Category Archives: Editor’s Choices

Editor’s Choices

Predictors of Unfavorable Outcome in Intracranial Angioplasty and Stenting in a Single-Center Comparison: Results from the Borgess Medical Center-Intracranial Revascularization Registry • F. Al-Ali, T. Cree, S. Hall, S. Louis, K. Major, S. Smoker, and S. Walker
Is it better to perform angioplasty or stent intracranial stenoses? In a registry of 140 patients the overall stroke rate after procedures was 13%, with the lowest rate in those treated with angioplasty only (4.5%) versus those who received stents (11–25%, depending on the technique used). Dilation success rate was higher with stenting and restenosis rate was higher with angioplasty only. … Continue reading >>

Editor’s Choices

Longitudinal Whole-Brain N-Acetylaspartate Concentration in Healthy Adults • D.J. Rigotti, I.I. Kirov, B. Djavadi, N. Perry, J.S. Babb, and O. Gonen
This article addresses the issue of neuronal changes over time. N-acetylaspartate is surrogate marker of neuronal viability and integrity as seen on hydrogen MR spectroscopy. Here, the authors utilized their own method of measuring whole-brain NAA in a small cohort of healthy adults with each receiving 4 scans (baseline and annual) during a 3-year period. The data were converted to absolute millimole concentrations of this metabolite. They found that whole-brain NAA was stable over a 3-year period in … Continue reading >>

Editor’s Choices

Acute Damage to the Posterior Limb of the Internal Capsule on Diffusion Tensor Tractography as an Early Imaging Predictor of Motor Outcome after Stroke • J. Puig, S. Pedraza, G. Blasco, J. Daunis-i-Estadella, F. Prados, S. Remollo, A. Prats-Galino, G. Soria, I. Boada, M. Castellanos, and J. Serena
Practical applications of diffusion tensor imaging are few, but this seems to be an interesting and a potentially important one: can it be used to predict motor outcome after stroke? Sixty patients within 12 hours of stroke were assessed with tractography at 5 different locations in the corticospinal tracts at admission, … Continue reading >>

Editor’s Choices

Have Referral Patterns for Vertebroplasty Changed since Publication of the Placebo-Controlled Trials? • M.T. Luetmer and D.F. Kallmes
Here is an article analyzing some of the consequences of the 2 famous (infamous?) randomized vertebroplasty trials published in the New England Journal of Medicine in August 2009. Curiously, it is by some of the same authors. They looked at monthly referral patterns for nearly 1200 patients during a 6-year period extending from 2004 to 2010. Although this article represents the experience of only 1 institution, the number of vertebroplasties dropped from 18 to 11 per month after August 2009. The … Continue reading >>

Editor’s Choices

Fetuses with Ventriculomegaly Diagnosed in the Second Trimester of Pregnancy by In Utero MR Imaging: What Happens in the Third Trimester? • P.D. Griffiths, J.E. Morris, G. Mason, S.A. Russell, M.N.J. Paley, E.H. Whitby, and M.J. Reeves
Brain abnormalities may be difficult to identify in fetuses and early in life, becoming easier to see with time. In this interesting study, the authors evaluated 99 pregnancies between 20-24 weeks that revealed mildly large ventricles but no other brain abnormalities. Forty-six women came back for re-evaluation at 30-32 weeks. What happened to the brains of those fetuses? Of the ones that … Continue reading >>

Editor’s Choices

Stent-Assisted Coiling of Complex Middle Cerebral Artery Aneurysms: Initial and Midterm Results • J.-F. Vendrell, V. Costalat, H. Brunel, C. Riquelme, and A. Bonafe
Complex middle cerebral artery aneurysms are difficult to treat surgically or via endovascular approaches. Here, the authors treated 52 such lesions (41 aneurysms were unruptured and 11 had previously bled) via a combined approach that included stenting and coil embolization. They were able to coil 50 aneurysms after stent deployment and the most common immediate complication was intra-stent clot formation. At 14 months, follow-up showed 7 recurrences and 5 of these were re-treated. No … Continue reading >>

Editor’s Choices

Blood-Brain Barrier Permeability Assessed by Perfusion CT Predicts Symptomatic Hemorrhagic Transformation and Malignant Edema in Acute Ischemic Stroke • J. Hom, J.W. Dankbaar, B.P. Soares, T. Schneider, S.-C. Cheng, J. Bredno, B.C. Lau, W. Smith, W.P. Dillon, and M. Wintermark
Symptomatic hemorrhagic transformation and malignant edema are the most feared complications of cerebral infarction, particularly after systemic thrombolysis; why are patients prone to develop them? These investigators retrospectively analyzed data obtained from 32 patients and gave special attention to the permeability of the blood-brain barrier (as measured by perfusion CT). Six patients developed SHT and/or ME and most had … Continue reading >>

Editor’s Choices

Intracranial Dural Arteriovenous Fistula with Retrograde Cortical Venous Drainage: Use of Susceptibility-Weighted Imaging in Combination with Dynamic Susceptibility Contrast Imaging • K. Noguchi, N. Kuwayama, M. Kubo, Y. Kamisaki, K. Kameda, G. Tomizawa, H. Kawabe, and H. Seto
In my experience, nearly all patients with dural arteriovenous fistulas have normal MR imaging studies unless they have cortical venous reflux. These authors used susceptibility-weighted imaging to evaluate such patients and compared the findings with those shown by gadolinium MR perfusion studies. They studied 10 individuals who by digital subtraction angiography had dural AVFs with cortical venous drainage. One hundred … Continue reading >>

Editor’s Choices

The Influence of Carotid Artery Catheterization Technique on the Incidence of Thromboembolism during Carotid Artery Stenting • H.J. Kim, H.J. Lee, J.H. Yang, I.S. Yeo, J.S. Yi, I.W. Lee, S.B. Lee, S.Y. Ryu, J.K. Kim, and P.S. Yang
The risk of stroke is one of the main concerns when performing carotid artery stenting and has prevented this technique from becoming widely accepted. Here, the authors used diffusion-weighted imaging to evaluate 32 consecutive patients who underwent CAS with 2 different catheterization techniques: one with a 7F or 8F catheter and the other with a coaxial system (same size) in … Continue reading >>

Editor’s Choices

Flat Detector CT in the Evaluation of Brain Parenchyma, Intracranial Vasculature, and Cerebral Blood Volume: A Pilot Study in Patients with Acute Symptoms of Cerebral Ischemia • T. Struffert, Y. Deuerling-Zheng, S. Kloska, T. Engelhorn, C.M. Strother, W.A. Kalender, M. Köhrmann, S. Schwab, and A. Doerfler
Flat detector technology may be the future of CT and though it has been used in the angiographic suite, its utility as the initial study in patients with acute stroke symptoms has not been fully evaluated. Here, the authors tested the hypothesis that FD-CT provides good anatomic and physiologic information that correlates … Continue reading >>