Multidisciplinary Teaching Atlas of the Pancreas: Radiological, Surgical, and Pathological Correlations

Casillas J, Levi JU, Quiroz, AO, et al. Multidisciplinary Teaching Atlas of the Pancreas: Radiological, Surgical, and Pathological Correlations. Springer; 2016; 1045 pp; 926 ill; $399

Cover of Multidisciplinary Teaching Atlas of the Pancreas by Casillas et alDr. Javier Casillas (Radiology) and Joe Levi (Surgery) have teamed up to make an amazingly well-illustrated, multidisciplinary and comprehensive book on the pancreas. While most books on this subject would likely not warrant a review in the AJNR, this one definitely deserves special mention and praise.

There are 21 chapters that are divided into seven sections. The first section, divided into 5 chapters, lays a foundation of background knowledge of the pancreas starting with embryology, anatomy, histology, physiology and imaging of the pancreas. The book then moves on to four chapters on the various cystic masses of the pancreas. There are then four chapters on solid pancreatic masses. Four chapters on various inflammatory conditions of the pancreas are followed by sections on pancreatic trauma and pancreatic surgery. The book concludes with a 40-question self-assessment. The book is 1045 pages in length but is surprisingly quick to read, as it is written in a bullet format and laced with a total of 926 illustrations. These illustrations include radiographic studies, intra-operative photographs, medical drawings, gross pathologic specimens, photomicrographs, and even a photo of a physician beaming with pride and holding up a bag of 800 ml of pus after percutaneous drainage of an infected pseudocyst.

Many books claim to be multidisciplinary, but this book truly is. While the primary author is a radiologist and “suggested shelving” is listed as radiology, any physician with interest in the pancreas would find this book to be very informative. What gives the book such a multidisciplinary feel is not just that it balances the absolute number of pages or words devoted to clinical information, radiology, pathology and treatment, …

Full Dose-Reduction Potential of Statistical Iterative Reconstruction for Head CT Protocols in a Predominantly Pediatric Population

Fellows’ Journal Club

The authors set out to determine the maximum level of statistical iterative reconstruction that can be used to establish dose-reduced head CT protocols in a primarily pediatric population while maintaining similar appearance and level of image noise in the reconstructed image. Dose-reduced head protocols using an adaptive statistical iterative reconstruction were compared for image quality with the original filtered back-projection reconstructed protocols in a phantom and CT dose index and image noise magnitude were assessed in 737 pre- and post-dose-reduced examinations. Implementation of 40% and 60% adaptive statistical iterative reconstruction led to an average reduction in the volume CT dose index of 43% for brain, 41% for orbit, 30% for maxilla, 43% for sinus, and 42% for temporal bone protocols for patients between 1 month and 26 years of age, while improving the contrast-to-noise ratio of low-contrast soft-tissue targets.

Abstract

Figure 4 from paper
Images of the 3-, 5-, 7-, and 9-mm low-contrast targets in the Catphan 700 phantom are acquired with FBP and dose-reduced ASIR reconstruction up to 60% ASIR for the soft reconstruction kernels at both 100 and 120 kVp and up to 40% for the standard reconstruction kernel at 100 kVp.

BACKGROUND AND PURPOSE

A statistical iterative reconstruction algorithm provides an effective approach to reduce patient dose by compensating for increased image noise in CT due to reduced radiation output. However, after a point, the degree to which a statistical iterative algorithm is used for image reconstruction changes the image appearance. Our aim was to determine the maximum level of statistical iterative reconstruction that can be used to establish dose-reduced head CT protocols in a primarily pediatric population while maintaining similar appearance and level of image noise in the reconstructed image.

