Category Archives: Editor’s Choices

Comparative Effectiveness of Ruptured Cerebral Aneurysm Therapies: Propensity Score Analysis of Clipping versus Coiling

Editor’s Choice January 2014

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The authors evaluated a national, multihospital database containing information on over 5200 patients to examine recent trends in ruptured aneurysm therapies and to compare peri-procedural outcomes between clipping and coiling treatments. Clipping therapy frequency decreased from 27% in 2006 to 21% in 2011. Unfavorable outcomes were more common after clipping compared with coiling, including discharge to long-term care, ischemic complications, neurologic complications, and other surgical complications.

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Abstract

BACKGROUND AND PURPOSE
The relative merits of treating ruptured aneurysms with clipping versus coiling continue to be a topic of debate. We evaluated a national, multihospital

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Prevalence of Radiologically Isolated Syndrome and White Matter Signal Abnormalities in Healthy Relatives of Patients with Multiple Sclerosis

Editor’s Choice January 2014

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Healthy individuals who either had no relatives with multiple sclerosis or had a family history of it were studied and evaluated according the Okuda and Swanton criteria for radiologically isolated syndrome. These investigators found that the frequency of white matter signal abnormalities and radiologically isolated syndrome were higher in the healthy relatives of patients with multiple sclerosis compared with nonfamilial healthy control subjects. In healthy relatives of patients with MS, smoking and obesity also contributed to the presence of white matter lesions.

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Abstract

BACKGROUND AND PURPOSE
The exact prevalence of WM signal abnormalities

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Morphologic, Distributional, Volumetric, and Intensity Characterization of Periventricular Hyperintensities

Editor’s Choice January 2014

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These authors sought to characterize white matter lesions of elderly adults and determine if some were artifacts. Using FLAIR they imaged 665 subjects without dementia, carefully measured and evaluated periventricular white matter lesions, and correlated these with several aspects of cardiovascular disease. They concluded that periventricular white matter hyperintensity levels, distribution, and association with risk factors and disease suggest that in old age, these are true tissue abnormalities and therefore should not be dismissed as artifacts.

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Abstract

BACKGROUND AND PURPOSE
White matter hyperintensities are characteristic of old age and identifiable on FLAIR and … Continue reading >>

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No Evidence for Impairment of Venous Hemodynamics in Children or Young Adults with Pediatric-Onset Multiple Sclerosis

Editor’s Choice December 2013

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The results of venous sonography, contrast-enhanced MRI, and MR venography in 26 pediatric patients with MS were compared with controls and 13 young adults with pediatric-onset MS. The authors concluded that chronic cerebrospinal venous insufficiency is rarely observed in children or young adults with pediatric-onset MS as venous anatomy and flow rates showed normal outflow in most subjects.

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Abstract

BACKGROUND AND PURPOSE
Chronic cerebrospinal venous insufficiency is a postulated etiologic factor for multiple sclerosis, but the higher frequency with longer disease duration and progressive disability suggests that chronic cerebrospinal venous insufficiency is secondary

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Higher Rates of Decline for Women and Apolipoprotein E ε4 Carriers

Editor’s Choice December 2013

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This study assesses the risk of being female in addition to the well-known factors of age and apolipoprotein E ε4 status in the development and progression of Alzheimer disease based on longitudinal brain atrophy, cognitive decline, and CSF markers. APOE ε4 accelerated rates of decline, especially in women. The gender effect was at least as important as APOE ε4 status and showed weaker relationships to CSF markers.

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Abstract

BACKGROUND AND PURPOSE
Age and the apolipoprotein E ε4 allele are well-known risk factors for Alzheimer disease, but whether female sex is also a risk … Continue reading >>

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T1 Gadolinium Enhancement of Intracranial Atherosclerotic Plaques Associated with Symptomatic Ischemic Presentations

Editor’s Choice December 2013

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The degree of contrast enhancement was assessed in 22 high-grade intracranial stenoses that were either symptomatic or asymptomatic. Seventy percent of symptomatic plaques showed contrast enhancement whereas this was seen in only 8% of those that were asymptomatic. This study suggests that intracranial stenoses can be evaluated with conventional MRI protocols and that there is a strong association between plaque contrast enhancement and ischemic symptoms.

