Editor’s Choices

Have Referral Patterns for Vertebroplasty Changed since Publication of the Placebo-Controlled Trials? • M.T. Luetmer and D.F. Kallmes
Here is an article analyzing some of the consequences of the 2 famous (infamous?) randomized vertebroplasty trials published in the New England Journal of Medicine in August 2009. Curiously, it is by some of the same authors. They looked at monthly referral patterns for nearly 1200 patients during a 6-year period extending from 2004 to 2010. Although this article represents the experience of only 1 institution, the number of vertebroplasties dropped from 18 to 11 per month after August 2009. The percentage of patients who underwent the procedure increased slightly, meaning that perhaps patient selection has also changed. The authors concluded that the number of vertebroplasty referrals to the Mayo Clinic decreased significantly since the publication of INVEST and the Australian Trial, yet they continue to offer the procedure to a high proportion of referred patients.

Hippocampal Shape Deformation in Female Patients with Unremitting Major Depressive Disorder • W.S. Tae, S.S. Kim, K.U. Lee, E.C. Nam, J.W. Choi, and J.I. Park
Although the fact is that hippocampal atrophy occurs in patients with major depression, shape contractions also happen but have been found to be inconsistent. Here, the authors used shape analysis to study the hippocampi in 21 women with major depression and 21 control subjects. Both hippocampi were small in patients compared with controls. Regional shape contractions were found in the ambient gyrus, basal hippocampal head, posterior subiculum, and dorsal hippocampus of the left hemisphere. The right hippocampus showed a similar pattern but was less atrophic compared with the left hippocampus. The authors concluded that atrophy and regional shape contractions in the hippocampi of patients with major depression were more dominant on the left side. The causes of hippocampal damage could be hypersecretion of glucocorticoids contributing to neuronal death or the failure of adult neurogenesis in the dentate gyrus.

Association of Olfactory Bulb Volume and Olfactory Sulcus Depth with Olfactory Function in Patients with Parkinson Disease • J. Wang, H. You, J.-F. Liu, D.-F. Ni, Z.-X. Zhang, and J. Guan
Before reading this article, I did not know that olfactory problems are as common as tremor in patients with Parkinson disease (70-90%). After rigidity/akinesia, olfactory dysfunction is the second most common symptom. Actually, Parkinson disease may be an olfactory disorder! Lewy bodies and subsequent atrophy happen initially in the olfactory bulbs and entorhinal cortex. The authors looked at olfactory bulb volume and depth of the olfactory sulci, correlated their findings with olfactometric tests, and compared their 20 patients with healthy controls. Abnormal volumes, depths, and olfaction tests were present in all patients with Parkinson disease but not in the controls. Their results provide evidence that early olfactory dysfunction in patients with Parkinson disease may be a primary consequence of damage to the olfactory bulb. Neuroimaging of olfactory structures together with the assessment of olfactory function may be used to identify patients with Parkinson disease.

Fellows’ Journal Club

Frequency and Location of Dilated Virchow-Robin Spaces in Elderly People: A Population-Based 3D MR Imaging Study • Y.-C. Zhu, C. Dufouil, B. Mazoyer, A. Soumaré, F. Ricolfi, C. Tzourio, and H. Chabriat
More about the perivascular spaces…where exactly are they located in older folks? We have come to accept the fact that as we get older, we have more of these and that patients with cerebrovascular disease also have more PVS. The authors used 3T and T1-weighted images from nearly 2000 individuals to evaluate the PVS. Dilated PVS were seen in the basal ganglia and white matter in all subjects and correlated with advancing age. Dilated PVS in the basal ganglia were more common in men. Large PVS were seen in one-third of individuals. Conclusion: dilated PVS were always detected in the basal ganglia or white matter in elderly people, and large PVS were also prevalent.

Carotid Artery Stenting without Angioplasty and Cerebral Protection: A Single-Center Experience with up to 7 Years’ Follow-Up • S. Baldi, T. Zander, M. Rabellino, G. González, and M. Maynar
When stenting a carotid artery there are options: performing angioplasty simultaneously and/or protecting the brain with specific distal devices. Do these 2 options make a difference in a patient’s outcome? Here, the authors prospectively identified 255 patients with symptomatic stenoses and/or high-risk morphology plaques and performed neurologic and carotid sonography before the procedure and at 1, 3, 6, and 12 months thereafter. The technique was successful in 99% of patients and complications were few, with 2 strokes (only 1 was disabling) and 1 transient ischemic attack. Nineteen patients re-stenosed and had to undergo angioplasties in follow-up sessions. The authors concluded that carotid stenting without angioplasty and protection is effective and safe with few complications and satisfactory clinical results.

Prediction of Disease-Free Survival in Patients with Squamous Cell Carcinomas of the Head and Neck Using Dynamic Contrast-Enhanced MR Imaging • S. Chawla, S. Kim, L.A. Loevner, W.-T. Hwang, G. Weinstein, A. Chalian, H. Quon, and H. Poptani
This article attempts to employ Ktrans obtained from dynamic contrast-enhanced MR studies as a biomarker to establish prognosis in patients with squamous cell carcinomas of the head and neck. The authors measured the period of disease-free survival in 57 patients from the end date of chemoradiation therapy (either death or last clinical visit were taken as end points). Pretreatment Ktrans and nodal volume were computed from the largest metastatic node, and median pretreatment Ktrans and volume were used to divide patients into 2 groups. Thirteen of 57 patients had died by the last follow-up. Patients with higher pretreatment Ktrans values had prolonged disease-free survival compared with patients with lower Ktrans values. However, there was no significant difference in disease-free survival when nodal volume was used as a predictor. The conclusion: pretreatment Ktrans may be a useful prognostic marker in head and neck SCC.