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Quantifying Intracranial Plaque Permeability with Dynamic Contrast-Enhanced MRI: A Pilot Study

Editor’s Choice

The purpose of this study was to use DCE MR imaging to quantify the contrast permeability of intracranial atherosclerotic disease plaques in 10 symptomatic patients and to compare these parameters against existing markers of plaque volatility using black-blood MR imaging pulse sequences. Ktrans and fractional plasma volume (Vp) measurements were higher in plaques versus healthy white matter and similar or less than values in the choroid plexus. Only Ktrans correlated significantly with time from symptom onset. Dynamic contrast-enhanced MR imaging parameters were not found to correlate significantly with intraplaque enhancement or hyperintensity. The authors suggest that Ktrans may be an independent imaging biomarker of acute and symptom-associated pathologic changes in intracranial atherosclerotic disease plaques.

Neuroimaging Clinics of North America: Adult Brain Tumors

Brandão LA, ed. Mukherji SK, consulting ed. Neuroimaging Clinics of North America: Adult Brain Tumors. Elsevier; 2016;26(4):493–694; $360.00

Brandao cover

This November 2016 issue of the Neuroimaging Clinics of North America consists of 9 chapters (nearly 200 pages in length) and covers a number of aspects of adult brain tumors. Edited by Dr. Lara Brandão with contributions from 21 international and national authors, this volume deals with (in order): posterior fossa tumors, lymphomas (2 chapters), the pre- and posttreatment evaluation of gliomas (2 chapters), metastasis, extra parenchymal tumors, advanced MR techniques, and interesting cases of pseudotumors. It is a bit surprising that there is not a chapter dedicated to the emerging brain tumor classifications based on molecular/genetic factors. While in our daily readings of brain MRs and CTs, we do not consider these molecular factors, these issues are discussed among members of neuro-oncology tumor boards, on which neuroradiologists are participants. With the increased emphasis on ICD types and their implications for therapy, some space on this subject is warranted. Had this been included, some of the terminology used elsewhere in the book might have been altered. Of course, the chapter on posttreatment of gliomas and the complexities in the analysis of such patients will be of great interest to the readers of this volume. The extensive material on lymphomas is important and noteworthy because of the increased incidence of disease and the multiple parameters that can be utilized in its detection and evaluation. Many important teaching points are raised in this 54-page (2-chapter) evaluation of lymphomas.

The images included in this volume are of high quality and are well-described, with important structural changes in brain tumors included. Even if one does not read the volume cover-to-cover, one can derive an understanding (providing a good review) of adult brain tumors and see …

RadiologyAsia 2017 Announces Three Renowned Speakers – Pamela Schaefer, Bertrand Ang, and Richard H. Wiggins

RadiologyAsia logo

Pamela Schaefer Neuro radiology

Pamela Schaefer

Dr. Schaefer is a recognised clinical expert in neuroradiology especially in acute stroke imaging. She has held leadership positions in multiple regional and national societies, including President of the American Society of Neuroradiology, Eastern Neuroradiology Society and the New England Roentgen Ray Society. She is also a renowned educator, teacher and editor; and a respected administrator at Massachusetts General Hospital in Neuroradiology and Clinical MRI.

 

Dr. Ang

Bertrand Ang

Dr Bertrand Ang is a senior consultant working in National University Hospital Department of Diagnostic Imaging. He specialises in body radiology with a special interest in oncology. He graduated from University of New South Wales (Australia) in 1998 and finished his radiology speciality with Master of Medicine (Radiology) National University of Singapore and Fellowship Royal College of Radiology in 2005. He is active in various tumour groups including Colorectal, Gynaecological and Urological tumour groups.

 

Dr. Wiggins

Richard H Wiggins

Dr. Richard H Wiggins is the Director of Head and Neck Imaging and the Director of Imaging Informatics at the University of Utah Health Sciences Center. He has served as the President of WNRS and ASHNR, and Program Chair for SIIM. He was elected the inaugural fellow of the Academy of Medical Science Educators, and is the recipient of the Teacher of the Year award from the Department of Radiology, the Distinguished Teaching Award from the Department of Otolaryngology, as well as the Honoured Educator Award from the Radiological Society of North America.

