Author Archives: Editorial Office

jrgantenberg

About Editorial Office (@AmJNeuroradiol)

The American Journal of Neuroradiology (AJNR) publishes original articles pertaining to the clinical imaging, therapy, and basic science of the central and peripheral nervous system, including but not limited to the brain, spine, head and neck, interventional procedures, techniques in imaging and intervention, and related educational, socioeconomic, and medicolegal issues.

Fellows’ Journal Club Recap: Provocative Discography and Lumbar Injury

Review by: Dr. James Fernandez and Dr. Sepand Salehian

http://www.ajnr.org/site/Podcasts/August2015FJC.mp3

Click to listen to the accompanying podcast (discussion of this article begins at 19:15)

The Spine Journal, published June 29, 2015, entitled: Does provocative discography cause clinically important injury to the lumbar intervertebral disc? A ten-year matched cohort study

A group of 75 asymptomatic or minimally symptomatic for low back pain were enrolled in a study for provocative discography involving L3-S1 disc spaces.  The subjects were recruited from one of three patient pools: those having documented cervical disease, subjects with previous lumbar disc herniation with complete symptom resolution, and subjects with no history of cervical or lumbar disc illness but with a history of somatization disorder.  Another 75 matched subjects from the same subject pools who did not have discography performed were utilized as control subjects.

After the 75 subjects underwent discography, both groups were followed for up to 10 years. Primary outcomes measured were any reported imaging or surgical intervention; and secondary outcomes measured any low back pain events occurring 6 months prior to the interview, serious low back pain episodes, disability due to back pain, or medical visits for evaluation and treatment of back pain.

In terms of primary outcome measures, as defined by this study, the results were reported as follows:

By 10-years follow-up, there were 16 lumbar surgeries performed in 11 subjects in the discography group and 4 surgeries in 3 subjects in the control group; resulting in a number needed to harm value (NNH value) of 7.3.

At 10 years after enrollment, 21 discography subjects and 11 control subjects had new CT or MRI evaluations for the clinical evaluation of low back pain and/or lower extremity radiculopathy. Based on these data, the number needed to harm (NNH) for 12 provocative lumbar discography with … Continue reading >>

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In Memoriam – William W.M. Lo, MD

by John L. Go, MD

William W.M. Lo, MD passed away on July 16, 2015 after a long illness peacefully surrounded by his family at home. Known as Bill by his friends and colleagues, he was born August 24, 1934 in Hong Kong. Attending the University of Iowa Medical School, he graduated in 1960, and completed radiology residency as well as fellowships in cardiovascular radiology and neuroradiology at the Los Angeles County-University of Southern California Medical Center from 1961-1966. His first and only job was as a radiologist at St. Vincent Medical Center from 1966-2005, where he served as Chief of Neuroradiology from 1983-1986 and 1989-2005, serving as chair of Radiology from 1986-1989. Bill also served as Clinical Professor of Radiology at the Keck School of Medicine at the University of Southern California from 1989 to 2015.

Bill joined St. Vincent Medical Center to work with the Otologists at the world famous House Ear Clinic where he developed a successful and fruitful collaborative relationship for over 40 years during the Golden Age of Radiology. A world expert on temporal bone imaging, Bill published over 50 peer-review articles on the temporal bone, 18 book chapters, and gave over 150 national and international invited lectures during his career. Some of his major contributions to temporal bone imaging include describing the aberrant carotid artery, descriptions of the endolymphatic duct and sac and pathology, and defining and describing pathology of the anterior epitympanic space, just to name a few, besides beautiful and descriptive pictorials of temporal bone anatomy. Because of his seminal work on temporal bone imaging, Bill was honored with the ASHNR Gold Medal Award in 2007 as well as a Presidential Citation Award from the American Otological Society in 2007.

Bill was also active in the radiology community, being elected as a … Continue reading >>

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ICYMI: July-August 2015 News Digest: Fetal Neuroimaging

Guest Editors

Thierry A.G.M Huisman and Andrea Poretti

Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

Summary

socialIn recent years, significant and continuous development of fetal MR imaging has revolutionized prenatal diagnosis of congenital and acquired brain abnormalities. Procedures that were once time-consuming and placed the mother and fetus at some risk have been made safer and more convenient thanks to developments such as ultrafast MR sequences, which are capable of producing high-resolution anatomic and functional images of the fetus. Furthermore, when ultrasonography (US) — still the primary imaging modality for studying the fetal brain — cannot provide a sufficiently detailed evaluation, fetal brain MRI has emerged as a crucial tool for confirming, correcting, and completing diagnoses made via US of complex pathologies in the fetal CNS. In this edition, 5 authors discuss their research.

