Author: jross

jross
Jeffrey Ross • Mayo Clinic, Phoenix

Dr. Jeffrey S. Ross is a Professor of Radiology at the Mayo Clinic College of Medicine, and practices neuroradiology at the Mayo Clinic in Phoenix, Arizona. His publications include over 100 peer-reviewed articles, nearly 60 non-refereed articles, 33 book chapters, and 10 books. He was an AJNR Senior Editor from 2006-2015, is a member of the editorial board for 3 other journals, and a manuscript reviewer for 10 journals. He became Editor-in-Chief of the AJNR in July 2015. He received the Gold Medal Award from the ASSR in 2013.

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.

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 …

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.

MRI Atlas-Based Measurement of Spinal Cord Injury Predicts Outcome in Acute Flaccid Myelitis

Editor’s Choice

Using the open source platform, the “Spinal Cord Toolbox,” the authors sought to correlate measures of GM, WM, and cross-sectional area pathology on T2 MR imaging with motor disability in 9 patients with acute flaccid myelitis. Proportion of GM metrics at the center axial section significantly correlated with measures of motor impairment upon admission and at 3-month follow-up. The proportion of GM extracted across the full lesion segment significantly correlated with initial motor impairment. This is the first atlas-based study to correlate clinical outcomes with segmented measures of T2 signal abnormality in the spinal cord.

Endovascular Stroke Treatment of Nonagenarians

Fellows’ Journal Club

The purpose of this study was the evaluation of procedural and outcome data of patients 90 years of age or older undergoing endovascular stroke treatment. The authors retrospectively analyzed prospectively collected data of 29 patients (mean age 91.9 years) in whom endovascular stroke treatment was performed between January 2011 and January 2016 (from a cohort of 615 patients). Successful recanalization (TICI % 2b) was achieved in 22 patients (75.9%). In 9 patients, an NIHSS improvement ≥ 10 points was noted between admission and discharge. After 3 months, 17.2% of the patients had an mRS of 0-2. Despite high mortality rates (∼45%) and moderate overall outcome, 17.2% of the patients achieved mRS 0-2 or prestroke mRS, and no serious procedure-related complications occurred.

Abstract

BACKGROUND AND PURPOSE

Although endovascular treatment has become a standard therapy in patients with acute stroke, the benefit for very old patients remains uncertain. The purpose of this study was the evaluation of procedural and outcome data of patients ≥90 years undergoing endovascular stroke treatment.

MATERIALS AND METHODS

We retrospectively analyzed prospectively collected data of patients ≥90 years in whom endovascular stroke treatment was performed between January 2011 and January 2016. Recanalization was assessed according to the TICI score. The clinical condition was evaluated on admission (NIHSS, prestroke mRS), at discharge (NIHSS), and after 3 months (mRS).

RESULTS

Twenty-nine patients met the inclusion criteria for this analysis. The median prestroke mRS was 2. Successful recanalization (TICI ≥ 2b) was achieved in 22 patients (75.9%). In 9 patients, an NIHSS improvement ≥ 10 points was noted between admission and discharge. After 3 months, 17.2% of the patients had an mRS of 0–2 or exhibited prestroke mRS, and 24.1% achieved mRS 0–3. Mortality rate was 44.8%. There was only 1 minor procedure-related complication (small SAH without clinical

Microstructure of the Default Mode Network in Preterm Infants

Editor’s Choice

A cohort of 44 preterm infants underwent T1WI, resting-state fMRI, and DTI at 3T, including 21 infants with brain injuries and 23 infants with normal-appearing structural imaging as controls. Neurodevelopment was evaluated with the Bayley Scales of Infant Development at 12 months’ adjusted age. Results showed decreased fractional anisotropy and elevated radial diffusivity values of the cingula in the preterm infants with brain injuries compared with controls. The Bayley Scales of Infant Development cognitive scores were significantly associated with cingulate fractional anisotropy. The authors suggest that the microstructural properties of interconnecting axonal pathways within the default mode network are of critical importance in the early neurocognitive development of infants.

Synthetic MRI in the Detection of Multiple Sclerosis Plaques

Fellows’ Journal Club

In this retrospective study, synthetic T2-weighted, FLAIR, double inversion recovery, and phase-sensitive inversion recovery images were produced in 12 patients with MS after quantification of T1 and T2 values and proton density. Double inversion recovery images were optimized for each patient by adjusting the TI. The number of visible plaques was determined by a radiologist for a set of these 4 types of synthetic MR images and a set of conventional T1-weighted inversion recovery, T2-weighted, and FLAIR images. Conventional 3D double inversion recovery and other available images were used as the criterion standard. Synthetic MR imaging enabled detection of more MS plaques than conventional MR imaging in a comparable acquisition time (approximately 7 minutes). The contrast for MS plaques on synthetic double inversion recovery images was better than on conventional double inversion recovery images.

Abstract

Figure 1 from paper
An example of DIR optimization. A DIR image with a second TI of 460 ms (A) (as determined according to the equations in the main text) shows better delineation of MS plaques than a DIR image with a second TI of 360 ms (B) or 560 ms (C).

BACKGROUND AND PURPOSE

Synthetic MR imaging enables the creation of various contrast-weighted images including double inversion recovery and phase-sensitive inversion recovery from a single MR imaging quantification scan. Here, we assessed whether synthetic MR imaging is suitable for detecting MS plaques.

MATERIALS AND METHODS

Quantitative and conventional MR imaging data on 12 patients with MS were retrospectively analyzed. Synthetic T2-weighted, FLAIR, double inversion recovery, and phase-sensitive inversion recovery images were produced after quantification of T1 and T2 values and proton density. Double inversion recovery images were optimized for each patient by adjusting the TI. The number of visible plaques was determined by a radiologist for a set of these 4 types of synthetic MR

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.

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 to …