MATERIALS AND METHODS

Select head examinations (brain, orbits, sinus, maxilla, and temporal bones) were investigated. Dose-reduced head

Mapping the Orientation of White Matter Fiber Bundles: A Comparative Study of Diffusion Tensor Imaging, Diffusional Kurtosis Imaging, and Diffusion Spectrum Imaging

Editor’s Choice

The authors evaluated fiber bundle orientations from DTI and diffusional kurtosis compared with diffusion spectrum imaging as a criterion standard to assess the performance of each technique. DTI, diffusional kurtosis imaging, and diffusion spectrum imaging datasets were acquired during 2 independent sessions in 3 volunteers. While orientation estimates from all 3 techniques had comparable angular reproducibility, diffusional kurtosis imaging decreased angular error throughout the white matter compared with DTI. Diffusion spectrum imaging and diffusional kurtosis imaging enabled the detection of crossing-fiber bundles. They conclude that fiber bundle orientation estimates from diffusional kurtosis imaging have less systematic error than those from DTI.

Abstract

BACKGROUND AND PURPOSE

White matter fiber tractography relies on fiber bundle orientation estimates from diffusion MR imaging. However, clinically feasible techniques such as DTI and diffusional kurtosis imaging use assumptions, which may introduce error into in vivo orientation estimates. In this study, fiber bundle orientations from DTI and diffusional kurtosis imaging are compared with diffusion spectrum imaging as a criterion standard to assess the performance of each technique.

MATERIALS AND METHODS

For each subject, full DTI, diffusional kurtosis imaging, and diffusion spectrum imaging datasets were acquired during 2 independent sessions, and fiber bundle orientations were estimated by using the specific theoretic assumptions of each technique. Angular variability and angular error measures were assessed by comparing the orientation estimates. Tractography generated with each of the 3 reconstructions was also examined and contrasted.

RESULTS

Orientation estimates from all 3 techniques had comparable angular reproducibility, but diffusional kurtosis imaging decreased angular error throughout the white matter compared with DTI. Diffusion spectrum imaging and diffusional kurtosis imaging enabled the detection of crossing-fiber bundles, which had pronounced effects on tractography relative to DTI. Diffusion spectrum imaging had the highest sensitivity for detecting crossing fibers; however, the diffusion spectrum imaging and diffusional

Journal Scan – This Month in Other Journals, July 2016

 

  1. Anderson MA, Burda JE, Ren Y, et al. Astrocyte scar formation aids central nervous system axon regeneration. Nature. 2016;532(7598):195–200. doi:10.1038/nature17623.

This is an important paper to be aware of:  Astrocytic scars have been regarded as barriers to central nervous system axon regrowth since around 1952. Through an impressive set of experiments, the authors show that using three genetically targeted loss-of-function manipulations in adult mice that prevent scar formation or stop scar forming astrocytes all failed to result in spontaneous regrowth of transected corticospinal, sensory or serotonergic axons through severe spinal cord injury (SCI) lesions.  Specifically, they 1) prevented astrocyte scar formation, 2) attenuating scar-forming astrocytes, and 3) ablated chronic astrocytic scars (using genetically targeted diphtheria toxin receptor and ultra-low doses of diphtheria toxin). They conclude that these experiments show that contrary to the prevailing dogma, astrocytic scar formation is not a principal cause for the failure of injured mature CNS axons to regrow across severe CNS lesions.   In fact, scar-forming astrocytes permit and support robust amounts of appropriately stimulated CNS axon regeneration.  These findings have obvious important implications for CNS repair strategies.

  1. Liddelow SA, Barres BA. Regeneration: Not everything is scary about a glial scar. Nature. 2016;532(14 April):182–183. doi:10.1038/nature17318.

