was significantly lower in CNS tumors compared to non-CNS tumors.

Global tendencies and frontier topics in hemodynamics research of intracranial aneurysms: a bibliometric analysis from 1999 to 2022

Background: Hemodynamics plays a crucial role in the initiation, enlargement, and rupture of intracranial aneurysms (IAs). This bibliometric analysis aimed to map the knowledge network of IA hemodynamic research.Methods: Studies on hemodynamics in IAs published from 1999 to 2022 were retrieved from the Web of Science Core Collection (WoSCC). The contributions of countries, institutions, authors, and journals were identified using VOSviewer, Scimago Graphica, and Microsoft Excel. Tendencies, frontier topics, and knowledge networks were analyzed and visualized using VOSviewer and CiteSpace.Results: We identified 2,319 publications on hemodynamics in IAs. The annual number of publications exhibited an overall increasing trend. Among these, the United States, Japan, and China were the three major contributing countries. Capital Medical University, State University of New York (SUNY) Buffalo University, and George Mason University were the three most productive institutions. Meng H ranked first among authors regarding the number of articles and citations, while Cebral JR was first among co-cited authors. The American Journal of Neuroradiology was the top journal in terms of the number of publications, citations, and co-citations. In addition, the research topics can be divided into three clusters: hemodynamics itself, the relationship of hemodynamics with IA rupture, and the relationship of hemodynamics with IA treatment. The frontier directions included flow diverters, complications, morphology, prediction, recanalization, and four-dimensional flow magnetic resonance imaging (4D flow MRI).Conclusion: This study drew a knowledge map of the top countries, institutions, authors, publications, and journals on IA hemodynamics over the past 2 decades. The current and future hotspots of IA hemodynamics mainly include hemodynamics itself (4D flow MRI), its relationship with IA rupture (morphology and prediction), and its relationship with IA treatment (flow diverters, complications, and recanalization).

Artificial Intelligence (AI) in Radiology: A Deep Dive Into ChatGPT 4.0's Accuracy with the American Journal of Neuroradiology's (AJNR) "Case of the Month".

The advent of artificial intelligence (AI), particularly large language models (LLMs) such as ChatGPT 4.0, holds significant potential in healthcare, specifically in radiology. This study examined the accuracy of ChatGPT 4.0 (July 20, 2023, version) in solving diagnostic quizzes from the American Journal of Neuroradiology's (AJNR) "Case of the Month." We evaluated the diagnostic accuracy of ChatGPT 4.0 when provided with a patient's history and imaging findings weekly over four weeks, using 140 cases from the AJNR "Case of the Month" portal (from November 2011 to July 2023). The overall diagnostic accuracy was found to be 57.86% (81 out of 140 cases). The diagnostic performance varied across brain, head and neck, and spine subgroups, with accuracy rates of 54.65%, 67.65%, and 55.0%, respectively. These findings suggest that AI models such as ChatGPT 4.0 could serve as useful adjuncts in radiological diagnostics, thus potentially enhancing patient care and revolutionizing medical education.

Worldwide Productivity and Research Trend of Publications Concerning Spontaneous Intracranial Hypotension: a Bibliometric Analysis

Background and Aim: Spontaneous intracranial hypotension (SIH) is a highly misdiagnosed disease. The main reason is the lack of awareness. This study sought to summarize the current status of research in this field via a bibliometric analysis. Materials and Methods: The publications were searched in the Web of Science Core Collection (WoSCC) database. Data analysis and visualization were carried out using the cooperative network and cluster analysis of R and Cite Space software. Results: A total of 618 publications from 2008 to 2021 were included in this study. The number of publications has a growth trend. The United States contributed the most articles, and Schievink WI is the most prolific author. Mayo Clinical ranked the first compared with other institutions. American Journal of Neuroradiology has published the most articles in this field. The top 3 clusters of reference co-citation are “delayed recurrence”, “cerebrospinal fluid-venous fistula”, and “floating dural sac sign”. The top 3 clusters of keyword co-appearance are “spinal fluid leak headache”, “symptom duration”, and “cerebral venous thrombosis”. The strongest citation burst of keywords is “CSF-venous fistula” and “paraspinal vein sign”. Conclusions: This study analyzes the research progress of SIH, and the current research mainly focuses on CSF-venous fistula. The bibliometric analysis of SIH is expected to help researchers effectively explore the disease.

