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Imaging Anatomy: Chest, Abdomen, Pelvis, 2nd Edition

Federle MP, Rosado-de-Christenson ML, Raman SP, Carter BW, Woodward PJ, Shaaban AM. Imaging Anatomy: Chest, Abdomen, Pelvis. 2nd ed. Elsevier; 2016; 1192 pp; $329.99

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For anyone predominantly or exclusively involved in neuroradiology, having a high-quality, well-illustrated, and readily available text covering the chest, abdomen, and pelvis is desirable. Those parts of the body have a nasty way of occasionally making the interpretations of spine imaging more difficult. Enter the second edition of Imaging Anatomy: Chest, Abdomen, Pelvis (2017), published by Elsevier and edited by Drs. Federle, Rosado-de-Christenson, Raman, Carter, Woodward, and Shaaban. As with all the books in this series, the drawings, the imaging, and the bullet point written material in this hardcover book is outstanding in quality.

The chest section is divided into 16 chapters, the abdomen into 17 chapters, and the pelvis into 8 chapters. The emphasis throughout, as the title implies, is on anatomy; however, in some sections (e.g., in the abdomen) there is more pathologic imaging than in others. Nearly all of the material is pertinent to our interpretation of spine imaging when large fields of view are included (or even if the FOVs are narrow). Nowhere is this more pertinent than when viewing thoracic lumbar spine imaging (CTs in particular) and analyzing the abdominal contents when required. Here would be a ready reference to help resolve questions related to anatomy and pathology incidentally seen on neuroimaging. The same can be said for the imaging of the pelvis. Here (as in the entire book) the illustrations of the anatomy are outstanding. These help to further one’s appreciation of the accompanying CT anatomy, although MR and US are included to a lesser extent. There are areas that will not be troublesome when viewing spine or lumbosacral plexus studies, such as detailed imaging anatomy of the heart …

Transverse Sinus Stenosis Is the Most Sensitive MR Imaging Correlate of Idiopathic Intracranial Hypertension

Fellows’ Journal Club

MR imaging and MRV images from 63 patients with idiopathic intracranial hypertension and 96 controls were reviewed by using 3 independent procedures. MRV images were graded for the presence and degree of stenosis of the transverse sinus. Postgadolinium coronal T1-weighted sequences were evaluated independent of MRV. The dimensions of the proximal and distal transverse sinus were measured. Transverse sinus stenosis was identified bilaterally on MRV in 94% of patients with IIH and in 3% of controls. On coronal T1 postgadolinium MR images, transverse sinus stenosis was identified in 83% of patients with IIH and 7% of controls. The authors conclude that transverse sinus stenosis is the most useful and sensitive imaging indicator of this disease state.

Hydrogel versus Bare Platinum Coils in Patients with Large or Recurrent Aneurysms Prone to Recurrence after Endovascular Treatment: A Randomized Controlled Trial

Editor’s Choice

This Level 1 expedited report was a pragmatic, multicenter, parallel, randomized (1:1) trial evaluating patients who were at high risk of aneurysm recurrence after endovascular treatment, including patients with large aneurysms (Patients Prone to Recurrence After Endovascular Treatment PRET-1) or with aneurysms that had previously recurred after coiling (PRET-2). The trial was stopped once 250 patients in PRET-1 and 197 in PRET-2 had been recruited because of slow accrual. A poor primary outcome occurred in 44.4% of those in PRET-1 allocated to platinum compared with 52.5% of patients allocated to hydrogel and in 49.0% in PRET-2 allocated to platinum compared with 42.1% allocated to hydrogel. Adverse events and morbidity were similar. The authors conclude that coiling of large and recurrent aneurysms is safe but often poorly effective according to angiographic results. Hydrogel coiling was not shown to be better than platinum.

2017-8 Neuroradiology Fellowship position at UNC

The Radiology Department at the University of North Carolina has an unexpected opening for our fellowship in Neuroradiology for the 2017-18 academic year. Applicants must have completed an ACGME accredited residency in diagnostic radiology prior to the start of the fellowship on July 1, 2017.

The fellowship is an ACGME accredited 1 year fellowship which trains 4 fellows annually. Fellows work closely with 6 full-time, board certified diagnostic neuroradiologists, including division chief, Dr. Mauricio Castillo, former editor-in-chief of the AJNR, current president of the ARRS, and past president of the ASNR.

