AJNR Blog - The Official Blog of the American Journal of Neuroradiology

Time 2021-01-10 22:08:45

Web Name: AJNR Blog - The Official Blog of the American Journal of Neuroradiology

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Mamourian A. Brain CT essentials. https://www.medmastery.comAs part of the Medmastery catalog of online medical tutorials, Dr. Mamourian has developed excellent lectures on brain CT essentials, which require approximately 3 hours of viewing time and can be split into small segments of viewing time as desired. The material can be reviewed and replayed.In this educational tool, there are 8 chapters, each of which contains multiple sections and all of which are narrated by Dr. Mamourian in a clear, unrushed manner.This video presentation covers basic anatomy/concepts in brain CT: trauma, stroke imaging, non-traumatic hemorrhage, brain tumor imaging, seizures/epilepsy, metabolic/infectious/demyelination, and skull abnormalities. Within each of these 8 categories there are a number of segments (from 3 to 6, depending on the subject matter, and each takes an average of 4 minutes to view). Overall, there are 36 segments. At the end of each category, there is a quiz with 5 questions, which covers the key points of the prior lecture. After each question, the registrants can click on the explanation given by Dr. Mamourian for the correct answer; this is particularly helpful for any question for which an incorrect answer was given. At the conclusion of the video the registrants may apply for Category 1 CME credits and a certificate is then mailed to them.Without going into each of these categories and chapters in detail, the reader of this review should be aware of the exceptional value of this educational tool. The images selected are of high quality and the MRI correlates are commonly shown, along with DSA images as needed for completeness. Embedded in each lecture are well-constructed drawings, which help the viewer better appreciate the material being presented. What the person who views this material will come away with is an understanding of the features of 1. Maigne JY, Doursounian L, Jacquot F. Classification of fractures of the coccyx from a series of 104 patients. Eur Spine J 2020;29:2534–42. Available from: https://doi.org/10.1007/s00586-019-06188-7The authors saw 1142 new consecutive patients presenting with acute or chronic coccydynia at their clinic. Among them, 104 were diagnosed with a fracture of the coccyx. The definitive diagnosis of fracture was made with the use of a standard X-ray film or a CT scan. In cases with nonunion, dynamic films were essential for studying the mobility of the broken segment.They identified three major possible mechanisms in coccyx fractures: flexion, compression and extension, each associated with certain fracture patterns. Accordingly, the patients were divided into three groups, according to the mechanism of the fracture.Flexion fractures (type 1) comprised patients with a history of external trauma—a fall or a direct blow on the sacrococcygeal junction. The fracture involved S5 or the first coccygeal vertebra (Co1), when and only when this vertebra was fused to S5, thus functionally belonging to the sacrum. The mechanism was likely a forced flexion of the lower sacrum or upper coccyx.Compression fractures (type 2) also comprised patients with a history of external trauma, but the likely mechanism was a compression of the first independent coccygeal vertebra, namely Co2 or Co1 when it was not fused to S5. The fracture line was vertical, extending from the upper to the lower end plate. Thus, they were intra articular fractures.Extension fractures (type 3) consisted in obstetrical fractures. The lower coccyx was involved. The likely mechanism was a forced extension of the coccyx occurring during the delivery.12 figures, 1 table2. Ospel JM, Menon BK, Demchuk AM, et al. Clinical course of acute ischemic stroke due to medium vessel occlusion with and without intravenous alteplase treatment. Stroke 2020;51:3232–40. Available Fellows Journal ClubConsecutive ischemic stroke and TIA admissions (COVID and non-COVID) to the authors hospital during a 10-week period from March 1 to May 10, 2020 were collected and compared with data from the same time period in 2019. Among 20 patients with COVID-19 and acute ischemic stroke, 15 (75%) had large-vessel occlusion. These patients were young (mean age, 46.5 years), male (93%), without major burden of traditional cardiovascular risk factors, and had a severe stroke presentation. Large vessel occlusions were observed in multiple vessels (40%), uncommonly affected vessels, and atypical locations with a large thrombus burden.Editor s ChoicePatients who received IV iodinated contrast in proximity ( 8 hours) to CTA/CTP as part of a separate