Editor’s Choice
Metabolic Changes in Patients with Aneurysmal Subarachnoid Hemorrhage Apart from Perfusion Deficits: Neuronal Mitochondrial Injury? • M. Wagner, A. Jurcoane, C. Hildebrand, E. Güresir, H. Vatter, F.E. Zanella, J. Berkefeld, U. Pilatus, and E. Hattingen
Because perfusion deficits may not account for all neuronal damage seen in subarachnoid hemorrhage, these authors measured cerebral metabolites in 58 patients with SAH without perfusion defects and/or infarctions. Using MR spectroscopy they discovered that NAA was significantly low in all patients, choline was elevated, and glutamate/glutamine was also decreased. The authors believe that these findings reflect neuronal mitochondrial injury.
Differentiation between Oligodendroglioma Genotypes Using Dynamic Susceptibility Contrast Perfusion-Weighted Imaging and Proton MR Spectroscopy • S. Chawla, J. Krejza, A. Vossough, Y. Zhang, G.S. Kapoor, S. Wang, D.M. O’Rourke, E.R. Melhem, and H. Poptani
These authors used perfusion imaging and MR spectroscopy to differentiate oligodendrogliomas with 1p/19q deletions from those with intact alleles. NAA/Cr, Cho/Cr, Glx/Cr, myo-inositol/Cr and the presence of lipids and lactate were assessed in areas of maximum perfusion in 40 patients. This study showed that as groups, integration of the MRS indices from the region containing the highest cerebral blood volume was useful in distinguishing tumors with 1p/19q abnormalities from those that did not have them.
Lumbar Facet Joint Synovial Cysts: Does T2 Signal Intensity Predict Outcomes after Percutaneous Rupture? • S.C. Cambron, J.J. McIntyre, S.J. Guerin, Z. Li, and D.A. Pastel
Can signal intensity of lumbar synovial cysts be used to predict their rupture during percutaneous injections? A total of 110 patients underwent MRI followed by percutaneous treatment and then their cyst T2 signal intensity was correlated with the success or failure of treatment. T2 hypointense cysts were harder to rupture, probably because they contained more calcification and were more gelatinous. Patients with T2 hyperintense cysts are likely to respond to percutaneous therapy.
Fellows’ Journal Club
Contrast Extravasation on CT Angiography Predicts Hematoma Expansion and Mortality in Acute Traumatic Subdural Hemorrhage • J.M. Romero, H.R. Kelly, J.E. Delgado Almandoz, J. Hernandez-Siman, J.C. Passanese, M.H. Lev, and R.G. González
Here the authors used the “spot sign” to evaluate contrast extravasation in subdural hematomas. A cohort of 157 patients underwent emergent CTA and 48-hour follow-up CT. Of these subjects, 15% showed active contrast extravasation initially and interobserver agreement for its detection was excellent. The presence of active extravasation correlated with significant hematoma expansion and predicted higher in-hospital mortality. Thus, this sign identifies high-risk patients.
Intracranial Aneurysms in Autosomal Dominant Polycystic Kidney Disease • M. Niemczyk, M. Gradzik, S. Niemczyk, M. Bujko, M. Gołębiowski, and L. Pączek
This study aimed to determine which patients with autosomal dominant polycystic kidney disease need to undergo MRA for screening of intracranial aneurysms. Of 83 pre-dialysis patients, aneurysms were found in nearly 17% and lead to subsequent treatment in 6%. Aneurysms were more common in older patients and most were smaller than 1 cm in size. Patients over 45 years of age should undergo MRA for aneurysm screening (see the accompanying commentary by Klein).
Brain MRI Findings in Neurologically Asymptomatic Patients with Infective Endocarditis • A. Hess, I. Klein, B. Iung, P. Lavallée, E. Ilic-Habensus, Q. Dornic, F. Arnoult, L. Mimoun, M. Wolff, X. Duval, and J.-P. Laissy
Detection of cerebral findings may alter treatment, so these authors used MRI to study 109 patients with acute infective endocarditis who were neurologically intact. They found 37% had ischemic lesions, 57% had microbleeds, and less commonly SAH, abscesses, and infectious aneurysms were noted. Thus, occult cerebral lesions are very common in patients with infective endocarditis even when neurologically asymptomatic.
