Hemorrhagic and Ischemic Stroke is a multidisciplinary, 584-page hardcover textbook which discusses the medical, radiological, surgical, and image-guided interventional aspects of this topic. It is co-edited by 2 neurosurgeons (Drs. Bendok and Batjer), a neurologist (Dr. Naidech), and a neuroradiologist (Dr. Walker). The imaging input into this text is substantial, and radiology abounds throughout the book, even in areas where imaging is not the primary topic of the section. A significant portion of the text is devoted to Radiology—Section II: Imaging Considerations. Authors include many prominent in neuroradiology so the reader is assured of up-to-date and relevant information.

One is immediately struck by the fanciful cover, apparently drawn by the artist Jennifer Pryll. It is enticing and attempts to summarize (a picture in this instance is worth many more than a thousand words) all sorts of aspects of surgery, imaging, and interventions. You gotta see it.

There are 4 major sections, each section with multiple chapters: Medical and Critical Care Considerations (6 chapters); Imaging Considerations (6 chapters); Open Surgical Approach (17 chapters); Neurointerventional Approaches (11 chapters). While all chapters should be of interest to a neuroradiologists, Chapter II commands most of our attention. Here, separate areas deal with Hemorrhagic and Ischemic Stroke relative to (1) CT, (2), MR (3) PET, (4) Ultrasound, and (5) Neuroangiography. There is a sixth chapter on Promising Developments in Stroke Imaging.

These chapters contain high quality imaging with up-to-date protocols in advanced stroke imaging. Tables abound throughout these chapters, so one gets for example a quick summary of perfusion weighted imaging parameters (CBV, CBF, etc., along with an adequate examples), MRA, the time evaluation of blood on MR, parameters for assessing carotid disease by ultrasound—again with abundant examples, guidelines for TCD, along with many more. The section ends with a short but beautiful chapter on the future of imaging in stroke by Drs. Rowley, Turski, and Strother. Besides the authors perspective on where stroke imaging/analysis is heading, we are shown new entities (or at least new to this reviewer) such as time resolved MRA using HYPR-highly constrained projection reconstruction. [“Y” fits into that acronym by the end of word highly]. We also see the result of phase contrast MRA yielding hemodynamic date.

For the neurointerventionalist there will be great interest in the chapters on Open Surgical approaches and also, obviously, in the 155-page section on neurointervention. In this latter section, the whole gamut of procedures is covered, including thrombolysis/thrombectomy, angioplasty/stenting, aneurysm coiling, management of dissections, embolization of intracranial AVMs and DAVFs, and Spinal AVMs and DAVFs. These chapters nicely complement and add to material that appears earlier in the text on open surgical perspectives of these abnormalities.

Please note that added to all of this written and illustrative material is a registration and code which allows the reader to access surgical/interventional videos of 10 different operative procedures such as AVM surgery, ECA-ICA bypass, aneurysm coiling, spinal dural fistula embolization, and more. These extra features enhance significantly the value of this textbook.

As a final note, one has to admire the many artist drawings which are so helpful to the reader’s understanding, particularly with issues related to surgery.

To this reviewer, Hemorrhagic and Ischemic Stroke is the best single publication on this topic produced to date. It is recommended in the highest terms to all neuroradiologists; in fact, it should be part of the personal library of anyone who deals with stroke (and what neuroradiologists doesn’t?).

]]> http://www.ajnrblog.org/2012/02/01/hemorrhagic-and-ischemic-stroke-medical-imaging-surgical-and-interventional-approaches/feed/ 0 http://www.ajnrblog.org/2012/01/30/3-radiology-societies-come-together-to-sponsor-women-in-neuroradiology-leadership-award/ http://www.ajnrblog.org/2012/01/30/3-radiology-societies-come-together-to-sponsor-women-in-neuroradiology-leadership-award/#comments Mon, 30 Jan 2012 21:40:28 +0000 cmeltzer http://www.ajnrblog.org/?p=5772 The Foundation of the ASNR, the American College of Radiology (ACR), and the American Association for Women Radiologists (AAWR) will jointly sponsor a mid-career neuroradiologist’s participation in the ACR’s inaugural Radiology Leadership Institute session.

