http://snipurl.com/21shrp0
(many of the comments at NYT are more interesting than the article!)

Pineal cysts measuring 5 mm or larger in greatest dimension were found in 478/48,417 patients (1.0%).  Follow up imaging was present in 151 patients for greater than 3 years. The authors conclude that follow-up imaging and neurosurgical evaluation are not mandatory for adults with asymptomatic pineal cysts.

2. Albuquerque, F. C., Hu, Y. C., Dashti, S. R., Abla, A. a, Clark, J. C., Alkire, B., Theodore, N., et al. (2011). Craniocervical arterial dissections as sequelae of chiropractic manipulation: patterns of injury and management. J Neurosurg 2011;6:1197-1205. doi:10.3171/2011.8.JNS111212

The authors describe the patterns of arterial injury after chiropractic manipulation and their management in the modern endovascular era in 13 patients since 2007.  Of particular note was the severity of the arterial injuries in the cohort. Not only were these lesions often lengthy, their neurological sequelae were frequently severe. Three patients were left permanently debilitated by stroke and 1 died, producing an adverse outcome rate of 31% (4 of 13 patients).

3. Chan, W. C. W., Sze, K. L., Samartzis, D., Leung, V. Y. L., & Chan, D. (2011). Structure and biology of the intervertebral disk in health and disease. Orthop Clin North Am 2011;42:447-64. doi:10.1016/j.ocl.2011.07.012

Very complete review of the anatomy and physiology of the intervertebral disc, including over 200 references.  It is amazing to me that we still do not know the precise origin and nature of the cells within the intervertebral disc, or the fate of the notochord cells.

4. Filippi, M., Rocca, M. a, De Stefano, N., Enzinger, C., Fisher, E., Horsfield, M. a, Inglese, M., et al. (2011). Magnetic resonance techniques in multiple sclerosis: the present and the future. Arch Neurol 2011;68:1514-20. doi:10.1001/archneurol.2011.914

Succinct review of the current and future imaging techniques in demyelinating disease.  Future areas that are touched upon include perfusion, ultra-high field, susceptibility weighted imaging, and iron quantification.  Brain atrophy measurements are one area which might have a direct clinical impact if they were more generally available with more automated techniques.

5. Hoff, E., Strube, P., Rohlmann, A., Groß, C., & Putzier, M. (2011). Which Radiographic Parameters Are Linked to Failure of a Dynamic Spinal Implant? Clin Orthop Relat Res 2011 Nov [Epub ahead of print]. doi:10.1007/s11999-011-2200-8

The authors prospectively analyzed the clinical and radiographic 2-year outcomes of the CD Horizon1 Agile Spinal System, which was a new pedicle screw- based implant for dynamic stabilization which was recalled from the market shortly after its launch in 2007 due to high failure rates.  They conclude that the underrepresented issue of compensation for shear forces that lead to translation should be addressed in future implant designs.

6. Hutton, M. J., Bayer, J. H., Powell, J., & Sharp, D. J. (2011). Modic vertebral body changes: The natural history as assessed by consecutive magnetic resonance imaging. Spine 2011;26:2304-7. doi:10.1097/BRS.0b013e31821604b6

This is a paper based on a premise regarding the evolution of endplate changes which is inferred by the authors, but has never been explicitly published, i.e., that end plate changes represent a process that is progressive (type 1 converts to type 2, which converts to type 3).  I am unaware of any literature that says that this progressive in inexorable, so I reject this assumption.  My understanding of endplate changes is that type I are edema and fibrovascular type marrow conversion, and type II are fatty marrow conversion.  Some type I may go to II, and some type II revert to type I.  Type III is uncommon, and we do not have longitudinal data to identify the precursor for that type.  I do agree that making a clinical decision related to operation or fusion based on the presence of endplate changes is very problematic.