Read the full introduction . . .

Commenting Authors

 … Continue reading >>

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Differential Diagnosis in Musculoskeletal MRI

differential-dx-mskltl-mri_HollenbergHollenberg GM, Weinberg EP, Meyers SP. Differential Diagnosis in Musculoskeletal MRI. Thieme; 2015; 676 pp; $199.99

Differential Diagnosis in Musculoskeletal MRI was written with the goal of providing a simple reference book on the various pathologies encountered in a musculoskeletal radiology practice through an image-rich presentation of disease states and injuries. In this aim, the authors have succeeded, and should be applauded for the breadth of topics they were able to cover. The book is about 676 pages in length, but because the text is focused and organized into tables and the figures occupy many full pages, the volume reads much quicker than a standard text of similar size. The authors have organized the material into 12 chapters, with the first half of the book devoted to joint imaging (shoulder, elbow, wrist, hand, hip, knee, ankle, and foot), and the second half covering bone and soft tissue tumors and tumor-like conditions. Unfortunately for readers of this journal, there is no dedicated spine chapter, although spine MRI examples play a prominent role in the illustration of hematopoietic disorders/red marrow conversion.

The focus of this book is really on MRI findings—there is little detail on clinical presentation or considerations of surgical management. Radiographs and CT are infrequently depicted, except in the chapter on bone tumors. Some readers may feel that the images are too small in some cases to optimally highlight the intended pathology, and in certain instances the educational value might have been enhanced by more robust cropping (eg, depictions of superior labral tears and “turf toe” injuries. However, because this book is primarily aimed at trainees, providing enough surrounding anatomy is important so that the scale of the abnormality (often miniscule in MSK) is properly appreciated.

The joint chapters are straightforward in terms of organization and depiction of pathology. The … Continue reading >>

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23rd Zurich Course on Diagnostic and Interventional Neuroradiology

The Department of Neuroradiology of the University Hospital of Zurich is sponsoring its
23rd Zurich Course on Diagnostic and Interventional Neuroradiology on August 31 –
September 5, 2015.

The diagnostic part of the course will cover selected topics on fundamental and advanced
clinical neuroimaging of the brain, including neuroanatomy, neurooncology, neuroimmunology and neurovascular disease with emphasis on hemorrhagic and ischemic
stroke.

The interventional part of the course will cover almost the entire spectrum of endovascular
interventional neuroradiology including acute ischemic stroke, intra- and extracranial
atherosclerotic disease, vascular lesions of the head and neck, hypervascular skull base
and intracranial tumors, dural arteriovenous fistulae, brain AVMs, spinal cord AVMs and
intracranial aneurysms.

Course Directors: Professor Anton Valavanis, Zurich & Professor Scott W. Atlas, Stanford.

For further information, contact Prof. A. Valavanis, Department of Neuroradiology,
University Hospital of Zurich, 8091 Zurich, Switzerland; Website: www.cinr-zurich.ch.
Phone +41-44-255 56 00, Fax +41-44-255 45 04, email: neuroradiologie@usz.ch.… Continue reading >>

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3D Atlas of Neurologic Disorders

3d-atlas-nowinskiNowinski WL, Chua BC, Wut Yi SH. 3D Atlas of Neurologic Disorders. Thieme; 2015; $299.99

This Atlas comes on a thumb drive and allows one to easily access key anatomic and associated pathologic disorders on vivid and spectacular rendering of the brain with associated vasculature, nerves, and supporting structures. One is able to see the displays in 3D color displays of tracts, deep structures, and their interconnections. While at first one might consider this an anatomic display, the power of the material is to show in 3D where lesions lie in a host of neurologic diseases. One can scroll across images in various projections while labels of the structures pop up. The 30-page glossary contained in the thumb drive has definitions of virtually every neurologic term one could imagine; this in itself is valuable. Concerning the disorders, one can, for example, click on what is called a “disturbance of temperature conservation”, and the display takes you directly to deep brain structures with a lesion shown at the level of the hypothalamus. Syndromes — Benedikt’s Syndrome, as an example — are beautifully shown, with a white lesion in the 3D display of the midbrain with the nearby nerves and tracts also depicted. Importantly, with each disorder there is a description of the clinical findings in a bullet-like format.

