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Color Atlas of Endo-Otoscopy Examination-Diagnosis-Treatment

Sanno M, Russo A, Caruso A, et al. Color Atlas of Endo-Otoscopy Examination-Diagnosis-Treatment;Thieme 2017; 348 pp; 1,007 ill; $109.99.

Endo-OtoscopyIn this first edition text, the authors have assembled an image-rich reference of the various manifestations of both common and rare pathologies of the external auditory canal, middle ear, and temporal bone. While the undoubted focus of the book remains the otoscopic evaluation of these entities, many of the otoscopic photographs are complemented with radiologic images, thereby including radiologists as potential beneficiaries of this work, in addition to the otolaryngologists, pediatricians, and audiologists who will all assuredly solidify their otoscopic examination.

The book is divided into 14 chapters, and generally follows a progression from superficial to deep, with early chapters devoted to diseases of the external ear and middle ear, with middle chapters focused on cholesteatomas, and the later chapters addressing rare lesions of the temporal bone and skull base.

Unsurprisingly, with over 1,000 images throughout this work, a majority of each chapter is devoted to showcasing the high-resolution otoscopic pictures, and when relevant, accompanying radiologic cross sectional images. All images are independently captioned, though many of the radiologic images require reading the preceding passage of text to acquire full understanding. All chapters offer a brief discussion on surgical management of these conditions as well, often with accompanying postoperative images. The book is concluded with a generous references section. Chapters 1 and 2 offer a brief description of otoscopic technique as well as a short discussion on the normal appearance of the tympanic membrane, and are of little relevance to the radiologist.

Chapter 3 focuses on various disease entities of the external auditory canal, ranging from otitis externa and myringitis, to mass lesions such as EAC cholesteatoma, as well as uncommon tumors that may involve this site. While a representative …

Spine Essentials Handbook: A Bulleted Review of Anatomy, Evaluation, Imaging, Tests, and Procedures

Singh K. Spine Essentials Handbook: A Bulleted Review of Anatomy, Evaluation, Imaging, Tests, and Procedures; Thieme 2019; 262 pp; 165 ill; $79.99.

This handbook provides general and basic clinical information related to the spinal axis. For neuroradiologists who wish to review clinical signs, muscular/ligamentous anatomy, plexal composition both brachial and lumbosacral, this would be a handy reference.

Also outlined are commonly used radiographic measurements, many of which spine surgeons use frequently, but ones which radiologists often times do not measure; such as balance lines or pelvic tilt. However, this is not a publication which deals with spine imaging in any significant way. In fact, 1 noteworthy figure (10.2), an oblique radiograph of the cervical spine, is described as a T1 MRI axial (this makes one concerned about accuracies elsewhere).

By and large, this is a potentially useful handbook which can serve as a quick, basic reference to spinal/paranasal anatomy and the associated clinical issues.…

Fellows’ Journal Club: Distal Balloon Angioplasty of Cerebral Vasospasm Decreases the Risk of Delayed Cerebral Infarction

Fellows’ Journal Club

A group of 392 patients was analyzed (160 before versus 232 after January 2015). Distal balloon angioplasty was associated with the following: higher rates of angioplasty (43% versus 27%) and intravenous milrinone (31% versus 9%); lower rates of postangioplasty delayed cerebral infarction (2.2% versus 7.5%) and new angioplasty (8% versus 19%) independent of the rate of patients treated by angioplasty and milrinone; and the same rates of stroke related to angioplasty (3.6% versus 3.1%), delayed cerebral infarction (7.7% versus 12.5%), mortality (10% versus 11%), and favorable outcome (79% versus 73%). The authors conclude that distal balloon angioplasty is safe and decreases the risk of delayed cerebral infarction and the recurrence of vasospasm compared with conventional angioplasty. It fails to show a clinical benefit possibly because of confounding changes in adjuvant therapies of vasospasm during the study period.

Abstract

BACKGROUND AND PURPOSE

Conventional angioplasty of cerebral vasospasm combines proximal balloon angioplasty (up to the first segment of cerebral arteries) with chemical angioplasty for distal arteries. Distal balloon angioplasty (up to the second segment of cerebral arteries) has been used in our center instead of chemical angioplasty since January 2015. We aimed to assess the effect of this new approach in patients with aneurysmal SAH.

