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Objective: The aim of this pilot cohort study was to examine changes in the organization of resting-state brain networks in high school football athletes and its relationship to exposure to on-field head impacts over the course of a single season. Methods: Seventeen male high school football players underwent functional magnetic resonance imaging and computerized neurocognitive testing (CNS Vital Signs) before the start of contact practices and again after the conclusion of the season. The players were equipped with helmet accelerometer systems (Head Impact Telemetry System) to record head impacts in practices and games. Graph theory analysis was applied to study intranetwork local efficiency and strength of connectivity within six anatomically defined brain networks. Results: We observed a significant decrease in the local efficiency (−24.9 ± 51.4%, r = 0.7, p < 0.01) and strength (−14.5 ± 26.8%, r = 0.5, p < 0.01) of functional connectivity within the frontal lobe resting-state network and strength within the parietal lobe resting-state network (−7.5 ± 17.3%, r = 0.1, p < 0.01), as well as a concomitant increase in the local efficiency (+55.0 +/- 59.8%, r = 0.5, p < 0.01) and strength (+47.4 +/- 47.3%, r = 0.5, p < 0.01) within the mediotemporal networks. These alterations in network organization were associated with changes in performance on verbal memory (p < 0.05) and executive function (p < 0.05). We did not observe a significant relationship between the frequency or cumulative magnitude of impacts sustained during the season and neurocognitive or imaging outcomes (p > 0.05). Conclusion: Our findings suggest the efficiency and strength of resting-state networks are altered across a season of high school football, but the association of exposure levels to subconcussive impacts is unclear. Advances in knowledge: The efficiency of resting-state networks is dynamic in high school football athletes; such changes may be related to impacts sustained during the season, though further study is needed.

Primary hyperparathyroidism (PHPT) is characterized by excessive, dysregulated production of parathyroid hormone (PTH) by 1 or more abnormal parathyroid glands. Minimally invasive surgical techniques have created a need for more precise localization of the parathyroid lesion by imaging. A variety of imaging protocols and techniques have been used for this purpose, but no one modality is clearly superior. Nuclear medicine scintigraphy and ultrasound imaging are established modalities, although multiphase or 4-dimensional computed tomography is an emerging modality with several advantages. This review provides a background regarding PHPT and key anatomy, and discusses these alternative parathyroid imaging modalities with updates.

Background and purposeThe effect of exposing the developing brain of a high school football player to subconcussive impacts during a single season is unknown. The purpose of this pilot study was to use diffusion tensor imaging to assess white matter changes during a single high school football season, and to correlate these changes with impacts measured by helmet accelerometer data and neurocognitive test scores collected during the same period.Materials and methodsSeventeen male athletes (mean age, 16 ± 0.73 years) underwent MR imaging before and after the season. Changes in fractional anisotropy across the white matter skeleton were assessed with Tract-Based Spatial Statistics and ROI analysis.ResultsThe mean number of impacts over a 10-g threshold sustained was 414 ± 291. Voxelwise analysis failed to show significant changes in fractional anisotropy across the season or a correlation with impact frequency, after correcting for multiple comparisons. ROI analysis showed significant (P < .05, corrected) decreases in fractional anisotropy in the fornix-stria terminalis and cingulum hippocampus, which were related to impact frequency. The effects were strongest in the fornix-stria terminalis, where decreases in fractional anisotropy correlated with worsening visual memory.ConclusionsOur findings suggest that subclinical neurotrauma related to participation in American football may result in white matter injury and that alterations in white matter tracts within the limbic system may be detectable after only 1 season of play at the high school level.

Susceptibility-weighted imaging (SWI) is a magnetic resonance imaging (MRI) technique that enhances image contrast by using the susceptibility differences between tissues. It is created by combining both magnitude and phase in the gradient echo data. SWI is sensitive to both paramagnetic and diamagnetic substances which generate different phase shift in MRI data. SWI images can be displayed as a minimum intensity projection that provides high resolution delineation of the cerebral venous architecture, a feature that is not available in other MRI techniques. As such, SWI has been widely applied to diagnose various venous abnormalities. SWI is especially sensitive to deoxygenated blood and intracranial mineral deposition and, for that reason, has been applied to image various pathologies including intracranial hemorrhage, traumatic brain injury, stroke, neoplasm, and multiple sclerosis. SWI, however, does not provide quantitative measures of magnetic susceptibility. This limitation is currently being addressed with the development of quantitative susceptibility mapping (QSM) and susceptibility tensor imaging (STI). While QSM treats susceptibility as isotropic, STI treats susceptibility as generally anisotropic characterized by a tensor quantity. This article reviews the basic principles of SWI, its clinical and research applications, the mechanisms governing brain susceptibility properties, and its practical implementation, with a focus on brain imaging.

362 Radiology reports should be fashioned for the benefit of patients, not to ameliorate radiologists’ inflated fears over very low risk legal consequences. Although on many occasions it is not possible to make specific diagnoses, when there is a high degree of certainty, radiologists should decisively, unambiguously, and definitively detail the findings and explain their significance. Anything less devalues the worth of our contribution to patient care.

standard of care. However, we recommend that the ACR consider a guideline about whether its use is a best practice given that a judge and jury might interpret the high proportion of radiologists who use CAD as establishing a standard of care. An ACR guideline could similarly address the specific issue of whether radiologists should indeed retain CAD markings and mention CAD results in their reports.

We report a case of ivory vertebra on 18F-sodium fluoride. A prostate cancer patient had a 18F-sodium fluoride PET scan to evaluate overall spread of disease. In addition to other findings of metastatic disease, the patient had an ivory vertebra.

This excerpt from the impression of a radiology report is a prime example of meaningless jargon that has insinuated itself into the radiology lexicon. In this case it is especially egregious, as there would be no clinical finding for the referring clinician to correlate. Few phrases in radiology are as meaningless and potentially infuriating to referring clinicians as “recommend clinical correlation,” “clinical correlation is advised,” “correlate clinically,” or similar derivations. Referring clinicians may interpret such phrases to mean that the radiologists believe they have not done their jobs. Even worse, the radiologists are now instructing them to do so in the official medical record. The phrase does not add information to the report, positively affect patient care, or absolve the radiologist of legal liability [1]. Radiologists should omit the nebulous “recommend clinical correlation” from their reports and provide specific diagnoses and recommendations. In cases of diagnostic uncertainty, radiologists should provide differential diagnoses. When clinical information is available, radiologists should incorporate that information in their estimations of the likelihood of each of the various diagnostic possibilities. Finally, radiologists should be aware that patients may have access to their reports and can be misled or made anxious by what they read. Using phrases such as “recommend clinical correlation” diminishes the usefulness of the radiology report, has the potential to disrupt relationships with referring clinicians, and confuses patients.