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Lorenzo Pinelli

@lorpin.bsky.social
144 followers 69 following 43 posts

Adult and pediatric neuroradiologist, lifelong learner, still on (what remains of) Twitter too, probably not for much time #MedSky

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Lorenzo Pinelli @lorpin.bsky.social · 14/04/2025
time.com/7275819/shou...
time.com
A Full-Body MRI Scan Could Save Your Life. Or Ruin It
Most medical experts are wary of the controversial scans.
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Lorenzo Pinelli @lorpin.bsky.social · 14/04/2025
Well, it depends on the case 🤷🏼‍♂️
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Reposted by Lorenzo Pinelli
The American Journal of Neuroradiology @theajnr.bsky.social · 07/03/2025
"The Association of Vascular Loops within the Internal Auditory Meatus or Contacting the Vestibulo-Cochlear Nerve with Audiovestibular Symptoms: A Systematic Review and Meta-Analysis" doi.org/10.3174/ajnr... #FellowsJournalClub
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Reposted by Lorenzo Pinelli
The American Journal of Neuroradiology @theajnr.bsky.social · 07/03/2025
"This systematic review and meta-analysis evaluated the association between the presence of a vascular loop within the IAM (IVL) or contacting the vestibulocochlear nerve (CN VIII NVC) and audiovestibular symptoms. There was no statistically significant correlation."
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Reposted by Lorenzo Pinelli
The American Journal of Neuroradiology @theajnr.bsky.social · 13/02/2025
"“Flow Void Sign”: Flow Artifact on T2-Weighted MRI Can Be an Indicator of Dural Defect Location in Ventral Type 1 Spinal CSF Leaks" doi.org/10.3174/ajnr... @NeuroradLal #CSFLeak #FellowsJournalClub
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Reposted by Lorenzo Pinelli
Lea Alhilali, MD @teachplaygrub.bsky.social · 31/12/2024
Can’t metabolize all the metabolic bone diseases? When you see weird bones, do you just say, “suggestive of metabolic bone disease” & hope no one ask questions? Metabolic disease are complex but a few are a slam dunk Bookmark this figure for the 4 classic xray patterns you NEED to know!
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Lorenzo Pinelli @lorpin.bsky.social · 29/12/2024
Indeed, more precise and easily understandable 👏🏼
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Lorenzo Pinelli @lorpin.bsky.social · 29/12/2024
Glad to see I’m not the only one asking these questions to residents who use this pre-packaged phrase in the body of the report. Often when there are no abnormalities at all (which for me generates a one word report: “Normal”). 🤷🏼‍♂️
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Lorenzo Pinelli @lorpin.bsky.social · 28/12/2024
No idea.. btw, the original paper (I haven’t it here right now, I will post it) was about osteoporotic fractures in elderly people, so I think it’s not a good idea to apply Genant classification to post-traumatic vertebral fracture in healthy people (like I often read in reports from elsewhere)🤔
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Lorenzo Pinelli @lorpin.bsky.social · 28/12/2024
I usually use the TLICS score, specifying I’m listing the radiological items only, and the AOSpine. TLICS is good, it was innovative, but later on some issues raised, especially for the evaluation of the integrity of the posterior ligamentous complex (discrepancies with surgical finding are common)🤓
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Lorenzo Pinelli @lorpin.bsky.social · 28/12/2024
Personally I find l the Genant classification weird (only 5% range for grade 1) and difficult to apply reliably (btw: the original paper is based on few cases), especially with visual evaluation only. If used, the grade should be obtained measuring, not visually 🤓
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Lorenzo Pinelli @lorpin.bsky.social · 19/12/2024
The usual amazing post by @teachplaygrub.bsky.social with crystal clear explanation of an intricate topic ! 👏🏼👏🏼👏🏼
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Lorenzo Pinelli @lorpin.bsky.social · 18/12/2024
In 1997 the American College of Physicians issued a position paper stating that in patients w/low pretest probability of Lyme disease, even positive test results do not increase the probability of Lyme disease, since they would have more chances of being a false positive than a true positive 🤦🏼‍♂️
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Lorenzo Pinelli @lorpin.bsky.social · 18/12/2024
This has also to do with the prevalence of a disease (another rule of screening, btw), and reminds me what happened several years ago with the fake epidemic of Lyme disease, because of which almost any patient with myalgia was suggested to undergo ELISA test for Lyme disease…
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Lorenzo Pinelli @lorpin.bsky.social · 18/12/2024
Even talking about “simple” brain or spine MRI: my experience is that patients undergoing brain or spine MRI with 0.001% of chances of a significant finding (explaining the symptoms), “just to be sure and more relaxed”, are NEVER told that their fear can be even bigger after the MRI 🤦🏼‍♂️.
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Lorenzo Pinelli @lorpin.bsky.social · 18/12/2024
And, when we inform the patients about WBMRI, how many times do we inform them about the possible scenario of discovering an “unknown thing”, that will need further exams, maybe invasive/dangerous, provoking anxiety/fears/side effects, maybe for nothing? 🤷🏼‍♂️
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Lorenzo Pinelli @lorpin.bsky.social · 18/12/2024
I then tried to convince you that WBMRI can be even more dangerous than jumping from a skyscraper roof! 😅 Of course, mine was a provocation, to highlight that medical responsibility (in this and other scenarios) can’t be only “to inform”, letting the patients to get the decision by themselves.