MATERIALS AND METHODS

The occurrence, date, territory, and cause of any cerebral infarction were retrospectively determined and correlated to angioplasty procedures. Delayed cerebral infarction, new angioplasty in the territory of a previous angioplasty, angioplasty complications, 1-month mortality, and 6- to 12-month modified Rankin Scale ≤ 2 were compared between 2 periods (before-versus-after January 2015, from 2012 to 2017) with adjustment for age, sex, World Federation of Neurosurgical Societies score, and the modified Fisher grade.

RESULTS

Three-hundred-ninety-two patients were analyzed (160 before versus 232 after January 2015). Distal balloon angioplasty was associated with the following:

Editor’s Choice: Convolutional Neural Network for Automated FLAIR Lesion Segmentation on Clinical Brain MR Imaging

Editor’s Choice

This convolutional neural network was retrospectively trained on 295 brain MRIs to perform automated FLAIR lesion segmentation. Performance was evaluated on 92 validation cases using Dice scores and voxelwise sensitivity and specificity, compared with radiologists’ manual segmentations. The authors’ model demonstrated accurate FLAIR lesion segmentation performance (median Dice score, 0.79) on the validation dataset across a large range of lesion characteristics. Across 19 neurologic diseases, performance was significantly higher than existing methods (Dice, 0.56 and 0.41) and approached human performance (Dice, 0.81).

Abstract

BACKGROUND AND PURPOSE

Most brain lesions are characterized by hyperintense signal on FLAIR. We sought to develop an automated deep learning–based method for segmentation of abnormalities on FLAIR and volumetric quantification on clinical brain MRIs across many pathologic entities and scanning parameters. We evaluated the performance of the algorithm compared with manual segmentation and existing automated methods.

MATERIALS AND METHODS

We adapted a U-Net convolutional neural network architecture for brain MRIs using 3D volumes. This network was retrospectively trained on 295 brain MRIs to perform automated FLAIR lesion segmentation. Performance was evaluated on 92 validation cases using Dice scores and voxelwise sensitivity and specificity, compared with radiologists’ manual segmentations. The algorithm was also evaluated on measuring total lesion volume.

RESULTS

Our model demonstrated accurate FLAIR lesion segmentation performance (median Dice score, 0.79) on the validation dataset across a large range of lesion characteristics. Across 19 neurologic diseases, performance was significantly higher than existing methods (Dice, 0.56 and 0.41) and approached human performance (Dice, 0.81). There was a strong correlation between the predictions of lesion volume of the algorithm compared with true lesion volume (ρ = 0.99). Lesion segmentations were accurate across a large range of image-acquisition parameters on >30 different MR imaging scanners.

CONCLUSIONS

A 3D convolutional neural network adapted from a U-Net architecture can

Fellows’ Journal Club: One-Stop Management with Perfusion for Transfer Patients with Stroke due to a Large-Vessel Occlusion: Feasibility and Effects on In-Hospital Times

Fellows’ Journal Club

The authors report the first 15 consecutive transfer patients with stroke with externally confirmed large-vessel occlusions who underwent flat panel detector CT perfusion and thrombectomy in the same room. Preinterventional imaging consisted of noncontrast flat panel detector CT and flat panel detector CT perfusion, acquired with a biplane angiography system. The flat panel detector CT perfusion was used to reconstruct a flat panel detector CT angiography to confirm the large-vessel occlusions. After confirmation of the large-vessel occlusion, the patient underwent mechanical thrombectomy. Fifteen transfer patients underwent flat panel detector CT perfusion and were treated with mechanical thrombectomy from June 2017 to January 2019. The median time from symptom onset to admission was 241 minutes. Median door-to-groin time was 24 minutes. Compared with 23 transfer patients imaged with multidetector CT, time was reduced significantly (24 minutes versus 53 minutes).

 

Abstract

BACKGROUND AND PURPOSE

In-hospital time delays lead to a relevant deterioration of neurologic outcomes in patients with stroke with large-vessel occlusions. At the moment, CT perfusion is relevant in the triage of late-window patients with stroke. We conducted this study to determine whether one-stop management with perfusion is feasible and leads to a reduction of in-hospital times.