Bibliometric Trends in Open Surgical and Endovascular Cerebrovascular Research.

The last decade has witnessed a major expansion in endovascular interventions concurrent with a contraction of open neurovascular surgeries. Whether research efforts have also shifted from open to endovascular neurosurgery is an effect that has not been explored extensively. Understanding the bibliometric trend is important for researchers, funding agencies, and publishing journals. The aim of this review is to explore this potential shift.We compared the bibliometrics of open cerebrovascular and endovascular research articles published in two neurosurgical journals (Journal of Neurosurgery, Neurosurgery) and two neuroradiological journals (Journal of Neurointerventional Surgery, American Journal of Neuroradiology). Data were collected between September 26, 2021, and October 18, 2021. Articles published in 2011, 2013, 2015, 2017, and 2019 from the journals were screened. Neurovascular articles were classified into open surgical, endovascular, or mixed. Bibliometric parameters were collected via SCOPUS and journals’ websites. A total of 8,018 articles were screened, of which 1,551 were included (16.2% open, 62.2% endovascular, 21.5% mixed). Most articles were related to aneurysms (76%). Open-access status correlated with increased citations (p<0.001) and Altmetric (p<0.001), which measures online activity. Comparing 2011 and 2019, the article distribution (open/endovascular/mixed) has changed significantly (χ2 test, p=0.002), with open articles dropping from 23.6% (68/288) to 12.9% (44/342) and endovascular articles rising from 56.6% (163/288) to 65.8% (225/342). Using the Kruskal-Wallis test, the citation distribution is different across the three groups in 2019 (p<0.001), favoring endovascular articles, but not in the other years. Our study suggests a trend of diminishing open neurovascular research output and increasing endovascular research output, in terms of both the number of articles and the citations. More time for citation accumulation may be required to verify this trend.

Knowledge framework and emerging trends in intracranial aneurysm magnetic resonance angiography: a scientometric analysis from 2004 to 2020.

As magnetic resonance angiography (MRA) has been increasingly used in the follow-up of intracranial aneurysms (IAs) as a non-invasive technique, the knowledge framework and areas of research interest in intracranial aneurysms magnetic resonance angiography (IAMRA) change approximately every 10 years. However, few studies have quantitatively analyzed the published literature in this field. In the present study, we used scientometrics to survey the knowledge field, development trends, and research focus of IAMRA with the aim of providing a reference for further study. We collected articles on IAMRA published from 2004 (Jan 1, 2004) to 2020 (May 24, 2020). Web of Science Core Collection databases (WoSCCd) including the Science Citation Index Expanded were searched. An experienced staff member from the Department of Radiology at Southern Medical University, assisted in screening articles for relevant articles. We used ArcGIS (a mapping and location analytics platform) to perform geographic visualization. Excel 2016 was used to analyze the literature data, including number of publications, impact factor (IF), and publication year. CiteSpace V was used to conduct a series of literature feature clustering, including author co-citation analysis, reference co-citation analysis (RCA), and burst keywords analysis. A total of 1,272 articles on IAMRA published between 2004 and 2020 were included. Of 257 journals, American Journal of Neuroradiology (IF 2018: 3.256) published the most IAMRA articles (109 publications, 8.57%), followed by Journal of Neurosurgery (IF 2018: 4.131, 51 publications, 4.16%), and Neuroradiology (IF 2018: 2.504, 51 publications, 4.01%). Of 56 countries, the USA published the most, with 347 articles [27.28%, IF: 3.14 (average IF of all journals in the country)], followed by Japan (242 articles, 19.03%, IF: 2.38), Germany (135 articles, 10.61%, IF: 3.21), and China (101 articles, 7.94%, IF: 2.86). A total of 1387 institutions published articles, with the Mayo Clinic publishing the most (33 articles, 2.59%), followed by Shanghai Jiao Tong University (25 article, 1.97%), Seoul National University (23 articles, 1.81%), and University Medical Center Utrecht (19 articles, 1.49%). Of 399 authors, Rinkel ranked first with 19 articles, followed by Li MH (18 articles), Uchino A (15 articles), and Saito N (13 articles). Cluster RCA showed that the first cluster was "#0 growth", followed by "#1 Guglielmi detachable coils". Timeline views showed that the time span of "#0 growth" was the closest to today. The modularity value was 0.6971, and the mean silhouette value was 0.5477. According to the burst keyword analysis, "risk factors associated to rupture" was the topic with the strongest burst since 2017. Studies conducted in several countries suggested that age is inversely related to the risk of rupture, which implies the importance of MRA follow-up for patients of different age. From 2004 to 2020, the number of published IAMRA-related articles gradually increased. The USA and Western Europe lead in the field, with a concentration of cutting-edge talents and high-level scientific research institutions. A synthesis of the clustering results of RCA and burst keyword analysis indicated that unruptured IA growth, stent-assisted coil embolization, and risk factors associated to rupture were the current hotspots in IAMRA research.

