Impact of neuroradiologist second opinion on staging and management of head and neck cancer

OBJECTIVE: Patients with head and neck cancer frequently present to academic tertiary referral centers with imaging studies that have been performed and interpreted elsewhere. At our institution, these outside head and neck imaging studies undergo formal second opinion reporting by a fellowship-trained academic neuroradiologist with expertise in head and neck imaging. The purpose of this study was to determine the impact of this practice on cancer staging and patient management. METHODS: Our institutional review board approved the retrospective review of randomized original and second opinion reports for 94 consecutive cases of biopsy proven or clinically suspected head and neck cancer in calendar year 2010. Discrepancy rates for staging and recommended patient management were calculated and, for the 32% (30/94) of cases that subsequently went to surgery, the accuracies of the reports were determined relative to the pathologic staging gold standard. RESULTS: Following neuroradiologist second opinion review, the cancer stage changed in 56% (53/94) of cases and the recommended management changed in 38% (36/94) of patients with head and neck cancer. When compared to the pathologic staging gold standard, the second opinion was correct 93% (28/30) of the time. CONCLUSION: In a majority of patients with head and neck cancer, neuroradiologist second opinion review of their outside imaging studies resulted in an accurate change in their cancer stage and this frequently led to a change in their management plan

‘Mind the Gap’—reforestation needs vs. reforestation capacity in the western United States

Tree establishment following severe or stand-replacing disturbance is critical for achieving U.S. climate change mitigation goals and for maintaining the co-benefits of intact forest ecosystems. In many contexts, natural post-fire tree regeneration is sufficient to maintain forest cover and associated ecosystem services, but increasingly the pattern and scale of disturbance exceeds ecological thresholds and active reforestation may be warranted. Our capacity to plant trees, however, is not keeping pace with reforestation needs. This shortfall is uniquely apparent in the western U.S., where wildfire size and severity have increased in recent decades and long-term divestment in the reforestation supply chain has limited our ability to respond to existing needs. Here we present an analysis of key facets of both the supply and demand side of reforestation in the western U.S. and address six questions: (1) What is the current backlog of potential reforestation needs driven by high-severity wildfire?; (2) How will increasing wildfire activity through the end of the century affect potential reforestation needs?; (3) What is our capacity to meet current and future reforestation needs?; (4) How can we scale the reforestation supply chain to meet current and future demands?; (5) What approaches to reforestation can promote forest resilience to climate change and wildfire?; and (6) Where are opportunities emerging from recent policy initiatives, innovative public-private partnerships, and natural capital markets for scaling reforestation? Between 1984 and 2000, annual tree planting capacity met post-fire needs but cumulatively over the last two decades (2000 to 2021) it has fallen short of fire-driven needs by an estimated 1.5 million ha (ca. 3.8 million ac). We anticipate this gap will increase 2 to 3 fold by 2050. Scaling up reforestation efforts to close this gap will require increased investment across all facets of the reforestation supply chain, public-private partnerships, and novel approaches to reforestation that increase the resilience of western forests to drought and wildfire. We highlight emerging opportunities from recent policy initiatives and conservation finance for expanding reforestation efforts

Mycotic aneurysm and cerebral infarction resulting from fungal sinusitis: imaging and pathologic correlation.

A 73-year-old man was admitted with invasive aspergillus of the sphenoid sinus. Endoscopic debridement of the sphenoid sinus was complicated by rupture of a mycotic cavernous carotid artery aneurysm with severe epistaxis. The aneurysm was closed emergently by endovascular coil placement. Subsequently, the mycotic aneurysm extended intradurally and caused fatal subarachnoid hemorrhage. The radiologic-pathologic data illustrate the mechanism of fungal mycotic aneurysm formation and growth. This case emphasizes the need for rapid diagnosis of potential fungal involvement of the central nervous system and suggests the necessity for aggressive treatment once fungal cerebrovascular involvement is identified

Spontaneous thrombosis of a basilar artery traumatic aneurysm in a child.

Traumatic aneurysms are rare and occur most commonly in young adults; however, the relative frequency in the pediatric population is high, owing to the low prevalence of congenital saccular aneurysms in children. Traumatic aneurysms typically involve the anterior circulation, and spontaneous thrombosis is uncommon; hence, surgery is usually necessary. We present a case of a posttraumatic aneurysm in a child that occurred after a fall from a large height and that spontaneously thrombosed