MATERIALS AND METHODS

In this observational study, we report the first 15 consecutive transfer patients with stroke with externally confirmed large-vessel occlusions who underwent flat panel detector CT perfusion and thrombectomy in the same room. Preinterventional imaging consisted of noncontrast flat panel detector CT and flat panel detector CT perfusion, acquired with a biplane angiography system. The flat panel detector CT perfusion was used to reconstruct a flat panel detector CT angiography to confirm the large-vessel occlusions. After confirmation of the large-vessel occlusion, the patient underwent mechanical thrombectomy. We recorded time metrics and safety parameters prospectively and compared them with

Editor’s Choice: Intrathecal Use of Gadobutrol for Glymphatic MR Imaging: Prospective Safety Study of 100 Patients

Editor’s Choice

The authors performed a prospective safety and feasibility study in 100 consecutive patients undergoing glymphatic MR imaging from September 2015 to August 2018. Short- and long-term serious and nonserious adverse events were registered clinically and by interview after intrathecal administration of 0.5 mL of gadobutrol (1.0 mmol/mL) along with 3 mL of iodixanol (270 mg I/mL). One serious adverse event (anaphylaxis) occurred in a patient with known allergy to iodine-containing contrast agents (1%). The main nonserious adverse events during the first 1–3 days after contrast injection included severe headache (28%) and severe nausea (34%), though the frequency depended heavily on the diagnosis. They conclude that intrathecal administration of gadobutrol in conjunction with iodixanol for glymphatic MR imaging is safe and feasible.

 

Abstract

BACKGROUND AND PURPOSE

Intrathecal contrast-enhanced glymphatic MR imaging has shown promise in assessing glymphatic function in patients with dementia. The purpose of this study was to determine the safety profile and feasibility of this new MR imaging technique.

MATERIALS AND METHODS

A prospective safety and feasibility study was performed in 100 consecutive patients (58 women and 42 men, 51 ± 19 years of age) undergoing glymphatic MR imaging from September 2015 to August 2018. Short- and long-term serious and nonserious adverse events were registered clinically and by interview after intrathecal administration of 0.5 mL of gadobutrol (1.0 mmol/mL) along with 3 mL of iodixanol (270 mg I/mL). Adverse events are presented as numbers and percentages.

RESULTS

One serious adverse event (anaphylaxis) occurred in a patient with known allergy to iodine-containing contrast agents (1%). The main nonserious adverse events during the first 1–3 days after contrast injection included severe headache (28%) and severe nausea (34%), though the frequency depended heavily on the diagnosis. After 4 weeks, adverse events had resolved.

CONCLUSIONS

Intrathecal administration of gadobutrol in

Handbook of Pediatric Neurosurgery

Jallo GI, Kothbauer KF, Recinos VM. Handbook of Pediatric Neurosurgery;Thieme 2018; 556 pp; 275 ill; $ 124.99.

Handbook of Pediatric Neurosurgery is a concise and practical pediatric neurosurgery textbook detailing the management of various pediatric neurosurgical disorders encountered in clinical practice. The primary author of this book is Dr. George Jallo, an internationally renowned pediatric neurosurgeon, with invaluable contributions from more than 80 national and international subspecialists in neurosurgery and other related fields.

The book has been nicely divided into 11 sections. It starts with an introduction dealing with critical care and pain management followed by a chapter outlining various imaging techniques when dealing with pediatric neurosurgery disorders. The next few sections cover specific disorders, including tumors, cerebrovascular disorders and vascular malformations in both the brain and the spine. There is an extensive review of congenital and developmental cranial and spinal anomalies as well as pediatric trauma and infection, involving the entire neural axis. There is an entire section dedicated to the understanding and surgical management of childhood epilepsy.  The book concludes with a review on neuronavigation in pediatric neurosurgery.

The highlights of this book are many. Many of the chapters conclude with an informative subsection, which deals with “common clinical questions” followed by “answers to the common clinical questions,” highlighting the wealth of experience of the various authors.  There are more than 275 excellent illustrations, intraoperative pictures as well as radiological images throughout the book.

Overall, this is an excellent textbook by expert pediatric neurosurgeons and other subspecialists who describe surgical procedures involved in the management of various pediatric neurosurgical disorders with an emphasis on certain operative techniques useful during surgery. The strategies and pearls gained from decades of experience provide an invaluable resource to young neurosurgeons learning the art of neurosurgery. This is by no means a comprehensive …

Pocketbook of Clinical IR: A Concise Guide to Interventional Radiology

Warhadpande S, Lionberg A, Cooper KJ. Pocketbook of Clinical IR: A Concise Guide to Interventional Radiology;Thieme 2019; 240 pp; 165 ill; $54.99.