Our trainees rotate regularly through core services including Brain imaging, ENT/Spine imaging, and outpatient imaging throughout the year and also spend 6 weeks out of the year rotating on the neurointerventional service with 2 dedicated interventional neuroradiologists. During the second half of the year, trainees participate in a rotation dedicated to Spine Intervention and Pain Management and are given up to 3 weeks of time for electives.

Each fellow receives 3 weeks of paid vacation plus an additional week off over the winter holidays. Fellows may also take up to a week off for meeting attendance. Additional information regarding salary and benefits can be found on the UNC GME website at

Interested individuals should send a curriculum vitae and references to:
Benjamin Huang, MD, MPH
Director, Neuroradiology Fellowship
Associate Professor of Radiology
UNC School of Medicine

Neuroimaging Clinics of North America: Pediatric Brain Tumors Update

Brandão LA, ed. Mukherji SK, consulting ed. Neuroimaging Clinics of North America: Pediatric Brain Tumors Update. Elsevier; 2017;27(1):1–194; $365.00

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As a follow-up to the last issue (November 2016) of the Neuroimaging Clinics of North America, which dealt with adult brain tumors, the current issue, also edited by Dr. Lara Brandão, concerns an update on pediatric brain tumors. One hundred and ninety-four pages in length, the material covers not only standard imaging/findings in pediatric tumors, but also importantly includes advanced techniques both in the initial patient assessment and in posttherapy evaluation. The nine chapters of this issue are: posterior fossa tumors; supratentorial tumors; neonatal brain tumors; pineal region masses; sella and the parasellar region rumors; extraparenchymal lesions; tumors and tumor-like masses that involve multiple spaces; peptide-based vaccine therapies; and advanced MR imaging/clinical applications. For the seasoned neuroradiologist, the last two chapters will be of greatest interest; however, the entire volume addresses key imaging points in a wide spectrum of neoplastic brain disorders. Dr. Brandão has done a remarkable job (similar to the editorship of the prior volume) getting the 24 authors to contribute their experiences and expertise to this important issue. If one is not a Neuroimaging Clinics of North America subscriber, then this single issue is a recommended purchase for one’s personal collection or for a departmental library.…

Journal Scan – This Month in Other Journals, March 2017

Daou B, Chalouhi N, Starke RM, et al. Clipping of previously coiled cerebral aneurysms: efficacy, safety, and predictors in a cohort of 111 patients. J Neurosurg. 2016;125(December):1-7. doi:10.3171/2015.10.JNS151544.

This retrospective cohort study evaluated the efficacy and safety of microsurgical clipping in the treatment of recurrent, previously coiled cerebral aneurysms and to identify risk factors that can affect the outcomes of this procedure. The mean patient age was 50.5 years, the mean aneurysm size was 7 mm, and 97.3% of aneurysms were in the anterior circulation. Complete aneurysm occlusion, as assessed by intraoperative angiography, was achieved in 97.3% of aneurysms (108 of 111 patients). Among patients, 1.8% had a recurrence after clipping. Retreatment was required in 4.5% of patients after clipping. Major complications were observed in 8% of patients and mortality in 2.7%. Ninety percent of patients had a good clinical outcome. Aneurysm size and location in the posterior circulation were significantly associated with higher complications. All 3 patients who had coil extraction experienced a postoperative stroke.

They conclude that surgical clipping is an appropriate treatment strategy for the management of recurrent cerebral aneurysms after endovascular coiling. Direct clipping of the aneurysm neck is feasible in most cases of recurrent, previously coiled cerebral aneurysms. Coil extraction should not regularly be attempted because it is associated with high morbidity. In other words, when direct clipping is not possible because of coil loops extending into the aneurysm neck, or with transmural calcification and scarring, other techniques such as wrapping should be considered.

Serrone JC, Tackla RD, Gozal YM, et al. Aneurysm growth and de novo aneurysms during aneurysm surveillance. J Neurosurg. 2016;125(6):1374-1382. doi:10.3171/2015.12.JNS151552.