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Lorenzo Pinelli @lorpin.bsky.social · 18/12/2024
Examples showing why “screening (especially by imaging)” is not always a good thing, even when you find “something”, are endless. Especially when you look at the CNS, where you often can’t solve the diagnostic dilemma of an incidental finding by “biopsying” the brain of a healthy person 🤷🏼‍♂️
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Lorenzo Pinelli @lorpin.bsky.social · 18/12/2024
Or, again: in the end the patient are so stressed by the idea of having a cerebral aneurysm, that they decide to undergo treatment, for an aneurysm that would never have ruptured, and suffers a complication with permanent neurological deficit, because of an operation they shouldn't have had …
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Lorenzo Pinelli @lorpin.bsky.social · 18/12/2024
Or, again: incidental small cerebral aneurysm, the patient receives conflicting opinions on what to do (to treat/not to treat), maybe because both decisions can be correct, and they can’t solve the dilemma by themselves. Of course, follow-up will be suggested, but it does not guarantee anything 🤷🏼‍♂️
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Lorenzo Pinelli @lorpin.bsky.social · 18/12/2024
Even worse with incidental aneurysms: are we sure that it is always 👍 to accidentally discover a cerebral aneurysm? Maybe so small that is not considered treatable. But now the patient knows they have it. So, while they had “screening” MRI/MRA done “to feel at ease”,in the end has their life ruined.
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Lorenzo Pinelli @lorpin.bsky.social · 18/12/2024
For several reasons, my friend. 1st: how you get a certain diagnosis of a malignant tumor? With further exams,some of them invasive/potentially dangerous. 2nd: does every “mass” we find must be removed?What do we know about the natural history of an incidentally discovered maybe millimetric lesion?
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Lorenzo Pinelli @lorpin.bsky.social · 18/12/2024
“Can we deny someone the right to jump from a skyscraper roof, if they request it & are willing to cover the cost, once we inform them about pros/cons? Ultimately, the decision should rest in their hands”. 😉🙏🏼
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Lorenzo Pinelli @lorpin.bsky.social · 18/12/2024
tough topic, as you obviously know, my friend…Unfortunately, information in this field inevitably suffers from a powerful bias, since it comes from the same side that offers the “screening”, and relies on the anxiety and fears of the people.Not everything that can be bought is also ethically correct
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Lorenzo Pinelli @lorpin.bsky.social · 18/12/2024
🙂‍↔️Screening has got rules (among them, to know exactly in advance WHAT disease you are looking for, that is a treatable disease with proven benefit of early treatment).”Screening” healthy people by putting them into a magnet is indeed a huge business that would sky🚀 incidentalomas and health costs 🤷🏼‍♂️
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Lorenzo Pinelli @lorpin.bsky.social · 15/12/2024
T H I S I S A W E S O M E ! 🎉
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Lorenzo Pinelli @lorpin.bsky.social · 14/12/2024
media.tenor.com
a man is peeking out of a door with the words `` may i come in '' written on it .
ALT: a man is peeking out of a door with the words `` may i come in '' written on it .
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Lorenzo Pinelli @lorpin.bsky.social · 14/12/2024
media.tenor.com
a woman in a lab coat is pointing at a brain scan with the words " officially it 's benign " behind her
ALT: a woman in a lab coat is pointing at a brain scan with the words " officially it 's benign " behind her
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Lorenzo Pinelli @lorpin.bsky.social · 13/12/2024
@stefantigges.bsky.social : I just zoomed in the pic of your post, which clearly depict Charcot-Bouchard “aneusysms” as segmental non-terminal nor saccular dilatations of the perforator arteries, according to modern understanding of their nature. Great job, as usual of you ! 👏🏼👏🏼🙏🏼
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Lorenzo Pinelli @lorpin.bsky.social · 13/12/2024
More on the topic 🤓 ⤵️
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Lorenzo Pinelli @lorpin.bsky.social · 13/12/2024
Great job! As a matter of curiosity, so-called “Charcot-Bouchard aneurysms” probably do not exist, at least as we imagine them (= intraparenchimal counterpart of the subarachnoid saccular aneurysms). They are arterial segmental dilatation, appearing saccular due to twisting/coiling of the vessels 🤓
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Lorenzo Pinelli @lorpin.bsky.social · 12/12/2024
Reference?
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Reposted by Lorenzo Pinelli
Peter Kranz, M.D. @petergkranz.bsky.social · 11/12/2024
📄 New Paper Alert! 📄 “Flow Void Sign”: Flow Artifact on T2-Weighted MRI Can Be an Indicator of Dural Defect Location in Ventral Type 1 Spinal CSF Leaks Congrats to @neuroradlal.bsky.social, @dgleao.bsky.social , David Butteriss, @brainscandan.bsky.social - super useful - I'm a believer!!
ajnr.org
“Flow Void Sign”: Flow Artifact on T2-Weighted MRI Can Be an Indicator of Dural Defect Location in Ventral Type 1 Spinal CSF Leaks
Patients with spontaneous intracranial hypotension caused by type 1 dural defects typically have an epidural fluid collection on MRI. Still, the location of the defect is not usually readily identifia...