An international bibliometric study of scientific articles on intracranial aneurysms.

The number of original scientific researches on intracranial aneurysms has risen over the last 30 years. Despite the rise in the number of articles, there is no up-to-date exhaustive bibliometric research in the literature. This study aimed to contribute to the literature via a bibliometric analysis of the original scientific researches on intracranial aneurysms published over the last 30 years. The literature review was done using the Web of Science. All articles and its citations containing aneurysm keywords were analyzed in the "title" section of articles published in the research areas: Neurosciences Neurology during 1980-2019. Correlation analyses between the number of articles produced by the countries and their economic and development indicators of gross domestic product, and Human Development Index were analyzed using the Spearman correlation coefficient. Linear regression analysis was utilized to estimate the number of articles to be published in the future. There were a total of 21,673 publications on intracranial aneurysms. Of these publications, 13,371 (61.7%) were articles. The three countries that produced the most articles were the USA (4098), Japan (2668), and China (937). A statistically significant correlation was found between the development indicators of world countries and publication productivity (p<0.001). The three journals that produced the most publications were Neurosurgery, Journal of Neurosurgery, and American Journal of Neuroradiology. The most cited article was published in Journal of Neurosurgery. This bibliometric study provides a collection of data that will help design future research on intracranial aneurysms more efficiently and make innovations at greater speed.

Bibliometric Analysis of the Top 100 Most-Cited Articles on Intracranial Flow Diversion

Flow diverters are novel, contemporary tools in treating intracranial aneurysms. There is rapid publication turnover, with newer devices introduced and expanding indications. The bibliometric analysis measures the impact of particular articles and summarizes the chronologic trends overall. In July 2020, we performed a thorough search of the Scopus database using the terms "flow diversion," "flow diverter," and "flow diverting stent." The top 100 most impactful articles were arranged based on citation count in descending order. The collected articles were then analyzed with an assessment of relevant factors. Almost 1671 articles were published between 2007 and 2020. The gathered top 100 most-cited articles amassed 10,035 citations, with an average citation count of 100.35. An 8.8% self-citation rate was identified for all authors. The publication trends peaked in 2012, in which 24% of articles were published. Most prolific categories with top citations are on pipeline embolization, followed by the SILK flow diverter category. The United States published the highest number of articles. The University of Buffalo and Mayo Clinic published most of the articles among other institutions. American Journal of Neuroradiology was the most productive journal by producing 28 articles. This bibliometric analysis shows significant chronologic trends, with a shift from usefulness and outcome to short-term and long-term complications. Areas to improve in flow diverter research can be addressed after this analysis of the most impactful articles on this topic.

