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Apparent Diffusion Coefficient Histograms of Human Papillomavirus–Positive and Human Papillomavirus–Negative Head and Neck Squamous Cell Carcinoma: Assessment of Tumor Heterogeneity and Comparison with Histopathology

Fellows’ Journal Club

One hundred five consecutive patients with primary oropharyngeal and oral cavity head and neck squamous cell carcinoma underwent MR imaging with anatomic and DWI sequences. The collected tumor voxels from the contoured ROIs provided histograms from which position, dispersion, and form parameters were computed. Histogram data were correlated with histopathology, p16-immunohistochemistry, and polymerase chain reaction for human papillomavirus DNA. Diffusion phenotypes of human papillomavirus–positive and human papillomavirus–negative head and neck squamous cell carcinomas showed significant differences, which reflect their distinct degree of tumor heterogeneity.

Real-Time Motor Cortex Mapping for the Safe Resection of Glioma: An Intraoperative Resting-State fMRI Study

Editor’s Choice

The authors conducted preoperative and intraoperative resting-state intrinsic functional connectivity analyses of the motor cortex in 30 patients with brain tumors. Factors that may influence intraoperative imaging quality, including anesthesia type and tumor cavity, were studied. Additionally, direct cortical stimulation was used to validate the accuracy of intraoperative resting-state fMRI in mapping the motor cortex. Fourteen patients who successfully completed both sufficient intraoperative resting-state fMRI and direct cortical stimulation were used for further analysis of sensitivity and specificity. Compared with those subjected to direct cortical stimulation, the sensitivity and specificity of intraoperative resting-state fMRI in localizing the motor area were 61.7% and 93.7%, respectively. They conclude that using intraoperative resting-state fMRI can avoid the risk of intraoperative seizures due to direct cortical stimulation and may provide neurosurgeons with valuable information to facilitate the safe resection of gliomas.

Interdisciplinary Management of Orbital Diseases: Textbook and Atlas

Welkoborsky H-J, Wiechens B, Hinni ML. Interdisciplinary Management of Orbital Diseases: Textbook and Atlas. Thieme; 2017; 354 pp; 689 ill; $169.99

Interdisciplinary Management of Orbital Diseases--Welkoborsky et al

Although written with ophthalmologists in mind, this beautifully illustrated and practical textbook, Interdisciplinary Management of Orbital Diseases, edited by Drs. Welkoborsky, Wiechens, and Hinni, has information to offer to neuroradiologists, particularly those who deal with a large volume of imaging of orbital disease. It is not the 20-page chapter on orbital imaging that would make this book appealing to our specialty (this specific material is covered more extensively in radiology texts); rather, it is the wealth of clinical material, patient photographs, histopathology, ophthalmoscopic images, genetics, and in some cases treatment including operative photographs, that could be of value.

This 340-page hardcover book covers orbital anatomy, pathophysiology, clinical examination, imaging, eye/eyelid disease, orbital complications from diseases primarily outside the orbit, endocrine disease, trauma, pathology, tumors (of the orbit and skull base), surgery, radiotherapy, and reconstructive orbital surgery.

This book can be recommended to your ophthalmology colleagues but is not considered a primary purchase for a radiologist.…

Annual International Symposium on the Fetal Brain

Annual International Symposium

International Symposium on the Fetal Brain
Children’s National Health System

Thursday, November 01, 2018 – Friday, November 02, 2018

Washington, DC

Event website:

A 360° review of advances in understanding of the fetal brain, presented by a panel of world-renowned experts in the fields of maternal-fetal medicine, developmental neuroscience, neurogenetics, fetal and neonatal neurology, and imaging.


Comparison of Clinical Outcomes of Intracranial Aneurysms: Procedural Rupture versus Spontaneous Rupture

Fellows’ Journal Club

This was a retrospective review of 1340 patients with 1595 unruptured saccular intracranial aneurysms that underwent endovascular coil embolization between February 2010 and December 2014. The clinical outcomes of patients with procedural rupture of saccular intracranial aneurysms were compared with those of 198 patients presenting with spontaneously ruptured aneurysms. Procedural rupture developed in 19 patients, and the morbidity related to procedural rupture was 26.3% with no mortality. Hunt and Hess scale grades and hospitalization days of patients with procedural rupture were equivalent to those of patients presenting with spontaneous aneurysm rupture. In multivariate analysis, spontaneous aneurysm rupture was a significant risk factor for worse clinical outcome. This study showed better clinical outcomes in the procedural-rupture group.

Angioarchitectures and Hemodynamic Characteristics of Posterior Communicating Artery Aneurysms and Their Association with Rupture Status

Editor’s Choice

The authors studied 313 posterior communicating artery aneurysms (145 ruptured, 168 unruptured) with image-based computational fluid dynamics. Aneurysms were classified into different angioarchitecture types depending on the location of the aneurysm with respect to parent artery bifurcation. Ruptured aneurysms had higher, more concentrated, and more oscillatory wall shear stress distributions; stronger and more concentrated inflow jets; and more complex and unstable flow patterns compared with unruptured aneurysms. They conclude that high-flow intrasaccular hemodynamic characteristics, commonly found in bifurcation-type angioarchitectures, are associated with the posterior communicating artery aneurysm rupture status.