Over an 11.5-year period, the authors recommended surveillance imaging to 192 patients with 234 unruptured intracranial aneurysms. The incidence of unruptured intracranial aneurysm growth and de novo aneurysm …

Differential Diagnosis in Neuroimaging: Brain and Meninges, Spine, and Head and Neck

Meyers SP. Differential Diagnosis in Neuroimaging: Brain and Meninges. Thieme; 2016; 652 pp; 1713 ill; $179.99

Meyers SP. Differential Diagnosis in Neuroimaging: Spine. Thieme; 2016; 288 pp; 309 ill; $149.99

Meyers SP. Differential Diagnosis in Neuroimaging: Head and Neck. Thieme; 2016; 664 pp; 1538 ill; $179.99

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With an unprecedented trifecta, Dr. Steven Meyers from the University of Rochester Medical Center has single-handedly authored and simultaneously published 3 books: Differential Diagnosis in Neuroimaging: Brain and Meninges (652 pages), Differential Diagnosis in Neuroimaging: Spine (288 pages), and Differential Diagnosis in Neuroimaging: Head and Neck (664 pages). The set up in each book is similar and follows the same format, which in turn adds to the appeal of these 3 publications.

Each book has a short introduction related to anatomy and/or development, and in some areas there are short descriptions of anatomy and function that precede specific material. Pathological cases are presented in well-defined sections, each containing abundant and well-chosen images that are combined with tables that list each disease and adjacent to columns containing findings and comments on the disease under consideration. This is not a common way of presenting material; however, it is effective, allowing a substantial amount of material to be discussed in a compact space. It also allows a nice separation of imaging findings from other important clinical and pathologic information. I do find it amazing that Dr. Meyers was able to obtain all of these images from his own files and collate them so completely.

The chapters in Brain are: congenital malformations; supratentorial intra-axial lesions; infratentrial intra-axial lesions; multiple lesions; white matter lesions and diffuse lesions in children; lesions of the basal ganglia; neurodegenerative disorders; ischemia/infarction in adults; ischemia/infarction in children; intra- and parasellar lesions; and pineal region lesions. The chapters in Spine are: congenital/development; …

General and Vascular Ultrasound: Case Review, 3rd Edition

McGahan JP, Teefey SA, Needleman L. General and Vascular Ultrasound: Case Review. 3rd ed. Elsevier; 2016; 376 pp; 800 ill; $59.99

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The third edition of General and Vascular Ultrasound: Case Review Series (2016) by John McGahan, Sharlene Teefey, and Laurence Needleman is an update to this classic series that has helped generations of radiology residents on their paths toward board certification. While the format of the new board exam is different, these cases of varying difficulty are no less relevant than they were when we all traveled to Louisville.

A total of 127 cases are categorized as Opening Round, Fair Game, and Challenge cases. As has historically been the case, Opening Round is a great warm-up for those basic cases that should be seen early in residency, Fair Game cases offer a good review for more senior residents, and Challenge cases give upper-level residents a run for their money. Even for general radiologists in practice, reviewing all of these cases can help individuals recall forgotten tidbits of knowledge about common cases we see fairly frequently. Approaching each case as an unknown is not only entertaining, but brings back mostly fond (and some not-so-fond) memories of countless hours of boards preparation.

Each case begins with an image, a brief history, and 4 multiple choice questions about the image. The subsequent page gives the diagnosis, the answer to the questions, and a commentary which varies in format depending on the case. Cross references to The Requisites series rounds out the case, along with acknowledgments where appropriate. The images are good and a section of supplemental images is a nice addition to round out the review of each case.

I continue to highly recommend the Case Review Series, including this book, to residents studying on rotation and preparing for the boards. The …

Books Received, March 2017

Neuro-Developmental Treatment: A Guide to NDT Clinical Practice
Judith C. Bierman, Mary Rose Franjoine, Cathy M. Hazzard, Janet M. Howle, Marcia Stamer (Authors)
Thieme; 2016; 688 pages; 339 illustrations; $79.99

The Greenberg Rapid Review: A Companion to the 8th Edition
Leonard I. Kranzler, Jonathan G. Hobbs (Authors)
Thieme; 2016; 1650 pages; 150 illustrations; $109.99…

Ascending and Descending Thoracic Vertebral Arteries

Fellows’ Journal Club

The authors report the angiographic anatomy and clinical significance of 9 cases of descending and 2 cases of ascending thoracic vertebral arteries. Located within the upper costotransverse spaces, ascending and descending thoracic vertebral arteries may have important implications during spine interventional or surgical procedures. They frequently provide radiculomedullary or bronchial branches, so they can also be implicated in spinal cord ischemia, as a supply of vascular malformations, or be a source of hemoptysis.