What the authors have presented to us is a unique, innovative way of teaching anatomy and demonstrating some intracranial pathologic conditions. It is recommended as a strong teaching tool, suitable for any radiology or neuroradiology library.… Continue reading >>

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Surgical Management of Pain

Burchiel KJ, Ed. Surgical Management of Pain. 2nd Ed. Thieme; 631 pp; 208 ill; $279.99

Surgical Managment of Pain--Kim J. BurchielThis comprehensive book is aimed primarily at neurosurgeons, but the various clinical pain syndromes that are covered may present to different medical specialists and to primary care providers well before reaching a neurosurgeon. Although the title is Surgical Management of Pain, substantial portions of the book cover pharmacologic and other nonsurgical methods of pain management. Thus, the book may be useful to a range of medical practitioners.

The first section consists of 3 chapters covering the neuroanatomy and physiology of pain mechanisms, including the pathophysiology of neuropathic pain. The next section consists of 9 chapters on approaches to assessment of the pain patient, pharmacologic management, management by anesthetic techniques, and multidisciplinary management. There is a chapter on pain treatment for the dying patient.

The next large section consists of 17 chapters, mostly in groups of 2, covering specific pain diagnoses and their nonsurgical management. Topics covered include back pain, craniofacial pain, trigeminal neuralgia, other cranial neuralgias, and postsurgical and posttraumatic neuropathic pain. There are chapters specifically covering posttherapeutic neuralgia, complex regional pain syndromes, cancer pain, and postoperative pain.

After laying this extensive foundation in the first half of the book, the book gets to describing surgical procedures for the various pain diagnoses. There are 27 chapters covering such techniques as spinal cord stimulation, peripheral nerve stimulation, intrathecal therapy, and ablative procedures. There is extensive discussion of techniques for surgical treatment of trigeminal neuralgia and other cranial neuralgias, with 10 chapters in that section.

Back and neck pains are probably the most common pain problems to be considered for surgical management. Chapters covering back and neck pain are scattered through the different sections of the book. These chapters cover anatomy, pathophysiology, pharmacologic management, physical … Continue reading >>

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ASNR 2015 Is Right Around the Corner, Register Now!

Are you attending the
ASNR 53rd Annual Meeting, April 25-30, 2015
Sheraton Chicago Hotel & Towers,
Chicago, Illinois

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The Aging Brain: Do Acute Infarcts Cause White Matter Disease? [Video]

White matter disease (leukoaraiosis) was long considered a normal occurrence in the aging process. Recent studies, however, have associated leukoaraiosis with dementia and disability, though how and why it develops is still unknown.

The authors of a recent paper, funded by an ASNR Scholar Award and published in Annals of Neurology, have posited one possible etiology: tiny, subclinical strokes. To investigate the relationship between acute infarct and white matter disease, the authors performed a prospective observational study, recruiting 5 subjects over a 12-month period; all subjects were older than 55 years, had had both a brain MRI within 6 months and an MR angiogram of the neck, and lastly, had moderate-to-severe leukoaraiosis (Fazekas scale ≥ grade 2).

At weekly intervals for 16 weeks, the authors took MRI scans of the subjects’ brains. The presence of acute infarct was established using diffusion tensor imaging (DTI), and patients were assessed every fourth week for changes in linguistic capacity or physical symptoms. No new neurological symptoms were noted in any of the subjects throughout the course of the study.

In all, 9 acute infarcts in 3 patients were detected in the cerebral white matter during the 16 weeks, and these clinically silent lesions progressed such that they began to take on the appearance of pre-existing areas of leukoaraiosis. The video below, from the University of Toronto, shows a week-by-week time-lapse of the acute infarcts arising de novo in the white matter, and then changing to appear as leukoaraiotic lesions on MRI:

The authors caution that the small sample size and short duration of the study contribute to uncertainty, but nonetheless suggest that their research provides reason to believe that very small, silent acute infarcts are a cause of white matter disease.

References

Conklin J, Silver FL, Mikulis DJ, et al. Are acute infarcts Continue reading >>

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The ASNR 2015 Abstract Submission Site is Now Open

The abstract submission site for the 53rd Annual Meeting at the Sheraton Chicago Hotel & Towers to be held on April 25-30, 2015 is now open:

asnr2015

ABSTRACT SUBMISSION SITE https://ww4.aievolution.com/asn1501/

The 2014 Annual Meeting was a success, with over 2000 attendees and a record number of submitted works; let’s keep that momentum and make our 2015 meeting another memorable year.

For more details about the 2015 ASNR Annual Meeting and The Foundation of the ASNR Symposium 2015, please visit www.asnr.org/2015/.… Continue reading >>

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