Diagnostic Imaging: Interventional Procedures

Walker TG. Diagnostic Imaging: Interventional Procedures. Amirsys; 2016; 800 pp; 800 ill; $339.00

Diagnostic Imaging Interventional Procedures 2nd Edition

This nearly 900-page hardcover book is not only a “how to do it” guide, but also covers key medical and surgical information related to the procedures under consideration.

The book was edited by Dr. Wicky from the University of Missouri, and there are 29 authors and 12 others listed as contributors. Clearly written for body interventionalists, there are only 4 chapters dealing with neuroradiology: stroke therapy, carotid/vertebral stenting, LPs and CSF leaks, and vertebral augmentation/sacroplasty.

There are no chapters devoted to the more classic neurointerventions such as coiling of intracerebral aneurysms or embolization of AV dural fistulas (spine or brain). Nonetheless, for those in a department where interventional radiologists may have a copy, one can read the latest thoughts regarding those 4 topics and how to deal with them. Actually, neuroradiologists ought to recommend this book to their body interventional colleagues.

In the manner of all the brilliant textbooks in this legendary series, the graphics/drawings are outstanding, the images are well-chosen, and the legends are complete with clear and unambiguous labeling.

Seven sections are included: general principles; venous, portal, and lymphatic procedures (covered in the chapters indicated above); posttransplant procedures; and nonvascular procedures. Each follows the same general pattern. For example, the chapter on varicoceles starts off with the key facts, followed by images (ultrasound and venography) taken before and after embolization, definitions/terminology, preprocedural steps (including indications/contraindications, equipment, medications, and assessing access), the procedure itself and specifics on what agents are used, postprocedural steps, outcomes, a clinical rating system, a wealth of well-selected images (4 pages worth), and selected references. This highly instructive format is repeated in every chapter—some chapters being more extensive than others—resulting in uniform clarity. As with all volumes in this series, the …

Arterial Spin-Labeling Perfusion MR Imaging Demonstrates Regional CBF Decrease in Idiopathic Normal Pressure Hydrocephalus

Fellows’ Journal Club

The authors assessed regional CBF in patients with idiopathic normal pressure hydrocephalus compared with healthy controls using the noninvasive quantitative arterial spin-labeling MR imaging technique. Twenty-one consecutive patients with NPH and 21 age- and sex-matched randomly selected healthy controls from a population registry were prospectively included. In patients with idiopathic NPH, perfusion was reduced in the periventricular white matter,lentiform nucleus, and thalamus compared with controls. They conclude that using pseudocontinuous ASL, they confirmed the findings of reduced perfusion in the periventricular white matter, basal ganglia, and thalamus in patients with idiopathic NPH previously observed with other imaging techniques.

The Brain Thermal Response as a Potential Neuroimaging Biomarker of Cerebrovascular Impairment

Editor’s Choice

The authors evaluated the use of noninvasive MR thermometry in patients with cerebrovascular disease, and hypothesized that the presence of a measurable brain thermalresponse would reflect the tissue hemodynamic state. MR imaging and MR thermometry were performed in 10 patients undergoing acetazolamide challenge for chronic, anterior circulation steno-occlusive disease. Cerebrovascular reactivity was calculated with BOLD imaging and arterial spin-labeling methods. Brain temperature was calculated pre- and post-acetazolamide using previously established chemical shift thermometry. They observed significant, voxelwise quadratic relationships between cerebrovascular reactivity from BOLD imaging and the brain thermal response and baseline brain temperatures, concluding that brain thermal response is a potential noninvasive biomarker for cerebrovascular impairment.

Journal Scan – This Month in Other Journals, November 2017

Linzey JR, Wilson TJ, Sullivan SE, Thompson BG, Pandey AS. Frontal Sinus Breach During Routine Frontal Craniotomy Significantly Increases Risk of Surgical Site Infection: 10-Year Retrospective Analysis. Neurosurgery. 2017;0(0):1-8. doi:10.1093/neuros/nyx046.

Frontotemporal craniotomies are at particular risk for breaching the frontal sinus, especially when the patient has a large frontal sinus or the surgeon is attempting to expose anterior communicating (ACOM) artery aneurysms. Frontal sinus breach (FSB) has the potential to cause postoperative complications due to the introduction of microflora from the frontal sinus into the sterile environment of the intracranial compartment. 

In this retrospective study, the authors are attempting to determine if FSB is a risk factor for developing cranial surgical site infections in patients undergoing craniotomies for clip ligation of anterior circulation aneurysms. They hypothesized that the surgical site infection (SSI) rate for craniotomies with an FSB would be significantly higher than for craniotomies without an FSB, given the contamination of the intracranial compartment during FSB. This study included 862 patients undergoing 910 craniotomies. Primary outcome of interest was occurrence of a cranial surgical site infection. Of the 910 craniotomies, 141 (15.5%) involved FSB. Of those involving FSB, 22 (15.6%) developed a cranial surgical site infection, compared to only 56 of the 769 without FSB (7.3%). Cranial surgical site infection requiring reoperation was much more likely in patients with FSB compared to those without a breach (7.8% vs 1.6%). Patients with FSBs had 2 times the odds of developing a cranial surgical site infection as those without FSB. The authors overall infection rate of 8.6% for craniotomies is comparable with other published data.  In addition, the length of surgical procedure was associated with increased risk of infection, which supports previously published data.  As expected, longer procedures were also more common in patients with FSB compared to those …