July Journal Round-Up

Welcome to the July journal round-up! This month we are privileged to welcome the British Society of Head and Neck Imaging’s trainee representative, Phil Touska, who has kindly written a companion round-up for head and neck radiology. Also look out for his summary of the recent BSHNI Annual Meeting on this blog next week. But to start with, this month’s neuro…

Emergency – Two review articles published this month on very different topics both illustrate the vital importance of understanding the clinical context when interpreting imaging. Siddiqui et al. in Emergency Radiology tackle the tricky area of the craniocervical junction and associated traumatic injuries, with reference to appropriate neurosurgical management. Similarly, in AJR Reiter et al. cover normal postoperative appearances following traumatic midface fractures and associated complications, focusing on understanding the operative techniques used to maximize utility to the maxillofacial surgeons.

Vascular/Intervention Caldwell et al. in Practical Neurology have written a concise and practical summary of acute stroke imaging covering important pitfalls in interpretation and appropriate imaging pathways. Within the setting of stroke, a number of articles this month focus on areas requiring further research following the major mechanical thrombectomy trials – for example, Satti et al. performed a retrospective review of mechanical thrombectomy in a paediatric population; although good recanalization rates and clinical outcomes were demonstrated, only 29 patients were included so further work is required. Hoving et al. looked at intracranial occlusions secondary to internal carotid artery dissections, and a systematic review also demonstrated largely favourable outcomes from endovascular treatment, but noted that the studies included were mainly case reports/series so again only limited conclusions could be drawn.

Away from vascular intervention, the trials and tribulations of image-guided lumbar puncture have been on the agenda, with a pragmatic problem-solving approach in AJNR to difficult adult LPs and a guide to ultrasound-guided paediatric LPs in Pediatric Radiology.

Tumour – In JNNP this month, Voets et al. review the white matter tracts pertinent to neuro-oncology treatment, covering functional and anatomical aspects and providing a thorough overview of the relevant tracts which will act as a useful reference guide. Another area of increasing importance in neuro-oncology is radiogenomics and the molecular-radiologic correlations following the updated WHO classification, and Smits and van den Bent have provided a detailed analysis of the known imaging features of glioma subtypes in Radiology – this will become increasingly important in neuro-oncology MDTs.

Inflammatory – With the uncertainty about gadolinium deposition continuing to feature heavily in the literature, Gupta et al. have looked into other ways of imaging disease activity in multiple sclerosis without the use of contrast, performing a meta-analysis and demonstrating some promise for DTI (fractional anisotropy).

Degenerative – A large scale study from Iceland published in JAMA Neurology examined the relevance of large perivascular spaces, and found that they are associated with a significantly increased risk of vascular dementia and are a marker for small vessel disease – and thus should be reported in cognitive impairment studies in the older population. In JNNP, Gellersen et al. examined cerebellar atrophy and found in a systematic review that patterns of atrophy were useful in discriminating neurodegenerative diseases. It is also a helpful reminder of the functional anatomy and connectivity of the cerebellum.

Paediatric – Hypoxic ischaemic encephalopathy in neonates can be difficult to diagnose and prognosticate from on MRI. A study by Trivedi et al. in Pediatric Radiology validates an MRI scoring system that can be used clinically, and was shown to predict neurodevelopmental outcomes at 18-24 months. Although multiple scoring systems exist, the authors contend that this is the first to incorporate DWI and this provides at the very least a practical checklist for abnormalities to assess for in the setting of HIE.

Hacohen et al. have developed a diagnostic algorithm for CNS demyelination in children, summarising discriminating radiological and laboratory test features between different demyelinating diseases, and highlighting imaging features of MOG-related disease.

Spine – In AJR, Anderson et al. have reviewed the imaging findings in chronic adhesive arachnoiditis, providing a helpful guide to this heterogeneous but debilitating disorder.

Particularly important for centres that perform aortic intervention, Gialdini et al. have investigated the occurrence of spinal cord infarction following aortic dissection and aneurysm repair. They found an incidence of 1/130 in dissection or ruptured aneurysm repair and 1/600 in unruptured aortic repair, which is important both for the vigilance of the neuroradiologist in this setting and communication of risk by the interventionalist.

Other – Contrast agents remain hot topics and whilst we worry about gadolinium deposition, there is good news from the CT side with a systematic review and meta-analysis by Brinjikji et al. which provides nonrandomized evidence that contrast given in the setting of acute stroke (CTA/CT perfusion) is not associated with acute kidney injury even in patients with chronic kidney disease.

And finally, for all those exhausted by multiple pineal cyst referrals to MDTs, you may wish to distribute Ramji et al.’s valuable pictorial review on normal neuroanatomical variants that can be misinterpreted to your referrers (after a careful peruse yourself!).