The 2017 RadiologyAsia Conference, themed “Bringing the State of the Art Imaging to Clinical Practice”, brings incredible value to attending delegates. The conference will feature 74 topics, over 50 renowned speakers and 4 tracks. Sign up today to learn and gain new insights from Pamela Schaefer, Bertrand Ang, Stephen Bird, Regina J Hooley, James G Smirniotopoulos, Ashish Chawla, Howard …

Journal Scan – This Month in Other Journals, February 2017

Domino JS, Baek J, Meurer WJ, et al. Emerging temporal trends in tissue plasminogen activator use. Neurology. 2016;87(21):2184-2191. doi:10.1212/WNL.0000000000003349.

Mexican Americans (MA) have an increased stroke burden when compared to their non-Hispanic white (NHW) counterparts, including increased stroke incidence and poorer neurologic, functional, and cognitive outcomes.

The authors explored the temporal trends in tissue plasminogen activator (tPA) administration for acute ischemic stroke (AIS) in a biethnic community without an academic medical center. Cases of AIS were identified from 7 hospitals in the Brain Attack Surveillance in Corpus Christi (BASIC) project, a population-based surveillance study from 2000-2012. There were 5,277 AIS cases identified from 4,589 individuals. tPA use was steady at 2% and began increasing in 2006, reaching 11% in subsequent years. Although ethnicity did not modify the temporal trend, Mexican Americans were less likely to receive tPA than non- Hispanic whites due to emerging ethnic differences in later years. The results suggest that increases in tPA use were greater in higher severity patients compared to lower severity patients, and a gap between MAs and NHWs in tPA administration may be emerging.  The authors conclude that as physician experience with tPA and its use in community settings increases, follow-up studies should continue to explore temporal trends in tPA as well as identify possible strategies to improve tPA use in MAs.

2 Figures (graphs), 2 Tables

Goldstein LB. IV tPA for acute ischemic stroke. Neurology. 2016;87(21):2178-2179. doi:10.1212/WNL.0000000000003366.

In this editorial on the Domino et al. paper, Dr. Goldstein notes that there were considerable barriers that slowed IV tPA adoption after it was approved by the FDA in 1996.  Eight years after FDA approval, IV tPA was being given to only 1%–2% of stroke patients. Transformation of the structure and organization of stroke care delivery were needed, and in part led …

2016 Lucien Levy Best Research Article Award Winner and Nominees Named

The Editors of AJNR are pleased to announce the annual Lucien Levy Best Research Article Award has been presented to:

Brain Network Architecture and Global Intelligence in Children with Focal Epilepsy by M.J. Paldino, F. Golriz, M.L. Chapieski, W. Zhang, and Z.D. Chu.

This award is named for the late AJNR Senior Editor who championed its establishment and recognizes the best original research paper accepted in 2016. The winning paper, submitted by authors from the Texas Children’s Hospital in Houston, was published electronically on October 13, 2016 and appeared in the February print issue. It was selected by a vote of the Journal’s Editor-in-Chief and Senior Editors.

Other nominated papers were:

Fate of Coiled Aneurysms with Minor Recanalization at 6 Months: Rate of Progression to Further Recanalization and Related Risk Factors by J.P. Jeon, Y.D. Cho, J.K. Rhim, D.H. Yoo, W.-S. Cho, H.-S. Kang, J.E. Kim, and M.H. Han

Diffusion-Weighted Imaging of Nasopharyngeal Carcinoma: Can Pretreatment DWI Predict Local Failure Based on Long-Term Outcome? by B.K.H. Law, A.D. King, K.S. Bhatia, A.T. Ahuja, M.K.M. Kam, B.B. Ma, Q.Y. Ai, F.K.F. Mo, J. Yuan, and D.K.W. Yeung

Porcine In Vivo Validation of a Virtual Contrast Model: The Influence of Contrast Agent Properties and Vessel Flow Rates by T.W. Peach, Y. Ventikos, J.V. Byrne, and Z. You

MR Imaging of Individual Perfusion Reorganization Using Superselective Pseudocontinuous Arterial Spin-Labeling in Patients with Complex Extracranial Steno-Occlusive Disease by V. Richter, M. Helle, M.J.P. van Osch, T. Lindner, A.S. Gersing, P. Tsantilas, H.-H. Eckstein, C. Preibisch, and C. Zimmer

A Semiautomatic Method for Multiple Sclerosis Lesion Segmentation on Dual-Echo MR Imaging: Application in a Multicenter Context by L.

