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Genetically Defined Oligodendroglioma Is Characterized by Indistinct Tumor Borders at MRI

Fellows’ Journal Club

The authors wanted to determine whether imaging characteristics previously associated with oligodendroglial tumors were still applicable given the 2016 WHO classification that made IDH mutation and 1p/19q codeletion the defining features of oligodendroglioma. They found that 92% of genetically defined oligodendrogliomas had noncircumscribed borders, compared with 45% of non-1p/19q codeleted tumors with at least partial histologic oligodendroglial morphology. Ninety-nine percent of oligodendrogliomas were heterogeneous on T1- and/or T2-weighted imaging.

Combining Diffusion Tensor Metrics and DSC Perfusion Imaging: Can It Improve the Diagnostic Accuracy in Differentiating Tumefactive Demyelination from High-Grade Glioma?

Editor’s Choice

Fourteen patients with tumefactive demyelinating lesions and 21 patients with high-grade gliomas underwent MR imaging with conventional, DTI, and DSC perfusion imaging. Conventional imaging sequences had a sensitivity of 80.9% and specificity of 57.1% in differentiating high-grade gliomas from tumefactive demyelinating lesions. DTI metrics (p:q tensor decomposition) and DSC perfusion demonstrated a statistically significant difference among enhancing portions in tumefactive demyelinating lesions and high-grade gliomas. The highest specificity was found for ADC, the anisotropic component of the diffusion tensor, and relative CBV. The authors conclude that DTI and DSC perfusion add profoundly to conventional imaging in differentiating tumefactive demyelinating lesions and high-grade gliomas.

Vertigo and Disequilibrium: A Practical Guide to Diagnosis and Management, 2nd Edition

Weber PC. Vertigo and Disequilibrium: A Practical Guide to Diagnosis and Management. 2nd ed. Thieme; 2016; 248 pp; 167 ill; $129.99

Cover of Weber

The second edition of Vertigo and Disequilibrium: A Practical Guide to Diagnosis and Management, authored and edited by Dr. Peter C. Weber, takes on the challenging task of summarizing the diagnosis, pathophysiology, and treatment of the various etiologies of vertigo and disequilibrium in a mere 230 pages. Although vertigo and disequilibrium are relatively common complaints, their work-up is a daunting and intimidating task for most physicians. Dr. Weber describes the vestibular system as a poorly understood “black box” because of limited exposure to its anatomy and pathophysiology during medical school and residency training. This book successfully addresses common misunderstandings and lays out a systematic approach to the assessment, diagnosis, and treatment of various etiologies accounting for vertigo and disequilibrium. The chapters are short, concise, clear, well-written, well-organized, and supplemented with helpful figures and tables, as well as updated references for more in-depth reading. The book ends with an appendix of practical frequently asked questions, which would be of use to both physicians and patients alike. The supplemental online videos, which have been expanded from the first edition, provide examples of common procedures, treatment maneuvers, physical examination techniques, and signs.

The first 6 chapters lay the groundwork for the rest of the book by succinctly summarizing important aspects of the medical history, physical examination, computerized testing, radiology work-up, anatomy, physiology, and laboratory testing in patients with vertigo and disequilibrium. At the beginning of Chapter 1, Dr. Weber stresses the paramount importance of a medical history: “The diagnosis of a patient with vertigo or dizziness can almost always be ascertained 80% of the time by taking an accurate history.” In the very first paragraph of the book, the author …

Spine Surgery: Tricks of the Trade, 3rd Edition

Vaccaro AR, Albert TJ, eds. Spine Surgery: Tricks of the Trade. 3rd ed. Thieme; 2016; 462 pp; 400 ill; $199.99

Cover of Vaccaro

Summarizing and organizing all aspects of spine surgery is a daunting and arduous task. The spinal column can provide a variety of pathology to the surgeon while offering particular vulnerability in the trauma setting, necessitating urgent or emergent attention. This text is authored by 2 of the most reputable spine surgeons in the world, which offers the reader some confidence as they navigate through the chapters. The other contributors are also recognized as experts in the subject category they are describing.