Why target an award specifically to women?

As the ASNR celebrates its 50^th Anniversary in April, it will swear in the 4^th women president in its long, venerable history.  While the number of women entering medical schools is approaching 50% nationally, women continue to be underrepresented in a number of medical specialties, including diagnostic radiology and particularly in neuroradiology.  In fact, the gender gap … Continue reading >>

Fighting For Our Health provides a left-sided perspective on the processes and powers that led to the passage of the Patient Protection and Affordable Care Act in March of 2010.  The author is neither an academic nor a health care provider.  He has spent much of his recent career working with an advocacy organization called Health Care for America Now that is headquartered on K street in Washington, D.C., backed by a coalition which includes grass roots support, powerful unions, and wealthy backers.

The author’s background and experience is a central theme of this tome. At times this is as much about him as it is about healthcare, which is both good and bad. On the positive side of the ledger, he provides a passionate and at times humorous perspective on the state of US politics, from the vantage point of those who were working to influence the President and the 111^th Congress in the 2009-2010 time period.

Be forewarned, however, that this is not a heavily referenced, even-handed, professorial analysis of the kind that we expect from academics or consulting gurus. The villains in his story are for the most part the insurance companies and their allies, a position with which many physicians will likely concur. In the book, physicians (at least the primary care doctors) are generally treated sympathetically when they are mentioned. The work’s focus is on politics and corporations and the advocacy itself rather than its implications for those of us who work in the field. That should be troubling to many of the readers of the AJNR, since the solutions Mr. Kirsch has fought so hard for will have serious and probably very negative consequences for specialists and specialties like ours.

The book’s greatest strength is that it takes you on the journey with him as the process unfolds. You don’t have to be a political junkie to become involved in this story of how advocacy gets done. The book contains many fascinating details on a range of issues, from forming alliances to coordinating messaging and generating influence.  Kirsch is not shy about taking sides and naming names. As the action plays out, he discusses how the votes were toted up in Congress to push the bill through. There is remarkable insight available in this book all the way down to the granular detail on how organizations like his work to mobilize the citizenry and to create change in America. There are lessons for physicians here and an opportunity for us to understand how perception is shaped.

Summary:

Those who are looking for a definitive analysis of how we got health reform and how it will affect neuroradiologists should look elsewhere.  This is a partisan book that will certainly appeal to the choir, in this case, those on the left who agree with the author that the White House did not go far enough with health reform in 2010.  It may not please folks elsewhere on the political spectrum, but all readers would benefit from deriving greater insights into how political action really gets done in the US, both inside and outside of the government.

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

With the ever-increasing availability of high-field strength MRI scanners, the demand for clinical functional MRI studies is outstripping the supply of formally trained individuals to fill this need.  fMRI: Basics and Clinical Applications seeks to address this critical need by providing the interested novice with the tools necessary to develop such a program.

The 181-page book is organized into two large sections that first review the basics of fMRI and then discuss various clinical applications.  The contributing authors are internationally distinguished experts in the fields of radiology, neurology, and neurosurgery.  The chapter topics are well organized and begin with an introductory overview of the challenges intrinsic to building a clinical fMRI program followed by a well-illustrated chapter reviewing neuroanatomy and cortical landmarks.   The neuroanatomy chapter is important, since fMRI interpretation requires a more in depth understanding of neural function and structure than radiologic interpretation of structural MRI. Missing from this chapter, however, is the inclusion of 3-D renderings that are now widely available.  Other topics reviewed in the Basics section include spatial resolution of fMRI techniques, a discussion on perfusion vs. blood oxygen level dependent (BOLD) imaging, the electrophysiologic basis underlying fMRI, and the pros and cons of high-field and ultra-high field MRI.  The Basics section ends with a chapter called “Press Button Solutions” that provides an incomplete review of various commercially available fMRI hardware and software tools.  The authors then compare these commercial solutions to spm2, a research-grade software solution, to determine how well each tool can reliably detect fMRI activations.  The author’s findings are not surprising, though one topic missing from the discussion involves regulatory issues that may restrict the ability to use more powerful research applications for clinical studies.

