March Journal Round-Up

Welcome to the March journal round-up!

Trauma – Blunt cerebrovascular injury presents a significant clinical and radiological problem, as it can be very difficult to detect but screening all patients risks overutilization of limited resources and potential overdiagnosis. Two articles this month tackle this issue – a concise review by Nagpal et al. in AJNR compares the available diagnostic criteria and grading scales, whilst Rutman et al. in Radiographics provide a more comprehensive pictorial review with a focus on explaining the underlying pathophysiology.

Another common pathology associated with blunt trauma, thoracolumbar spine injury, is the subject of a review by Bonfante et al. in Neurographics, who discuss the pathology and biomechanics of injury to this region, compare the available classification systems for the injuries and discuss the clinical utility of these systems. This is a useful reference for anyone reporting trauma studies.

Vascular – Last month we included the ASNR’s guidance on vessel wall imaging. This month Pinho et al. in Neurographics give us a practical guide to vessel wall imaging, covering technical guidance on optimising imaging protocols and normal and abnormal findings. Potential expanded roles for vessel wall imaging are covered in two further articles this month – Dlamini et al. examine the application in paediatric stroke, and Lehman et al. in JNS review its use in aneurysm imaging (table 1 is an excellent reference guide to the findings in different types of aneurysm).

With the increasing use of T2* and susceptibility weighted imaging as well as higher field strengths, microhaemorrhages are being detected with greater frequency and it can be difficult to determine their significance. Haller et al. in Radiology provide a clear and relevant review that covers their detection, radiological-pathological correlation and their significance to multiple disease processes, as well as normal ageing.

Intervention – Two studies this month provided further evidence for the potential to extend the role of mechanical thrombectomy beyond large vessel occlusion within 6 hours of symptom onset. Following encouraging evidence from prospective trials, a retrospective study by Bucke et al. looked at the outcomes of patients with wake up strokes and strokes of uncertain daytime onset time in comparison to their ‘control’ cohort of within-time mechanical thrombectomy, and showed equivalence of the outcomes of the wake-up stroke cohort with controls and also a benefit related to the use of advanced imaging (i.e. MRI and CT perfusion). Haussen et al. used two prospective registries to compare mechanical thrombectomy with medical treatment alone in patients with mild symptoms (NIHSS </=5), and demonstrated a benefit in discharge NIHSS for mechanical thrombectomy.

Inflammatory – A review in Nature Reviews Neurology by Geraldes et al. should be required reading for neuroradiology trainees – the MAGNIMS study group reconvened to update their ‘red flags’, radiological signs that should alert the radiologist against a diagnosis of multiple sclerosis in the presence of white matter lesions. Given the prevalence of nonspecific white matter lesions in neuroradiology practice, this remains a frequent problem and their mnemonic ‘MIMICS’ is valuable to remember pointers towards other causes.

One aspect the authors of the above review touch upon is the central vein sign (veins running within the centre of white matter lesions), a presumed biomarker to distinguish MS from other causes of white matter lesions, which has been around for a while but has gained traction more recently with a publication by NAIMS on its evolution and use in 2016. An editorial in Neurology this week by Miller suggests this sign is ready for clinical use, expanding on an article by Cortese et al. demonstrating the sign’s value in distinguishing between MS and NMO spectrum disorders.

Paediatric – An article in AJR by Orru et al. provides a simple and effective approach to the assessment of the child with macrocephaly, with suggested imaging protocols and a pictorial review of common and less common causes.

Miscellaneous – Finally, a fascinating article by Reicher et al. in BJR examines the working practice of UK neuroradiologists and asks what we can learn from the aviation industry, specifically air traffic controllers who perform a qualitatively similar job, and cognitive science about how to improve it. The discrepancy between working practices as described by surveys conducted of the two professions and its potential impact on performance makes for thought-provoking reading!

That’s all for this month. As ever, let us know if there’s anything important we’ve missed, and have a good month!