The text consists of 21 distinct sections providing organization and appropriate categorization of all aspects of spine surgery. Within these 21 sections, 112 chapters highlight the finer details of each topic and procedure. The chapters are each very easy to read and understand, no matter the level of one’s training or discipline. These chapters are all structured with a similar foundation and schematic so that the readers of this text can anticipate the areas of focus from page to page.  Uniformly, each of the 112 chapters includes a description of the procedure discussed, indications/contraindications, and special considerations. Each also highlights key procedural steps and shares the experiences of other surgeons to help avoid pitfalls and ensure technical completion of the surgical objective.

As an owner of both the second and third editions, I can personally attest to the quality improvements of this resource. Color illustrations, charts, and photographs are featured in every chapter, as opposed to only black and white pictures in the previous edition. Moreover, this edition provides online access to a multitude of videos that demonstrate the technical aspects of these operations, which were filmed in the operating room or on cadavers. Furthermore, the scope of …

Journal Scan – This Month in Other Journals, April 2017

Zurawski J, Lassmann H, Bakshi R. Use of Magnetic Resonance Imaging to Visualize Leptomeningeal Inflammation in Patients With Multiple Sclerosis. JAMA Neurol. 2017;74(1):100. doi:10.1001/jamaneurol.2016.4237.

You are well aware that MS is a chronic demyelinating disease traditionally characterized by an initial relapsing-remitting clinical course and focal inflammatory lesions that have a predilection for the periventricular white matter.  However, histopathologic and imaging studies have illustrated a more complex pathologic substrate involving cortical demyelination, gray matter atrophy, and meningeal inflammation.  The authors evaluate the status and prospects regarding the emerging role of MR to visualize leptomeningeal enhancement (LME) in patients with MS and place these findings in the proper pathobiologic and clinical context.

Absinta et al (Absinta M, Vuolo L, Rao A, et al. Gadolinium-based MRI characterization of leptomeningeal inflammation in multiple sclerosis. Neurology. 2015;85(1):18-28.) found that LME was significantly more common than had been initially reported, and its presence was associated with patient age, disease severity, and clinical type of MS. The authors used high-resolution 3T 3-dimensional T2 FLAIR MRI with a voxel size of 1.0 × 1.0 × 1.0mm and postcontrast images obtained 10 minutes after gadolinium injection. They demonstrated LME in 74 of 299 patients with MS (24.7%) compared with only 1 of 37 (2.7%) age-matched controls with out MS. Perhaps of particular importance, LME was twice as frequent (33%) in patients with progressive forms of MS (present in 44 patients with secondary progressive MS) (SPMS) and 74 patients with primary progressive MS (PPMS) compared with those with relapsing-remitting (RR) disease (19%). Disease duration, and Expanded Disability Status Scale scores were associated with LME. Whole-brain and cortical atrophy were also associated with LME. There was no association between LME and WM lesion enhancement or WM lesion volume. Leptomeningeal enhancement topography abutted the pial surface on the cerebral convexity …

MCQ Based Review of Neuroradiology-Update, Category–Brain, 500 MCQs For ABR Core, Certifying and CAQ Exams

Takhtani D. MCQ Based Review of Neuroradiology-Update. iTunes; 2015; 636 pp and ill; $12.99

Cover of Takhtani

MCQ Based Review of Neuroradiology is an innovative collection of 500 multiple choice questions (MCQs) dealing with a wide variety of subjects including pathophysiology, clinical manifestations, neuroimaging, and physics. It is intended as a review for radiologists in training planning to take their core, certifying, or CAQ examinations or for practicing radiologists who desire a case- and question-based neuroradiology review.

The questions are divided into 3 groups based on difficulty level. Each chapter begins with a series of images followed by several MCQs and finally by answer pages that cover the main topic and ancillary information. The images are of high quality and are well annotated, the questions are clear and well thought out, and the articles are well-written and provide reliable and up-to-date information. Furthermore, the book is incredibly interactive. Most of the terms are linked to the Internet and to other parts of the book, you can search within the book, highlight, add notes, and even listen to the text.

Having recently taken the ABR’s Core Examination, I can attest to the usefulness of this book in preparing for the new exam format. Particularly in the area of physics as it pertains to neuroradiology, this book presents practical and clinically relevant scenarios that come up in everyday practice and the explanations are coherent and easy to follow.

