Journal Scan – This Month in Other Journals, September 2017

McKeith IG, Boeve BF, Dickson DW, et al. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology. 2017;65(12):1863-1872. doi:10.1212/WNL.0000000000004058

The Dementia with Lewy Bodies (DLB) Consortium last reported on diagnosis and management in December 2005, and its recommendations have been widely cited for both clinical and research use. The revised DLB criteria which are presented incorporate new developments and result from a review process that combined the reports of 4 multidisciplinary, expert working groups with a meeting that included patient and care partner participation. Dementia, defined as a progressive cognitive decline of sufficient magnitude to interfere with normal social or occupational functions, or with usual daily activities, is an essential requirement for DLB diagnosis. Disproportionate attentional, executive function, and visual processing deficits relative to memory and naming are typical. DLB consciousness fluctuations are typically delirium-like, occurring as spontaneous alterations in cognition, attention, and arousal. They include waxing and waning episodes of behavioral inconsistency, incoherent speech, variable attention, or altered consciousness that involves staring or zoning out.

Recurrent, complex visual hallucinations occur in up to 80% of patients with DLB and are a frequent clinical signpost to diagnosis. They are typically well-formed, featuring people, children, or animals, sometimes accompanied by related phenomena including passage hallucinations (transient visual hallucinations consisting of people or animals that pass sideways out of the visual field), sense of presence, and visual illusions.

Spontaneous parkinsonian features, not due to antidopaminergic medications or stroke, are common in DLB, eventually occurring in over 85%. Parkinsonism in Parkinson disease (PD) is defined as bradykinesia in combination with rest tremor, rigidity, or both. Many DLB patients’ parkinsonism falls short of this, so documentation of only one of these cardinal features is required.

REM sleep behavior disorder is a parasomnia manifested by recurrent …

Journal Welcomes New Editors

Dr. Yvonne Lui

AJNR Senior Editor Dr. Jody Tanabe recently accepted a new assignment as Acting Chair at the University of Colorado School of Medicine and has ended her term after 3½ years of dedicated service to the Journal. Her role overseeing functional and advanced imaging submissions will be filled by Dr. Yvonne Lui, Associate Professor of Radiology and Chief of Neuroradiology at New York University School of Medicine. Dr. Lui is a graduate of Yale University School of Medicine and completed her radiology and neuroradiology training at NYU. Her interests are focused on advanced MR imaging of the central nervous system and she leads an NIH-funded research program on brain injury. Dr. Lui is a charter member of the NIH Scientific Review Committee for Medical Imaging, reviews for 7 other academic journals, and serves as the 2017 President of the New York Roentgen Society. She has also served as AJNR’s Podcast Editor since 2013.

Dr. Wende Gibbs

Dr. Wende Gibbs will be stepping into Dr. Lui’s role as AJNR’s Podcast Editor. She will be the host of the Journal’s monthly podcast, 1 of 3 episodes published each month. Dr. Gibbs is an Assistant Professor of Neuroradiology and Director of Spine Imaging and Intervention at the University of Southern California, Keck School of Medicine. She previously completed a 2-year fellowship at the Barrow Neurological Institute. Dr. Gibbs has authored a number of publications and book chapters and holds leadership and committee positions for the ASNR, ASSR, ARRS, WNRS, and ABR. She is a member of the AJNR Editorial Board and reviews for 7 journals. Her main interests are spine oncology, pain management, and patient-centered care.…

Influence of Carotid Siphon Anatomy on Brain Aneurysm Presentation

Fellows’ Journal Club

Lateral view DSA images of 692 consecutive patients with intracranial aneurysms treated at the authors’ institution were reviewed and had their angles measured. Data on the location, presentation, and size of the lesions were collected and evaluated by multivariate analysis in relation to the measured angles. Multivariate analysis showed an association between angles of >15.40° and rupture (P = .005), postsiphon location (P = .034), and aneurysm size of >1.001 mm (P = .015). These findings may be associated with the hemodynamic interactions of blood flow and the curvature of the carotid siphon.