CYTOTOXIC EDEMA IN CHEMOTHERAPY-ASSOCIATED POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Posterior reversible encephalopathy syndrome (PRES) is a clinical radiographic syndrome characterized by seizures, visual disturbances and altered mental status. MRI of the brain exhibits vasogenic edema. Failure of autoregulation of cerebral arteries and disruption of the endothelium of the blood-brain-barrier are the two mechanisms underlying vasogenic edema. PRES has many triggers, including the use of chemotherapeutic agents. We present the case of a patient on treatment with paclitaxel/carboplatin, diagnosed with PRES, with radiographic evidence of both vasogenic and cytotoxic edema. CASE PRESENTATION: A 61-year-old male diagnosed with squamous cell carcinoma of the lung, recently started on Carboplatin and Paclitaxel, presented to the hospital with altered mental status. He was afebrile, blood pressure 117/77 mmHg, pulse 105 and respiratory rate 24. Physical exam revealed an unresponsive male in respiratory distress. Initial CT brain and blood investigations were unremarkable. He was admitted to the ICU and intubated for failure to protect his airway. MRI brain, revealed hyperintensities on T2-weighted and FLAIR imaging with patchy restricted diffusion involving bilateral fronto-parieto-occipital cortex typical of vasogenic edema and PRES. During further workup, he was found to have a left atrial thrombus from tumor invasion. He was started on anticoagulation and loaded with levetiracetam. He was noted to have dense hemiparesis two days later and underwent CT angiography of the brain which confirmed vasogenic with cytotoxic edema and diffusely increased vascularity as a consequence of decreased cerebral autoregulation. He regained consciousness and tolerated extubation, with complete resolution of hemiparesis. Following extubation, he was found to have visual disturbances which resolved and he was discharged with no neurological deficits. DISCUSSION: PRES with both vasogenic and cytotoxic edema is rare. Our patient had a recent MRI brain and PET/CT for tumor staging, which was negative for brain metastasis. There was a lack of evidence supporting an alternative cause for development of cytotoxic edema making PRES the most likely cause. Several studies have reported cytotoxic edema in PRES. In them, endothelial dysfunction seems to cause both vasogenic and cytotoxic edema occurs in PRES, with areas surrounding marked vasogenic edema usually progressing to cytotoxic edema. CONCLUSIONS: There is increasing evidence for development of PRES with several chemotherapy agents like carboplatin/paclitaxel. It may be characterized by vasogenic as well as cytotoxic edema. Cytotoxic edema is probably related to local decreased perfusion and arteriolopathy. Further research is warranted to understand the pathophysiologic mechanisms involved. It is important to recognize symptoms early and have a high clinical suspicion in spite of radiological evidence of cytotoxic edema, as PRES generally has an excellent prognosis with complete resolution. Reference #1: Janjua, T. K., Hassan, M., Afridi, H. K., & Zahid, N. A. (2017). Oxaliplatin-induced posterior reversible encephalopathy syndrome (PRES). BMJ case reports, 2017, bcr2017221571. https://doi.org/10.1136/bcr-2017-221571 Reference #2: Roth, C., & Ferbert, A. (2011). The posterior reversible encephalopathy syndrome: what's certain, what's new?. Practical neurology, 11(3), 136 -144. https://doi.org/10.1136/practneurol-2011-000010 Reference #3: Gao, B., Yu, B. X., Li, R. S., Zhang, G., Xie, H. Z., Liu, F. L., & Lv, C. (2015). Cytotoxic Edema in Posterior Reversible Encephalopathy Syndrome: Correlation of MRI Features with Serum Albumin Levels. AJNR. American journal of neuroradiology, 36(10), 1884 -1889. https://doi.org/10.3174/ajnr.A4379 DISCLOSURES: No relevant relationships by Bilal Bangash, source=Web Response No relevant relationships by Michael Buscher, source=Web Response No relevant relationships by Jay Parekh, source=Web Response No relevant relationships by Prachi Pednekar, source=Web Response No relevant relationships by Pranav Sharma, source=Web Response

Scientific Collaboration across Time and Space: Bibliometric Analysis of the American Journal of Neuroradiology, 1980-2018.

