3D Pseudocontinuous Arterial Spin-Labeling MR Imaging in the Preoperative Evaluation of Gliomas

Editor’s Choice

Fifty-eight patients with pathologically confirmed gliomas underwent preoperative 3D pseudocontinuous arterial spin-labeling and ROC curves were generated for parameters to distinguish high-grade from low-grade gliomas. Both maximum CBF and maximum relative CBF were significantly higher in high-grade than in low-grade gliomas. After adjustment for age, a higher maximum CBF and higher maximum relative CBF were associated with worse progression-free survival.

Journal Scan – This Month in Other Journals, October 2017

Horn A, Reich M, Vorwerk J, et al. Connectivity Predicts deep brain stimulation outcome in Parkinson disease. Ann Neurol. 2017;82(1):67-78. doi:10.1002/ana.24974.

The benefit of deep brain stimulation (DBS) for Parkinson disease (PD) may depend on connectivity between the stimulation site and other brain regions, but which regions and whether connectivity can predict outcome in patients remain unknown. The authors attempted to identify the structural and functional connectivity profile of effective DBS to the subthalamic nucleus (STN) and test its ability to predict outcome.

The authors utilized a training dataset of 51 PD patients with subthalamic nucleus DBS which was combined with publicly available human connectome data (diffusion tractography and resting state functional connectivity) to identify connections reliably associated with clinical improvement (motor score of the Unified Parkinson Disease Rating Scale [UPDRS]). This connectivity profile was then used to predict outcome in an independent cohort of 44 patients. Resting state functional connectivity data was obtained on 1,000 healthy subjects using a 3T Siemens (Erlangen, Germany) MRI, part of the Brain Genomics Superstruct Project (https://dataverse.harvard.edu/dataverse/GSP). MRI data from 90 patients were obtained from the Parkinson’s Progression Markers Initiative (PPMI) database.  Scanning parameters can be found on the project website (www.ppmi-info.orgz). In the training dataset, connectivity between the DBS electrode and a distributed network of brain regions correlated with clinical response including structural connectivity to supplementary motor area and functional anticorrelation to primary motor cortex. This same connectivity profile predicted response in an independent patient cohort.

The authors cite four main conclusions: 1) a specific pattern of structural and functional connectivity with subthalamic nucleus DBS electrodes correlates with clinical outcome across patients in PD. 2) structural and functional connectivity are independent predictors of DBS response. 3) connectivity profiles derived from one patient cohort can predict clinical outcome …

Hippocampal and Deep Gray Matter Nuclei Atrophy Is Relevant for Explaining Cognitive Impairment in MS: A Multicenter Study

Editor’s Choice

Brain dual-echo, 3D T1-weighted, and double inversion recovery scans were acquired at 3T from 62 patients with relapsing-remitting MS and 65 controls. Focal WM and cortical lesions were identified, and volumetric measures from WM, cortical GM, the hippocampus, and deep GM nuclei were obtained. Compared with those with who were cognitively preserved, patients with MS with cognitive impairment had higher T2 and T1 lesion volumes and a trend toward a higher number of cortical lesions. Significant brain, cortical GM, hippocampal, deep GM nuclei, and WM atrophy was found in patients with MS with cognitive impairment versus those who were cognitively preserved. The authors conclude that hippocampal and deep GM nuclei atrophy are key factors associated with cognitive impairment in MS.

The American Society of Head and Neck Radiology Presents 2017 Gold Medal to Edward E. Kassel, M.D., FACR


The American Society of Head and Neck Radiology Presents 2017 Gold Medal to Edward E. Kassel, M.D., FACR during 51st Annual Meeting

Edward E. Kassel, M.D., FACR
Edward E. Kassel, M.D., FACR

The American Society of Head and Neck Radiology (ASHNR) awarded its 2017 Gold Medal to Edward E. Kassel, M.D., FACR during the Gold Medal Award Luncheon on September 18, 2017 during the ASHNR 51stAnnual Meeting at Caesars Palace in Las Vegas, Nevada, September 16-20, 2017.

The ASHNR Gold Medal is presented annually to a member who has provided dedicated service to the Society, and to the science and education of head and neck radiology.  Dr. Kassel became the twenty-first recipient of the ASHNR Gold Medal since the Awards inception in 2000.

Dr. Kassel obtained his DDS from the University of Toronto’s Faculty of Dentistry and his MD at the University of Western Ontario. He completed his post-graduate training in Medical Imaging at U of T in 1977. He was an attending neuroradiologist at Sunnybrook Health Sciences Centre (1977- 1992), Radiologist-in-Chief at Mount Sinai Hospital (1992-1996) and the attending neuroradiologist in the University Health Network/Mount Sinai Hospital Joint Department of Medical Imaging (1997-2014).  Dr. Kassel served as 2008-2009 ASHNR President.

