Editor’s Choices
Combined Diffusion and Perfusion MR Imaging as Biomarkers of Prognosis in Immunocompetent Patients with Primary Central Nervous System Lymphoma • F.E. Valles, C.L. Perez-Valles, S. Regalado, R.F. Barajas, J.L. Rubenstein, and S. Cha
Here, the authors sought to determine if ADC values and perfusion measurements provided prognostic information in 25 treatment-naïve immunocompetent patients with brain lymphoma. The studied parameters were obtained from the enhancing tumor regions. The results of this investigation reinforce the validity of ADC values as a prognostic biomarker and provide evidence of low tumor CBV as a novel risk factor for adverse prognosis in immunocompetent patients with primary brain lymphoma.
Robust Perfusion Deficits in Cognitively Impaired Patients with Secondary-Progressive Multiple Sclerosis • P.L. Francis, R. Jakubovic, P. O’Connor, L. Zhang, A. Eilaghi, L. Lee, T.J. Carroll, J. Mouannes-Srour, A. Feinstein, and R.I. Aviv
These authors investigated the effect of perfusion deficits on patients with MS with cognitive impairment. In 45 patients with secondary-progressive MS, cognition was assessed using standardized clinical tests and CBF and CBV perfusion maps were obtained, analyzed, and correlated with gray and white matter and lesion volumes. Perfusion in the deep gray matter nuclei and frontal cortex was significantly reduced in cognitively impaired patients with MS despite no significant differences regarding gray matter, white matter, and lesion volumes. Of the cognitive parameters investigated, information processing speed was most affected.
Factors Influencing Clinically Meaningful Recanalization after IV-rtPA in Acute Ischemic Stroke • A. Murphy, S.P. Symons, J. Hopyan, and R.I. Aviv
Predictors of clinically meaningful recanalization were assessed in 126 patients with acute anterior circulation stroke treated with IV thrombolysis. End points were CT angiographic recanalization and good clinical outcome at 90 days. Clinically meaningful recanalization occurred in 29% of patients, who had fewer neurologic deficits and higher ASPECTS at baseline. Admission NIHSS score and site of arterial occlusion were significant predictors of meaningful recanalization. Specifically, mild baseline deficits and distal vessel occlusions were significant predictors of clinically meaningful recanalization. A combination of these was better than either parameter alone.
Fellows’ Journal Club
Location of the Clot and Outcome of Perfusion Defects in Acute Anterior Circulation Stroke Treated with Intravenous Thrombolysis • N. Sillanpää, J.T. Saarinen, H. Rusanen, I. Elovaara, P. Dastidar, and S. Soimakallio
These investigators studied the impact of clot location in patients with acute stroke receiving IV thrombolysis. Four locations (ICA, proximal M1, distal M1, and M2 segment and more distal) of clots were correlated with CT perfusion maps, mismatches, salvaged brain volumes, and outcomes in 105 patients. Clots that were more proximal in location produced larger perfusion defects and lesion volumes. The amount of tissue salvaged was greater in patients with more distally located clots. In conclusion, admission CBV defects were larger in proximal vessel occlusions. More of the penumbra was salvaged if the occlusion was located more distally. This effect reached a plateau in the distal M1 segment of the MCA.
Perfusion-Weighted Imaging–Derived Collateral Flow Index is a Predictor of MCA M1 Recanalization after IV Thrombolysis • F. Nicoli, P. Lafaye de Micheaux, and N. Girard
This article addresses the importance of collateral circulation in preserving the tissues contained within the ischemic penumbra in patients with acute stroke treated with IV thrombolysis. The authors evaluated not only the presence of collaterals but also their quality. They quantified a normalized collateral circulation deficit and correlated it with parameters thought to affect its quality, such as baseline NIHSS score, volume of DWI abnormalities, and modified Rankin scale at 3 months. The normalized collateral circulation deficit correlated with NIHSS, lesion volume as seen on DWI, and recanalization at 24 hours. Full recanalization as well as the probability of full recanalization also correlated with the normalized collateral circulation deficit. Thus, this index is a good predictor of recanalization and outcome in patients with acute stroke treated with IV thrombolysis.
Trends in Spinal Pain Management Injections in Academic Radiology Departments • J.J. Freeman, R.K. Kilani, C.D. Lascola, L. Gray, and D.S. Enterline
Through a survey sent to 186 academic departments of radiology, the authors sought to determine patterns of spinal pain management injections by neuroradiologists. Twenty-one percent of surveys were completed showing that over 50% of departments were involved in this type of procedure with the number of procedures remaining stable during the past 5 years in most locations. The majority of referrals came from orthopedic surgeons, neurosurgeons, and neurologists. The most common procedures were epidural steroid injections, nerve root blocks, facet injections, and synovial cyst aspirations. Most fellows and more than 50% of residents were considered to have achieved proficiency in these procedures during their training.
