January Journal Round-Up

Welcome to the January journal round-up! Before we begin, we are pleased to announce the BSNR Trainee Study Days will be held in Newcastle on May 10-11^th, with a focus on paediatric and spinal imaging and a mixture of lectures and workshops, modeled on the successful pre-annual meeting trainee days. Please email bsnr.traineeday@gmail.com to register your interest or for more information.

Vascular/Intervention – There is more support for extended (>6 hours) thrombectomy for proximal anterior circulation occlusions with the publication by Albers et al. in NEJM of results from the DEFUSE 3 trial. Using CT or MR perfusion and an automated imaging postprocessing system to select patients, they showed in an RCT that intervention following medical therapy up to 16 hours still conferred benefit.

Jansen et al. in Radiology went looking for other imaging correlates of response to intra-arterial therapy. They retrospectively used MR CLEAN trial data to examine whether a score based on the degree of cortical vein opacification (‘COVES’) on CT angiography could predict outcome, showing a higher mortality and no shift towards better functional outcome following intra-arterial treatment in those with a COVES (calculated looking at the superficial middle cerebral vein, vein of Labbe and the sphenoparietal sinus) of more than 0.

Neoplastic – In Practical Neurology, Larsen et al. give a timely overview of the role of imaging in the diagnosis, treatment planning and monitoring of low-grade glioma, in view of the trend towards more aggressive treatment and the changes in the 2016 WHO classification.

Leaning more towards treatment, Patibandla et al. have summarised the applications of stereotactic radiosurgery to help the neuroradiologist in the neuro-oncology MDT, with a pragmatic approach to the imaging aspects of common usages.

Inflammatory – It was all about multiple sclerosis (MS) this month, with the updated McDonald criteria published in the Lancet Neurology – key changes including the demonstration of CSF oligoclonal bands, the admissibility of symptomatic lesions in determination of dissemination in space or time, and the inclusion of cortical lesions with juxtacortical lesions. And just in the nick of time, as in the same journal a retrospective study by Filippi et al demonstrated equivalence of the 2010 McDonald criteria with the 2016 MAGNIMS criteria in predicting progression from clinically isolated syndrome, but highlighted possible areas for future development (at least one of which, the symptomatic lesions, has been incorporated into the new McDonald guidelines).

An appropriately timed overview of the current state of knowledge in MS is provided by Reich et al. in NEJM, and although the imaging aspect is limited this is a valuable and clear summary of our understanding of the complex pathophysiology of this still poorly understood disease.

A major set of differential diagnoses of MS are NMO (neuromyelitis optica)-spectrum disorders, and fortunately Garbugio Dutra et al. have published an excellent review of the history, diagnostic criteria, imaging features and differentials for these diseases.

Away from demyelination, IgG4-related disease is an increasingly diagnosed systemic disorder and its central and peripheral nervous system manifestations are outlined in a useful review by AbdelRazek et al. As it can mimic a number of other conditions, the detailed knowledge of the clinical context and systemic manifestations provided is crucial and the imaging features are also helpfully outlined.

Degenerative – Two interesting articles this month examined the diagnostic criteria for cerebral amyloid angiopathy (CAA), increasingly recognised and important in older populations (see the August round-up for more clinical context). In Stroke, Greenberg and Charidimou examine the evolution and validation of the most commonly used diagnostic criteria, the Boston criteria, and look at future directions for its development.

Conversely, Rodrigues et al. in Lancet Neurology set out to develop criteria to determine CAA as the cause for intracranial lobar haemorrhage on CT (the Edinburgh CT criteria), and found that two imaging findings, concurrent subarachnoid haemorrhage and ‘finger-like projections’ from parenchymal haemorrhage, in combination with APOE4 allele possession, had high specificity for CAA. The accompanying comment by Werring points out the need to compare these two sets of criteria and the potential strengths of both.

Paediatric – Neuroimaging is critical in the evaluation of paediatric traumatic brain injury, and a review by Mendoza et al. in Neurographics provides a useful summary of the spectrum of findings in accidental TBI, particularly paediatric-specific patterns of injury, and the emerging uses of advanced imaging in this context. In Emergency Radiology, Tang et al. examine the emergency vascular conditions seen in paediatric populations, with a focus on the importance of recognising stroke mimics.

Miscellaneous – Treatment effects are often a difficult or forgotten area and so a comprehensive review of treatment-related CNS abnormalities by Lincoln et al. in BJR is very welcome, covering the spectrum of side effects including PRES, IRIS, radiation and newer biologic agents and their specific complications.

And finally, we are constantly threatened with obliteration as radiologists by artificial intelligence and specifically deep learning. A review by Zaharchuk et al. in AJNR gives an in-depth explanation of the process by which deep learning can have useful applications in neuroradiology – but also provides hope that this will help rather than replace us!

That’s all for now, see you next month!