The Clinical Applications section is organized based on the type of indication for fMRI and includes standard clinical methodologies for pre-surgical brain mapping, as well as research-based applications and combining fMRI with other physiological tools.  Readers interested in getting a clinical fMRI program off the ground will find the chapters discussing sensorimotor and language mapping for epilepsy and tumor resections most informative and practical.  A full chapter is devoted to “Special Issues in fMRI-studies involving Children.”  The remaining chapters discuss more research-based applications, including mapping brain rehabilitation following stroke, and combining fMRI with direct cortical stimulation, transcranial magnetic stimulation, and magnetoencephalography.

This book accomplishes its goal of providing an overview of how fMRI can be applied to clinical applications.  The daunting challenges of conducting clinical fMRI studies are softened, and the reader gains focus on the various areas within their own program that they must strengthen.  While some editors may exclude valuable details that can shorten a text’s shelf-life, it is these pearls that make this title a must-have for the novice neuroimager.  While informative, this book does feed into the modern “fast and easy” philosophy and generally understates the challenges and limitations of push-button fMRI solutions that further separate the clinician from their data.  There were also a number of important issues the book did not cover, including how to properly use statistics in single subject studies, the role of functional connectivity in brain mapping, standardization of experimental paradigms, and quality control.  With these caveats in mind, I strongly recommend this book to anyone interested in learning more about the field of clinical fMRI.

It was a pleasure to review this book, which is very comprehensive in its coverage on the diagnosis, management, and prognosis of diseases of the posterior fossa. This book has described extensively and accurately the anatomical aspects of posterior fossa through skull base and intraoperative images, with apt correlation to the radiological imaging. This correlation enables the reader to understand and remember better the normal anatomy of posterior fossa.

Further, the author has covered all the important and commonly encountered topics of posterior fossa:  trauma, congenital abnormalities, vascular malformations, and tumors. There are detailed descriptions of the molecular basis of the disease, appearance on imaging, and intra-operative aspects of the disease. The images have accurate figure legends and are appropriately placed, giving a good visual description of the text. For example, the chapter “Hemagiomas and Dural Fistulas” begins with microscopic pathology, followed by imaging studies, followed by a series of illustrations describing the various approaches to the brain stem, and then finally ends with endovascular imaging and treatment. This clinico-pathological-radiological understanding is the key to accurate diagnosis and management of any disease.

In addition, I find that the topics covered are very up-to-date and relevant to the title of the book. The references are rightly chosen to include not only landmark papers on the topic but also latest developments in the management.

This book is essential to every neurosurgery resident or attending and is definitely a good study for beginners of radiology and neuroradiology who are in the process of understanding of posterior fossa anatomy and diseases. It also serves as a reference for practicing neuroradiologists for descriptions of radiological images and their appearance intraoperatively. The surgical approaches may not be of direct relevance, but the book does explain significantly the postoperative changes noted on radiological imaging.

Basar Sarikaya^a and Alexander M. McKinney^a
aDepartment of Radiology/Neuroradiology
University of Minnesota and Hennepin County Medical Centers
Minneapolis, Minnesota

We read the article recently published on-line in the American Journal of Neuroradiology by Marquering et al¹ with great interest, and we appreciate the authors’ efforts to test the hypothesis suggested in one of the articles published by our group in 2005,² by reproducing the same methods, albeit on a different subject population. In that particular regard, we would like to note several prominent differences from ours in their study, most notably the method of selecting their patient population. The preliminary work by McKinney et al² had been intended to lay the basic foundation for future studies with the possibility of using calcium (Ca) volume detection as a screening test for carotid atherosclerotic disease. Given the inherent features of a screening test, such a test should be an adequate one to detect the disease at certain cutoff points, not solely in the diseased or the high-risk population, but in the general population (ie, including mostly nondiseased as well as diseased subjects).³Hence, we think that the current study deviates from this belief by incorporating high-risk patients as the selected subject population.

