Editor’s Choices
Feasibility of Angiographic CT in Peri-Interventional Diagnostic Imaging: A Comparative Study with Multidetector CT • M.-N. Psychogios, J.-H. Buhk, P. Schramm, A. Xyda, A. Mohr, and M. Knauth
Today, many interventional neuroradiologists work with angiographic equipment that is also capable of obtaining CT images, clearly something advantageous when hemorrhages or other complications are suspected during or immediately after a procedure. In this study, the authors compared the results of angiographic CT with those of multidetector CT in 84 patients (postaneurysm coiling, -thrombectomy, or -angioplasty with stent deployment). Both CT methods rated equally in the detection of supratentorial complications (such as hemorrhage) but MDCT was clearly superior in the evaluation of posterior fossa complications when compared with ACT. The authors concluded ACT is very useful except in the evaluation of cerebellar infarctions.
Higher Rates of Mortality but Not Morbidity Follow Intracranial Mechanical Thrombectomy in the Elderly • Y. Loh, D. Kim, Z.-S. Shi, S. Tateshima, P.M. Vespa, N.R. Gonzalez, S. Starkman, J.L. Saver, R. Jahan, D.S. Liebeskind, G.R. Duckwiler, and F. Viñuela
In this article, the authors compared thrombectomy performed using the Merci device in patients younger and older than 80 years to determine the influence of age on procedure outcome (something of significant importance as our patient population ages). They looked at the following parameters in both patient groups: recanalization rates, hospital length of stay, hemorrhagic transformation, death, and disability on discharge. The only difference in these parameters was death rate, which was more common in the elderly (48% vs 15%); the other parameters showed no differences between groups. This important observation needs to be kept in mind when performing thrombectomy in patients of advanced age.
Wallerian Degeneration in the Corticospinal Tract Evaluated by Diffusion Tensor Imaging Correlates with Motor Deficit 30 Days after Middle Cerebral Artery Ischemic Stroke • J. Puig, S. Pedraza, G. Blasco, J. Daunis-i-Estadella, A. Prats, F. Prados, I. Boada, M. Castellanos, J. Sánchez-González, S. Remollo, G. Laguillo, A.M. Quiles, E. Gómez, and J. Serena
Wallerian degeneration is not uncommon after middle cerebral artery infarctions and portends a worse prognosis if present. These authors used diffusion tensor imaging (and fractional anisotropy measurements) as well as signal changes on conventional MR images to assess WD after MCA infarctions. Sixty patients were evaluated within 12 hours of infarct onset, at 3 days, and at 30 days. All results were compared with ratings according to the NIHSS scale. At day 30, FA in the ipsilateral corticospinal tract was significantly lower when compared with the unaffected side. This finding also correlated strongly with the presence of significant motor deficit. The authors suggest that FA at 30 days postinfarct may serve as a surrogate marker in future stroke studies.
Fellows’ Journal Club
Imaging Characteristics of Primary Laryngeal Lymphoma • N.A. Siddiqui, B.F. Branstetter IV, B.E. Hamilton, L.E. Ginsberg, C.M. Glastonbury, H.R. Harnsberger, E.L. Barnes, and E.N. Myers
The larynx is a very rare site for primary lymphoma with less than 100 cases reported in the literature. Here, the authors report the MR, CT, and positron-emission tomography features in 20 such cases. The patients’ ages (30–90 years) varied but this finding was more common in women. At presentation, the tumors were large (4 cm) and tended to begin in the supraglottic region but variably extended into both the infraglottic and hypopharyngeal areas in about 60% of patients. Cartilage invasion and lymph nodes were positive in 20% of patients and all tumors showed uptake on PET. No tumors displayed central necrosis and all enhanced uniformly. Although these tumors are rare, this combination of findings may suggest the diagnosis.
Artery of Percheron Infarction: Imaging Patterns and Clinical Spectrum • N.A. Lazzaro, B. Wright, M. Castillo, N.J. Fischbein, C.M. Glastonbury, P.G. Hildenbrand, R.H. Wiggins, E.P. Quigley, and A.G. Osborn
Some years ago, I wrote a short case report on this topic and since then it has been part of AJNR’s Most Read list. You can think about this article as the Rolls Royce version of that earlier manuscript. The authors collected data on 37 patients with occlusion of the artery of Percheron seen during a 9-year period. The most common ischemic patterns observed involved the medial thalami and midbrain, medial thalami without the midbrain, both of these sites plus the anterior thalami, and medial and anterior thalami without the midbrain. Additionally, fluid-attenuated inversion recovery hyperintensity on the surfaces of the interpeduncular cistern was present in nearly nearly two-thirds of patients and this new sign may be used to support the diagnosis of occlusion of the artery of Percheron. Recognition of this sign may help manage patients, as this type of infarction should not be considered lacunar. NB: I am a co-author of this article but that is not the reason why I selected it as a Fellows’ Journal Club choice!
The Triple Rule-Out for Acute Ischemic Stroke: Imaging the Brain, Carotid Arteries, Aorta, and Heart • A.D. Furtado, D.D. Adraktas, N. Brasic, S.-C. Cheng, K. Ordovas, W.S. Smith, M.R. Lewin, K. Chun, J.D. Chien, S. Schaeffer, and M. Wintermark
In this study, the authors sought to assess the utility of a comprehensive imaging protocol for stroke patients aimed at evaluating the heart chambers and coronary arteries, the circle of Willis, the aorta, and the carotid arteries. Stroke patients in whom these common embologenic sites are diseased carry a worse prognosis. The protocol was used to evaluate 120 patients. With regard to quality, 100% of the studies of the aorta, carotid, and vertebral arteries were of excellent quality whereas 58–73% of coronary artery studies were judged as good. The authors concluded their stroke protocol achieved excellent opacification of the left heart chambers, the cervical arteries, and each coronary artery, in addition to adequate carotid and coronary artery image quality.
