Author: MCastillo

Mauricio Castillo • Univ of North Carolina

I am Division Chief of Neuroradiology at the University of North Carolina in Chapel Hill. In addition, I am a Professor of Radiology and the current Editor-in-Chief of the American Journal of Neuroradiology. I trained in Diagnostic Radiology at the University of Miami and was a Neuroradiology fellow at Emory University.

Fellows’ Journal Club for June 2015

Kalnins AU, Halm K, Castillo M. Screening for Self-Plagiarism in a Subspecialty-versus-General Imaging Journal Using iThenticate.

The prevalence of self-plagiarism in 2 journals was investigated using commercially available plagiarism software. Self-plagiarism was low in both journals, but slightly higher in AJNR than in Radiology. Because the annual cost of screening all manuscripts is relatively low, broad screening may be justified to avoid the negative impact of self-plagiarism.

Ramalho JN, Tedesqui G, Ramalho M, et al. Evidence Levels for Neuroradiology Articles: Low Agreement among Raters.

Rating of articles by the original manuscript reviewers and 3 other radiologists at different time points was investigated in 100 AJNR articles. The results show that the levels-of-evidence criteria adopted for use in AJNR did not allow consistent manuscript classification between readers or even by the same reader at 2 time points.

Welker K, Boxerman J, Kalnin A, et al. ASFNR Recommendations for Clinical Performance of MR Dynamic Susceptibility Contrast Perfusion Imaging of the Brain.

This article discusses the utility of DSC perfusion MR imaging in the setting of tumors and ischemia and suggests guidance on its implementation, processing, interpretation, and reporting.…

Editor’s Choices from June 2015

Hart BL, Ketai L. Armies of Pestilence: CNS Infections as Potential Weapons of Mass Destruction.

The imaging findings of CNS infection agents that may be used by governments and terrorist groups are presented. Viruses and anthrax are highly infectious and effective biowarfare weapons but bacteria also fulfill these requirements.

Asdaghi N, Coulter JI, Modi J, et al. Statin Therapy Does Not Affect the Radiographic and Clinical Profile of Patients with TIA and Minor Stroke.

Imaging and clinical outcomes of high-risk patients with TIA and stroke who underwent acute statin treatment were assessed. These patients tended to be older, male, hypertensive, and have more atherosclerotic disease than those who did not receive statins. Early statin therapy was not associated with a reduction of DWI-positive lesions, infarct volume, or functional outcome at 3 months.

Shams S, Martola J, Cavallin L, et al. SWI or T2*: Which MRI Sequence to Use in the Detection of Cerebral Microbleeds? The Karolinska Imaging Dementia Study.

The prevalence of cerebral microbleeds was evaluated in 246 patients using T2* and SWI. Microbleeds were detected in 21% by SWI vs. 17% by T2* imaging. SWI performed well with both thin and thick sections. Thus, SWI is better than T2* for this purpose and robust enough to permit comparison across studies.…

Fellows’ Journal Club Choices for May 2015

Jiang XY, Zhang SH, Xie QZ, et al. Evaluation of Virtual Noncontrast Images Obtained from Dual-Energy CTA for Diagnosing Subarachnoid Hemorrhage.

A group of 37 patients underwent noncontrast CT and dual-energy CTA for diagnosis of SAH. From the latter, virtual noncontrast images were reconstructed and assessed for SAH. Agreement between true and virtual noncontrast images for diagnosis of SAH was 92%. Thus, virtual noncontrast CT images reliably diagnosed SAH while reducing radiation dose. (See accompanying commentary by Brisman.)

Prager AJ, Martinez N, Beal K, et al. Diffusion and Perfusion MRI to Differentiate Treatment-Related Changes Including Pseudoprogression from Recurrent Tumors in High-Grade Gliomas with Histopathologic Evidence.

Sixty-eight patients with treated high-grade gliomas who developed increasing enhancing masses of indeterminate nature underwent DWI and DSC as part of their studies. Pseudoprogression was found in 15% who showed higher ADC as well as lower relative cerebral blood volume when compared with those with recurrent tumors.

Kranz PG, Amrhein TJ, Gray L. Incidence of Inadvertent Intravascular Injection during CT Fluoroscopy–Guided Epidural Steroid Injections.

Retrospective analysis of 575 CT fluoroscopy-guided epidural injections was done to detect inadvertent arterial or venous injections. Intravascular injections occurred in 26% of cervical transforaminal injections, 9% of cervical interlaminar injections, 8% of lumbar transforaminal injections, and 2% of lumbar interlaminar injections. These findings are similar to previous reports using conventional fluoroscopy and demonstrate that intravascular injections may be detected with CT fluoroscopy.…

Editor’s Choices for May 2015

Krings T, Kim H, Power S, et al. Neurovascular Manifestations in Hereditary Hemorrhagic Telangiectasia: Imaging Features and Genotype-Phenotype Correlations.