Another notable point of difference is that the current study used Ca thresholds of 0.03 and 0.09 mL, whereas the previous study by McKinney et al² found the best combination of sensitivity and specificity at the 0.06-mL threshold, as reflected in the abstract. Instead of using the 0.06-mL threshold, the authors chose differently but note in their article “The chosen Ca volume thresholds used in our test were the largest (0.09 mL) and smallest (0.03 mL) that performed well in the study of McKinney et al.” This is a correct statement, but one that does not clearly reflect the stated results of the earlier study.

Third, in the study by McKinney et al,² several factors had been listed as limitations, which are also in effect for the article by Marquering et al,¹ because the methods were quite similar, with the exception of the patient population. In a very recent study,⁴coincidentally published nearly at the same time as the article by Marquering et al, we made 3 important improvements in the study protocol: 1) We replaced CTA with catheter angiography as the diagnostic tool to assess the luminal patency, leaving the use of the gold standard NASCET criteria instead of NASCET-like surrogate criteria to assess the stenosis; 2) we replaced CTA with nonenhanced CT to overcome overlapping of Ca and contrast densities as was seen in the previous study, which could have resulted in overestimation of the Ca burden in the previous study; and 3) we changed the subject population to a more random one that simulates a sampling of the general population. Our patient population in this newer study consisted of patients imaged for reasons other than stroke or cerebrovascular disease, which was thought more reflective of the disease-free general population. The results of this second study were quite similar to those published in 2005, pertaining to the correlation of Ca volume with luminal stenosis; we note that in this more recent study, the Ca volume threshold of 0.06 mL was again found to have the best performance.⁴

Suggesting a definitive hypothesis at this point to explain the discrepant results between the 2 studies published by our group and the study by Marquering et al¹ is actually beyond the scope of this communication. However, we briefly state that such discordant findings could well be explained in the context of “spectrum bias,” implying that the performance of a diagnostic test may vary between different clinical settings due to changes in the patient case mix, therefore affecting the reproducibility of study results.⁵ Because “spectrum bias” is not a true bias in the statistical sense, some authors instead suggest using the term “spectrum effects.”⁶ As a side note, Marquering et al actually showed some poor correlation on the nonaffected side, which, in a way, could again be explained by spectrum bias (ie, the nonaffected side might be regarded as a different subgroup). Other factors might also play a role in the interpretation of their results as outlined in the first paragraph.

Ca volume detection for the carotid and intracranial circulation is a relatively newer topic for research with many unknowns at the moment. However, the facts we learned from the cardiology literature should be enlightening. Ca volume in the form of a Ca score has been used for many years to predict atherosclerotic disease of the coronary arteries.^6–8 Besides a well-known correlation with the luminal stenosis, using the additional diagnostic value of Ca volume has been suggested because the luminal diameter might not always reflect the severity of the atherosclerotic disease alone, due to positive remodeling.⁹ Unfortunately, but understandably, to our knowledge, there is no published work in the literature to test the Ca score against luminal stenosis in patients with acute myocardial syndrome. These patients would most likely undergo catheter angiography with possible intervention in the first place without any less accurate test under development because conventionally, there has been no need to perform a “screening test” on the diseased population.

