June Journal Round-Up

Welcome to the June neuroradiology journal round-up! Below are some of the most useful articles (in my humble opinion) for neuroradiology trainees from this month, separated into categories – do let me know of any you think should be on here!

Emergency – When it comes to emergency neuroimaging this month, the eyes have it; both Emergency Radiology and Radiographics have articles focusing on this potential ‘blind spot’ for radiologists. Thelen et al. present a concise pictorial review of post-traumatic injuries, while Nguyen et al. cover a more all-encompassing range of orbital pathologies including infection, trauma, vascular disease and inflammation. Taken together, they are a useful reminder and reference for an important review area on the emergency CT head.

Also in Emergency Radiology, a sadly ever more relevant overview of penetrating brain trauma by Vakil and Singh focuses on bullet injuries. A particularly interesting section focuses on the wound types caused by different motion of the bullet at time of impact, with implications for ongoing management and prognosis, and there is an equally important discussion of complications following these injuries.

Vascular – Intracranial vascular malformations have been a hot topic this month, with an overview of cerebral arteriovenous malformation imaging in AJR timed perfectly to coincide with a consensus statement on their management in Stroke, which provides important clinical context for neuroradiologists as well as more direct management guidance for interventionalists.

Also in Stroke, there is a comprehensive topical review of dural arteriovenous malformations by Reynolds et al., and the supplemental material contains detailed information on treatment options and outcomes.

Away from vascular malformations, an editorial in Neurology by Carrera and Wintermark examines the issue of imaging-based selection for acute stroke treatment, and essentially the utility of perfusion CT in this context, which will presumably become more and more relevant in the era of mechanical thrombectomy.

Intervention – Interventionalists will be interested to read the concise multi-organisation working group consensus guidelines for ‘Standards of Practice in Interventional Neuroradiology’ published in Neuroradiology this month. Perhaps with some relevance to these standards, in JNNP early results from a trial of clipping versus coiling of unruptured aneurysms demonstrated no difference in morbidity at one year, but an increase in neurological deficits and hospitalisation of over five days in the clipping group.

Inflammatory/Infection – The gamut of imaging findings in viral infections of the CNS can be bewildering, and a virus-by-virus breakdown in Emergency Radiology serves as a handy reference guide. Similarly, there is an expanding subset of autoimmune encephalitides, and an open access AJNR review by Kelley et al. dives into the distinguishing features and clinical importance of the different subtypes – particularly striking is the apparent prevalence of NMDA receptor encephalitis in young patients with limbic encephalitis (apparently more than any single viral aetiology in young patients, according to the California Encephalitis Project). Elsewhere, a pragmatic and worthwhile update on multiple sclerosis imaging in the BJR by Igra et al. focuses on diagnostic criteria and treatment related complications.

Degenerative – As the article by Harper et al. in JNNP points out, imaging studies in dementia rarely have pathological confirmation of dementia type, so this study of 215 pathologically confirmed people with dementia is a very valuable resource for delineating patterns of atrophy and will hopefully have practical clinical applications.

PaediatricHaverkamp et al. provide an overview and pictorial essay of paediatric spinal neoplasms in this month’s Neurographics, with useful summary differential diagnosis tables for lesions in each spinal compartment, and there is a focus on surrounding further investigations and management for each pathology.

Spine – In JNS Spine this month, Schultz et al. offer some tips for the clinicoradiological conundrum of differentiating dorsal arachnoid webs from anterior spinal cord herniation, performing a cohort study of a small number of patients with each. The most useful signs to differentiate the two were the shape of the dorsal indentation (‘scalpel-shaped’ in DAW, ‘C-shaped’ in SCH) and the presence of a preserved ventral CSF plane in DAW.

Other – Synthetic MRI is an exciting prospect, potentially allowing multiple sequences to be reconstructed from a single scan and thereby significantly reducing scan times, but its potential has not yet been fully assessed. The MAGiC prospective trial, published in AJNR, takes a significant leap in that direction, demonstrating noninferiority of multiple sequences, although currently with increased artefacts affecting T2 FLAIR. Watch this K-space!

With growing interest in the long-term effects of repeated Gadolinium agent administration, ISMRM has published a summary of the evidence along with their recommendations for clinical and research use in the Lancet Neurology – the driving point of which is that we know that gadolinium is deposited, but we do not know what the biological significance of this is as yet and further research is required.

Finally, a great excuse for medical students at the back of lecture halls everywhere – students who spent longer playing on a smartphone game performed better on a simulated interventional radiology task (renal artery cannulation) in an article in Clinical Radiology, and only in those who played for more than 5 hours a week. So that’s what all those interventionalists sitting in meetings are doing…

That’s all for now. Let me know if you find these articles helpful, and about anything else you’ve been reading this month!