In summary, in this increasingly digital world, this book has many features that make it a very dynamic and interactive learning experience, and is a valuable educational tool for any radiologist desiring to sharpen their diagnostic abilities in neuroimaging.…

Register for the 2nd Annual International Symposium on the Fetal Brain

ISFB Logo

Where: Washington, D.C.

When: August 24-25, 2017

Register now for this multidisciplinary, CME-accredited two-day event featuring a 360-degree review of advances in understanding of the fetal brain presented by a panel of world-renowned experts in the fields of imaging,  fetal and neonatal neurology, maternal-fetal medicine, developmental neuroscience, neurogenetics, and genetics. The updated agenda and speaker list is available now at fetalbrainsympoium.com.

In addition to expert talks on clinical and research innovation, this year’s conference will offer a poster session and breakout breakfast sessions with practical clinical applications designed to better address needs and answer questions for all members of the multidisciplinary audience.

Join the event to explore a range of topics related to the fetal brain, connect with international colleagues, and discover the countless cultural and historic sites of Washington, D.C.

Register now to take advantage of early bird pricing before it ends April 13. Visit FetalBrainSymposium.com.

Washington, D. C.
Washington DC, USA skyline on the Potomac River with Lincoln Memorial, Washington Monument, and Arlington Memorial Bridge.

MR Fingerprinting of Adult Brain Tumors: Initial Experience

Fellows’ Journal Club

MR fingerprinting is a technique in which pseudorandomized acquisition parameters are used to simultaneously quantify multiple tissue properties, including T1 and T2 relaxation times. The authors evaluated the ability of MR fingerprinting–derived T1 and T2 relaxometry to differentiate the 3 common types of intra-axial brain tumors (17 glioblastomas, 6 lower grade gliomas, and 8 metastases). Using these parameters, they explored the T1 and T2 properties of peritumoral white matter in various tumor types. Mean T2 values could differentiate solid tumor regions of lowergrade gliomas from metastases and the mean T1 of peritumoral white matter surrounding lowergrade gliomas differed from peritumoral white matter around glioblastomas.

Predictive Utility of Marketed Volumetric Software Tools in Subjects at Risk for Alzheimer Disease: Do Regions Outside the Hippocampus Matter?

Editor’s Choice

The authors assessed the prognostic efficacy of individual-versus-combined regional volumetrics in 2 commercially available brain volumetric software packages for predicting conversion of patients with mild cognitive impairment to Alzheimer disease. One hundred ninety-two subjects (mean age, 74.8 years) diagnosed with mild cognitive impairment at baseline were studied. On univariable analysis of 11 NeuroQuant and 11 Neuroreader regional volumes, hippocampal volume had the highest area under the curve for both software packages (0.69, NeuroQuant; 0.68, Neuroreader) and was not significantly different between packages. They conclude that of the multiple regional volume measures available in FDA-cleared brain volumetric software packages, hippocampal volume remains the best single predictor of conversion of mild cognitive impairment to Alzheimer disease at 3-year follow-up.

AJNR Debuts New Web Site

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AJNR has unveiled a brand new Web platform. In addition to the fresh modern design, easier navigation, and improved functionality, the site is now completely mobile-optimized. This eliminates the need for the Journal’s iOS app and at the same time addresses the Android market, which was underserved by the old platform. The new Web site is a major investment in the Journal’s on-line presence. It is built on HighWire Press’s Drupal-based architecture that allows increased capabilities and the flexibility to accommodate new features and changing technology.

Editor-in-Chief Jeffrey Ross shared his enthusiasm for the enhanced experience the new site brings to AJNR’s readers, saying, “We are excited to partner with HighWire and to bring to our readers a modern, responsive AJNR Web site using the JCore platform.  Our readers will find an uncluttered interface, which presents both current and archival content in an easy to access format, with minimal click-through, and that is readily available on whatever device they choose to consume content.”

Dr. Ross selected an Altmetrics tool to analyze article level usage, reach, and social media impact as the first new function added to the site.

Article Level Metrics Product Sheet Final

Please be sure to visit and bookmark the updated www.ajnr.org soon and share your feedback. Former users of AJNR’s iOS app should now access the site through their Safari browser.…