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.…

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.

SPECT and SPECT/CT: A Clinical Guide

Kim CK, Zukotynski KA. SPECT and SPECT/CT: A Clinical Guide. Thieme; 2017; 218 pp; 250 ill; $99.99

Cover of Zukotynski

While this 218-page softcover book is written for those primarily involved in nuclear medicine or for those in a general radiology practice who maintain some involvement in nuclear medicine, there are sections of the book that would be of interest to neuroradiologists. Two chapters encompassing 33 pages deal with SPECT and SPECT/CT in the neurosciences and in the thyroid/parathyroid glands. Throughout this volume, Drs. Kim and Zukotynski, along with 14 other contributing authors, have put together succinct and well-illustrated chapters. The format is similar across sections, with short descriptions of key diseases, radiopharmaceuticals used, images, and bibliographies.

In the chapter on SPECT in the neurosciences, a general overview is given in 7 pages. It would have been good to have had a normal SPECT shown in 2 planes in order to compare with the abnormals. Brain tumor imaging is only peripherally mentioned. The chapter on thyroid and parathyroid glands is more extensively dealt with (in 26 pages) and is a decent review of the benign and malignant lesions of both glands, along with some unusual variants.

Certainly this would not be a primary purchase for a neuroradiologist or for a neuroradiology sectional library. It would be a publication that could be borrowed from a colleague or from a department library, and the contents that pertain to neuroradiology could be quickly reviewed.




Acute Basilar Artery Occlusion: Differences in Characteristics and Outcomes after Endovascular Therapy between Patients with and without Underlying Severe Atherosclerotic Stenosis

Fellows’ Journal Club

Sixty-two patients with acute basilar artery occlusion underwent multimodal endovascular therapy with stent-retriever thrombectomy as a first-line endovascular therapy. Patients with underlying intracranial atherosclerotic stenosis underwent additional intracranial angioplasty and stent placement. Underlying intracranial atherosclerotic stenosis was identified at the occlusion site in 15 patients (24.1%). Occlusion in the proximal segment of the basilar artery was more common in patients with intracranial atherosclerotic stenosis (60% versus 6.4%), whereas occlusion in the distal segment was more common in those without it. Patients with and without underlying intracranial atherosclerotic stenosis who underwent endovascular therapy had similar outcomes.

Temporal and Spatial Variances in Arterial Spin-Labeling Are Inversely Related to Large-Artery Blood Velocity

Editor’s Choice

The authors performed consecutive pseudocontinuous arterial spin-labeling and phase-contrast MR imaging on 82 individuals (healthy young adults, healthy older adults, and older adults with cerebral small vessel disease or chronic stroke infarcts) and examined associations between extracranial phase-contrast hemodynamics and intracranial arterial spin-labeling characteristics, which were defined by labeling efficiency, temporal signal-to-noise ratio, and spatial coefficient of variation. Large-artery blood velocity was inversely associated with labeling efficiency, temporal SNR, and spatial coefficient of variation of arterial spin-labeling. They conclude that choosing arterial spin-labeling timing parameters with on-line knowledge of blood velocity may improve CBF quantification.