July Journal Round-Up

Welcome to the July journal round-up! A reminder that registration for the BSNR annual meeting and SpR trainee day remains open, visit www.neuroradiology2018.com to register. 

Intervention – The management of tandem occlusions, where an intracranial arterial occlusion coincides with an extracranial internal carotid artery occlusion, is controversial and can be challenging. In JNIS this month, Wilson et al. designed a systematic review and meta-analysis to address this, comparing extracranial and intracranial first approaches as well as stenting versus angioplasty. They found, having included 33 studies, that there was no difference in outcome between these groups and just under half of patients with tandem occlusions had good neurological outcomes.

Paraspinal arteriovenous fistula are a complex entity and multiple classification systems have been proposed. Wendl et al. in BJR review the literature and their own case series in order to develop a clinically useful system, and the article functions as a review of the different subtypes and available treatment options.

Neoplastic – An interesting case series in Neurology Clinical Practice by Dhamija et al. reviews their centre’s experience of neuroradiological findings in Cowden syndrome, stressing that it is not only Lhermitte-Duclos that is found in these patients, and suggesting broadening of the diagnostic criteria to include more neuroimaging abnormalities.

Inflammatory/Infective – With the ongoing concern about gadolinium administration, particularly in those undergoing multiple repeat scans, Karimian-Jazi et al.’s investigation of the utility of gadolinium in multiple sclerosis follow-up is timely. They found that if T2 lesion load is stable, the chance of their being an enhancing lesion is extremely low and not administering gadolinium could therefore be considered.

Tyler in NEJM has written a concise review of acute viral encephalitis, which is clinically focussed and provides valuable context when reporting MRI in these cases.

Degenerative – Nuclear imaging has an expanding role in the evaluation of dementia, and the review of PET/CT in dementia by Zukotynski et al. in AJR is a helpful overview, discussing the findings in specific pathologies but also the role for newer tracers and future directions for clinical evaluation.

Spine – Brucellar spondylodiscitis is a rare entity but clinically important because it mimics tuberculous infection. Liu et al. in Academic Radiology looked at their own case series to determine if their were useful distinguishing features on imaging, finding that the use of fat-saturated T2 imaging showed uniform increased signal intensity across the whole vertebra in brucellar infection compared to heterogeneous partial involvement in tuberculosis.

Kunam et al. in Radiographics have produced an excellent review of incomplete spinal cord syndromes, including an accessible overview of relevant anatomy and the imaging findings of the specific syndromes.

And in Insights into Imaging, Moghaddam and Bhatt provide a framework for a systematic approach to evaluating intramedullary cord lesions, focusing on the location, length and enhancement pattern of the lesion in order to correctly classify it.

Paediatric – A consensus statement in Pediatric Radiology by Choudhary et al. aims to provide guidance for both doctors and the courts on the correct interpretation of findings in the setting of abusive head trauma. This is compulsory reading for anyone involved in these cases, giving a practical overview of the process of diagnosis and the many pitfalls involved, and the sources of misunderstanding or misinformation that cause problems in court.

Interpretation of neuroimaging in the context of haematopoietic stem cell transplantation can be difficult due to the myriad potential neurological complications. Bonardi et al.’s review in Radiographics provides clinical context, outlines the categories of complication and highlights the importance of understanding the treatment timeline and the patient’s current immune status as this changes the imaging appearances.

That’s all for this month, let us know if there’s anything you think we’ve missed and see you next month!