That’s all for neuro this month, but please click here to go on to Phil’s excellent roundup for head and neck imaging…


  1. Siddiqui J, Grover PJ, Makalanda HL, Campion T, Bull J, Adams A. The spectrum of traumatic injuries at the craniocervical junction: a review of imaging findings and management. Emerg Radiol. 2017 Aug 1;24(4):377–85.
  2. Reiter MJ, Schwope RB, Theler JM. Postoperative CT of the Midfacial Skeleton After Trauma: Review of Normal Appearances and Common Complications. American Journal of Roentgenology. 2017 Jul 13;W1–11.
  3. Caldwell J, Heran MKS, McGuinness B, Barber PA. Imaging in acute ischaemic stroke: pearls and pitfalls. Practical Neurology. 2017 Jul 25;practneurol-2016-001569.
  4. Satti S, Chen J, Sivapatham T, Jayaraman M, Orbach D. Mechanical thrombectomy for pediatric acute ischemic stroke: review of the literature. Journal of NeuroInterventional Surgery. 2017 Aug 1;9(8):732–7.
  5. Hoving JW, Marquering HA, Majoie CBLM. Endovascular treatment in patients with carotid artery dissection and intracranial occlusion: a systematic review. Neuroradiology. 2017 Jul 1;59(7):641–7.
  6. Hudgins PA, Fountain AJ, Chapman PR, Shah LM. Difficult Lumbar Puncture: Pitfalls and Tips from the Trenches. American Journal of Neuroradiology. 2017 Jul 1;38(7):1276–83.
  7. Muthusami P, Robinson AJ, Shroff MM. Ultrasound guidance for difficult lumbar puncture in children: pearls and pitfalls. Pediatr Radiol. 2017 Jun 1;47(7):822–30.
  8. Voets NL, Bartsch A, Plaha P. Brain white matter fibre tracts: a review of functional neuro-oncological relevance. J Neurol Neurosurg Psychiatry. 2017 Jul 14;jnnp-2017-316170.
  9. Smits M, van den Bent MJ. Imaging Correlates of Adult Glioma Genotypes. Radiology. 2017 Jul 19;284(2):316–31.
  10. Gupta A, Al-Dasuqi K, Xia F, Askin G, Zhao Y, Delgado D, et al. The Use of Noncontrast Quantitative MRI to Detect Gadolinium-Enhancing Multiple Sclerosis Brain Lesions: A Systematic Review and Meta-Analysis. American Journal of Neuroradiology. 2017 Jul 1;38(7):1317–22.
  11. Ding J, Sigurðsson S, Jónsson PV, Eiriksdottir G, Charidimou A, Lopez OL, et al. Large Perivascular Spaces Visible on Magnetic Resonance Imaging, Cerebral Small Vessel Disease Progression, and Risk of Dementia: The Age, Gene/Environment Susceptibility–Reykjavik Study. JAMA Neurol [Internet]. 2017 Jul 17 [cited 2017 Jul 27]; Available from: http://jamanetwork.com/journals/jamaneurology/fullarticle/2643984
  12. Gellersen HM, Guo CC, O’Callaghan C, Tan RH, Sami S, Hornberger M. Cerebellar atrophy in neurodegeneration—a meta-analysis. J Neurol Neurosurg Psychiatry. 2017 May 27;jnnp-2017-315607.
  13. Trivedi SB, Vesoulis ZA, Rao R, Liao SM, Shimony JS, McKinstry RC, et al. A validated clinical MRI injury scoring system in neonatal hypoxic-ischemic encephalopathy. Pediatr Radiol. 2017 Jun 16;1–9.
  14. Hacohen Y, Mankad K, Chong WK, Barkhof F, Vincent A, Lim M, et al. Diagnostic algorithm for relapsing acquired demyelinating syndromes in children. Neurology. 2017 Jul 18;89(3):269–78.
  15. Anderson TL, Morris JM, Wald JT, Kotsenas AL. Imaging Appearance of Advanced Chronic Adhesive Arachnoiditis: A Retrospective Review. American Journal of Roentgenology. 2017 Jun 22;1–8.
  16. Gialdini G, Parikh NS, Chatterjee A, Lerario MP, Kamel H, Schneider DB, et al. Rates of Spinal Cord Infarction After Repair of Aortic Aneurysm or Dissection. Stroke. 2017 Jan 1;STROKEAHA.117.017071.
  17. Brinjikji W, Demchuk AM, Murad MH, Rabinstein AA, McDonald RJ, McDonald JS, et al. Neurons Over Nephrons. Stroke. 2017 Jul 1;48(7):1862–8.
  18. Ramji S, Touska P, Rich P, MacKinnon AD. Normal neuroanatomical variants that may be misinterpreted as disease entities. Clinical Radiology [Internet]. 2017 Jul 23 [cited 2017 Jul 27];0(0). Available from: http://www.clinicalradiologyonline.net/article/S0009-9260(17)30348-3/fulltext


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