Hence, we certainly value the results presented in the article by Marquering at al¹ and appreciate their important contribution to the literature and understanding of this topic. In our opinion, all 3 studies cited here are essentially preliminary studies.^1,2,4 Ongoing research concerning Ca volume detection in the carotid and cerebral vasculature could focus on the direct relation of the Ca volume with disease presence as a marker, regardless of the degree of luminal stenosis, because there is a growing body of evidence suggesting that there is a correlation between the Ca volume and ischemic white matter disease burden, and also ultimately with clinical disease states such as dementias.^10–13 Future effort could focus on easy, reliable, and reproducible methods of Ca volume detection in the carotid and cerebral vasculature.

References

1. Marquering HA, Majoie CB, Smagge L, et al. The relation of carotid calcium volume with carotid artery stenosis in symptomatic patients. AJNR Am J Neuroradiol 2011;32:1182–87 » Abstract/FREE Full Text
2. McKinney AM, Casey SO, Teksam M, et al. Carotid bifurcation calcium and correlation with percent stenosis of the internal carotid artery on CT angiography. Neuroradiology 2005;47:1–9 » CrossRef » Medline
3. Khoury MJ, McCabe LL, McCabe ER. Population screening in the age of genomic medicine. N Engl J Med 2003;348:50–58 » CrossRef » Medline
4. Sarikaya B, Lohman B, McKinney AM, et al. Correlation between carotid bifurcation calcium burden on non-enhanced CT and percent stenosis, as confirmed by digital subtraction angiography. Br J Radiol 2011 Sep 6 [Epub ahead of print]
5. Ransohoff DF, Feinstein AR. Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. N Engl J Med 1978;299:926–30 » Medline
6. Willis BH. Spectrum bias: why clinicians need to be cautious when applying diagnostic test studies. Fam Pract 2008;25:390–96. Epub 2008 Sep 1 » Abstract/FREE Full Text
7. Agatston AS, Janowitz WR, Hildner FJ, et al. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol1990;15:827–32 » Abstract
8. Simons DB, Schwartz RS, Edwards WD, et al. Noninvasive definition of anatomic coronary artery disease by ultrafast computed tomographic scanning: a quantitative pathologic comparison study. J Am Coll Cardiol1992;20:1118–26 » Abstract
9. Glagov S, Weisenberg E, Zarins CK, et al. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 1987;316:1371–75 » Medline
10. Nandalur KR, Baskurt E, Hagspiel KD, et al. Carotid artery calcification on CT may independently predict stroke risk. AJR Am J Roentgenol2006;186:547–52 » Abstract/FREE Full Text
11. de Weert TT, Cakir H, Rozie S, et al. Intracranial internal carotid artery calcifications: association with vascular risk factors and ischemic cerebrovascular disease. AJNR Am J Neuroradiol 2009;30:177–84 » Abstract/FREE Full Text
12. Chung PW, Park KY, Moon HS, et al. Intracranial internal carotid artery calcification: a representative for cerebral artery calcification and association with white matter hyperintensities. Cerebrovasc Dis 2010;30:65–71 » CrossRefMedline
13. Bos D, Ikram MA, Elias-Smale SE, et al. Calcification in major vessel beds relates to vascular brain disease. Arterioscler Thromb Vasc Biol2011;31:2331–37 » Abstract/FREE Full Text

Reply

Published online before print December 8, 2011, doi: 10.3174/ajnr.A2946
AJNR 2012 33: E15

H.A. Marquering^a, C.B. Majoie^b and P.J. Nederkoorn^c
aDepartment of Radiology/Biomedical Engineering and Physics
^bDepartment of Radiology
^cDepartment of Neurology
Academic Medical Center
University of Amsterdam
Amsterdam, the Netherlands

We thank Drs Sarikaya and McKinney for their response to our article entitled “The Relation of Carotid Calcium Volume with Carotid Artery Stenosis in Symptomatic Patients”¹ and would hereby like to respond to some of their very meaningful discussion points.

We certainly agree that there is a large difference in the definition of the domain between our study and the 2 studies performed by their group.^2,3 In our study, we have correlated the calcium volume with the degree of stenosis of the carotid artery in a population of high-risk patients with recent neurologic symptoms. In the studies of Sarikaya et al³ and McKinney et al,² the relation between carotid artery stenosis and calcium volume was investigated in a more “general” patient population.

