August Journal Round-Up

Welcome to the August journal round-up. A quick reminder that there are still a few places left at time of writing for the BSNR trainee day before the annual meeting, on 11th October – info and book your place here: https://www.neuroradiology2018.com/spr-teaching-day.

Tumour – Pseudoprogression remains a difficult clinical and radiological issue, and in an article in JMRI this month, Thust et al. provide a pragmatic overview, reviewing the available evidence and diagnostic criteria and examining the role of conventional, advanced and novel imaging techniques in tackling the issue.

In European Radiology this month, Li et al. examined a cohort of central neurocytomas and other intraventricular tumours in order to determine the most useful diagnostic imaging features; they found six: the most sensitive was the ‘broad base attachment’ sign and then the ‘soap bubble’ and ‘peripheral cyst’ signs, and the most specific were the ‘scalloping sign’, ‘fluid-fluid level’ sign and the ‘gemstone’ sign.

Vascular & Intervention – The utility of vessel wall imaging is still being determined in clinical practice but with a new study in AJNR by Larsen et al. this takes a step forward, with useful radiopathological correlation. They looked at patients who had vessel wall imaging before clipping of unruptured MCA aneurysms which were then examined post exclusion, and the wall enhancement tended to correlate with pathological evidence of inflammation, which may be a step towards predicting rupture.

A systematic review in JNNP by Kaesmacher et al. set out to determine if the received wisdom about the adequacy of a TICI2b outcome in mechanical thrombectomy is supported by evidence. After examining 14 studies including 2379 patients found that TICI3 perfusions are associated with superior outcome and safety profile than TICI2b, so this should perhaps be targeted in mechanical thrombectomy.

White matter disease – Subcortical U fibres are often invoked but seem less frequently understood, so a focused review in Neurographics by Riley et al. is welcome. Covering the anatomy and normal myelination pattern before delving into pathology, this provides a useful approach to white matter disease based on the involvement of U-fibres.

Unfortunately, ethanol and methanol poisoning are a relatively common occurrence and a second useful Neurographics review by Yedavalli et al. looks at the diverse acute and chronic manifestations of both.

Distinguishing tumefactive demyelination from genuine tumour is a frequent problem in neuro-oncology MDTs and a systematic review and meta-analysis by Suh et al. in AJNR demonstrates the value of conventional MRI and the need for ongoing work on advanced imaging. Useful conventional MRI signs included open rim enhancement, a T2 hypointense rim, mild or absent mass effect, or mild perilesional oedema.

Spine ­Mauch et al. in AJNR examine another common clinical conundrum, distinguishing between benign osteoporotic and malignant vertebral compression fractures. They tailor their review to the pitfalls of different imaging techniques and examine the most useful imaging features and the role of advanced imaging.

Paediatric – The mucopolysaccharidoses are a complex group of disorders with mostly skeletal manifestations, and a review in Pediatric Radiology by Nicolas-Jilwan and AlSayed collects the relevant neuroimaging manifestations (the summary table of clinical and imaging findings in the different conditions is particularly helpful).

Also in Pediatric Radiology, D’Arco et al. provide an excellent pictorial review of paediatric posterior fossa tumours with reference to the 2016 WHO classification, with a flow chart that is invaluable for identifying tumours based on their imaging features.

That’s all for this month. Hope to see many of you at BSNR in a few weeks!

 

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