Scientific collaboration is traditionally acknowledged through coauthorship. Studies on this topic are few in the neuroimaging literature. This study is a bibliometric analysis of the American Journal of Neuroradiology (AJNR) between 1980 and 2018, with the primary aim of evaluating changes in article collaboration. Full bibliographic records from 1980 to 2018 were retrieved. Yearly metrics calculated included the number of articles published, the average number of authors, and the average number of affiliations per article. The levels of evidence of 160 random articles were determined. Geographic characteristics of author affiliations were analyzed. Changes across time were evaluated using linear regression, while Spearman rank-order correlation was used to determine relationships between level of evidence and time, number of authors, and number of affiliations. There was a steady linear growth in the number of articles (R 2 = 0.70, P < 1e-10) from 1980 to 2018. There were clear linear increases in the average number of authors (R 2 = 0.91, P < 1e-15) and affiliations (R 2 = 0.90, P < 1e-15) per article. There was a significant correlation between level of evidence and time period (Spearman ρ = -0.42, P < 1e-7), indicating that articles trended toward better methodologic quality or strength of results over time. A significant correlation existed between the level of evidence and the number of authors (Spearman ρ = -0.39, P < 1e-6). There were linear increases in the average number of different geographic locales of authors per article by country/region (R 2 = 0.80, P < 1e-13), state/province (R 2 = 0.88, P < 1e-15), and locality/city/town (R 2 = 0.86, P < 1e-15). From 1980 to 2018, as the quantity of articles published in the AJNR increased, their level of evidence improved, while an increasing number of authors with different affiliations and from different geographic locales collaborated on these articles.

Reply:

We greatly appreciate the interest of Dr Kim in our work and his knowledgeable comments regarding our article that was recently published in the American Journal of Neuroradiology .[1][1] He has highlighted several important points that we will address in this response. The first implication on the

Publicly Available Metrics Underestimate AJNR Twitter Impact and Follower Engagement.

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.

RARE COMPLICATION OF A RARE DISEASE

SESSION TITLE: Pulmonary Pathology II SESSION TYPE: Med Student/Res Case Report PRESENTED ON: 10/21/2019 3:15 PM - 4:15 PM INTRODUCTION: Primary pulmonary lymphoma (PPL) comprises of only 1% of pulmonary malignancies and has been described with systemic autoimmune diseases. It may be associated with a fatal disease known as intravascular lymphoma which is extremely rare and can lead to a diagnostic dilemma. CASE PRESENTATION: 58 year old female with history of Sjögren’s syndrome presented to the pulmonology clinic with complaints of shortness of breath cough and low grade fever for 2 weeks. She was vitally stable with bronchial breath sounds at the right lower lung zone. Chest X-ray showed right middle lobe collapse. The CT scan chest after 2 weeks of conservative treatment showed soft tissue density in the bronchus intermedius (BI). Bronchoscopy revealed pinkish lesion in BI. The histopathology showed high grade B cell Non-Hodgkin's lymphoma. The patient was started on chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin and prednisolone). After third cycle of chemotherapy she was admitted with fever and bodyaches. She became increasingly somnolent and dropped her GCS requiring intubation. The MRI brain showed diffusely scattered foci of signal dropout on SWI throughout the brain, predominantly in the corpus callosum and diffuse multifocal areas of diffusion restriction in periventricular and subcortical white matter. Lumbar puncture and EEG were negative. Brain biopsy was not attempted considering her clinical instability. She was treated with pulse steroids leading to improvement in GCS. A follow up MRI after pulse therapy showed interval improvement of the brain lesions. DISCUSSION: We believe that our case describes the presentation of a malignancy which progressed to develop a rare complication known as Intravascular lymphoma (IVL); it is a subtype of extranodal large B-cell lymphoma which spreads in angiotropic pattern to virtually any organ of the body, brain and skin being the most common sites. The gold standard of diagnosis is histological evidence of intravascular invasion but studies are being reported to identify noninvasive modalities of diagnosis of IVL (1). Recent literature reports various neuroimaging findings of IVL like multiple foci of high signal intensity in the deep white matter, infarct like changes and intracranial mass (2). Treatment of IVL is based on the RCHOP regimen, however prognosis is poor (3). The responsiveness to steroid therapy supports the diagnosis of IVL. CONCLUSIONS: A high index of suspicion is required to diagnose IVL in patients with Non-Hodgkins who present with neurological symptoms. An emerging evidence supports the use of neuroimaging in diagnosis of IVL in patients without tissue diagnosis. Reference #1: Shimada K, Kinoshita T, Naoe T, Nakamura S. Presentation and management of intravascular large B-cell lymphoma. The lancet oncology. 2009 Sep 1;10(9):895-902 Reference #2: Yamamoto A, Kikuchi Y, Homma K, O'uchi T, Furui S. Characteristics of intravascular large B-cell lymphoma on cerebral MR imaging. American Journal of Neuroradiology. 2012 Feb 1;33(2):292-6 Reference #3: Baehring JM, Longtine J, Hochberg FH. A new approach to the diagnosis and treatment of intravascular lymphoma. Journal of neuro-oncology. 2003 Feb 1;61(3):237-48 DISCLOSURES: no disclosure on file for Arsalan Ahmad; No relevant relationships by Hasaan Omar, source=Web Response No relevant relationships by Aqusa Zahid, source=Web Response No relevant relationships by Ali Zubairi, source=Web Response

