MR Elastography Analysis of Glioma Stiffness and IDH1-Mutation Status

Editor’s Choice

Tumor stiffness properties were prospectively quantified in 18 patients with histologically proved gliomas using MR elastography. Images were acquired on a 3T MR imaging unit with a vibration frequency of 60 Hz. Tumor stiffness was compared with unaffected contralateral white matter, across tumor grade, and by IDH1-mutation status. Gliomas were softer than healthy brain parenchyma, 2.2kPa compared with 3.3kPa, with grade IV tumors softer than grade II. MR elastography demonstrated that not only were gliomas softer than normal brain but the degree of softening was directly correlated with tumor grade and IDH1-mutation status.

Diagnostic Imaging: Pediatrics, 3rd Edition

Merrow AC Jr. Diagnostic Imaging: Pediatrics. 3rd ed. Elsevier; 2017; 1312 pp; 2500 ill; $442.00

Cover of Quencer

Although written primarily for pediatric radiologists, the third edition of Diagnostic Imaging: Pediatrics, published by Elsevier, contains an abundance of material for the neuroradiologist. In fact, there are 3 sections (brain, spine, and head and neck) totaling 220 pages that are strictly neuro-based, and if one considers other areas where there is an overlap with neuroradiology, such as multicentric diseases or airway disease, there is appeal to those who interpret neuro-based cases.

In keeping with the style of the many other books in this remarkable series, the case material is presented in a format that is well-known to all radiologists. This hardcover volume, edited by Dr. Merrow from Cincinnati Children’s Hospital with contributions from 25 other authors, includes—in addition to the neuroradiology sections mentioned above—the following sections: airway, chest, cardiac, gastrointestinal, genitourinary, and musculoskeletal.

While topics in the brain, spine, and head and neck are covered in other, more specialized books in this series, having all pediatric imaging together in 1 volume is an educational plus. Of course, the e-version may be obtained with a scratch-off code when the book is purchased. As expected, each section begins with “The Approach to…”. For example, there are pages for normal myelination in the brain section and a review of cardiac anatomy in the cardiac section.

Throughout, the book lives up to the extremely high standards associated with this series. Every radiologist practicing a great deal of pediatrics imaging should have rapid access to the book either through their own copy or through one in a departmental/sectional library.

The quality of images and drawings, the completeness of imaging findings, and the all-inclusive nature of this publication makes it a highly recommended purchase.…

Journal Scan – This Month in Other Journals, January 2018

Wilkinson RJ, Rohlwink U, Misra UK, et al. Tuberculous meningitis. Nat Rev Neurol. 2017;13(10):581-598. doi:10.1038/nrneurol.2017.120.

Tuberculosis remains a global health problem, with an estimated 10.4 million cases and 1.8 million deaths resulting from the disease in 2015. The most lethal and disabling form of tuberculosis is tuberculous meningitis, for which more than 100,000 new cases are estimated to occur per year. In adults, the best-documented risk factor for tuberculous meningitis is HIV‑1 co‑infection. Among HIV-infected individuals who live in areas where tuberculosis is highly endemic, the proportion of HIV‑1‑associated meningitis cases attributable to Mycobacterium tuberculosis can exceed 50%. Individuals with tuberculous meningitis and a HIV‑1 co‑infection have a twofold to threefold increase in relative risk of death from any cause with overall mortality around 40%, even in those individuals prescribed antiretroviral therapy. Drug-resistant tuberculous meningitis in people co‑infected with HIV‑1 has a particularly poor prognosis, approaching 100% mortality.

Bacterial replication must occur in the CNS for tuberculous meningitis pathogenesis to proceed. However, the bacillary load in the CSF rarely exceeds 100–1000 bacterial colonies per milliliter, and viable bacilli are difficult to detect in the majority of individuals. Early studies in experimental animal models showed that the meningitis syndrome and even death of tuberculin-sensitized animals could be induced by meningeal inoculation with dead bacilli. Much of the tissue damage is therefore attributed to a dysregulated host inflammatory response. Once bacilli have traversed the blood–brain barrier, they are taken up by microglia and can also replicate in these cells, leading to the induction of microglial cytokine and chemokine production.

The importance of infarction to long-term outcomes has led to interest in cranial vessel imaging. CTA has been used to define lesions in the anterior and posterior cerebral circulation, and has demonstrated that the supraclinoid portion of the internal carotid artery …

Diagnostic Ultrasound, 2-Volume Set, 5th Edition

Rumack CM, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier; 2018; 2240 pp; $349.99

Cover of Rumack

Diagnostic Ultrasound has been a respected and commonly used reference text for everyone who works with clinical ultrasonography worldwide for more than 2 decades. Seven years after the release of its fourth edition, the fifth edition of the renowned textbook in diagnostic ultrasonography by Rumack and Levine is finally available. The text underwent a thorough review of its contents and references, with several new images and videos added to the already large pictorial pool. This book provides fundamental sonographic information to a diverse audience and a wide range of radiology subspecialties, including abdominal, pediatric, women’s, vascular, and neuroimaging, with contributions from more than 100 experts in the field. It brings up-to-date information on the latest ultrasonography techniques (eg, contrast-enhanced ultrasonography, elastography, and 3D imaging), clinical indications, and pathologic findings.