Imaging features were correlated with genotypes in 75 patients with hereditary hemorrhagic telangiectasia. Sixty-one percent of patients showed small, superficial, capillary malformations without shunting, whereas 43% had true AVMs of small size and low Spetzler-Martin grade. High-flow AVFs were present in 12% of patients and multiple malformations were seen in 44%. No correlation between gene mutations and lesion types was found.

Golden MJ, Morrison LA, Kim H, et al. Increased Number of White Matter Lesions in Patients with Familial Cerebral Cavernous Malformations.

Because endothelial cell abnormalities are found in white matter hyperintensities and cavernous malformations, the authors set out to determine if an increased number of white matter lesions was present in 191 patients with familial cerebral cavernous malformations all carrying the same gene defect. Results were compared with those obtained via logistic regression analysis in healthy controls and patients with sporadic cavernous malformations. White matter lesions were found in 15% of patients with the familial disease, 2% of healthy controls, and 2.5% of those with sporadic malformations. In patients with the familial disease, only age was associated with white matter lesions.

Cho CH, Hsu L, Ferrone ML, et al. Validation of Multisociety Combined Task Force Definitions of Abnormal Disk Morphology.

Fifty-four patients underwent classification of lumbar disk herniations during preoperative MRI and surgery using the new multisociety classification. Disagreement as to classification based on MRI studies occurred in only 1 instance and agreement of preoperative classification with operative findings was 70%. The authors believe that though this level of agreement is reasonable, differences exist between what neuroradiologists see on imaging and what surgeons encounter.…

Fellows’ Journal Club Choices for April 2015

Shams S, Martola J, Granberg T, et al. Cerebral Microbleeds: Different Prevalence, Topography, and Risk Factors Depending on Dementia Diagnosis — The Karolinska Imaging Dementia Study.

MR studies in more than 1500 patients with dementia revealed that 22% had microbleedsthat were predominantly lobar and occipital in cases of Alzheimer disease. Patients with microbleeds were older, male, and hypertensive. Prevalence, location, and risk factors of microbleeds varied depending on dementia diagnosis and may be taken into account when anticoagulating such patients.

Bertrand A, Vignal C, Lafitte F, et al. Open-Angle Glaucoma and Paraoptic Cyst: First Description of a Series of 11 Patients.

MR imaging in 11 patients with severe glaucoma and paraoptic cysts is reported. The cysts showed high T2 and variable T1 signal. The authors suggest that these cysts work as valves and may serve to preserve vision.

Polan RM, Poretti A, Huisman TAGM, et al. Susceptibility-Weighted Imaging in Pediatric Arterial Ischemic Stroke: A Valuable Alternative for the Noninvasive Evaluation of Altered Cerebral Hemodynamics.

Based on imaging findings in 24 pediatric patients,the authors conclude that SWI-DTI mismatch predicts progression in pediatric arterial ischemic stroke. SWI-hyperintense signal is not useful for predicting the development of malignant edemabut SWI should be routinely added to the neuroimaging diagnostic protocol of pediatric arterial ischemic stroke.…

Editor’s Choices for April 2015

van der Kolk AG, Zwanenburg JJM, Denswil NP, et al. Imaging the Intracranial Atherosclerotic Vessel Wall Using 7T MRI: Initial Comparison with Histopathology.

In this preliminary study, 7T imaging was capable of identifying not only intracranial wall thickening but different plaque components such as foamy macrophages and collagen. Signal heterogeneity was typical of advanced atherosclerotic disease.

Ohta T, Nakahara I, Ishibashi R, et al. The Maze-Making and Solving Technique for Coil Embolization of Large and Giant Aneurysms.

These authors describe the use of 2 intra-aneurysmal catheters to deploy first large coils and then smaller, more traditional coils that ultimately fill the interstices left by the larger coils until aneurysms are tightly packed. When this technique was used to occlude large/giant aneurysms, follow-up angiography revealed no recurrences compared with nearly 40% in a group of similar lesions treated in conventional fashion.

Brinjikji W, Luetmer PH, Comstock B, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations.

This meta-analysis of the literature reveals that imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.…

Must-Read AJNR Articles for Neuroradiology Fellows

During the last 8 years AJNR has published 1 to 4 review articles per issue, which are a veritable “who’s who” and “what’s what” in clinical neuroradiology. Additionally, during 2007 to 2010 we also published a series of review articles on physics. From these 2 groups, I have taken a completely subjective approach to select not only my own favorites, but those that I think all neuroradiology fellows should read and that should eventually form part of their learning curriculum.…

Conscious Sedation versus General Anesthesia during Endovascular Acute Ischemic Stroke Treatment: A Systematic Review and Meta-Analysis

Fellows’ Journal Club

March 2015

(3 of 3)

Nine studies encompassing nearly 2000 patients treated with or without anesthesia for acute stroke were analyzed. Patients with acute ischemic stroke undergoing intra-arterial therapy may have worse outcomes with general anesthesia compared with conscious sedation. However, the difference in stroke severity at the onset may confound the comparison in the available studies.

EIC signature