For more information on the ASHNR Gold Medal, or the Society in general, contact Business Manager Ken Cammarata at ASHNR, 800 Enterprise Drive, Suite 205, Oak Brook, IL 60523-4216, Phone: 630-574-0220, ext. 226, Fax: 630-574-0661, Email: kcammarata@asnr.org, Website: www.ashnr.org.…

Analysis of 30 Spinal Angiograms Falsely Reported as Normal in 18 Patients with Subsequently Documented Spinal Vascular Malformations

Fellows’ Journal Club

Eighteen patients with 19 lesions underwent a total of 30 negative spinal angiograms. The lesions included 9 epidural arteriovenous fistulas, 8 dural arteriovenous fistulas, and 2 perimedullary arteriovenous fistulas. Seventeen patients underwent endovascular (11) or surgical (6) treatment, with a delay ranging between 1 week and 32 months; the Aminoff-Logue score improved in 76.5%. Causes of the inadequate results included: 1) lesion angiographically documented but not identified (55.6%); 2) region of interest not documented (29.6%); or 3) level investigated but injection technically inadequate (14.8%). All the angiograms falsely reported as normal were caused by correctible, operator-dependent factors.

Identification and Quantitative Assessment of Different Components of Intracranial Atherosclerotic Plaque by Ex Vivo 3T High-Resolution Multicontrast MRI

Editor’s Choice

Fifty-three intracranial arterial specimens with atherosclerotic plaques from 20 cadavers were imaged by 3T MR with T1, T2, and proton-density–weighted FSE and STIR sequences. The signal characteristics and areas of fibrous cap, lipid core, calcification, fibrous tissue, and healthy vessel wall were recorded on MR images and compared with histology. The signal intensity of the lipid core was significantly lower than that of the fibrous cap on T2-weighted, proton-density, and STIR sequences and was comparable on T1-weighted sequences. Optimal contrast between the lipid core and fibrous cap was found on T2-weighted images. Ex vivo 3T MR imaging can accurately identify and quantitatively assess intracranial atherosclerotic plaque components, providing a direct reference for in vivo intracranial plaque imaging.

PET/CT in Cancer: An Interdisciplinary Approach to Individualized Imaging

Beheshti M, Langsteger W, Rezaee A, eds. PET/CT in Cancer: An Interdisciplinary Approach to Individualized Imaging. Elsevier; 2017; 276 pp; $99.99

Cover of Beheshti

PET/CT in Cancer: An Interdisciplinary Approach to Individualized Imaging is a comprehensive book focused on the role of PET/CT in cancer staging and the assessment of therapeutic response to individualized treatments. The book uses a multidisciplinary approach, with contributions from 16 specialists in nuclear medicine, radiology, medical oncology, radiation oncology, surgical oncology, and clinical oncology. These contributors detail research from leading comprehensive cancer centers in Europe and North America.

The book is organized into 12 different chapters, each of which is focused on a different cancer type (eg, head and neck, lung, breast, gastroesophageal, colorectal, hepatobiliary, gynecologic, prostate, melanoma, lymphoma, gastroenteropancreatic neuroendocrine neoplasms, and brain tumors). Each chapter is subdivided into different sections covering important clinical information about the cancer type, staging classifications, indications for PET/CT according to major clinical guidelines, evidence-based recommendations, and clinical points of view about each topic. The multidisciplinary approach is evident in each chapter, with a discussion section about the role of PET/CT in staging and evaluating the response to antineoplastic treatment and its prognostic value.

Each chapter includes a brief outline of diagnostic pitfalls of PET/CT imaging, including potential causes of false-positive and false-negative findings. At the end of each chapter, there are teaching cases that highlight the strengths and limitations of PET/CT in clinical scenarios, along with pertinent teaching points for accurate image interpretation and pitfalls for each individual radiotracer. Some chapters also discuss the clinical application of radiotracers beyond fludeoxyglucose (FDG).

Overall, the chapters are well-organized and concise, and they incorporate comprehensive reviews of the literature with up-to-date citations from scholarly publications. The chapters are supplemented with tables and bullet point outlines to emphasize certain topics and allow for quick …

Influence of Carotid Siphon Anatomy on Brain Aneurysm Presentation

Fellows’ Journal Club

Lateral view DSA images of 692 consecutive patients with intracranial aneurysms treated at the authors’ institution were reviewed and had their angles measured. Data on the location, presentation, and size of the lesions were collected and evaluated by multivariate analysis in relation to the measured angles. Multivariate analysis showed an association between angles of >15.40° and rupture (P = .005), postsiphon location (P = .034), and aneurysm size of >1.001 mm (P = .015). These findings may be associated with the hemodynamic interactions of blood flow and the curvature of the carotid siphon.

Amide Proton Transfer Imaging Allows Detection of Glioma Grades and Tumor Proliferation: Comparison with Ki-67 Expression and Proton MR Spectroscopy Imaging

Editor’s Choice

Amide proton transfer–weighted imaging (APTWI) is a novel molecular MR imaging technique developed to detect and quantitatively visualize endogenous proteins and peptides. APTWI is usually reported in terms of asymmetry in the magnetization transfer ratio at 3.5 ppm. This study included 42 patients with low-grade (n = 28) or high-grade (n = 14) glioma, all of whom underwent conventional MR imaging, proton MR spectroscopy imaging, and amide proton transfer–weighted imaging on the same 3T scanner within 2 weeks before surgery. The asymmetric magnetization transfer ratio at 3.5 ppm values measured by different readers showed good concordance and were significantly higher in high-grade gliomas than in low-grade gliomas, with sensitivity and specificity values of 92.9% and 71.4%, respectively, at a cutoff value of 2.93%. The asymmetric magnetization transfer ratio at 3.5 ppm may serve as a potential biomarker not only for assessing proliferation, but also for predicting histopathologic grades in gliomas.