This is an Editorial that goes along with the previous paper by Anderson et al.  How do we reconcile previous experiments showing scar is bad with this current information?  One potential answer is that other inhibitory cell types such as fibroblasts and pericytes, also contribute to the glial scar.  Other studies have identified different types of reactive astrocyte. Perhaps in the previous studies different types of injury produced different types of reactive astrocyte, some being inhibitory and others not so much.  They conclude that “ in spite of long-held beliefs to the contrary, reactive astrocytes may …

Interventional Oncology

Gandhi R, Ganguli S, eds. Interventional Oncology. Thieme; 2015; 227 pp; 142 ill; $89.99

Cover of Interventional Oncology edited by Gandhi et alInterventional oncology (IO) is a fast-growing field that is leading to significant and exciting advances in care of cancer patients. To practice IO, one must have a good fund of knowledge, including knowledge of medical oncology and cancer imaging. Additionally, specific procedural skills and experience must be learned and acquired. Finally, one must relish clinical care and follow-up for these complex patients. The book Interventional Oncology, edited by Ripal Gandhi and Suvranu Ganguli, gives a good introduction to IO and covers these aspects in a concise and well-organized manner.

The book is organized into 13 chapters, which first cover percutaneous ablative procedures, including individual chapters on RCC, adrenal, thoracic, bone tumor, HCC, and metastatic liver ablation. Intra-arterial therapies are then discussed, with individual chapters on HCC chemo-embolization and HCC radioembolization. Additional chapters on intra-arterial treatment of colorectal hepatic metastases, cholangiocarcinoma, and neuroendocrine tumors follow. A chapter devoted to portal vein embolization is the penultimate chapter, followed by a chapter reviewing cutting edge and emerging therapies in this burgeoning field, including immunoebolization, chemosaturation, and irreversible electroporation. All of these chapters are intentionally concise, and given the precise topics for each chapter, a practicing interventional radiologist or trainee would easily be able to reference this book and read about key background points, indications, technical considerations, expected outcomes, and complications, immediately prior to seeing a cancer patient in-clinic or performing an IO procedure. Conspicuously missing from this book, in this reviewer’s opinion, is a chapter on percutaneous biopsy. Without skills and knowledge to perform high-quality, low-risk biopsies, and without knowing the emerging oncologic indications for biopsy, an interventional radiologist is unlikely to be able to participate meaningfully in the care of cancer patients.

Compared to current interventional …

Emergency Radiology COFFEE Case Book

Khurana B, Mandell J, Sarma A, et al. Emergency Radiology COFFEE Case Book: Case-Oriented Fast Focused Effective Education. Cambridge University Press; 2016; 672 pp; 1425 ill; $155

Cover of Emergency Radiology COFFEE Case Book by Khurana et alThis is well-constructed case based book (672 pages) on what is considered to be emergency imaging. Why the authors had to throw in the acronym COFFEE, for case-oriented fast focused effective education, in the title is unclear; this is not a “coffee table” book.

There are 2 sections, one devoted to nontraumatic abdomen, chest, ENT, brain, and musculoskeletal conditions, and the second devoted to traumatic brain, chest, abdomen, and musculoskeletal conditions. The former section illustrates and describes 54 cases, the latter 31 cases. For the neuroimaging portion, the cases are relatively commonplace for any ER/trauma center. They are well-imaged, well-described, and importantly, each case includes additional images that enter into the differential diagnosis. Not only in the ENT section but in a few other areas of the book, simple diagrams help in understanding the underlying imaging.

The 20 neuroradiology cases are well-chosen, and for any radiologist working in an ER these would be good to review, as would the images in other parts of the book. As we all know, it is often the subtle, easily missed finding buried in a stack of hundreds of images that is most demanding, particularly when evaluating a patient. Showing a single or a couple of images in a book where we know the finding is present is far less of a challenge than actually discovering the abnormality.

Nonetheless, the book would fit nicely in an ER radiology area, ready for quick consultation.…

Seven AVMs: Tenets and Techniques for Resection

Lawton MT. Seven AVMs: Tenets and Techniques for Resection. Thieme; 2014; 352 pp; 869 ill; $189.99

Cover fo Seven AVMs: Tenets and Techniques for Resection, by LawtonThis is the first edition of Professor Michael Lawton’s Seven AVMs: Tenets and Techniques for Resection. Coming off the heels of the successful book Seven Aneurysms: Tenets and Techniques for Clipping, Lawton presents his approach to AVMs from his vast experience using a methodical and systematic approach to a dynamic and variable pathology.

