Editor’s Choices
Angiographic and Clinical Outcomes in 200 Consecutive Patients with Cerebral Aneurysm Treated with Hydrogel-Coated Coils • T. Gunnarsson, F.C. Tong, P. Klurfan, C.M. Cawley, and J.E. Dion
Because this issue features interventional content, here is another related article. Hydrophilic coated coils absorb fluid and expand inside an aneurysm, theoretically leading to better packing and lower recanalization rates. The authors retrospectively studied their immediate and intermediate term results using HydroCoils in the treatment of 200 consecutive aneurysms. They also looked into complications. Initially, they were able to obliterate about one-half of small and large aneurysms. At 16 months, recanalization was present in 18% of small and 29% of large aneurysms. Periprocedural adverse effects were seen in 6% of patients. The authors concluded that first-generation hydrophilic coils performed at least as well as bare platinum ones.
Treatment of Stenoses of Vertebral Artery Origin Using Short Drug-Eluting Coronary Stents: Improved Follow-Up Results • Z. Vajda, E. Miloslavski, T. Güthe, S. Fischer, G. Albes, A. Heuschmid, and H. Henkes
With this article, we continue our emphasis on interventional treatment. Stenoses at the vertebral artery origin seem to be different than carotid ones and are known to respond immediately and very favorably to stent insertion. Unfortunately, the long-term results are not that great. These investigators used drug-eluting coronary stents for this purpose with the idea that they may improve long-term results. Thus, they treated 48 patients who were thereafter anticoagulated. They were able to immediately reduce the degree of the stenoses about 4-fold and at a 7-month follow-up only 12% of patients were judged to have significant recurrent narrowings. Conclusion: these special stents are safe and do a good job in maintaining a midterm patency rate.
Anisotropic Diffusion Properties in Infants with Hydrocephalus: A Diffusion Tensor Imaging Study • W. Yuan, F.T. Mangano, E.L. Air, S.K. Holland, B.V. Jones, M. Altaye, and K. Bierbrauer
Here the authors seek to determine the effect of ventricular dilation upon adjacent white matter using diffusion tensor imaging. For their study, they retrospectively assessed DTI studies in 17 children with hydrocephalus and compared them with 17 similar controls. They obtained measurements in 5 white matter regions plus the callosum and internal capsules. Abnormal metrics were obtained in hydrocephalic subjects in most white matter regions interrogated, in the callosum, and to a lesser extent in the internal capsules. They concluded that hydrocephalus leads to abnormalities in most of the white matter examined.
Fellows’ Journal Club
Diffusion Tensor Imaging of the Subcortical Auditory Tract in Subjects with Congenital Cochlear Nerve Deficiency • C.-M. Wu, S.-H. Ng, J.-J. Wang, and T.-C. Liu
If your cochlear nerve is absent, do you still have the normal intracerebral connections for the auditory pathway? This is the question asked by this group of investigators. They used DTI at 3T in 12 patients with unilateral absent cochlear nerve and in 12 controls. Then they measured fractional anisotropy and mean diffusivity at different points along the auditory pathways in both groups. Preserved axial diffusion bilaterally in patients implies that the tracts are present, but the fact that bilaterally they had low FA and high MD (when compared to controls) suggests that these tracts are not normal but have axonal loss and/or demyelination.
Is CT Still Useful in the Study Protocol of Retinoblastoma? • P. Galluzzi, T. Hadjistilianou, A. Cerase, S. De Francesco, P. Toti, and C. Venturi
Exposure to radiation from CT has received considerable attention lately and it is very important in children, especially if multiple studies are contemplated. CT has been used traditionally for the diagnosis of retinoblastoma because of the lesion’s intrinsic calcium. The authors retrospectively analyzed a gamut of different MR sequences and correlated their findings with those of CT, clinical examination, and histology (in some cases sonography, too) in 28 tumors. The best techniques to detect calcium were US and CT (about 95% each), but MR was close behind (nearly 90%). If you combine the clinical and MR data, no calcifications were missed and thus MR imaging works well for the diagnosis of retinoblastoma, saving patients radiation exposure.
Evaluation of the Occlusion Status of Coiled Intracranial Aneurysms with MR Angiography at 3T: Is Contrast Enhancement Necessary? • M.E.S. Sprengers, J.D. Schaafsma, W.J. van Rooij, R. van den Berg, G.J.E. Rinkel, E.M. Akkerman, S.P. Ferns, and C.B.L.M. Majoie
Wouldn’t it be great to avoid doing catheter angiograms in post-coiled aneurysms? MR angiography at 3T is exquisite and the authors sought to determine if adding gadolinium to this technique further improves the detection of residual lesion lumen. Six months after coiling, they examined 72 aneurysms using time-of-flight MRA before and after contrast administration. The correlation of both MRA techniques with angiography was good and both showed similar results. Interobserver agreement was excellent. Thus, noncontrast MRA suffices for this purpose. (For controversies regarding this issue, read the Opinion and Counterpoint articles found in this issue in the Research Perspectives section.)