The difference in patient population follows from the different objectives. Sarikaya et al³and McKinney et al² investigated the role of calcium volume in screening patients at risk, whereas our study explored the possibility of using calcium volume to identify stenoses of >70%. In current clinical practice, the degree of stenosis of the internal carotid artery is used in the decision to perform carotid endarterectomy, because it is the strongest predictor of its effect.^4,5 With such a difference in objectives and in patient domain, it is actually not surprising to observe a spectrum effect.⁶ However, the extent of this effect was beyond our expectations.

The second issue that was addressed by Sarikaya and McKinney is that in our article, we presented the diagnostic accuracy for thresholds different from the optimal value reported in their articles, 0.06 cm³. We actually used a whole range of thresholds, including 0.06 cm³, as presented in the receiver operating characteristic analysis curve (Fig 3 in our article). This curve shows that for all thresholds, the diagnostic accuracy is rather poor. We presented the diagnostic accuracy for 0.03 and 0.09 cm³to illustrate the outer ends of the range of sensitivity and specificity of the calcium volume−based stenosis detection for our patient population. However, a direct comparison would benefit from the presentation of the values for the 0.06-cm³threshold.

We acknowledge Sarikaya and McKinney for observing the weak correlation of calcium volume and the degree of stenosis of the carotid artery on the unaffected side, as opposed to the absence of such a correlation on the affected side. This suggests a stronger correlation of calcium volume and degree of stenosis in asymptomatic patients or arteries. We also thought this was a puzzling finding. Hypothetically, it may express a relation of plaque composition and potential neurologic symptoms. Actually, we have performed a study in the same patient population in which we correlated the intracranial calcium volume burden with intracranial stenosis, which we hope to publish soon. In this study, we actually confirmed the correlation of calcium volume and stenosis in the intracranial arteries. We agree with Sarikaya and McKinney that the role of carotid artery calcium volume and its relation with various neurologic symptoms requires additional research effort.

References

1. Marquering HA, Majoie CB, Smagge L, et al. The relation of carotid calcium volume with carotid artery stenosis in symptomatic patients. AJNR Am J Neuroradiol 2011;32:1182–87 » Abstract/FREE Full Text
2. McKinney AM, Casey SO, >Teksam M, et al. Carotid bifurcation calcium and correlation with percent stenosis of the internal carotid artery on CT angiography. Neuroradiology 2005;47:1–9 » CrossRef » Medline
3. Sarikaya B, Lohman B, McKinney AM, et al. Correlation between carotid bifurcation calcium burden on non-enhanced CT and percent stenosis, as confirmed by digital subtraction angiography. Br J Radiol 2011 9 6. [Epub ahead of print]
4. Barnett HJ, Taylor DW, Eliasziw M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis: North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med1998;339:1415–25 » CrossRef » Medline
5. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998;351:1379–87 » CrossRef » Medline
6. Willis BH. Spectrum bias: why clinicians need to be cautious when applying diagnostic test studies. Fam Pract 2008;25:390–96 » Abstract/FREE Full Text

Intra- and Extraluminal Structural and Functional Venous Anomalies in Multiple Sclerosis, as Evidenced by 2 Noninvasive Imaging Techniques • K. Dolic, K. Marr, V. Valnarov, M.G. Dwyer, E. Carl, Y. Karmon, C. Kennedy, C. Brooks, C. Kilanowski, K. Hunt, A.H. Siddiqui, D. Hojnacki, B. Weinstock-Guttman, and R. Zivadinov
Here is another article that should add to the controversy over the relationship between MS and venous anomalies. The authors assessed the utility of sonography and MRV (2 different techniques) for detecting intra- and extraluminal venous abnormalities in 150 patients with MS and 63 matched controls. Results were as follows: patients with MS had significantly more intraluminal and structural abnormalities than controls and patients with progressive MS had more extraluminal and flow abnormalities than those with nonprogressive disease.

