Editor’s Choices
Association of White Matter Hyperintensity Measurements on Brain MR Imaging with Cognitive Status, Medial Temporal Atrophy, and Cardiovascular Risk Factors • J. Appel, E. Potter, N. Bhatia, Q. Shen, W. Zhao, M.T. Greig, A. Raj, W.W. Barker, H. Potter, E. Schofield, Y. Wu, D.A. Loewenstein, and R. Duara
Features of cardiovascular-related brain changes may overlap somewhat with those of Alzheimer patients. In this prospective study, the authors evaluated the presence and severity of white matter hyperintensities and mesial temporal atrophy in 192 patients with no cognitive impairment, mild cognitive impairment, and probable Alzheimer disease. Cardiovascular risk factors were also calculated for all. Both abnormalities were more common in patients with probable Alzheimer disease than in those with no cognitive impairment. White matter changes were related to temporal atrophy but not to cardiovascular risk factors. The results suggest that white matter changes in Alzheimer patients are probably related to neurodegeneration and not underlying cardiovascular conditions.
Brain Structural Variability due to Aging and Gender in Cognitively Healthy Elders: Results from the São Paulo Ageing and Health Study • P.K. Curiati, J.H. Tamashiro, P. Squarzoni, F.L.S. Duran, L.C. Santos, M. Wajngarten, C.C. Leite, H. Vallada, P.R. Menezes, M. Scazufca, G.F. Busatto, and T.C.T.F. Alves
Here is more information on the aging brain. These Brazilian investigators culled morphometric and volumetric gray matter data from 132 patients enrolled in a long-term study. They compared these data to age with the purpose of identifying regional age-related volume alterations in elderly individuals. It seems that we men (these findings were not seen in any of the women) have accelerated gray matter losses in temporal and prefrontal neocortex and in mesial temporal cortex, too. The authors concluded that atrophy of these regions is a part of the normal aging process.
The Effect of Exercise on the Cerebral Vasculature of Healthy Aged Subjects as Visualized by MR Angiography • E. Bullitt, F.N. Rahman, J.K. Smith, E. Kim, D. Zeng, L.M. Katz, and B.L. Marks
Here is additional information that exercising is good for you. There is some evidence that aerobics may reduce brain atrophy and white matter changes seen with advancing age. These investigators assessed differences in brain vasculature as seen on MR angiography in patients with high and low levels of physical activity. The arteries were segmented, their numbers counted, and their radii and tortuosity evaluated. Not surprisingly, the authors found that aerobically active subjects have significantly fewer tortuous vessels and a larger number of smaller arteries. Thus, it is possible that exercise contributes to healthy brain aging.
Fellows’ Journal Club
Long-Term Follow-Up of 1036 Cerebral Aneurysms Treated by Bare Coils: A Multicentric Cohort Treated between 1998 and 2003 • S. Gallas, A.C. Januel, A. Pasco, J. Drouineau, J. Gabrillargues, A. Gaston, C. Cognard, and D. Herbreteau
Finally, long-term results of endovascular treatment of aneurysms are becoming available. In this study from France, a large cohort of patients treated between 5-10 years ago with bare platinum coils were followed annually with MR imaging and catheter digital subtraction angiography. After initial treatment, complete occlusion was demonstrated in slightly more than 70% of patients, subtotal occlusion in 24%, incomplete occlusion in 2%, and failure of occlusion in 3%, leading to a second procedure in 72 (7%) of the original 1063 aneurysms. Retreatment was due to an initial incomplete occlusion or to later recanalization. Fewer than 5 patients rebled during the 10-year follow-up period. As I imagined, retreatment is not common and even in the face of incomplete occlusions the rate of rebleeding is very small.
Subsequent Fracture after Percutaneous Vertebroplasty Can Be Predicted on Preoperative Multidetector Row CT • A. Hiwatashi, T. Yoshiura, K. Yamashita, H. Kamano, T. Dashjamts, and H. Honda
You do a vertebroplasty and in a few months the patient develops another painful fracture in an adjacent vertebra. It would be nice to know which vertebrae are prone to this. Here, the authors prospectively evaluated 26 patients with 58 fractured vertebrae using CT multiplanar reformations 1 day pre-procedure. In those with recurrent pain at least 3 months after the initial treatment, spine MR imaging was done. New fractures occurred in 28 vertebrae, 14 adjacent to the treated one and 14 remote to it. Risk factors included use of steroid medications and low CT attenuation. Further collapse of the treated vertebrae was documented in 10 patients. (You may also want to read the Editorial and accompanying Commentary related to vertebroplasties that appear in this issue.)
Is All “Communicating” Hydrocephalus Really Communicating? Prospective Study on the Value of 3D-Constructive Interference in Steady State Sequence at 3T • A. Dinçer, S. Kohan, and M.M. Özek
After first reading this article, we started doing the CISS sequence in these patients and I am happy to report that it works well. That is, not uncommonly one discovers a culprit for the so-called “communicating hydrocephalus.” The authors of this study used 3D-CISS and phase-contrast flow studies to image 134 patients with large ventricles and no apparent cause on conventional sequences. The CISS studies detected obstructing membranes in 20% of patients who were later treated endoscopically instead of via shunt. The authors’ conclusion is that CISS images can document obstructing membranes, particularly in the fourth ventricle, and basal cisterns and this affects management and prognosis.
