RadCases: Ultrasound Imaging

Azar N, Donaldson CK. RadCases: Ultrasound Imaging. Thieme; 2015; 224 pp; 460 ill; $59.99

Azar and Donaldson cover

RadCases: Ultrasound Imaging by Nami Azar and Carolyn K. Donaldson was published by Thieme in 2015 and is part of the RadCases series edited by Jonathan Lorenz and Hector Ferral. This book fits in well with the RadCases series as a case-based review of ultrasound cases, which includes common and unusual diseases and demonstrates how they appear on ultrasound, with supplemental cross-sectional images in some cases. The hardcover includes 100 cases plus a scratch-off code that allows the purchaser to access all 100 cases and an additional 150 cases online for 1 year.

Cases are presented in a random fashion with respect to topic, just as cases may be read in practice. Thus, a gallbladder case may be followed by a thyroid case, then a kidney case, and then a scrotal case. One drawback to this format is that it hinders focused studying of 1 topic area at a time. A benefit is that it is a more realistic format and facilitates the presentation of each case as an unknown. Each case begins with 1 or more ultrasound images and a brief clinical presentation. Further workup images and sometimes cross-sectional images are shown on the same page. When the page is turned, the second page summarizes the imaging findings with an annotated description. A differential diagnosis is given with the correct disease in bold print. A brief section on essential facts and pearls and pitfalls follows. Each of these sections is written in brief bullet points.

The cases are a nice mix of complex and basic cases. Topics are reviewed succinctly but effectively. Image quality is very good and the images are practical, reflecting what might be encountered in clinical practice. There is a nice …

Endovascular Stroke Treatment of Nonagenarians

Fellows’ Journal Club

The purpose of this study was the evaluation of procedural and outcome data of patients 90 years of age or older undergoing endovascular stroke treatment. The authors retrospectively analyzed prospectively collected data of 29 patients (mean age 91.9 years) in whom endovascular stroke treatment was performed between January 2011 and January 2016 (from a cohort of 615 patients). Successful recanalization (TICI % 2b) was achieved in 22 patients (75.9%). In 9 patients, an NIHSS improvement ≥ 10 points was noted between admission and discharge. After 3 months, 17.2% of the patients had an mRS of 0-2. Despite high mortality rates (∼45%) and moderate overall outcome, 17.2% of the patients achieved mRS 0-2 or prestroke mRS, and no serious procedure-related complications occurred.

Abstract

BACKGROUND AND PURPOSE

Although endovascular treatment has become a standard therapy in patients with acute stroke, the benefit for very old patients remains uncertain. The purpose of this study was the evaluation of procedural and outcome data of patients ≥90 years undergoing endovascular stroke treatment.

MATERIALS AND METHODS

We retrospectively analyzed prospectively collected data of patients ≥90 years in whom endovascular stroke treatment was performed between January 2011 and January 2016. Recanalization was assessed according to the TICI score. The clinical condition was evaluated on admission (NIHSS, prestroke mRS), at discharge (NIHSS), and after 3 months (mRS).

RESULTS

Twenty-nine patients met the inclusion criteria for this analysis. The median prestroke mRS was 2. Successful recanalization (TICI ≥ 2b) was achieved in 22 patients (75.9%). In 9 patients, an NIHSS improvement ≥ 10 points was noted between admission and discharge. After 3 months, 17.2% of the patients had an mRS of 0–2 or exhibited prestroke mRS, and 24.1% achieved mRS 0–3. Mortality rate was 44.8%. There was only 1 minor procedure-related complication (small SAH without clinical

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.

Nerve Surgery

Mackinnon SE. Nerve Surgery. Thieme; 2015; 645 pp; 879 ill; $299.99

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Dr. Susan Mackinnon is a world-renowned expert in all aspects of peripheral nerve injury and repair, from basic science to surgery and clinical treatment to clinical discovery. She has served as Professor and Chair of Plastic Surgery at Washington University School of Medicine for almost two decades.

As an author of more than 500 articles in numerous areas of nerve injury and repair, she is likely best known for her work on the development of nerve allograft repair with immunosuppression, the understanding of tubular nerve repair strategies, and more recently, nerve transfers. She co-authored a book with Lee Dellon in the late 80s on peripheral nerve surgery, and the current textbook, now almost 30 years later, is a much-needed update on and advance in the field.

The book is organized into sections, going from basic science and anatomy and physiology of nerve repair to the concept of nerve grafting. As opposed to the previous text, there is a real focus on nerve transfers, a relatively new area of peripheral nerve surgery. The text is extremely well-organized and of enormous value as a reference text for any practitioner involved in nerve repair.