Like its previous edition, the book is composed of 2 volumes divided into 5 parts and 56 printed chapters. An important online “virtual” chapter was added to the current edition, dedicated only to ultrasound artifacts. Volume 1 includes Parts I, II, and III, beginning with chapters on ultrasound physics and followed by sections on abdominal, pelvic, thoracic, small parts, carotid, and peripheral vascular imaging. The chapters on extracranial cerebral vessels should be of great interest to neuroradiologists and neurointerventionalists, particularly those involved with stroke care. Volume 2 is dedicated, once again, to obstetric and pediatric ultrasound, with several chapters focused on fetal and pediatric neuroimaging. In addition to the extensive review of congenital and acquired pediatric and fetal brain, head and neck, and spine disorders, interesting new topics have been included, such as fetal and infant central nervous system findings of Zika infection.

Overall, the text is well-organized and comprehensive, with a very direct, easy-to-read style. A …

ASNR and Seek Entries for Annual Meeting Case of the Day Brain Category


The American Society of Neuroradiology (ASNR) and are again collaborating to give you the opportunity to submit an adult brain case to ASNR 2018 Case of the Day.

Each day during the ASNR 56th Annual Meeting (June 2 – 7) in Vancouver, BC, Canada a case will be shown as the official Case of the Day. This has traditionally been ‘invite only’, but just like last year, this year one of the cases will be chosen from cases you submit to

In addition to one ASNR 2018 Case of the Day winner, will also be showcasing a number of the best submissions as “Cases of the Day” on its home page and through social media!


There are a number of prizes available:


The winner gets two great prizes:

  • Standard Room for two (2) nights at the meeting venue at Fairmont Waterfront Hotel and including complimentary daily in-room WiFi and health club access (value of USD $545). The prize is courtesy of the American Society of Neuroradiology (ASNR). The reservation can be used at any point during the ASNR 56th Annual Meeting dates from Friday, June 1 through Thursday, June 7. If you are not planning to attend the conference, then that’s ok. You will receive the prize either way, and you can, if you wish, transfer it. Any questions, please contact, Ashley Boser, at ASNR office, 630-574-0220, Ext. 231 or email:
  • The editoral team will be giving the winner a 12-month all-access pass to Radiopaedia’s online courses valued at USD $480.


The editorial team will be selecting a runner-up who will receive a 12-month all-access pass to Radiopaedia’s online courses valued at USD $480.

For instructions on how to submit your “Case of the Day,” please click here

CT Texture Analysis Potentially Predicts Local Failure in Head and Neck Squamous Cell Carcinoma Treated with Chemoradiotherapy

Fellows’ Journal Club

This was a retrospective study including 62 patients diagnosed with primary head and neck squamous cellcarcinoma who underwent contrast-enhanced CT examinations for staging, followed by chemoradiotherapy. CT texture features of thewhole primary tumor were measured using an in-house developed Matlab-based texture analysis program. Histogram, gray-level co-occurrence matrix, gray-level run-length, gray-level gradient matrix, and Laws features were used for texture feature extraction. Three histogram features (geometric mean, harmonic, and fourth moment) and 4 gray-level run-length features (short-run emphasis, gray-level nonuniformity, run-length nonuniformity, and short-run low gray-level emphasis) were significant predictors of outcome.

Preoperative Cerebral Oxygen Extraction Fraction Imaging Generated from 7T MR Quantitative Susceptibility Mapping Predicts Development of Cerebral Hyperperfusion following Carotid Endarterectomy

Editor’s Choice

Seventy-seven patients with unilateral internal carotid artery stenosis underwent preoperative 3DT2*-weighted imaging using a multiple dipole-inversion algorithm with a 7T MR scanner. Quantitative susceptibility mapping images wereobtained, and oxygen extraction fraction maps were generated. Quantitative brain perfusion single-photon emission CT was alsoperformed before and immediately after carotid endarterectomy. Ten patients (13%) showed post–carotid endarterectomy hyperperfusion. Multivariate analysis showed that a high quantitative susceptibility mapping–oxygen extraction fraction ratio was significantly associated with the development of post–carotid endarterectomy hyperperfusion.

Setting the Stage for 2018: How the Changes in the American Joint Committee on Cancer/Union for International Cancer Control Cancer Staging Manual Eighth Edition Impact Radiologists

Fellows’ Journal Club

The updated eighth edition of the Cancer Staging Manual of the American Joint Committee on Cancer will be implemented in January 2018. There are multiple changes to the head and neck section of the manual, which will be relevant to radiologists participating in multidisciplinary head and neck tumor boards and reading pretreatment head and neck cancer scans.

Predictors of Incomplete Occlusion following Pipeline Embolization of Intracranial Aneurysms: Is It Less Effective in Older Patients?

Editor’s Choice

This was a retrospective analysis of 465 consecutive aneurysms treated with the Pipeline Embolization Device between 2009 and 2016, at 3 academic institutions in the United States. Cases with angiographic follow-up were selected to evaluate factors predictive of incomplete aneurysm occlusion at last follow-up. Older age (more than 70 years), nonsmoking status, aneurysm location within the posterior communicating artery or posterior circulation, greater aneurysm maximal diameter (>21 mm), and shorter follow-up time (<12 months) were significantly associated with incomplete aneurysm occlusion at last angiographic follow-up.