Editor’s Choices

Combining Diffusion Tensor Metrics and DSC Perfusion Imaging: Can It Improve the Diagnostic Accuracy in Differentiating Tumefactive Demyelination from High-Grade Glioma?

Editor’s Choice

Fourteen patients with tumefactive demyelinating lesions and 21 patients with high-grade gliomas underwent MR imaging with conventional, DTI, and DSC perfusion imaging. Conventional imaging sequences had a sensitivity of 80.9% and specificity of 57.1% in differentiating high-grade gliomas from tumefactive demyelinating lesions. DTI metrics (p:q tensor decomposition) and DSC perfusion demonstrated a statistically significant difference among enhancing portions in tumefactive demyelinating lesions and high-grade gliomas. The highest specificity was found for ADC, the anisotropic component of the diffusion tensor, and relative CBV. The authors conclude that DTI and DSC perfusion add profoundly to conventional imaging in differentiating tumefactive demyelinating lesions and high-grade gliomas.

Predictive Utility of Marketed Volumetric Software Tools in Subjects at Risk for Alzheimer Disease: Do Regions Outside the Hippocampus Matter?

Editor’s Choice

The authors assessed the prognostic efficacy of individual-versus-combined regional volumetrics in 2 commercially available brain volumetric software packages for predicting conversion of patients with mild cognitive impairment to Alzheimer disease. One hundred ninety-two subjects (mean age, 74.8 years) diagnosed with mild cognitive impairment at baseline were studied. On univariable analysis of 11 NeuroQuant and 11 Neuroreader regional volumes, hippocampal volume had the highest area under the curve for both software packages (0.69, NeuroQuant; 0.68, Neuroreader) and was not significantly different between packages. They conclude that of the multiple regional volume measures available in FDA-cleared brain volumetric software packages, hippocampal volume remains the best single predictor of conversion of mild cognitive impairment to Alzheimer disease at 3-year follow-up.

Evaluation of Encephaloduroarteriosynangiosis Efficacy Using Probabilistic Independent Component Analysis Applied to Dynamic Susceptibility Contrast Perfusion MRI

Editor’s Choice

In this prospective study, 13 patients underwent unilateral indirect cerebral revascularization and DSC-MR imaging before and after surgery. Conventional perfusion parameters (relative CBV, relative CBF, and TTP) and probabilistic independent components that reflect the relative contributions of DSC signals consistent with arterial, capillary, and venous hemodynamics were calculated and examined for significant changes after surgery. Before surgery, tissue within the affected hemisphere demonstrated a high probability for hemodynamics consistent with venous flow and a low probability for hemodynamics consistent with arterial flow, whereas the contralateral control hemisphere demonstrated the reverse. Consistent with symptomatic improvement, the probability for venous hemodynamics within the affected hemisphere decreased with time after surgery. The authors conclude that probabilistic independent component analysis yielded sensitive measurements of changes in local tissue perfusion that may be associated with newly formed vasculature after indirect cerebral revascularization surgery.

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.

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.

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.

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.

Limited Dorsal Myeloschisis and Congenital Dermal Sinus: Comparison of Clinical and MR Imaging Features

Editor’s Choice

These investigators retrospectively reviewed the clinical and MR imaging findings of 12 patients with limited dorsal myeloschisis and 10 patients with congenital dermal sinus. A crater covered with pale epithelium was the most common skin lesion in limited dorsal myeloschisis (83%). Infectious complications were common in congenital dermal sinus (60%), but not found in limited dorsal myeloschisis. They show that limited dorsal myeloschisis has distinct MR imaging features including a visible intrathecal tract with dorsal tenting of the cord at the tract-cord union.

Emergent Endovascular Management of Long-Segment and Flow-Limiting Carotid Artery Dissections in Acute Ischemic Stroke Intervention with Multiple Tandem Stents

Editor’s Choice

The authors investigated the role of emergent endovascular stenting of long-segment carotid dissections in the acute ischemic stroke setting in 15 patients. They specifically evaluated long-segment carotid dissections requiring stent reconstruction with multiple tandem stents (≥ 3 stents) and presenting with acute (<12 hours) ischemic stroke symptoms (NIHSS score, ≥ 4). Carotid stent reconstruction was successful in all patients with no residual stenosis or flow limitation. Nine patients (60%) harbored intracranial occlusions, and 6 patients (40%) required intra-arterial thrombolysis/thrombectomy, achieving 100% TICI 2b–3 reperfusion. They conclude that emergent stent reconstruction of long-segment and flow-limiting carotid dissections in acute ischemic stroke intervention is safe and effective, with favorable clinical outcomes.

Metabolic Abnormalities in the Hippocampus of Patients with Schizophrenia: A 3D Multivoxel MR Spectroscopic Imaging Study at 3T

Editor’s Choice

Nineteen patients with schizophrenia and 11 matched healthy controls underwent MR imaging and multivoxel point-resolved 1H-MRS at 3T to obtain their hippocampal gray matter absolute NAA, Cr, and Cho concentrations. Patients’ average hippocampal GM Cr concentrations were 19% higher than those of controls. NAA and Cho showed no differences. The authors conclude that the findings suggest the hippocampal volume deficit in schizophrenia is not due to net loss of neurons, which is in agreement with histopathology studies but not with prior 1H-MR spectroscopy reports. Elevated Cr would be consistent with hippocampal hypermetabolism.