Pediatric Intracranial Aneurysms: New and Enlarging Aneurysms after Index Aneurysm Treatment or Observation • S.W. Hetts, J.D. English, C.F. Dowd, R.T. Higashida, J.T. Scanlon, and V.V. Halbach
Although de novo intracranial aneurysms are very rare, their incidence is increased in children with other aneurysms. These authors sought to determine the factors that result in new or rapidly enlarging aneurysms in children. They reviewed 114 aneurysms not associated with other vascular malformations and found that 8.4% of children developed new or enlarging aneurysms. Nearly all of these patients had originally presented with fusiform aneurysms. Other features that lead to new or enlarging aneurysms included multiple aneurysms at presentation and immunosuppression. New aneurysms generally occurred 4 years after the initial one was diagnosed and at locations distal to the initial site.
Deep Medullary Vein Involvement in Neonates with Brain Damage: An MR Imaging Study • F. Arrigoni, C. Parazzini, A. Righini, C. Doneda, L.A. Ramenghi, G. Lista, and F. Triulzi
These investigators report a new finding that may lead to the development of periventricular leukomalacia in premature infants. They analyzed conventional T1 and T2 images in 21 babies who showed areas of low T2 signal corresponding to the deep medullary veins. These abnormalities were found in association with cavities or cysts and, when followed, about 25% of patients developed typical MRI indications of periventricular leukomalacia. The authors suggest these findings may be related to venous thrombosis or engorgement and precede the onset of periventricular leukomalacia.
Systematic Differences between Lean and Obese Adolescents in Brain Spin-Lattice Relaxation Time: A Quantitative Study • F. Cazettes, W.H. Tsui, G. Johnson, R.G. Steen, and A. Convit
In this provocative study, the authors sought changes in the brain structure of obese teenagers when compared with lean individuals. They used T1 as a surrogate marker of brain maturation in 2 sequences and compared it with values obtained from a control (lean) group. Some surprising findings: obese subjects had lower HDL, higher LDL, higher fasting glucose, smaller brain volumes, and significantly different T1 values in the frontal and parietal lobes. Next step: to assess if these findings impact neurodevelopment during adolescence and beyond.
Fellows’ Journal Club
High Signal Intensity on T2-Weighted MR Imaging at Term-Equivalent Age in Preterm Infants Does Not Predict 2-Year Neurodevelopmental Outcomes • H. Kidokoro, P.J. Anderson, L.W. Doyle, J.J. Neil, and T.E. Inder
High T2 signal throughout the neonatal brain has always been thought to correlate with poor neurodevelopmental outcome. Here, 160 preterm babies with this finding were evaluated and T2 data correlated with ADC and fractional anisotropy values. Neurodevelopment was assessed 2 years later. Although high T2 signal correlated with higher ADC and lower FA values, it had no correlation with neurodevelopmental outcomes.
Whole-Brain Perfusion CT Patterns of Brain Arteriovenous Malformations: A Pilot Study in 18 Patients • D.J. Kim and T. Krings
Can the pattern of whole-brain perfusion be different from patient to patient among those who harbor brain AVMs? Can it be used to explain different clinical manifestations and presentations? Eighteen patients with brain AVMs were studied using CT perfusion. Major patterns were recognized as follows: about 50% of patients had arterial “steal” and presented with either seizures or focal deficits and the others had a “venous congestion” pattern and their symptoms were variable. These patterns start to shed light on the effects of AVMs on the brain as a whole and seem to indicate that presentations may be related to perfusion abnormalities.
Interpretation Errors in CT Angiography of the Head and Neck and the Benefit of Double Reading • K. Lian, A. Bharatha, R.I. Aviv, and S.P. Symons
Because there is considerable information and a large number of images to look at in CTA studies of the neck and brain, it is easy to overlook important findings. Does double reading reduce mistake rates? For this purpose, 503 studies were reviewed. Of these, 144 were reported by a single neuroradiologist, 209 by 1 staff member and 1 resident, and 150 by 1 staff neuroradiologist and 1 fellow. The overall rate of misses was 4% and it was double when the staff neuroradiologist alone interpreted the studies. Thus, double reading reduces but does not completely eliminate errors. The most commonly missed findings were small aneurysms.