Temporal Bone Dissection Guide, 2nd Edition

Francis HW, Niparko JK. Temporal Bone Dissection Guide. 2nd ed. Thieme; 2016; 96 pp; 165 ill; $89.99

Francis and Niparko cover

The second edition of Temporal Bone Dissection Guide provides an excellent foundation for mastering temporal bone anatomy as well as otologic and neurotologic surgical procedures through a well-organized presentation of essential temporal bone anatomy and its clinical application in temporal bone surgery. The authors’ systematic approach to the presentation of the material parallels the progression of knowledge acquisition and skill development among otolaryngology residents and neurotology fellows-in-training. Following a well-emphasized discussion on the proper use of the operating microscope and otologic instruments, including suction/irrigation and high-speed drills, the authors describe temporal bone surface anatomy and the fundamentals of performing a successful and safe mastoidectomy before proceeding to discuss deeper, more complex anatomic features and mastery of anatomic landmarks in lateral skull base procedures. The second edition has also added a section on endoscopic middle ear dissection, which has become an essential component in mastering otologic surgical technique. Furthermore, this edition has expanded the description of techniques for infratemporal and extended middle fossa dissection.

The text of the dissection manual provides easy-to-follow, fundamental information that is supplemented with well-labeled illustrations, histologic slides, and radiographic images, as well as current references with suggested reading. Furthermore, included with the purchase of the dissection manual is access to online videos of cadaveric and intraoperative temporal bone dissection with narration by the contributing authors. A potential limitation of the manual is that it does not provide images of cadaveric or intraoperative temporal bone dissection, which could help readers further hone their understanding of the complex 3D anatomy.

The accurate and concise information presented in the dissection manual reflects the cumulative surgical and teaching experience of the contributing authors. Although several temporal bone dissection manuals have been published …

White Matter Injury and General Movements in High-Risk Preterm Infants

Fellows’ Journal Club

Cerebral palsy has been predicted by analysis of spontaneous movements in the infant termed “General Movement Assessment.” The authors evaluated the utility of General Movement Assessment in predicting adverse cognitive, language, and motor outcomes in very preterm infants and attempted to identify brain imaging markers associated with both adverse outcomes and aberrant general movements in 47 preterm infants using MRI volumetric analysis and DTI. Nine infants had aberrant general movements and were more likely to have adverse neurodevelopmental outcomes, compared with infants with normal movements. In infants with aberrant movements, Tract-Based Spatial Statistics analysis identified significantly lower fractional anisotropy in widespread WM tracts. They conclude that aberrant general movements at 10–15 weeks’ postterm are associated with adverse neurodevelopmental outcomes and specific white matter microstructure abnormalities for cognitive, language, and motor delays.

Abstract

Figure 1 from paper
Differences in white matter at term-equivalent age between infants with normal and aberrant fidgety movements at 10–15 weeks. Mean FA skeleton, in green, is overlaid on the mean FA map. Superimposed are pseudocolored voxels having significantly greater anisotropy in infants with normal than in infants with aberrant fidgety movements. Color bar shows the range of P values represented by the pseudocolors. Significantly higher regions of FA can be observed in the splenium (ccs) and genu (ccg) of the corpus callosum, inferior (ilf) and superior longitudinal fasciculus (slf), fronto-occipital fasciculus (fof), anterior (alic) and posterior (plic) internal capsule, corona radiata (cr), cerebellar peduncles (cp), and fornix/stria terminalis (fx/st). Z represents the MR imaging axial section coordinates (zero is the center of the anterior commissure).

BACKGROUND AND PURPOSE

Very preterm infants (birth weight, <1500 g) are at increased risk of cognitive and motor impairment, including cerebral palsy. These adverse neurodevelopmental outcomes are associated with white matter abnormalities on MR imaging at term-equivalent age. Cerebral palsy has been

Limited Dorsal Myeloschisis and Congenital Dermal Sinus: Comparison of Clinical and MR Imaging Features

Editor’s Choice

These investigators retrospectively reviewed the clinical and MR imaging findings of 12 patients with limited dorsal myeloschisis and 10 patients with congenital dermal sinus. A crater covered with pale epithelium was the most common skin lesion in limited dorsal myeloschisis (83%). Infectious complications were common in congenital dermal sinus (60%), but not found in limited dorsal myeloschisis. They show that limited dorsal myeloschisis has distinct MR imaging features including a visible intrathecal tract with dorsal tenting of the cord at the tract-cord union.