 

References

1. Thelen J, Bhatt AA, Bhatt AA. Emergency orbital pathology: what the radiologist should know. Emerg Radiol. 2017 Jun 17;1–8.
2. Nguyen VD, Singh AK, Altmeyer WB, Tantiwongkosi B. Demystifying Orbital Emergencies: A Pictorial Review. RadioGraphics. 2017 Apr 21;37(3):947–62.
3. Vakil MT, Singh AK. A review of penetrating brain trauma: epidemiology, pathophysiology, imaging assessment, complications, and treatment. Emerg Radiol. 2017 Jun 1;24(3):301–9.
4. Tranvinh E, Heit JJ, Hacein-Bey L, Provenzale J, Wintermark M. Contemporary Imaging of Cerebral Arteriovenous Malformations. American Journal of Roentgenology. 2017 Mar 7;208(6):1320–30.
5. Derdeyn CP, Zipfel GJ, Albuquerque FC, Cooke DL, Feldmann E, Sheehan JP, et al. Management of Brain Arteriovenous Malformations: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2017 Jan 1;STR.0000000000000134.
6. Reynolds MR, Lanzino G, Zipfel GJ. Intracranial Dural Arteriovenous Fistulae. Stroke. 2017 May 1;48(5):1424–31.
7. Carrera E, Wintermark M. Imaging-based selection of patients for acute stroke treatment Is it ready for prime time? Neurology. 2017 Jun 13;88(24):2242–3.
8. Jansen O, Szikora I, Causin F, Brückmann H, Lobotesis K. Standards of practice in interventional neuroradiology. Neuroradiology. 2017 Jun 1;59(6):541–4.
9. Darsaut TE, Findlay JM, Magro E, Kotowski M, Roy D, Weill A, et al. Surgical clipping or endovascular coiling for unruptured intracranial aneurysms: a pragmatic randomised trial. J Neurol Neurosurg Psychiatry. 2017 Jun 20;jnnp-2016-315433.
10. Maller VV, Bathla G, Moritani T, Helton KJ. Imaging in viral infections of the central nervous system: can images speak for an acutely ill brain? Emerg Radiol. 2017 Jun 1;24(3):287–300.
11. Kelley BP, Patel SC, Marin HL, Corrigan JJ, Mitsias PD, Griffith B. Autoimmune Encephalitis: Pathophysiology and Imaging Review of an Overlooked Diagnosis. American Journal of Neuroradiology. 2017 Jun 1;38(6):1070–8.
12. Igra MS, Paling D, Wattjes MP, Connolly DJA, Hoggard N. Multiple sclerosis update: use of MRI for early diagnosis, disease monitoring and assessment of treatment related complications. BJR. 2017 Apr 26;90(1074):20160721.
13. Harper L, Bouwman F, Burton EJ, Barkhof F, Scheltens P, O’Brien JT, et al. Patterns of atrophy in pathologically confirmed dementias: a voxelwise analysis. J Neurol Neurosurg Psychiatry. 2017 May 4;jnnp-2016-314978.
14. Haverkamp BT, Nizamuddin RA, Loskutov A, Lowe LH, Adler KE. Imaging Spectrum of Pediatric Spinal Neoplasms [Internet]. 2017 [cited 2017 Jun 25]. Available from: http://asnr.publisher.ingentaconnect.com/content/asnr/ng/2017/00000007/00000003/art00001
15. Schultz R, Steven A, Wessell A, Fischbein N, Sansur CA, Gandhi D, et al. Differentiation of idiopathic spinal cord herniation from dorsal arachnoid webs on MRI and CT myelography. Journal of Neurosurgery: Spine. 2017 Mar 24;26(6):754–9.
16. Tanenbaum LN, Tsiouris AJ, Johnson AN, Naidich TP, DeLano MC, Melhem ER, et al. Synthetic MRI for Clinical Neuroimaging: Results of the Magnetic Resonance Image Compilation (MAGiC) Prospective, Multicenter, Multireader Trial. American Journal of Neuroradiology. 2017 Jun 1;38(6):1103–10.
17. Gulani V, Calamante F, Shellock FG, Kanal E, Reeder SB. Gadolinium deposition in the brain: summary of evidence and recommendations. The Lancet Neurology. 2017 Jul 1;16(7):564–70.
18. Alsafi Z, Hameed Y, Amin P, Shamsad S, Raja U, Alsafi A, et al. Assessing the effects of manual dexterity and playing computer games on catheter–wire manipulation for inexperienced operators. Clinical Radiology [Internet]. 2017 May 15 [cited 2017 Jun 25];0(0). Available from: http://www.clinicalradiologyonline.net/article/S0009-9260(17)30128-9/fulltext

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