The neuroradiology aspects of this book are relatively minor and limited—mostly to images of tumors of the peripheral nervous system. The area of imaging of nerve injuries is really a sub-subspecialty within this field of neuroradiology and is essentially not covered in this text.

The text does cover many of the surgical aspects of peripheral nerve repair, including (but not limited to) direct nerve repair, nerve graft, and nerve transfers. It includes entrapment neuropathies as well as tendon transfers for functional recovery.

The images are excellent and clearly labeled. Only a few are taken from the original …

LINNC NYC 2017 Seminar

LINNC NYC

Don’t miss this course in neuroradiology and neurosurgery!

Mark your calendars for March 24-25, 2017.

Program topics include:

  • Stenting
  • Flow diverters
  • Y-stenting for aneurysm treatment
  • Stroke treatment

The seminar is accredited for 14.75 AMA PRA Category 1 Credits™ by the ACCME through the joint providership of the Mayo Clinic College of Medicine and is compliant with the Eucomed Code of Ethical Business Practice.

Our meeting’s philosophy is based on you!

Led by Jacques Moret and faculty, we are gearing up for the seminar with recorded cases focusing on a wide variety of themes and techniques linked to our specialty. Our program is being adapted in real time to fit your needs and provide you with tips and tricks that are directly applicable to your daily practice.

Access the program

Grants for young doctors:

The LINNC Seminar and its scientific committee promote talent and educate tomorrow’s best physicians through an exceptional grant. Registration fees, accommodation, and transportation are included.

View application terms

Join us and discover the LINNC Seminar experience!

Opportunity to Attend a Hands-On Clinical fMRI and Diffusion Tractography Course

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May 3-5, 2017

24 CME and 3 SAM credits

Course Director: Andrei I. Holodny, MD

Conference Location:

Weill Greenberg Center
Weill Medical College of Cornell University
1305 York Avenue (at 70th Street)
New York, NY 10065

Course Overview:

During most MRI procedures, there is no need for interaction between the administrator of the test and the patient. The situation is quite the opposite in functional MRI (fMRI), where the neurological status of the patient must be assessed; an appropriate paradigm must be selected based on the neurological assessment and prior MRI examinations. Further, the paradigm must be delivered to and successfully performed by the patient while in the MRI machine. In addition, there is a rather complicated analysis of the fMRI and diffusion tractography data, which must be performed and assessed. How to properly perform these tasks is often not addressed during residency and fellowship training or in annual scientific society meetings.

Target Audience:

Clinicians involved in fMRI, including neuroradiologists, neurosurgeons and neurologists.

Educational Objectives:

  • Understand the fundamental principles behind fMRI and diffusion tractography
  • Choose the optimal fMRI paradigms appropriate for the patient and clinical situation
  • Deliver fMRI paradigms correctly and monitor the patient for adequate compliance
  • Hands on experience so that the attendee will be able to analyze fMRI and diffusion tractography
  • Understand how data is delivered to a neurosurgical navigational system and used by the neurosurgeon
  • Avoid pitfalls in the interpretation of clinical fMRI and diffusion tractography
  • Optimize fMRI billing and coding

Accreditation Statement:

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the International Institute for Continuing Medical Education, Inc. and fMRI Consultants LLC. The International Institute for Continuing Medical Education Inc. is accredited by the ACCME …

Synthetic MRI in the Detection of Multiple Sclerosis Plaques

Fellows’ Journal Club

In this retrospective study, synthetic T2-weighted, FLAIR, double inversion recovery, and phase-sensitive inversion recovery images were produced in 12 patients with MS after quantification of T1 and T2 values and proton density. Double inversion recovery images were optimized for each patient by adjusting the TI. The number of visible plaques was determined by a radiologist for a set of these 4 types of synthetic MR images and a set of conventional T1-weighted inversion recovery, T2-weighted, and FLAIR images. Conventional 3D double inversion recovery and other available images were used as the criterion standard. Synthetic MR imaging enabled detection of more MS plaques than conventional MR imaging in a comparable acquisition time (approximately 7 minutes). The contrast for MS plaques on synthetic double inversion recovery images was better than on conventional double inversion recovery images.

Abstract

Figure 1 from paper
An example of DIR optimization. A DIR image with a second TI of 460 ms (A) (as determined according to the equations in the main text) shows better delineation of MS plaques than a DIR image with a second TI of 360 ms (B) or 560 ms (C).