This short 240-page soft-cover handbook on interventional radiology (IR), written with residents, fellows, and younger attendings in mind, has only a small portion devoted to neuro IR (16 pages), which appears at the very end of the book. Topics specifically covered are:

  • Ischemic stroke
  • Carotid artery stenosis
  • Cerebral aneurysms
  • AVMs
  • Bleeds of the head and neck
  • VB compressive fractures

This is a short, valuable resource for a general radiology library or as a personal copy for those engaged in a significant IR volume.…

Journal Scan — This Month in Other Journals — July 2019

1. Bourcier R, Goyal M, Liebeskind DS, et al. Association of Time From Stroke Onset to Groin Puncture With Quality of Reperfusion After Mechanical Thrombectomy. JAMA Neurol. 2019;76(4):405. doi:10.1001/jamaneurol.2018.4510.

Challenges in the field of acute ischemic stroke (AIS) related to large-vessel occlusion (LVO) focus on reducing time to reperfusion, optimizing imaging methods for patient selection, and evaluating the best technical approach. Reperfusion is significantly associated with clinical outcome in patients undergoing endovascular thrombectomy (EVT). Reperfusion is commonly scored with the modified TICI (mTICI) grading scale, with 0 indicating persistent complete occlusion and 3 indicating complete reperfusion. Because grade 2b was shown to be the best cutoff for predicting favorable outcome at 90 days, grades 2b and 3 are termed successful reperfusion. A pooled analysis of the first 5 randomized clinical stroke trials, which predominantly used stent retrievers as the primary approach, demonstrated that successful reperfusion was obtained in 71% of patients, whereas the rate of mTICI 0 to 2a varied from 12% to 41%. Successful reperfusion is influenced by device choice and strategy, use of intravenous (IV) alteplase, collateral status, and thrombus size, location, or composition.

The authors sought to analyze the rate of reperfusion after endovascular thrombectomy started at different intervals after symptom onset in patients with AIS. They conducted a meta-analysis of individual patient data from 7 randomized trials of the Highly Effective Reperfusion Using Multiple Endovascular Devices (HERMES) group. This is a multicenter cohort study of the intervention arm of randomized clinical trials included in the HERMES group. Patients with anterior circulation AIS who underwent endovascular thrombectomy for M1/M2 or intracranial carotid artery occlusion were included.

Among the 728 included patients decreases in rates of successful reperfusion defined as a TICI score of 2b/3 were observed with increasing time from admission or first imaging to groin puncture. …

Fellows’ Journal Club: 3T MRI Whole-Brain Microscopy Discrimination of Subcortical Anatomy, Part 2: Basal Forebrain

Fellows’ Journal Club

The authors applied an optimized TSE T2 sequence to washed whole postmortem brain samples (n=13) to demonstrate and characterize the detailed anatomy of the basal forebrain using a clinical 3T MR imaging scanner. They identified most basal ganglia and diencephalon structures using serial axial, coronal, and sagittal planes relative to the intercommissural plane. Specific oblique image orientations demonstrated the positions and anatomic relationships for selected structures of interest to functional neurosurgery.

Abstract

BACKGROUND AND PURPOSE

The basal forebrain contains multiple structures of great interest to emerging functional neurosurgery applications, yet many neuroradiologists are unfamiliar with this neuroanatomy because it is not resolved with current clinical MR imaging.

MATERIALS AND METHODS

We applied an optimized TSE T2 sequence to washed whole postmortem brain samples (n = 13) to demonstrate and characterize the detailed anatomy of the basal forebrain using a clinical 3T MR imaging scanner. We measured the size of selected internal myelinated pathways and measured subthalamic nucleus size, oblique orientation, and position relative to the intercommissural point.

RESULTS

We identified most basal ganglia and diencephalon structures using serial axial, coronal, and sagittal planes relative to the intercommissural plane. Specific oblique image orientations demonstrated the positions and anatomic relationships for selected structures of interest to functional neurosurgery. We observed only 0.2- to 0.3-mm right-left differences in the anteroposterior and superoinferior length of the subthalamic nucleus (P = .084 and .047, respectively). Individual variability for the subthalamic nucleus was greatest for angulation within the sagittal plane (range, 15°–37°), transverse dimension (range, 2–6.7 mm), and most inferior border (range, 4–7 mm below the intercommissural plane).

CONCLUSIONS

Direct identification of basal forebrain structures in multiple planes using the TSE T2 sequence makes this challenging neuroanatomy more accessible to practicing neuroradiologists. This protocol can be used to better define individual variations relevant