7. Kalb, S., Martirosyan, N. L., Kalani, M. Y. S., Broc, G. G., & Theodore, N. (2011). Genetics of the Degenerated Intervertebral Disc. World Neurosurg 2011 Nov 9 [Epub ahead of print; uncorrected proof]. doi:10.1016/j.wneu.2011.07.014

Review of the genetics and biochemistry of the disc.  Probably more than anyone really wants to know about this topic, so just peruse Table 1.

8. Marder, E., Gupta, P., Greenberg, B. M., Frohman, E. M., Awad, A. M., Bagert, B., & Stüve, O. (2011). No Cerebral or Cervical Venous Insufficiency in US Veterans With Multiple Sclerosis. Arch Neurol 2011;68:1521-5. doi:10.1001/archneurol.2011.185

Eighteen patients (3 women and 15 men) with a diagnosis of definite MS fulfilling revised McDonald criteria or clinically isolated syndrome were compared to 11 age and sex matched controls.  Five parameters of venous outflow used by Zamboni et al were examined: (1) IJV or vertebral vein reflux, (2) deep cerebral vein reflux, (3) IJV stenosis, (4) absence of flow in IJVs or vertebral veins, and (5) change in cross-sectional area of the IJV with postural change. The study failed to detect a significant difference in the Zamboni et al criteria for impairment to cerebral venous drainage in patients with MS compared with control subjects.

9. Moragas, M., Martínez-Yélamos, S., Majós, C., Fernández-Viladrich, P., Rubio, F., & Arbizu, T. (2011). Rhombencephalitis: a series of 97 patients. Medicine 2011;4:256-61. doi:10.1097/MD.0b013e318224b5af

A retrospective observational study of patients with clinical and imaging features of rhombencephalitis.  The authors found the etiologies of rhombencephalitis were quite varied, and included unknown cause (n = 31), multiple sclerosis (n = 28), Behcet disease (n = 10), Listeria monocytogenes infection (n = 9), paraneoplastic syndrome (n = 6), Epstein-Barr virus (n = 4), tuberculosis (n = 2), pneumococcal infection (n = 2).  Not an image rich article, with only one MR figure.

10. Ren, X., Lin, S., Wang, Z., Luo, L., Jiang, Z., Sui, D., Bi, Z., et al. (2011). Clinical, radiological, and pathological features of 24 atypical intracranial epidermoid cysts. J Neurosurg 2011 Dec 16 [Epub ahead of print]. doi:10.3171/2011.10.JNS111462

Fourteen (58.3%) of 24 lesions were misdiagnosed and 21 (87.5%) of 24 were complicated with spontaneous intracystic hemorrhage.  Contrast enhancement of lesions was also demonstrated in 20% of cases.  Fat suppressed imaging or T2* imaging use was not documented.

11. Ropper, A. E., Cahill, K. S., Hanna, J. W., McCarthy, E. F., Gokaslan, Z. L., & Chi, J. H. (2011a). Primary Vertebral Tumors: A Review of Epidemiologic, Histologic and Imaging Findings Part I: Benign Tumors. Neurosurgery 2011;69(6):1171-80. doi:10.1227/NEU.0b013e31822b8107

12. Ropper, A. E., Cahill, K. S., Hanna, J. W., McCarthy, E. F., Gokaslan, Z. L., & Chi, J. H. (2011b). Primary Vertebral Tumors: A Review of Epidemiologic, Histologic and Imaging Findings: Part II: Locally Aggressive and Malignant Tumors. Neurosurgery 2012;70(1):211-9. doi:10.1227/NEU.0b013e31822d5f17

These two papers make a nice review of spinal tumors, and should be read together.  The first part, if taken by itself, is somewhat confusing since the major Table describing the tumors includes both benign and malignant lesions.  Also, use the table from Part II, since the table in Part I is split between pages with the end of the table rotated sideways with respect to the text.