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Abstract

BACKGROUND AND PURPOSE
Contrast enhancement of intracranial atherosclerotic plaques has recently been investigated using high field and high resolution MR imaging as a risk factor in the … Continue reading >>

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Editor’s and Fellows’ Journal Club Choices, November 2013

Editor’s Choices

Perfusion Deficits Detected by Arterial Spin-Labeling in Patients with TIA with Negative Diffusion and Vascular Imaging • X.J. Qiao, N. Salamon, D.J.J. Wang, R. He, M. Linetsky, B.M. Ellingson, and W.B. Pope
The current definition of TIA calls for normal imaging including DWI. Here the authors used arterial spin-labeling perfusion to detect abnormalities in nearly 50 patients within 24 hours of symptom onset and in 36 controls. The sensitivity and specificity of ASL in TIA diagnosis was 55.8% and 90.7%, respectively, and in nearly 94% of readings abnormalities that matched the clinical neurologic deficits were identified by the … Continue reading >>

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Editor’s and Fellows’ Journal Club Choices, October 2013

Editor’s Choices

Association of CT Perfusion Parameters with Hemorrhagic Transformation in Acute Ischemic Stroke • A.R. Jain, M. Jain, A.R. Kanthala, D. Damania, L.G. Stead, H.Z. Wang, and B.S. Jahromi
Because hemorrhagic transformation affects treatment and patient prognosis, these authors explored whether CT perfusion predicts it. Twenty percent of their subjects developed hemorrhagic transformation and these patients did not differ from controls in terms of age, gender, time to presentation, or comorbidities. Only CBV was found to be lower and predictive of hemorrhagic transformation.

Parenchymal Hypointense Foci Associated with Developmental Venous Anomalies: Evaluation by Phase-Sensitive MR Imaging at 3T • … Continue reading >>

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Editor’s and Fellows’ Journal Club Choices, August 2013

Editor’s Choice

Metabolic Changes in Patients with Aneurysmal Subarachnoid Hemorrhage Apart from Perfusion Deficits: Neuronal Mitochondrial Injury? • M. Wagner, A. Jurcoane, C. Hildebrand, E. Güresir, H. Vatter, F.E. Zanella, J. Berkefeld, U. Pilatus, and E. Hattingen
Because perfusion deficits may not account for all neuronal damage seen in subarachnoid hemorrhage, these authors measured cerebral metabolites in 58 patients with SAH without perfusion defects and/or infarctions. Using MR spectroscopy they discovered that NAA was significantly low in all patients, choline was elevated, and glutamate/glutamine was also decreased. The authors believe that these findings reflect neuronal mitochondrial injury.

Differentiation between Oligodendroglioma Continue reading >>

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Editor’s and Fellows’ Journal Club Choices, July 2013

Editor’s Choice

Super-Resolution Track Density Imaging of Glioblastoma: Histopathologic Correlation • R.F. Barajas, Jr, C.P. Hess, J.J. Phillips, C.J. Von Morze, J.P. Yu, S.M. Chang, S.J. Nelson, M.W. McDermott, M.S. Berger, and S. Cha
Track density is a new imaging technique that allows submillimeter voxel resolution. These investigators used TDI to image 34 GBMs and correlated their findings with histopathology. TDI was elevated in tissues containing aggressive features and, regardless of contrast enhancement, these regions showed cellular proliferation, architectural disruption, and hypoxia. Thus, TDI may be helpful in identifying tumor infiltration in nonenhancing components of GBM.

Multimodal MR Imaging (Diffusion, Continue reading >>

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