Amide Proton Transfer Imaging Allows Detection of Glioma Grades and Tumor Proliferation: Comparison with Ki-67 Expression and Proton MR Spectroscopy Imaging

Editor’s Choice

Amide proton transfer–weighted imaging (APTWI) is a novel molecular MR imaging technique developed to detect and quantitatively visualize endogenous proteins and peptides. APTWI is usually reported in terms of asymmetry in the magnetization transfer ratio at 3.5 ppm. This study included 42 patients with low-grade (n = 28) or high-grade (n = 14) glioma, all of whom underwent conventional MR imaging, proton MR spectroscopy imaging, and amide proton transfer–weighted imaging on the same 3T scanner within 2 weeks before surgery. The asymmetric magnetization transfer ratio at 3.5 ppm values measured by different readers showed good concordance and were significantly higher in high-grade gliomas than in low-grade gliomas, with sensitivity and specificity values of 92.9% and 71.4%, respectively, at a cutoff value of 2.93%. The asymmetric magnetization transfer ratio at 3.5 ppm may serve as a potential biomarker not only for assessing proliferation, but also for predicting histopathologic grades in gliomas.

Neuroimaging Clinics of North America: Advances in Imaging of Multiple Sclerosis

Mukherji SK, ed. Rovira À, consulting ed. Neuroimaging Clinics of North America: Advances in Imaging of Multiple Sclerosis. Elsevier; 2017;27(2):195–370; $365.00

Neuroimaging Clinics of North America-Advances in Imaging of Multiple Sclerosis-ALex Rovira

MRI is often performed for a suspicion of multiple sclerosis or for follow-up in patients known to have MS. Enter the May 2017 volume of the Neuroimaging Clinics of North America, entitled Advances in Imaging of Multiple Sclerosis. This issue, edited by Dr. Àlex Rovira, consists of 12 chapters with 29 authors contributing to these chapters. Not only does this volume cover adult and pediatric brain and spine MS, but it contains an update on all of the new concepts in MR imaging, such as iron mapping, detecting cortical lesions, MR spectroscopy, PET imaging, and the detection of microstructural changes with ultra-high-field (7T) MR.

The volume also serves as a strong review of NMO spectrum disorders, which is immediately applicable to one’s daily work. The subdivision of NMO (or NMOSD, as it is now referred to) into seropositive/seronegative types bears study, as do the images contained in this chapter. The clinical necessity to distinguish NMOSD from MS because of treatment variations is pointed out in this chapter.

Of great additional interest is the chapter on monitoring treatment responses in MS because, as the authors point out, there should be a consistent, reproducible protocol so that therapeutic measures can be accurately assessed. This pertains not only to volumes of WM lesions and their enhancement, but also to associated brain atrophy (which is covered in a subsequent chapter).

This issue of the Neuroimaging Clinics of North America is one that should be available to all neuroradiologists and is a recommended purchase for one’s own personal library.


Diagnostic Performance of a 10-Minute Gadolinium-Enhanced Brain MRI Protocol Compared with the Standard Clinical Protocol for Detection of Intracranial Enhancing Lesions

Fellows’ Journal Club

A total of 53 patients underwent MR imaging consisting of 5 basic fast precontrast sequences plus standard and accelerated versions of the same postcontrast T1WI sequences. Two neuroradiologists assessed the image quality and the final diagnosis for each set of postcontrast sequences and compared their performances. The 10-minute brain MR imaging protocol with contrast was comparable in diagnostic performance with the standard protocol in an inpatient motion-prone population, with the additional benefits of reducing acquisition times and image artifacts.