13. Sahm, F., Capper, D., Jeibmann, A., Habel, A., Paulus, W., Troost, D., & von Deimling, A. (2011). Addressing Diffuse Glioma as a Systemic Brain Disease With Single-Cell Analysis. Arch Neurol 2011 Dec 12 [Epub ahead of print]. doi:10.1001/archneurol.2011.2910

This article makes use of the occurrence of heterozygous mutations in the cytosolic isocitrate dehydrogenase 1 gene (IDH1) which have been shown to constitute the most frequent alteration in diffuse astrocytoma and oligodendroglioma of World Health Organization grades II and III and in secondary glioblastoma World Health Organization grade IV.  The authors evaluated whole brain or hemispheric sections in 4 patients with glioma with a mutation specific monoclonal antibody.  The present analysis demonstrates for the first time the extent of infiltration of diffuse glioma on the single-cell level and underlines the concept of addressing glioma not as a focal but a systemic disease of the entire brain.

14. Sanai, N., Chang, S., & Berger, M. S. (2011). Low-grade gliomas in adults. J Neurosurg 2011;115:948-65. doi:10.3171/2011.7.JNS10238

All encompassing review of low grade gliomas, and it is highly recommended reading.  Extent of resection has been increasingly shown to correlate with improved outcome, as well as with better seizure control and reduced histological upgrading rates.

15. Williams, M. a, & Venkatesan, A. (2011). No Endovascular Innovation Without Evaluation in Chronic Cerebrospinal Venous Insufficiency: A Call for the IDEAL Model. Arch Neurol 2011;68:1510-2. doi:10.1001/archneurol.2011.1555

Cogent editorial regarding current endovascular therapies in patients with MS.  The authors call for the patients’ choice not being endovascular interventions or nothing; rather, to be between proven MS treatments and enrollment in clinical trials for endovascular interventions in MS for those who meet the inclusion criteria.

UNC Neuroradiology Neuropathology Monthly Conference, October 2011 (PPT)

I am happy to announce the introduction of the AJNR Case of the Month as an additional feature to the already established AJNR Case of the Week and Classic Image. In fact, the first case will go live in the first week of November.

Objective of COM: Build the case every week over a period of 4 weeks. For example, the first week could have non-contrast CT images; the second week, contrast-enhanced CT images; the third week, conventional MR images; and the fourth week, advanced MR images. Also, at this point in time (fourth week), the diagnosis will be provided with a succinct discussion. In addition, an expert in the field will discuss the findings, which will be provided as an audio clip. It is our hope that such a format will be engaging and thought-provoking, stimulate learning, and fun.

Enjoy!

The Portal comprises four sections:  “Articles You Should Read,” where we have collated a list of articles from a range of journals that we believe neuroradiology fellows should read; “Submit Your Case Report,” which provides a list of journals that routinely accept articles based on small series, pictorial essays, and case reports; “Meetings to Attend,” a list of upcoming meetings offering good educational value for fellows; and “The Marketplace,” where fellows may post job ads and comment about the job situation in general.

Dr. Susie Muir (smuir@unch.unc.edu) has been named Portal Editor. Please visit the Portal at  http://www.ajnr.org/site/fellows/portal.xhtml and share this information with your fellows.

RCVS presentation (PPT)

http://www.neurographics.org

Neurographics is a new educational journal published by the ASNR.  It consists of solicited articles based on educational exhibits from the ASNR annual meeting.  As the AJNR moves toward more original research, Neurographics has been reintroduced for educational articles, reviews, and case reports.

The new journal is free online, or can be printed on demand from the web site.  Check it out and send your feedback to ng@asnr.org

Neurorad Neuropath UNC, May 2011 (PPT)

April 2011 Neurorad-pathology (PPT)

To access your free subscription please visit our website

www.interventionalneuroradiology.it

and login with the

user: inrdigital@centauro.it

password: inuro-11

Thank you for your ongoing support of Interventional Neuroradiology.

Warmest regards,

Marco Leonardi

Professor of Neuroradiology

Bologna University, Italy