Editor’s Choices
Apparent Diffusion Coefficient Values of Middle Ear Cholesteatoma Differ from Abscess and Cholesteatoma Admixed Infection • S. Thiriat, S. Riehm,S. Kremer, E. Martin, and F. Veillon
Lately, we have seen several articles and comments in AJNR and on the AJNR Blog about the use of diffusion-weighted imaging for middle ear cholesteatoma. In this retrospective study, the authors further refined the use of the technique in this clinical situation. They analyzed the images of 15 patients with suspected acquired middle ear cholesteatomas and found they could be divided into 3 groups according to their apparent diffusion coefficient ranges. These nicely corresponded to the surgical findings as follows: patients with pure cholesteatoma, those with cholesteatoma and superimposed infection, and those with abscess or infection and no cholesteatoma. It is obvious that DWI is very useful in this setting.
Intra-Arterial Recanalization Techniques for Patients 80 Years or Older with Acute Ischemic Stroke: Pooled Analysis from 4 Prospective Studies •A.I. Qureshi, M.F.K. Suri, A.L. Georgiadis, G. Vazquez, and N.A. Janjua
The utility of revascularization in younger individuals is well established, but its utility in older (octogenarians in this case) patients is not. As our population becomes older, this question gains even more importance. The authors of this article reviewed data published previously in 4 articles. They identified 24 older patients and compared the results of revascularization with an age- and gender-matched group of younger ones. Older patients showed a risk of poor outcome 1-3 months after the procedures and increased mortality rates. Even after adjusting for other variables, older patients showed a poorer outcome than younger ones.
Acute Ischemic Infarction Defined by a Region of Multiple Hypointense Vessels on Gradient-Echo T2* MR Imaging at 3T • D. Kaya, A. Dinçer, M.E. Yildiz, M.O. Çizmeli,and C. Erzen
We all know (and probably have seen) that a clot-occluded middle cerebral artery may be hypointense on gradient-echo images. In this study, the authors took this observation further and assessed the presence of multiple hypointense blood vessels on GRE images obtained at 3T in the regions of acute infarctions. These hypointensities were identified in all 20 patients studied and the size of these regions nicely matched that of the perfusion defects as seen on MTT, TTP, and rCBF maps at 72 hours postevent in the same patients. The authors conclude that intravascular hypointensities on GRE images may be used as a supportive finding in hyperacute brain ischemia and that they provide a good volume estimate of the infarcted zone.
Fellows’ Journal Club
Diagnostic Accuracy and Yield of Multidetector CT Angiography in the Evaluation of Spontaneous Intraparenchymal Cerebral Hemorrhage • J.E. Delgado Almandoz, P.W. Schaefer, N.P. Forero, J.R. Falla, R.G. Gonzalez, and J.M. Romero
Not all intracranial hemorrhages are due to hypertension and, depending upon patient age and hematoma location, a vascular study (generally a catheter angiogram) may be needed to rule out an underlying lesion. These authors evaluated the utility of multidetector CT angiography for this purpose. From a very large group of patients who presented with hemorrhage and had CTA, they were able to identify underlying lesions in nearly 15% of their cases. They recommend that CTA may be helpful under the following circumstances: age younger than 45 years, lobar or infratentorial location, parenchymal plus intraventricular location, female gender, no known hypertension, and no impaired coagulation. CTA may obviate the more invasive catheter angiography in these patients by yielding excellent sensitivity and specificity.
Retained Surgical Sponges after Craniotomies: Imaging Appearances and Complications • A.K. Kim, E.B. Lee, L.J. Bagley, and L.A. Loevner
Although this article is just a short case report, I have included it here because fellows and residents may be the first to make or suggest a diagnosis of retained surgical sponges. Currently, most surgical sponges have radiopaque markers, but these unfortunately may not be seen on MR imaging. With time, these sponges elicit surrounding inflammation and/or infection that may simulate residual or recurrent tumor or an abscess. MR images of retained intra- and extracranial sponges in 3 patients are nicely presented in this report.
Calcifying Pseudoneoplasms of the Neuraxis: CT, MR Imaging, and Histologic Features • A.H. Aiken, H. Akgun, T. Tihan, N. Barbaro, and C. Glastonbury
Here is a new entity to be included when discussing the differential diagnosis of calcified masses arising outside or in the brain parenchyma; these pseudotumors may potentially be confused with meningiomas or vascular lesions. Although these lesions are well known to neurosurgeons and neuropathologists, neuroradiologists are less familiar with them. In this short report, the authors discuss their experience with 4 of these cases. It is suggested that these lesions represent a mesenchymal healing reaction that originates from fibroblasts. It is not clear if they grow, but those that are in the cortex or compress it may produce seizures.