Hospitalization Costs for Endovascular and Surgical Treatment of Unruptured Cerebral Aneurysms in the United States Are Substantially Higher Than Medicare Payments • W. Brinjikji, D.F. Kallmes, G. Lanzino, and H.J. Cloft
Aneurysm clipping is associated with longer hospital stays and higher total charges. Because coiling of aneurysms has become routine, it is important to know how much we are getting paid for these 2 procedures. For uncomplicated treatments, the average Medicare payment for clipping and coiling was 49% and 53%, respectively. For patients with major complications, the average percentage payments decreased to 34% and 41% for coiling and clipping, respectively. Therefore, hospitalization costs for patients undergoing clipping and coiling of unruptured cerebral aneurysms are substantially higher than Medicare payments.

Idiopathic Thoracic Spinal Cord Herniation: Retrospective Analysis Supporting a Mechanism of Diskogenic Dural Injury and Subsequent Tamponade • M. Brus-Ramer and W.P. Dillon
Cord herniation is a rare but treatable condition of uncertain etiology and, if you have been following AJNR’s Blog, there has been considerable discussion of this entity among our readers. Here the authors postulate that anterior disk herniations erode the dura and then the cord becomes anteriorly displaced to tamponade the defect, resulting in a progressive myelopathy. To prove their point, the authors retrospectively reviewed their own cases and all published ones. In more than two-thirds of cases the herniations occurred at disk levels supporting their hypothesis.

Fellows’ Journal Club

Quality Control in Neuroradiology: Discrepancies in Image Interpretation among Academic Neuroradiologists • L.S. Babiarz and D.M. Yousem
This article should interest our fellows because most of them train at academic institutions. These authors looked at 1000 neuroimaging studies that had follow-up imaging and rated the discrepancies found in the reports. Nearly 88% of follow-up studies agreed with the original reports and there was a 2% rate of clinically significant interpretation discrepancies (8 CT and 12 MRI) among neuroradiologists. Most discrepancies involved interpretation of vascular and neoplastic lesions. This threshold could potentially serve to design future practice quality improvement studies.

Utilization Rates of Neuroradiology across Neuroscience Specialties in the Private Office Setting: Who Owns or Leases the Scanners on Which Studies Are Performed? • L.S. Babiarz, D.M. Yousem, L. Parker, D.C. Levin, and V. Rao
All of us are interested in interpreting studies with high relative value units and this trend extends to imaging studies interpreted by nonradiologists. Here, the authors used 10 years of data from the Centers for Medicare and Medicaid Services to assess this issue in regard to CT and MRI studies. During this period of time, utilization rates of MRI and CT studies grew by 2.5% and 2.1%, respectively. In 2008 only 56.6% of fees were charged by radiologists, followed by independent testing facilities, other specialists, neurologists, and neurosurgeons. The authors concluded that all nonradiologists showed greater overall utilization growth in private office neuroradiology than did radiologists. Also, nonradiologists generally showed greater utilization increases in MR than CT. Radiologists’ private office neuroradiology technical fee share shrank from 83.6% to 56.6% between 1998 and 2008.

Quantification of Thrombus Hounsfield Units on Noncontrast CT Predicts Stroke Subtype and Early Recanalization after Intravenous Recombinant Tissue Plasminogen Activator • J. Puig, S. Pedraza, A. Demchuk, J. Daunis-i-Estadella, H. Termes, G. Blasco, G. Soria, I. Boada, S. Remollo, J. Baños, J. Serena, and M. Castellanos
Anecdotally we know that high-density clots are probably more organized and difficult to lyse. These investigators calculated HU values for MCA thrombi on noncontrast CT within 4.5 hours of symptom onset and correlated it with successful recanalization after intravenous tPA treatment given 169 +/− 102 minutes thereafter. Best outcomes were achieved for M1, low-density, and thrombi not originating from the heart. Worse outcomes were related to high-density thrombi and those originating from the heart.