BACKGROUND AND PURPOSE

Synthetic MR imaging enables the creation of various contrast-weighted images including double inversion recovery and phase-sensitive inversion recovery from a single MR imaging quantification scan. Here, we assessed whether synthetic MR imaging is suitable for detecting MS plaques.

MATERIALS AND METHODS

Quantitative and conventional MR imaging data on 12 patients with MS were retrospectively analyzed. Synthetic T2-weighted, FLAIR, double inversion recovery, and phase-sensitive inversion recovery images were produced after quantification of T1 and T2 values and proton density. Double inversion recovery images were optimized for each patient by adjusting the TI. The number of visible plaques was determined by a radiologist for a set of these 4 types of synthetic MR

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.

Neuroimaging Clinics of North America: Adult Brain Tumors

Brandão LA, ed. Mukherji SK, consulting ed. Neuroimaging Clinics of North America: Adult Brain Tumors. Elsevier; 2016;26(4):493–694; $360.00

Brandao cover

This November 2016 issue of the Neuroimaging Clinics of North America consists of 9 chapters (nearly 200 pages in length) and covers a number of aspects of adult brain tumors. Edited by Dr. Lara Brandão with contributions from 21 international and national authors, this volume deals with (in order): posterior fossa tumors, lymphomas (2 chapters), the pre- and posttreatment evaluation of gliomas (2 chapters), metastasis, extra parenchymal tumors, advanced MR techniques, and interesting cases of pseudotumors. It is a bit surprising that there is not a chapter dedicated to the emerging brain tumor classifications based on molecular/genetic factors. While in our daily readings of brain MRs and CTs, we do not consider these molecular factors, these issues are discussed among members of neuro-oncology tumor boards, on which neuroradiologists are participants. With the increased emphasis on ICD types and their implications for therapy, some space on this subject is warranted. Had this been included, some of the terminology used elsewhere in the book might have been altered. Of course, the chapter on posttreatment of gliomas and the complexities in the analysis of such patients will be of great interest to the readers of this volume. The extensive material on lymphomas is important and noteworthy because of the increased incidence of disease and the multiple parameters that can be utilized in its detection and evaluation. Many important teaching points are raised in this 54-page (2-chapter) evaluation of lymphomas.

The images included in this volume are of high quality and are well-described, with important structural changes in brain tumors included. Even if one does not read the volume cover-to-cover, one can derive an understanding (providing a good review) of adult brain tumors and see …

RadiologyAsia 2017 Announces Three Renowned Speakers – Pamela Schaefer, Bertrand Ang, and Richard H. Wiggins

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Pamela Schaefer Neuro radiology

Pamela Schaefer

Dr. Schaefer is a recognised clinical expert in neuroradiology especially in acute stroke imaging. She has held leadership positions in multiple regional and national societies, including President of the American Society of Neuroradiology, Eastern Neuroradiology Society and the New England Roentgen Ray Society. She is also a renowned educator, teacher and editor; and a respected administrator at Massachusetts General Hospital in Neuroradiology and Clinical MRI.

 

Dr. Ang

Bertrand Ang

Dr Bertrand Ang is a senior consultant working in National University Hospital Department of Diagnostic Imaging. He specialises in body radiology with a special interest in oncology. He graduated from University of New South Wales (Australia) in 1998 and finished his radiology speciality with Master of Medicine (Radiology) National University of Singapore and Fellowship Royal College of Radiology in 2005. He is active in various tumour groups including Colorectal, Gynaecological and Urological tumour groups.

 

Dr. Wiggins

Richard H Wiggins

Dr. Richard H Wiggins is the Director of Head and Neck Imaging and the Director of Imaging Informatics at the University of Utah Health Sciences Center. He has served as the President of WNRS and ASHNR, and Program Chair for SIIM. He was elected the inaugural fellow of the Academy of Medical Science Educators, and is the recipient of the Teacher of the Year award from the Department of Radiology, the Distinguished Teaching Award from the Department of Otolaryngology, as well as the Honoured Educator Award from the Radiological Society of North America.

The 2017 RadiologyAsia Conference, themed “Bringing the State of the Art Imaging to Clinical Practice”, brings incredible value to attending delegates. The conference will feature 74 topics, over 50 renowned speakers and 4 tracks. Sign up today to learn and gain new insights from Pamela Schaefer, Bertrand Ang, Stephen Bird, Regina J Hooley, James G Smirniotopoulos, Ashish Chawla, Howard …