Relationship between Glioblastoma Heterogeneity and Survival Time: An MR Imaging Texture Analysis

Editor’s Choice

A group of 133 patients with primary glioblastoma who underwent postcontrast T1-weighted imaging (acquired before treatment) and whose data were filed with the survival times were selected from the Cancer Genome Atlas. On the basis of overall survival, the patients were divided into 2 groups: long-term (≥12 months, n = 67) and short-term (<12 months, n = 66) survival. To measure heterogeneity, the authors extracted 3 types of textures, co-occurrence matrix, run-length matrix, and histogram, reflecting local, regional, and global spatial variations, respectively. Then the support vector machine classification was used to determine how different texture types perform in differentiating the 2 groups. The results suggest that local and regional heterogeneity may play an important role in the survival stratification of patients with glioblastoma.

Diagnostic Imaging: Oral and Maxillofacial, 2nd Edition

Koenig LJ, Tamimi DF, Petrikowski CG, Perschbacher SE. Diagnostic Imaging: Oral and Maxillofacial. 2nd ed. Elsevier; 2017; 1072 pp; 2500 ill; $339.00

Cover of Koenig

Five years have passed since the first edition of Diagnostic Imaging: Oral and Maxillofacial was published. That edition has now been updated with this second edition; it is a larger book (over 1,000 pages), and while much of the material shown in the prior edition has been republished, some new material appears. Examples include a 53-page section on the cervical spine that covers developmental alterations, degenerative disorders, tumor and tumor-like conditions, fibro-osseous lesions, and tumoral calcinosis.

The purchase of this edition is recommended only for those who don’t already have a copy of the first edition. It covers virtually all of the abnormalities one would expect to encounter in the oral and maxillofacial regions. How the cervical spine snuck into a book with this title is a bit confounding, but consider it a bonus. The senior editor is (as for the prior edition) Dr. Lisa Koenig; she is a faculty member in the dental school at Marquette University, and 7 associate editors are likewise in schools of dentistry. Dr. Harnsberger is the diagnostic radiology editor, so one sees the usual, superior quality of diagnostic imaging, color drawings, and descriptive material from him and from other radiologists who contributed to this book. The book is divided into 3 major parts: anatomy, diagnoses, and differential diagnoses. Each consists of separate, well-defined chapters and makes looking up anatomy and diseases easy and straightforward. As we all know about this entire series, the layouts, graphics, and details in bullet point format make the material clear and digestible.

In the end, one recognizes there is more to the teeth, mandible, and maxilla than one imagined. Now when you look at a CT of …

Functional Connectivity in Virally Suppressed Patients with HIV-Associated Neurocognitive Disorder: A Resting-State Analysis

Fellows’ Journal Club

Eighteen patients with active HIV-associated neurocognitive disorder (recent diagnosis with progressing symptoms) on combination antiretroviral therapy with viral suppression in both blood and CSF and 9 demographically matched control subjects underwent resting-state functional MR imaging. The connectivity in the 6 known neural networks was assessed. There were significant group differences between the control and HIV-associated neurocognitive disorder groups in the salience and executive networks. The authors conclude that active HIV-associated neurocognitive disorder in virally suppressed patients is associated with significantly decreased connectivity in the salience and executive networks, thereby making it potentially useful as a biomarker.

The Impact of Conscious Sedation versus General Anesthesia for Stroke Thrombectomy on the Predictive Value of Collateral Status: A Post Hoc Analysis of the SIESTA Trial

Editor’s Choice

Using imaging data from the Sedation versus Intubation for Endovascular Stroke TreAtment (SIESTA) trial, the authors assessed collateral status with the score of Tan et al and graded it from absent to good collaterals (0–3). They examined the association of collateral status with 24-hour improvement of the NIHSS score, infarct volume, and mRS at 3 months according to the sedation regimen in a cohort of 104 patients. The sedation mode, conscious sedation or general anesthesia, did not influence the predictive value of collaterals in patients with large-vessel occlusion anterior circulation stroke undergoing thrombectomy in the SIESTA trial.