Editor’s Choices
Delayed Ipsilateral Parenchymal Hemorrhage Following Flow Diversion for the Treatment of Anterior Circulation Aneurysms • J.P. Cruz, M. Chow, C. O’Kelly, B. Marotta, J. Spears, W. Montanera, D. Fiorella, and T. Marotta
Acute and subacute complications from the use of the Pipeline device are becoming evident. Here, the authors report delayed ipsilateral hemorrhage in 8.5% of patients with anterior circulation aneurysms treated with this device. All bleeds were distant from the treated aneurysms. All procedures were done without complications and when waking after the embolization all patients were normal. Despite this, hemorrhages occurred 1–6 days postprocedure, and were not related to aneurysm size, intraprocedural complications, or anticoagulation.
Feasibility of Cerebral Blood Volume Mapping by Flat Panel Detector CT in the Angiography Suite: First Experience in Patients with Acute Middle Cerebral Artery Occlusions • T. Struffert, Y. Deuerling-Zheng, T. Engelhorn, S. Kloska, P. Gölitz, M. Köhrmann, S. Schwab, C.M. Strother, and A. Doerfler
Because of the potential benefits of flat panel CT in assessing perfusion and the brain parenchyma, these investigators correlated studies with multisection and perfusion CT. All 4 techniques were used to study 16 patients with MCA occlusions posttreatment. There was a high correlation for CBV obtained with both flat panel and standard techniques. The authors concluded that this new flat panel CT application allows assessment of CBV in acute stroke patients. Their initial results indicated that these measurements may predict final infarct volume. The ability to assess this key parameter of cerebral perfusion within the angiographic suite may improve the management of these patients.
The Added Value of Apparent Diffusion Coefficient to Cerebral Blood Volume in the Preoperative Grading of Diffuse Gliomas • A. Hilario, A. Ramos, A. Perez-Nuñez, E. Salvador, J.M. Millan, A. Lagares, J.M. Sepulveda, P. Gonzalez-Leon, A. Hernandez-Lain, and J.R. Ricoy
Is it worth doing both DWI and perfusion imaging in gliomas? These authors sought to study if ADC and rCBV improved diagnostic accuracy in the preoperative grading of gliomas by assessing 162 patients who later underwent surgery. rCBV was significantly different between grade II and IV and between grade III and IV gliomas, but not between grades II and III. ADC values were significantly different for all 3 grades. Conclusion: ADC measurements were better than rCBV values for distinguishing the grades of gliomas, and the combination of minimum ADC and maximum rCBV improved the diagnostic accuracy of glioma grading.
Fellows’ Journal Club
Cranial CT with Adaptive Statistical Iterative Reconstruction: Improved Image Quality with Concomitant Radiation Dose Reduction • O. Rapalino, Shervin Kamalian, Shahmir Kamalian, S. Payabvash, L.C.S. Souza, D. Zhang, J. Mukta, D.V. Sahani, M.H. Lev, and S.R. Pomerantz
Most state-of-the-art CT scanners have some type of iterative reconstruction program that allows for lower patient radiation exposure. At my institution we use it, when available, for most neuroimaging studies. Six levels in 100 CT iterative reconstruction studies were compared with conventional CT obtained previously in the same patients. SNR and CNR were computed and the studies were blindly and qualitatively evaluated. The results showed that iterative reconstruction studies had lower image noise and increased low-contrast resolution while allowing lower radiation doses without affecting spatial resolution.
Interventional Stroke Therapies in the Elderly: Are We Helping? • N. Zeevi, G.A. Kuchel, N.S. Lee, I. Staff, and L.D. McCullough
Our fellows are called in many times to assess older patients with stroke. This article attempts to answer if we are really helping these patients by performing thrombolysis. The authors compared patients with acute stroke (n=37) who were older than 75 years of age with a control group (n=70) who were younger than 75 years. NIHSS scores were similar in both groups. Patients older than 75 years were less likely to receive endovascular treatments. Older patients had higher rates of symptomatic intracranial hemorrhage, disability, and mortality.
When Should I Do Dynamic CT Myelography? Predicting Fast Spinal CSF Leaks in Patients with Spontaneous Intracranial Hypotension • P.H. Luetmer, K.M. Schwartz, L.J. Eckel, C.H. Hunt, R.E. Carter, and F.E. Diehn
Which patients with intracranial hypotension will need dynamic CT myelography? The authors assessed brain and spine MRI studies and opening pressure measurements in 150 consecutive patients with intracranial hypotension to see if these can predict fast CSF spine leaks that will require dynamic myelography. Fast leaks were present in 21% and correlated well with the presence of spinal extra-arachnoid fluid. No correlation between fast leaks and brain MRI findings was found. Thus, when spinal extra-arachnoid fluid is documented on MRI studies there is no need for conventional CT myelography but the patient should be directly studied with dynamic CT myelography.