There are only a handful of surgeons, not only in the country but also in the world, that have the privileged opportunity to operate on this volume of AVMs (over 500). He has courageously taken advantage of this responsibility and turned it into a manuscript that allows the neurosurgery community to learn from his experience.

The book begins with a forward by Professors Albert Rhoton Jr. and Robert Spetzler, both attesting to Dr. Lawton’s surgical expertise and ability to produce a book capable of tackling this daunting feat. The book is then divided into three sections: 1) 10 tenets or general principles for the surgical management of AVMs, 2) the 7 AVMs, and 3) selection strategies.

The hardcover is extensively illustrated with high-quality figures (over 700) including anatomic drawings, operative photographs, and contemporary imaging. To provide a better conceptualization of the AVMs and their relationships to eloquent brain, arteries, vessels, and ventricles, the figures include multiple anatomic illustrations of the AVM (coronal, anterior) plus a surgeon’s view. Furthermore, clear and concise legends supplement the detailed text.

The last section of the book discusses the selection strategies with mention of natural history, grading systems, and multimodality intervention (embolization, radiosurgery). Unfortunately, the ARUBA (A Randomized Trial of Unruptured Brain AVMs) trial was not in press before this book was published; however, Dr. Lawton’s views on this study and its controversies …

New Clinically Feasible 3T MRI Protocol to Discriminate Internal Brain Stem Anatomy

Fellows’ Journal Club

Track density imaging (TDI) is a novel MR imaging postprocessing technique based on high angular-resolution diffusion acquisitions that generate super-resolution images derived by whole-brain probabilistic streamline tractography. TDI and echo modulation curve T2 mapping were combined with simultaneous multisection acquisition to reveal anatomic detail at 7 canonical levels of the brain stem. Compared with conventional MR imaging contrasts, many individual brain stem tracts and nuclear groups were directly visualized for the first time at 3T.

Summary

Rostral midbrain. Upper row: A, Proton-density weighted. B, T2-weighted. C, DEC-DTI. D, Anatomic schematic. Bottom row: E, EMC PD map. F, EMC T2 map. G, stDEC-TDI. H, stTDI. The lower row novel contrast images better depict brain stem anatomy compared with the upper row conventional images. Notice the appreciable difference in the EMC T2 value between the red nuclei (31) and the substantia nigra (32) compared with that of the standard multi-spin-echo T2 image. The stDEC-TDI map shows the oculomotor nuclear complex (33) in green and the MLF (34) in light blue, whereas the DEC-DTI map in this region shows a uniform green.
Rostral midbrain. Upper row: A, Proton-density weighted. B, T2-weighted. C, DEC-DTI. D, Anatomic schematic. Bottom row: E, EMC PD map. F, EMC T2 map. G, stDEC-TDI. H, stTDI. The lower row novel contrast images better depict brain stem anatomy compared with the upper row conventional images. Notice the appreciable difference in the EMC T2 value between the red nuclei (31) and the substantia nigra (32) compared with that of the standard multi-spin-echo T2 image. The stDEC-TDI map shows the oculomotor nuclear complex (33) in green and the MLF (34) in light blue, whereas the DEC-DTI map in this region shows a uniform green.

Two new 3T MR imaging contrast methods, track density imaging and echo modulation curve T2 mapping, were combined with simultaneous multisection acquisition to reveal exquisite anatomic detail at 7 canonical levels of the brain stem. Compared with conventional MR imaging contrasts, many individual brain stem tracts and nuclear groups were directly visualized for the first time at 3T. This new approach is clinically practical and feasible (total scan time = 20 minutes), allowing better brain stem anatomic localization and characterization.