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Lorenzo Pinelli @lorpin.bsky.social · 11/12/2024
Sorry for the long reply, it’s a topic I really feel a lot 😌 ... I just took advantage of your funny 🎅🏻post to throw the stone into the pond, but this does not change my professional esteem for you (I learned a lot on TB from your insightful posts on the “other platform” 🙏🏼 ). Merry Christmas! 🎅🏻🎄
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Lorenzo Pinelli @lorpin.bsky.social · 11/12/2024
The list is almost endless. I read your mind 😊: “Dear (neuro)radiologist,add whatever MR sequence you want, but please do the exam I “ordered” (a 👎🏼 term, IMHO.. I do prefer “requested”). The problem here is the TIME constraint: we always have to find a balance between what we’d like and what we can🤷🏼‍♂️
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Lorenzo Pinelli @lorpin.bsky.social · 11/12/2024
In a different scenario: non enhanced lumbar spine MRI ordered for a patient with low-back pain refractory to analgesic drugs. We unfortunately find a probable spine tumor: will the ordering clinician will be offended if I inject CM (not ordered), extending the exam to the whole spine? 😇
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Lorenzo Pinelli @lorpin.bsky.social · 11/12/2024
young outpatient with dizziness, normal neck vessels US, “brain MRI + MRA” ordered . Will you be offended if, instead of the (useless) MRA, I acquire a high res 3D T2WI of the temporal bone (not requested), demonstrating a small vestibular schwannoma, otherwise not visible? 🤓
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Lorenzo Pinelli @lorpin.bsky.social · 11/12/2024
… why so little confidence in the work of your radiologists? Why should one think that your orders will be changed for the worse? Why is it so difficult to think of the (neuro)radiologist as an ally who, like the clinician, wants to reach the correct diagnosis, rather than an “enemy”? 😊
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Lorenzo Pinelli @lorpin.bsky.social · 11/12/2024
For Christmas, I would like clinicians to stop ordering useless exams (and not ordering the needed ones!) 😁 Jokes apart, dear @isaacerbele.bsky.social , I know the issue of relationship between clinicians and (neuro)radiologists is a hot topic, and I don’t wanna offend anyone, but …
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Reposted by Lorenzo Pinelli
adgoldmanyassen.bsky.social @adgoldmanyassen.bsky.social · 11/12/2024
Join us on 12/12 at 3PM Eastern Time for the monthly PEdiAtric NeUroradiology Teaching Series (PEANUTS) lecture: "Malformations of Cortical Development" Dr. Julie Guerin from the Mayo Clinic Register in advance for this webinar: zoom.us/webinar/regi...
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Lorenzo Pinelli @lorpin.bsky.social · 11/12/2024
Beautiful, great insight, and I love the way you draw ! 👏🏼 Was just thinking: there are lots of reasons why we offer tissues to a crying patient, you highlighted some of them, I’m quite sure among them there’s also the will to be kind to a suffering human being …😊
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Lorenzo Pinelli @lorpin.bsky.social · 07/12/2024
(I forgot: normal middle ear too!)
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Lorenzo Pinelli @lorpin.bsky.social · 07/12/2024
Young non syndromic female patient with bilat slowly worsening mixed hearing loss, normal otoscopy and inner ear, and the most bulbous/patulous IACs I’ve ever come across 😳, supposedly incidental @dshatzkes.bsky.social @cmglastonbury.bsky.social @mohitagneurorad.bsky.social @tabbykennedy.bsky.social
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Lorenzo Pinelli @lorpin.bsky.social · 07/12/2024
Agreed, very helpful paper!
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Lorenzo Pinelli @lorpin.bsky.social · 07/12/2024
What a helpful clinical 💎! 🙏🏼
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Lorenzo Pinelli @lorpin.bsky.social · 04/12/2024
👏🏼💪🏼🙏🏼
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Lorenzo Pinelli @lorpin.bsky.social · 04/12/2024
“Italian style” 😂
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Lorenzo Pinelli @lorpin.bsky.social · 03/12/2024
Thank YOU for continuously sharing your endless knowledge!
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Lorenzo Pinelli @lorpin.bsky.social · 03/12/2024
We should also remember that Bell’s palsy (or idiopathic peripheral facial nerve paralysis, if you din’t like eponyms) typically presents acutely and reaches the zenith in few hours. A slowly worsening FN deficit is NOT typical for Bell’s palsy and it should raise suspicion of secondary paralysis 🤓
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Reposted by Lorenzo Pinelli
Wm O'Brien DO @wmobriendo.bsky.social · 03/12/2024
Legendary Cortex Club at #RSNA24 - our fearless leader Mohit is not yet on #BlueSky but we're working on him...😊 Great group of international friends & colleagues, with the group continuing to grow! #NeuroRadSky
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