Endovascular Therapy of M2 Occlusion in IMS III: Role of M2 Segment Definition and Location on Clinical and Revascularization Outcomes

Fellows’ Journal Club

The authors reviewed the impact of revascularization on clinical outcomes in 83 patients with M2 occlusions in the Interventional Management of Stroke III trial according to specific M1–M2 segment anatomic features. AnmRS 0–2 outcome was associated with reperfusion for M2 trunk (n = 9) or M2 division (n = 42) occlusions, but not for M2 branch occlusions (n = 28). Of the 83 participants with M2 occlusion who underwent endovascular therapy, 41.0% achieved mRS 0–2 at 90 days, including 46.6% with modified TICI 2–3 reperfusion compared with 26.1% with modified TICI 0–1 reperfusion. They conclude that mRS 0–2 at 90 days was dependent on reperfusion for M2 trunk but not for M2 branch occlusions in IMS III.

Abstract

Figure 1 from paper
A, Right M1 trunk gives rise to the ATA with the posterior temporal branch filling on microcatheter injection. B, Lateral view baseline common carotid arteriogram confirms mid- and posterior temporal lobe cortical supply from the patent posterior temporal artery.

BACKGROUND AND PURPOSE

Uncertainty persists regarding the safety and efficacy of endovascular therapy of M2 occlusions following IV tPA. We reviewed the impact of revascularization on clinical outcomes in 83 patients with M2 occlusions in the Interventional Management of Stroke III trial according to specific M1-M2 segment anatomic features.

MATERIALS AND METHODS

Perfusion of any M2 branch distinguished M2-versus-M1 occlusion. Prespecified modified TICI and arterial occlusive lesion revascularization and clinical mRS 0–2 end points at 90 days for endovascular therapy–treated M2 occlusions were analyzed. Post hoc analyses of the relationship of outcomes to multiple baseline angiographic M2 and M1 subgroup characteristics were performed.

RESULTS

Of 83 participants with M2 occlusion who underwent endovascular therapy, 41.0% achieved mRS 0–2 at 90 days, including 46.6% with modified TICI 2–3 reperfusion compared with 26.1% with modified TICI 0–1 reperfusion (risk

Pediatric Radiology: The Requisites, 4th Edition

Walters MM, Robertson RL. Pediatric Radiology: The Requisites. 4th ed. Elsevier; 2016; 432 pp; 1200 ill; $109.99

Walters and Robertson cover

The 4th edition of Pediatric Radiology, edited by Drs. Walters and Robertson, along with 21 other contributors, covers the field of pediatric radiology in 420 pages. Of course, in a book this short that attempts to address a large subspecialty, only the highlights of every area can be covered. This is the overall intent of the book—to provide a foundation in pediatric radiology upon which one can build. The neuroradiology portion of the book is reserved for the last 3 chapters (brain, spine, head and neck) and includes 144 pages. For a seasoned neuroradiologist, there are certainly other texts that are more inclusive; however, for a resident or fellow beginning a rotation in pediatric radiology or in neuroradiology, this is a solid introduction to the field. The images are crisp and each chapter summarizes the key elements.

Brain: congenital anomalies; neurocutaneous syndrome; hydrocephalus infections/inflammation; tumors; vascular disease and vascular anomalies; trauma; metabolic disease

Spine: developmental abnormalities; vascular abnormalities; trauma infection; inflammation; tumors

Head and Neck: congenital and developmental abnormalities (including orbits, nasal cavity, face, temporal bone, neck/oral cavity); trauma; infection/inflammatory conditions; tumors

For those who do not practice or observe much pediatric neuroradiology, these 3 chapters provide a wonderful summary, and the last chapter in particular allows one to evaluate and read about abnormalities that are infrequently encountered.

This book is recommended for any radiology library, whether in a private or academic practice. Neuroradiologists will not consider this a primary personal purchase.…