Journal Scan – This Month in Other Journals, February 2018

Liu KC, Starke RM, Durst CR, et al. Venous sinus stenting for reduction of intracranial pressure in IIH: a prospective pilot study. J Neurosurg. 2017;127(5):1126-1133. doi:10.3171/2016.8.JNS16879.

Although many cases of IIH are idiopathic, a number of patients have been found to have venous sinus stenosis as a potential underlying mechanism. During cerebral venography, manometry has demonstrated significant pressure gradients across the stenotic segments with elevated venous pressures most frequently proximally in the superior sagittal sinus. Currently, it is unclear whether this stenosis is the cause of IIH or the result of elevated ICP as a secondary disease process. Although stenting of the venous sinus stenosis has been shown in select cases to resolve the pressure gradient, the effect on ICP remains unclear. Additionally, the effects on visual and neurological outcomes remain incompletely defined. 

The purpose of this pilot study was to assess the effects of venous sinus stenting on ICP in a small group of patients with IIH.  

Ten patients for whom medical therapy had failed were prospectively followed. Ophthalmological examinations were assessed, and patients with venous sinus stenosis on MR angiography proceeded to catheter angiography, venography with assessment of pressure gradient, and ICP monitoring. Patients with elevated ICP measurements and an elevated pressure gradient across the stenosis were treated with stent placement. 

All patients had elevated venous pressure (mean 39.5 mm Hg), an elevated gradient across the venous sinus stenosis (30.0 mm Hg), and elevated ICP (42.2 mm Hg). Following stent placement, all patients had resolution of the stenosis and gradient (1 mm Hg). The ICP values showed an immediate decrease (to a mean of 17.0 mm Hg), and further decreased overnight (to a mean of 8 mm Hg). All patients had subjective and objective improvement, and all but one improved during follow-up. 

The novel findings of …

Skull Base Imaging

Chong V. Skull Base Imaging. Elsevier; 2018; 350 pp; $99.99

Cover of Chong

Skull Base Imaging is a relatively short but succinct text that deals with issues and images that neuroradiologists face on a daily basis. Edited by Dr. Vincent Chong with contributions from 30 authors from around the globe, this 409-page book highlights, in 17 chapters, imaging and the clinical importance of abnormalities of the skull base, including (but not limited to) the sinuses, temporal bone, craniocervical junction, and bone lesions. Within most chapters is information that directly addresses why certain observations are important in patient care and surgical and interventional management. Emphasized by a number of authors is the need to construct radiology reports, which are meaningful particularly to the surgeon.

As is appropriate, some chapters contain normal anatomic descriptions and illustrations and importantly, as in imaging of the sinuses, middle ear, mastoids and IAC, CT predominantly demonstrates the consequences of prior surgery. All of the chapters were well illustrated and appropriately written. Noteworthy are the anatomic descriptions of the paranasal sinuses, the variants that in turn determine the variable drainage pathways, what should appear in CT reports, how this is surgically important, and where danger areas exist. There are good demonstrations of multiple abnormalities, such as invasive fungal sinusitis, idiopathic inflammatory pseudotumors, perineural spread of SCC, and invasion of the skull base, among other abnormalities.

The chapter on imaging in endoscopic endonasal skull base surgery, co-authored by radiologists and a surgeon, describes anatomic limitations in endoscopic surgery, which are important details for radiologists to understand.

Imaging of the temporal bone is discussed in 5 chapters (Inflammatory, Tumors, Trauma, Hearing Loss, Postoperative Findings) and is a large portion of the book. The variety and choices of images (CT and MR) depict the salient features of these chapters. For those who …

Expert DDx: Brain and Spine, 2nd Edition

Jhaveri MD, Salzman KL, Ross JS, et al. Expert DDx: Brain and Spine. 2nd ed. Elsevier; 2018; 1096 pp; 3500 ill; $329.99

Cover of Jhaveri

There are different ways to present imaging material in a textbook or online. One is to index diseases and refer the reader to the proper pages; another is to show the imaging related to a specific set or sets of clinical findings/symptoms. A third is to group images according to the observed imaging findings and describe/illustrate multiple cases showing those findings. This last approach is generally the one taken by the authors of the second edition of Expert DDx: Brain and Spine. By doing this, most entities encountered in a neuroradiology practice are seen.

