Editor’s Choices
Carotid Atherosclerotic Plaque Progression and Change in Plaque Composition Over Time: A 5-Year Follow-Up Study Using Serial CT Angiography • M.J. van Gils, D. Vukadinovic, A.C. van Dijk, D.W.J. Dippel, W.J. Niessen, and A. van der Lugt
These authors studied temporal changes in plaque size and composition using CTA. Their subjects were 109 patients who underwent baseline and follow-up CTA of the extracranial internal carotid arteries during an average 5-year period. When plaque volumes increased (69%) these did so at a rate of 1.2% per year. Composition changes included decreasing lipids (1.8%) and fibrous tissues (1.5%) as well as increasing calcifications (3.3%); thus, serial temporal changes in plaques may be assessed by CTA. Plaque burden is a heterogeneous and slow process.
Malignant CTA Collateral Profile Is Highly Specific for Large Admission DWI Infarct Core and Poor Outcome in Acute Stroke • L.C.S. Souza, A.J. Yoo, Z.A. Chaudhry, S. Payabvash, A. Kemmling, P.W. Schaefer, J.A. Hirsch, K.L. Furie, R.G. González, R.G. Nogueira, and M.H. Lev
“Malignant” stroke features include a large core (>100 ml), little penumbra, and no collateral circulation, and portray a poor outcome. These authors studied patients with proximal intracranial arterial occlusions and assessed infarct core size and collateral circulation as seen on CTA. After analyzing 197 such patients, they determined that those with poor collateral grades (absent collateral circulation) had larger infarct cores, large lesions on DWI, and a poor functional outcome. Additionally, patients with poor collaterals had higher NIHSS scores at admission.
Relationship between Tumor Enhancement, Edema, IDH1 Mutational Status, MGMT Promoter Methylation, and Survival in Glioblastoma • J.A. Carrillo, A. Lai, P.L. Nghiemphu, H.J. Kim, H.S. Phillips, S. Kharbanda, P. Moftakhar, S. Lalaezari, W. Yong, B.M. Ellingson, T.F. Cloughesy, and W.B. Pope
IDH1 mutations and MGMT promoter methylation correlate with better prognosis and longer survival in patients with glioblastomas. This article looks at the relationship between edema and contrast enhancement and these features. The authors studied 202 glioblastomas and found that patients with methylated tumors with no or little edema had longer survival rates. All IDH1 mutant tumors were located in the frontal lobes and were mostly nonenhancing. It seems that common anatomic features may provide insight into the molecular behavior of some glioblastomas.
Fellows’ Journal Club
Does Intracranial Venous Thrombosis Cause Subdural Hemorrhage in the Pediatric Population? • L.A. McLean, L.D. Frasier, and G.L. Hedlund
In children with subdural hematomas, can the cause be intracranial venous thrombosis? This is an important question, particularly if child abuse is also being considered as subdural hematomas are commonly associated with abuse. These authors retrospectively looked for subdural hematomas in 36 children with venous thrombosis and discovered that even if the latter was extensive and severe, no subdural hematomas were present.
Active Bleeding in Acute Subarachnoid Hemorrhage Observed by Multiphase Dynamic-Enhanced CT • K. Suzuki, N. Tanaka, S. Morita, H. Machida, E. Ueno, and H. Kasuya
This investigation retrospectively assessed dynamic multiphase CT studies in 51 patients with SAH to try to identify the site and cause of their bleeding. Extravasation of contrast was evident in 25.5% of cases with the most common sites of aneurysms being the MCA and basilar/vertebral arteries and the least common being the ICA and anterior cerebral arteries. Patients with active bleeding had larger hematomas.
Spectrum of MR Imaging Findings in Wernicke Encephalopathy: Are Atypical Areas of Involvement Only Present in Nonalcoholic Patients? • N.D. Ha, Y.C. Weon, J.C. Jang, B.S. Kang, and S.H. Choi
Are MRI findings different in nonalcoholic vs alcoholic Wernicke encephalopathy? Here, the authors assessed MRI in 24 patients and correlated findings with the clinical features of the disease. Despite previous reports stating that nonalcoholic Wernicke encephalopathy presents different and more extensive abnormalities, the results of this study indicate the contrary; that is, there is no difference in MRI findings between groups. The medulla was frequently affected and less than 20% of patients had the typical clinical triad.