imaging study had a much higher likelihood of core infarct underestimation with RAPID software compared with contrast-naive patients. Over-reliance on RAPID postprocessing for treatment disposition of patients with extended window emergent large-vessel occlusion should be avoided, particularly in cases with recent IV contrast administration. Fellows Journal ClubThe authors describe 10 patients (16 years of age or older) with acute necrotizing encephalopathy. In their study, bilateral thalamic involvement with the trilaminar pattern of diffusion restriction on MR imaging was the predominant finding seen in all of the patients reviewed. Ancillary findings of cerebral white matter, brain stem, and cerebellum involvement with sparing of the basal ganglia were also seen.Editor s ChoiceNeurite orientation dispersion and density imaging (NODDI) assesses microstructural features of neurites contributing to diffusion imaging signals. Twenty-one subjects with MS underwent serial enhanced MRIs including NODDI, the key metrics of which are the neurite density and orientation dispersion index. Twenty-one age- and sex-matched healthy controls underwent unenhanced MR imaging with the same protocol. NODDI is a promising tool with the potential to detect acute MS inflammation. The observed heterogeneity among lesions may correspond to gradients in severity and clinical recovery after the acute phase.Fellows Journal ClubIntradural AVF below the conus medullaris may develop either on the filum terminale or the cauda equina (lumbosacral and coccygeal radicular nerves). Only 3 detailed cauda equina AVFs have been reported in the literature. The authors present the angiographic and MR imaging findings of cauda equina and filum terminale AVF cases, supplemented with literature research to characterize the radiologic features of the 2 entities. On angiography, filum terminale AVFs were invariably supplied by the extension of the anterior spinal artery accompanied by a closely paralleling filum terminale vein. Cauda equina AVFs were fed by either a radicular or a spinal artery or both arteries, often with a characteristic wavy radicular-perimedullary draining vein.Editor s ChoiceThe authors identified all fetal MR imaging performed at their institution during a 10-year period (n = 145) and assessed agreement between prenatal prognosis and postnatal outcome. Prenatal prognosis was determined by a pediatric neurologist who reviewed the fetal MR imaging report and categorized each pregnancy as having a favorable, indeterminate, or poor prognosis. Assessment of postnatal neurodevelopmental outcome was made solely on the basis of the child s Gross Motor Function Classification System score and whether the child developed epilepsy. Postnatal outcome was categorized as favorable, intermediate, or poor. There was 93.0% agreement between prenatal and postnatal imaging diagnoses. Prognosis was favorable in 44.2%, indeterminate in 50.0%, and poor in 5.8% of pregnancies. There was 93.5% agreement between a favorable prenatal prognosis and a favorable postnatal outcome.Fellows Journal ClubUsing prospectively acquired T2-relaxometry data from 606 intervertebral discs in 101 volunteers without back pain in a narrow age range (25–35 years), the authors calculated intra- and intersubject variation in T2 times of IVDs graded by 2 neuroradiologists on the Pfirrmann scale. Intrasubject variation of IVDs was assessed relative to other healthy IVDs (Pfirrmann grade, #2) in the same individual. Multiple intersubject variability measures were calculated using healthy extraneous references ranging from a single randomly selected IVD to all healthy extraneous IVDs, without and with segmental stratification. They conclude that the study demonstrates a significantly higher variation in the T2 times of IVDs across subjects, and suggests that normative measures based on the T2 times of healthy lumbar IVDs from the same individual are likely to provide the most discriminating means of identifying degenerated IVDs on the basis of T2 relaxometry.Editor s ChoiceThis is a retrospective review of head and neck biopsies performed from January 2013 through December 2019. Clinical diagnosis and indication, patient demographics, mass location and size, biopsy needle type, technical approach, dose-length product, sedation details, complications, diagnostic histopathologic yield, and the use of iodinated contrast were recorded for each case. Twenty-seven CT-guided head and neck core needle biopsies were performed in 26 patients. The diagnostic sample rate was 100% (27/27). A concordant histopathologic diagnosis was obtained in 93% (25/27) of cases. There was a single complication of core needle biopsy, a small asymptomatic superficial hematoma.

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