Selection of Patients with Stroke for Thrombectomy Must Be Judicious and Should Not Be Offered to Any Patient with Large-Vessel Occlusion with a Femoral Pulse.

In this issue of the American Journal of Neuroradiology ( AJNR ), the authors reported their findings in the retrospective study, “Clinical Outcome after Thrombectomy in Patients with Stroke with Premorbid Modified Rankin Scale Scores of 3 and 4: A Cohort Study with 136 Patients.”[1][1] The

The Top 20 Most Prolific Authors in the American Journal of Neuroradiology: What Is Their Impact?

Many articles that are relevant to patient care but published in radiology journals may escape notice by clinicians. We sought to determine how often the 20 most prolific American Journal of Neuroradiology (AJNR) authors from 2013 to 2017 published in clinical journals and the extent to which their articles were disseminated into the clinical literature. We counted all authors' first- or senior-authored articles in the AJNR from 2013 to 2017 to identify the 20 most prolific authors in AJNR. We searched for these 20 authors' total articles from 2013 to 2017 to determine which were published in radiology or clinical journals and the number of citations received from radiology and clinical journals. Authors were sorted into quartiles according to these metrics, and other descriptive statistics were performed. The top 20 AJNR authors contributed to 1463 articles during 5 years, including 711 (48.6%) in radiology and 752 (51.4%) in clinical journals. These articles were cited 15,857 times, including 4659 (29.3%) by articles in radiology journals. The more prolific authors published in clinical journals more often (Spearman ρ = 0.65, P = .002) and were cited more (ρ = 0.42, P = .07). Articles published in clinical journals were cited more often (mean, 12.3 clinical, 9.3 radiology general versus 8.7 in AJNR), and whether published in radiology or clinical journals, they were cited more frequently by clinical journals. Regardless of where it is published, radiology research is disseminating into the clinical realm. Radiology articles published in clinical journals are cited more often than those published in radiology journals.

Heinz First to Routinely Catheterize Carotid and Vertebral Arteries in America.

The 1967 article of Amundsen et al, “Cerebral Angiography via the Femoral Artery with Particular Reference to Cerebrovascular Disease,”[1][1] was chosen by the American Journal of Neuroradiology ( AJNR ) as the “Best Paper” in neuroradiology in 2003. Heinz and associates developed the

CT Texture Analysis: Defining and Integrating New Biomarkers for Advanced Oncologic Imaging in Precision Medicine: A Comment on “CT Texture Analysis Potentially Predicts Local Failure in Head and Neck Squamous Cell Carcinoma Treated with Chemoradiotherapy”

The remarkable article by Kuno et al[1][1] in this issue of the American Journal of Neuroradiology raises several questions: Can texture analysis provide reliable biomarkers to predict treatment success in head and neck squamous cell carcinoma (HNSCC)? If so, will the role of the expert clinical