October Journal Round-Up

Welcome to the October journal round-up!

Vascular – Mokin et al. tackle the issue of ASPECTS subjectivity in an interesting article in Stroke this month, using Hounsfield unit measurements (as a ratio and subtraction with the unaffected side) to provide a more objective measure and pave the way for automated image interpretation. This would hopefully standardise and speed up management decisions in thrombectomy, but requires validating in more extensive datasets.

Also considering automated assessments, Hanning et al. developed an automated segmentation and analysis of white matter lesion density on CT and showed a reasonable correlation with subsequent MRI white matter lesion load, which they felt may also lead to more rapid treatment decisions in acute stroke.

Baradaran et al. in AJNR performed a systematic review looking at high-risk features of carotid plaque on CTA, finding that the presence of soft plaque, plaque ulceration and increased carotid wall thickness correlated with ipsilateral ischaemia, whilst plaque calcification had a negative relationship with ischaemia.

Intervention – Two important studies in JNIS this month are again focused on thrombectomy. Frei et al. share their experience of using a standardized thrombectomy protocol (from pre-hospital to IR suite), and show a significant reduction in door to recanalization time. Alondo de Lecinana et al. describe the results of a prospective observational study showing that mechanical thrombectomy is safe and should be performed in patients with contraindication to intravenous thrombolysis.

Tumour – In Neurographics this month, there is a focus on glioma with reference to the 2016 WHO tumour classification (available here). A two-part review by Arevalo et al. in the first part gives an overview of basic tumour genetics covering significant mutations and the updated classification of gliomas, and in the second focuses on imaging features associated with the IDH mutant and wild type (see also the July blog and the review by Smits et al.).

Also with reference to the updated classification, a case series by Nunes et al. in AJNR examines the recently reported entity of a multinodular and vacuolating neuronal tumour, which is a ‘don’t touch’ lesion, and its imaging characteristics.

Inflammatory – Double inversion recovery remains a potentially powerful tool in MS imaging, and Eichinger and colleagues in AJNR have investigated a pre and post contrast and subtraction protocol to compare it to T1 weighted imaging. They demonstrate that DIR is more sensitive in detecting enhancing lesions, and suggest it as an alternative to T1 imaging.

Degenerative – Structural MRI can be of limited use in the setting of motor neuron disease, although volumetric MRI can demonstrate areas of parenchymal loss. Senda and colleagues looked at whether imaging characteristics (volume and DTI) could predict progression in motor neuron disease. They showed that atrophy and particularly grey matter loss, and a decrease in fractional anisotropy, in specific areas beyond just the corticospinal tract correlated with an increased rate of clinical disease progression.

Spine – Cardenas et al. provide a useful and comprehensive pictorial review of pathologies of the conus medullaris and cauda equine in Neurographics, covering the spectrum of congenital, infectious/inflammatory, vascular, traumatic and neoplastic aetiologies.

Paediatrics – There is a focus on the rare Menkes disease in AJNR, with a two part review focusing on the vascular/white matter and grey matter changes in this progressive disorder. The authors compare their own case series with the literature for every imaging finding, which makes for a definitive review of this disorder although may be mainly relevant to specialist centres.

More common in everyday practice is the pineal cyst, and Jussila et al. followed up their cohort of pineal cysts in children and showed that the majority do not change, and suggest only re-imaging in the context of unusual radiological features or clinical symptoms.

Although we hope that it will not become necessary in the UK, there is a focused pictorial review in Radiographics this month demonstrating the pre- and postnatal imaging features of Zika virus in the brain covering sonographic and MR findings, and important differential diagnoses.

Miscellaneous – The debate about the use of gadolinium based contrast agents continues, and it is important as radiologists to be informed as to the mechanisms of action being uncovered. A useful review in BJR by the group that initially reported gadolinium deposition in the brain goes through our current knowledge of the mechanisms of gadolinium deposition, and in particular the role of the relatively newly-investigated glymphatic system.

And finally, just in case you wanted another differential for those nonspecific white matter lesions, in Neurology this month Alperin et al. discuss the findings of increased periventricular white matter lesions in returning astronauts. They do not say how often this history was mentioned in the clinical details.

That’s all for now – let us know what you’ve found useful this month!