September Journal Round-Up

Welcome to the September journal round-up (with apologies for the delay). Thank you for the responses to the blogs so far, and please do get in touch with any more ideas for what you would like to see or what you would like to write! Here’s what we’ve been reading this month…

Emergency – Chilvers et al. in Clinical Radiology this month assessed their cohort of trauma cervical spine CT in order to determine the predictors on CT of ligamentous injury on MRI, as well as assessing a normal range of commonly used measurements in this context. They found that in the absence of fractures, the basion-dens interval (>10mm) and widened C0-C1 (>3mm) and C1-C2 (>6mm) facet joints were predictors of significant ligamentous injury at the craniocervical junction, and >50% subluxation of a facet joint and an obscured paraspinal fat pad were predictors in the subaxial spine.

Vascular – The appropriate initial imaging in acute stroke to allow for decisions regarding thrombectomy remains a controversial topic, and in JNIS Ryu et al. have performed a systematic review to assess the utility of perfusion imaging, finding that there is an associated increased probability of a favourable outcome particularly as it may allow inclusion of patients who would otherwise not be considered eligible.

As the treatment of stroke evolves, accurate assessment of CT imaging is paramount. Cora et al. have demonstrated the utility of a validated case archive for training general radiology trainees in the interpretation of CT angiography, showing a reduction in the major discrepancy rate and providing a framework for the case archive which can hopefully be a useful model to extend to other learner groups and topics.

Away from stroke imaging, Silvis et al. provide an excellent clinical overview of venous sinus thrombosis which contains useful context for the radiologist.

Intervention – An important study in Stroke by Achit et al. uses data from the THRACE RCT to demonstrate the cost-effectiveness of mechanical thrombectomy (in combination with intravenous thrombolysis) as opposed to intravenous thrombolysis alone.

In AJNR, Barreras et al. look into a case series of false-negative spinal angiograms, when vascular malformations have subsequently been diagnosed, and highlight important operator factors which led to the misdiagnosis, providing a checklist to avoid similar mistakes in future.

Inflammatory– Multiple sclerosis is on the agenda in AJNR this month, neatly timed ahead of the soon-to-be-unveiled latest update to the McDonald criteria. Two open access articles by McNamara et al. cover the spectrum of multiple sclerosis neuroimaging: the first covers the numerous specific agents used in treatment and the role of MRI, and the second covers pharmacovigilance/safety monitoring and MRI surveillance protocols in more detail.

Infection – Two review articles in Nature Reviews Neurology and Practical Neurology provide an overview of tuberculous meningitis. Wilkinson et al. cover the pathogenesis, clinical features, diagnostic paradigms and management in great detail whilst Shah et al. draw on their experience of patients in East London to provide specific learning points based on five case studies. Taken together they provide useful education on a sadly increasingly common problem.

Degenerative – Normal pressure hydrocephalus can be a difficult diagnosis for the radiologist to make, and Miskin et al. aimed to determine the utility of two techniques, the callosal angle and Evans index. They found that these may act as a useful screening technique to lead to dedicated volumetric imaging.

Paediatric – The risks associated with sedation in children undergoing MRI are not negligible and in Pediatric Radiology, Barkovich et al. examine ways in which the need can be minimise. Protocol rationalisation, motion and noise correction and maximizing the child’s comfort are some possible solutions outlined in this pragmatic article.

Spine – Weidauer et al. provide a comprehensive review of imaging of myelopathies, with some excellent diagrams outlining the lesion distribution within the cord for specific aetiologies, and provide a framework for the approach to these tricky clinical scenarios.

That’s all for now, do let us know what you have found helpful this month!