Essentials of Pain Management by Drs. Nalini Vadivelu, Richard D. Urman, and Roberta L. Hines is a 834-page detailed text on this subject.  The authors are anesthesiologists dealing with the management of the commonest of all symptoms that practitioners deal with on a day-to-day basis.  The book is divided into nine parts covering all aspects of a pain management.  The book covers the subject broadly and chapters touch on alternative forms of treatment such as acupuncture as well as the psychosocial and psychological aspects of pain. Pharmacology of commonly used drugs is detailed. Their use is explained with diagrams, charts, and tables. These are clear and easy to follow.  Most of the chapters will be of particular interests to those in the clinical disciplines, especially in pain management practice. In this regard, the text is detailed, and the authors cover the subject comprehensively. Clear diagrams and photographs are used to show pertinent anatomical detail. These clearly demonstrate the target site/s of the various treatments. Each area of intervention is described under subheadings.  These are divided into the anatomy pertinent to the intervention and the technique.  These sections are kept short and succinct, but are in enough detail to be comprehensive. Section 6 deals with regional anesthesia techniques and is described in detail.  Surface anatomy (with photographs /diagrams) and surface anatomical landmarks relevant to the particular site are shown.  Technique and recommended pharmacologic agents are described. Further sections deal with labor pain and its management. Suggested strategies in cancer-related pain is covered.  The armamentarium of drugs, blocks, and pain pumps gives the reader a detailed overview of this subject.

Where necessary, radiographic images are provided to illustrate a particular point. A drug formulary of agents used in pain management is provided. Included is a pediatric section, which would prove valuable to those in this field.  Rehabilitation of the chronic pain sufferer is included, and the role of a multidisciplinary approach in this task is discussed.  Chapters include occupational therapy assessment and nursing perspectives in its arrangement.  Many of the chapters end with case scenarios and suggested approaches to their management. Of interest to the Neuroradiology audience would be Chapter 21 which details Principles of ultrasound techniques. This chapter gives a fairly detailed overview of ultrasound techniques in general, but especially in reference to needle guidance.  It is, of course, specifically aimed at the technique used in peripheral nerve interventions. Chapter 6 gives a very brief description of diagnostic imaging techniques used in pain management. It is very short and hence not of much value to the Neuroradiology audience.

Generally, the images and diagrams are labeled clearly and legends are suitably descriptive.  Compared to other books dealing with this subject it covers this topic broadly but in sections not as comprehensively.  Its breadth rather than its depth of detail is what impresses. References are up to date and comprehensive.  Overall an excellent book for those contemplating going into or already performing the practice of pain management.

From Neurology to Methodology and Back:  An Introduction to Clinical Neuroengineering
Natasha Maurits
Springer 2012, 285 pages, 131 Illustrations, $79.95

Stem Cells and Cancer Stem Cells:  Therapeutic Applications in Disease and Injury, Volume 2
M.A. Hayat
Springer 2012, 385 pages, 65 illustrations, $209.00

The Neurosurgical Instrument Guide
Christopher S. Eddleman
Thieme 2011, 534 pages, 240 illustrations, $64.99

Pediatric and Adolescent Concussion: Diagnosis, Management, and Outcomes
Jennifer Niskala Apps And Kevin D. Walter (Editors)
Springer 2012, 212 pages, 5 illustrations, $59.95

Phase Response Curves in Neuroscience:  Theory, Experiment, and Analysis
Series:  Springer Series in Computational Neuroscience, Vol. 6
Schultheiss, Nathan W.; Prinz, Astrid A.; Butera, Robert J. (Eds.)
Springer 2012, 518 pages, 170 illustrations, $239.00

Color Atlas of Ultrasound Anatomy
Berthold Block (author)
Thieme 2011, 328 pages, $49.99