Effect of Stenting on Cerebral CT Perfusion in Symptomatic and Asymptomatic Patients with Carotid Artery Stenosis • L.G. Merckel, J. Van der Heijden, L.M. Jongen, H.W. van Es, M. Prokop, and A. Waaijer
These authors assessed the effects of carotid stenting in both asymptomatic and symptomatic patients using CT perfusion. Forty-five patients had stenoses >70%; 31 were symptomatic, the rest were not. Patients underwent CT perfusion before and after stenting and MTT, CBV, and CBF were studied. All 3 parameters changed significantly after stenting: CBF increased, MTT decreased, and CBV decreased. Conclusion: stenting improves CBF in both asymptomatic and symptomatic patients. Decreased CBV may indicate impaired autoregulation.
Cerebral Perfusion Long Term after Therapeutic Occlusion of the Internal Carotid Artery in Patients Who Tolerated Angiographic Balloon Test Occlusion • S. Gevers, D. Heijtel, S.P. Ferns, P. van Ooij, W.J. van Rooij, M.J. van Osch, R. van den Berg, A.J. Nederveen, and C.B. Majoie
These investigators used ASL perfusion to objectively measure CBF in 11 patients who underwent occlusion of an ICA after passing a test balloon occlusion. All CBF values were normal and there were no differences between the ipsi- and contralateral hemispheres. However, arrival of labeled blood was prolonged on the ipsilateral side. In most patients, collateral flow occurred via both the anterior and posterior communicating arteries.
Post–Vertebral Augmentation Back Pain: Evaluation and Management • S. Kamalian, R. Bordia, and A.O. Ortiz
The causes of persistent pain following vertebral augmentation were investigated by these authors. They evaluated 124 patients and those with pain underwent fluoroscopy at 3 weeks, 3 months, and 12 months. Pain was present in 23% of patients and in most cases arose from the sacroiliac and/or lumbar facet joints. It was immediately relieved in 59% of those who had a local injection of steroid/anesthetics. Forty-one percent had relief after additional injections and 34% eventually required neurolysis for pain control. Thus, pain after vertebral augmentation commonly arises from sites distal to the initial procedure.
Fellows’ Journal Club
The Predictive Value of 3D Time-of-Flight MR Angiography in Assessment of Brain Arteriovenous Malformation Obliteration after Radiosurgery • D.R. Buis, J.C.J. Bot, F. Barkhof, D.L. Knol, F.J. Lagerwaard, B.J. Slotman, W.P. Vandertop, and R. van den Berg
This article addresses a common clinical problem: the MRA assessment of treatment effects on AVMs. The authors looked at the utility of T2 and time-of-flight MRA images in 120 pre- and postradiosurgery AVMs; 55 of these had been previously embolized. They compared the MRI findings with those from DSA and discovered that both MR sequences performed poorly when the residual nidus was less than 10 mm in size. Therefore, DSA is highly recommended to make the diagnosis of complete AVM obliteration.
Diffusion-Weighted Imaging of Malignant Ocular Masses: Initial Results and Directions for Further Study • A.R. Sepahdari, R. Kapur, V.K. Aakalu, J.P. Villablanca, and M.F. Mafee
Although the use of DWI in neck masses has become routine, its utility in the assessment of intraocular lesions is not certain. These authors analyzed ADC values in 21 malignant ocular masses. As expected, ADCs were low but the values were inversely correlated with the thickness of the lesions, implying that small and/or thin lesions may be inadequately assessed by this method. However, DWI was useful in characterizing masses that were relatively large.
The Use of In Utero MR Imaging to Delineate Developmental Brain Abnormalities in Multifetal Pregnancies • P.D. Griffiths, S.A. Russell, G. Mason, J. Morris, E. Fanou, and M.J. Reeves
In utero MRI has been used to successfully discover anomalies in singleton pregnancies. Here, the authors performed that technique to study 51 multifetal pregnancies in which at least 1 fetus was suspected to be abnormal. They compared their results with those from sonography. There was a 66% agreement and a 34% disagreement between techniques with the most important issue being the status of the corpus callosum. They concluded that both techniques had similar rates of discrepancies when multifetal pregnancies were compared to singleton ones. Additionally, findings lead to terminations in 24% of cases.