Editor’s Choices
Intra- and Extraluminal Structural and Functional Venous Anomalies in Multiple Sclerosis, as Evidenced by 2 Noninvasive Imaging Techniques • K. Dolic, K. Marr, V. Valnarov, M.G. Dwyer, E. Carl, Y. Karmon, C. Kennedy, C. Brooks, C. Kilanowski, K. Hunt, A.H. Siddiqui, D. Hojnacki, B. Weinstock-Guttman, and R. Zivadinov
Here is another article that should add to the controversy over the relationship between MS and venous anomalies. The authors assessed the utility of sonography and MRV (2 different techniques) for detecting intra- and extraluminal venous abnormalities in 150 patients with MS and 63 matched controls. Results were as follows: patients with MS had significantly more intraluminal and structural abnormalities than controls and patients with progressive MS had more extraluminal and flow abnormalities than those with nonprogressive disease.
Hospitalization Costs for Endovascular and Surgical Treatment of Unruptured Cerebral Aneurysms in the United States Are Substantially Higher Than Medicare Payments • W. Brinjikji, D.F. Kallmes, G. Lanzino, and H.J. Cloft
Aneurysm clipping is associated with longer hospital stays and higher total charges. Because coiling of aneurysms has become routine, it is important to know how much we are getting paid for these 2 procedures. For uncomplicated treatments, the average Medicare payment for clipping and coiling was 49% and 53%, respectively. For patients with major complications, the average percentage payments decreased to 34% and 41% for coiling and clipping, respectively. Therefore, hospitalization costs for patients undergoing clipping and coiling of unruptured cerebral aneurysms are substantially higher than Medicare payments.
Idiopathic Thoracic Spinal Cord Herniation: Retrospective Analysis Supporting a Mechanism of Diskogenic Dural Injury and Subsequent Tamponade • M. Brus-Ramer and W.P. Dillon
Cord herniation is a rare but treatable condition of uncertain etiology and, if you have been following AJNR’s Blog, there has been considerable discussion of this entity among our readers. Here the authors postulate that anterior disk herniations erode the dura and then the cord becomes anteriorly displaced to tamponade the defect, resulting in a progressive myelopathy. To prove their point, the authors retrospectively reviewed their own cases and all published ones. In more than two-thirds of cases the herniations occurred at disk levels supporting their hypothesis.
Fellows’ Journal Club
Quality Control in Neuroradiology: Discrepancies in Image Interpretation among Academic Neuroradiologists • L.S. Babiarz and D.M. Yousem
This article should interest our fellows because most of them train at academic institutions. These authors looked at 1000 neuroimaging studies that had follow-up imaging and rated the discrepancies found in the reports. Nearly 88% of follow-up studies agreed with the original reports and there was a 2% rate of clinically significant interpretation discrepancies (8 CT and 12 MRI) among neuroradiologists. Most discrepancies involved interpretation of vascular and neoplastic lesions. This threshold could potentially serve to design future practice quality improvement studies.
Utilization Rates of Neuroradiology across Neuroscience Specialties in the Private Office Setting: Who Owns or Leases the Scanners on Which Studies Are Performed? • L.S. Babiarz, D.M. Yousem, L. Parker, D.C. Levin, and V. Rao
All of us are interested in interpreting studies with high relative value units and this trend extends to imaging studies interpreted by nonradiologists. Here, the authors used 10 years of data from the Centers for Medicare and Medicaid Services to assess this issue in regard to CT and MRI studies. During this period of time, utilization rates of MRI and CT studies grew by 2.5% and 2.1%, respectively. In 2008 only 56.6% of fees were charged by radiologists, followed by independent testing facilities, other specialists, neurologists, and neurosurgeons. The authors concluded that all nonradiologists showed greater overall utilization growth in private office neuroradiology than did radiologists. Also, nonradiologists generally showed greater utilization increases in MR than CT. Radiologists’ private office neuroradiology technical fee share shrank from 83.6% to 56.6% between 1998 and 2008.
Quantification of Thrombus Hounsfield Units on Noncontrast CT Predicts Stroke Subtype and Early Recanalization after Intravenous Recombinant Tissue Plasminogen Activator • J. Puig, S. Pedraza, A. Demchuk, J. Daunis-i-Estadella, H. Termes, G. Blasco, G. Soria, I. Boada, S. Remollo, J. Baños, J. Serena, and M. Castellanos
Anecdotally we know that high-density clots are probably more organized and difficult to lyse. These investigators calculated HU values for MCA thrombi on noncontrast CT within 4.5 hours of symptom onset and correlated it with successful recanalization after intravenous tPA treatment given 169 +/− 102 minutes thereafter. Best outcomes were achieved for M1, low-density, and thrombi not originating from the heart. Worse outcomes were related to high-density thrombi and those originating from the heart.