When confronted with a certain finding or findings, one may not recall or think of the multiple differential possibilities. This book allows them to do exactly that. Divided into 2 parts (skull/brain and spine), this 1000-page hardcover book edited by Drs. Jhaveri, Salzman, Ross, Moore, Osborn, and Ho covers in Part 1 the skull, meninges, ventricles/periventricular region, extra-axial space, brain parenchyma (infratentorial and supratentorial), sella, pineal gland, vasculature, and cranial nerves; in Part 2, the CV junction, vertebral segments, disc/end plates, and extradural, intradural, and intramedullary areas are covered. The vast collection of cases on both MR and CT is remarkable for its completeness and for the quality of the images.

This second edition is far more expensive than the first edition (published in 2009). It includes more descriptive material and a greater number of images, and it uses a smaller font size so there is more information available to the reader. The details accompanying the images allow one to rapidly assimilate essential information for each disease.

This volume is highly recommended for both seasoned neuroradiologists and those in training.…

Two-Center Experience in the Endovascular Treatment of Ruptured and Unruptured Intracranial Aneurysms Using the WEB Device: A Retrospective Analysis

Fellows’ Journal Club

The authors performed a retrospective analysis of all ruptured and unruptured aneurysms treated with a WEB device between August 2014 and February 2017. Primary outcome measures included the feasibility of implantation and the angiographic outcome. Secondary outcome measures included the clinical outcome at discharge and procedural complications. One hundred two aneurysms in 101 patients, including 37 (36.3%) ruptured aneurysms, were treated with the WEB device. Implantation was successful in 98 (96.1%) aneurysms. Additional devices (stents/coils) were necessary in 15.3% (15/98) of aneurysms. Delayed aneurysm ruptures have not been observed during the follow-up period to date. They conclude that the WEB device offers a safe and effective treatment option for broad-based intracranial aneurysms without the need for dual antiplatelet therapy.

Dynamic Contrast-Enhanced MRI–Derived Intracellular Water Lifetime (τi): A Prognostic Marker for Patients with Head and Neck Squamous Cell Carcinomas

Editor’s Choice

The authors evaluated 60 patients with dynamic contrast-enhanced MR imaging before treatment. Median, mean intracellular water molecule lifetime, and volume transfer constant values from metastatic nodes were computed from each patient. Kaplan-Meier analyses were performed to associate mean intracellular water molecule lifetime and volume transfer constant and their combination with overall survival and beyond. Patients with high mean intracellular water molecule lifetime had overall survival significantly prolonged by 5 years compared with those with low mean intracellular water molecule lifetime. Patients with high mean intracellular water molecule lifetime had significantly longer overall survival at long-term duration than those with low mean intracellular water molecule lifetime. Volume transfer constant was a significant predictor for only the 5-year follow-up period. They conclude that a combined analysis of mean intracellular water molecule lifetime and volume transfer constant provided the best model to predict overall survival in patients with squamous cell carcinomas of the head and neck.

Fundamentals of Musculoskeletal Ultrasound, 3rd Edition

Jacobson JA. Fundamentals of Musculoskeletal Ultrasound. 3rd ed. Elsevier; 2017; 472 pp; $99.99

Cover of Jacobson

Ultrasound as an imaging modality has proven to be a very useful and cost-effective tool in the diagnosis of musculoskeletal disorders. Recent improvements in portability and imaging resolution have further expanded its value and turned it into one of the primary methods for initially evaluating musculoskeletal injuries.

Dr. Jon A. Jacobson, Professor of Radiology at the University of Michigan, crowns his vast research and academic activities with this well-organized and easily accessible textbook.

Now in its third edition, this title provides a comprehensive review of the utility of ultrasound in the assessment of musculoskeletal disorders and covers all of the salient points needed to make an accurate diagnosis, including the basics of anatomy, scanning techniques, patient positioning, pathologies, imaging pitfalls, and controversies.

The volume is comprised of 9 chapters and a preface, designed to help the reader understand the principles of musculoskeletal ultrasound and therefore practice with more confidence. Numerous examination checklists and sample reports make it an excellent resource for quick consults.

The text contains almost 1200 high-quality images and over 200 narrated video clips of real-time dynamic ultrasound imaging. The high-resolution images in each chapter effectively demonstrate normal anatomy and pathology. The narrated videos (available online) splendidly demonstrate not only normal anatomy and pathology, but also patient positioning and technique. Together, they turn this edition into a helpful teaching tool that enables the dynamic character of ultrasound to be studied and assessed more effectively by the reader.

Chapter 1 outlines some of the basic concepts concerning the use and purpose of ultrasound explicitly. These basics range from understanding how to properly use the machine to best interpret what is visualized to different scanning techniques needed to more accurately depict musculoskeletal pathologies. It begins by …

Do Fluid-Attenuated Inversion Recovery Vascular Hyperintensities Represent Good Collaterals before Reperfusion Therapy?