 

Read this article: http://bit.ly/28L3nDs

Differentiation of Speech Delay and Global Developmental Delay in Children Using DTI Tractography-Based Connectome

Editor’s Choice

This study investigated whether diffusion tensor imaging tractography-based connectome can differentiate global developmental delay from speech delay in young children. Twelve children with pure speech delay, 14 children with global developmental delay, and 10 children with typical development underwent 3T DTI. Whole-brain connectome analysis was performed by using 116 cortical ROIs. Network metrics were measured at individual regions: strength, efficiency, cluster coefficient, and betweeness. Compared with typical development, global and local efficiency were significantly reduced in both global developmental delay and speech delay. Nodal strength of the cognitive network was reduced in global developmental delay, whereas the nodal strength of the language network was reduced in speech delay. This finding resulted in a high accuracy of >83% to discriminate global developmental delay from speech delay.

Abstract

ROIs showing significantly altered network metrics in the group comparison of TD > GD. In the 2D connectogram, the color of anatomic label scales the P value of group difference in the AAL template. Similarly, the color of each circle represents the P value of individual metrics. The 3D connectogram shows individual pair-wise pathways having significant group differences in nodal strength (ie, the greater radius of the sphere, the greater the group difference). In both 2D and 3D connectograms, block arrows indicate the hippocampal network whose nodal properties are significantly reduced in GD compared with TD.
ROIs showing significantly altered network metrics in the group comparison of TD > GD. In the 2D connectogram, the color of anatomic label scales the P value of group difference in the AAL template. Similarly, the color of each circle represents the P value of individual metrics. The 3D connectogram shows individual pair-wise pathways having significant group differences in nodal strength (ie, the greater radius of the sphere, the greater the group difference). In both 2D and 3D connectograms, block arrows indicate the hippocampal network whose nodal properties are significantly reduced in GD compared with TD.

BACKGROUND AND PURPOSE

Pure speech delay is a common developmental disorder which, according to some estimates, affects 5%–8% of the population. Speech delay may not only be an isolated condition but also can be part of a broader condition such as global developmental delay. The present study investigated whether diffusion tensor imaging tractography-based connectome can differentiate global developmental delay from speech delay in young children.

MATERIALS AND METHODS

Twelve children with pure speech delay (39.1 ±

Surgical Pediatric Otolaryngology, 2nd Edition

Potsic WP, Cotton RT, Handler SD, Zur KB, eds. Surgical Pediatric Otolaryngology. 2nd ed. Thieme; 2016; 694 pp; 900 ill; $169.99

Cover of Surgical Pediatric Otolaryngology, edited by Potsic, Cotton, Handler, and ZurSurgical Pediatric Otolaryngology, edited by William P. Potsic, Robin T. Cotton, Steven D. Handler, and Karen B. Zur, is the second edition of this textbook dedicated to the surgical procedures involved it the Pediatric Otolaryngology subspecialty. The first edition, published in 1997, has been an essential tool for most pediatric otolaryngologists. This new edition helps brings updated information involving new technology that has made routine procedures more effective as well as advancements in tech, particularly in the field of hearing. The surgical procedures explained include the surgical protocols used by 24 other faculty members at Children’s Hospital of Philadelphia and Cincinnati Children’s hospital.

The textbook is divided into 8 different sections. Each section begins with highlights regarding the disease processes covered. The first section encompasses ear surgical procedures for chronic otitis media, congenital malformations, trauma, hearing restoration with cochlear implants, and bone anchor hearing aids. An additional chapter on perilymphatic fistula management was surprising due to the rare nature of this entity. The second section deals with problems of the nose, including the management of nasal deformities and trauma, tumors of the nasal cavity, and repair of nasal stenosis, including choanal atresia. This section contrasts the endoscopic versus open approaches for the surgical management of narrowing of the nasal passages. The endoscopic portion provides key instruments that can ease the surgical process.

The next section of the atlas encompasses the surgical management of tumors in addition to structural and functional problems of the nasopharynx, oral cavity, and oropharynx, particularly the management of nasopharyngeal angiofibroma, where it provides a thorough explanation on endoscopic assisted techniques. Tonsillectomy and adenoidectomy procedures are discussed using multiple surgical techniques and advancements in …