Fellows’ Journal Club

The authors evaluated 244 consecutive patients eligible for reperfusion therapy with MCA stroke and pretreatment MR imaging with both FLAIR and PWI. The FLAIR vascular hyperintensity score was based on ASPECTS, ranging from 0 (no FLAIR vascular hyperintensity) to 7 (FLAIR vascular hyperintensities abutting all ASPECTS cortical areas). The hypoperfusion intensity ratio was defined as the ratio of the time-to-maximum >10-second over time-to-maximum >6-second lesion volumes. The FLAIR vascular hyperintensities were more extensive in patients with good collaterals than those with poor collaterals. The FLAIR vascular hyperintensity score was independently associated with good collaterals. They conclude that the ASPECTS assessment of FLAIR vascular hyperintensities could be used to rapidly identify patients more likely to benefit from reperfusion therapy.

Reproducibility of Deep Gray Matter Atrophy Rate Measurement in a Large Multicenter Dataset

Editor’s Choice

The authors assessed the reproducibility of 2 automated segmentation software packages (FreeSurfer and the FMRIB Integrated Registration and Segmentation Tool) by quantifying the volume changes of deep GM structures by using back-to-back MR imaging scans from the Alzheimer Disease Neuroimaging Initiative’s multicenter dataset in 562 subjects. Back-to-back differences in 1-year percentage volume change were approximately 1.5–3.5 times larger than the mean measured 1-year volume change of those structures. They conclude that longitudinal deep GM atrophy measures should be interpreted with caution and that deep GM atrophy measurement techniques require substantially improved reproducibility, specifically when aiming for personalized medicine.

Neurosurgical Emergencies, 3rd Edition

Loftus CM. Neurosurgical Emergencies. 3rd ed. Thieme; 2017; 420 pp; 400 ill; $169.99

Cover of Loftus

As neuroradiologists, we deal daily with neurosurgical emergencies of one sort or another. While many of the decisions regarding patient management are clear, there are others about which the criteria for intervention or nonintervention are less well-appreciated. Examples abound: criteria for operating on an SDH, timing for operating or intervening on an aneurysm, treatment/decompression of acute spinal cord injury, etc.

This third edition of Neurosurgical Emergencies, edited by Dr. Christopher Loftus of the Temple University School of Medicine, is a 420-page hardcover book with contributions from 86 authors. It is divided into 37 chapters, nearly every one of which is pertinent to the practice of neuroradiology. Chapter subjects include: loss of consciousness, ICP monitoring, acute hydrocephalus, herniations, cerebral trauma, intracranial hemorrhage, pituitary apoplexy, SAH, acute stroke, venous thrombosis, cerebral infections, emergency treatment of brain tumors, decompression of the optic/facial nerves, status epilepticus, multisystem trauma, acute disc disease, vertebral column fractures/dislocations, spine and spinal cord injury, cord compression due to metastatic disease, spinal vascular malformations, infection of the spine, guidelines for treatment of spine injuries, treatment of peripheral nerve injuries, treatment of compressive peripheral neuropathies, acute shunt malfunction, and myelomeningoceles.

There is adequate imaging in these chapters, and the descriptive information in the subsections in each chapter adds a level of information that will be of value when reading studies, preparing educational lectures, or teaching in a one-on-one environment. We all realize that it is extremely beneficial to read material that is outside our exact areas of subspecialty but is related clinically; doing so brings out information with which one may not be familiar but is nonetheless germane. This book is such an example. It is recommended to readers of the AJNR and members of the ASNR.…

Deep Brain Nuclei T1 Shortening after Gadobenate Dimeglumine in Children: Influence of Radiation and Chemotherapy

Fellows’ Journal Club

The authors reviewed clinical charts and images of patients 18 years of age or younger with ≥4 gadobenatedimeglumine–enhanced MRIs for 6 years. Seventy-six children (60 unconfounded by treatment, 16 with radiochemotherapy) met the selection criteria. T1 signal intensity ratios for the dentate to pons and globus pallidus to thalamus were calculated and correlated with number of injections, time interval, and therapy. Among the 60 children without radiochemotherapy, only 2 had elevated T1 signal intensity ratios. Twelve of the 16 children with radiochemotherapy showed elevated signal intensity ratios. Statistical analysis demonstrated a significant signal intensity ratio change for the number of injections. Compared with published adult series, children show a similar pattern of T1 hyperintense signal changes of the dentate and globus pallidus after multiple gadobenatedimeglumine injections. The T1 signal changes in children are accelerated by radiochemotherapy.