Editor’s Choices

Acute Damage to the Posterior Limb of the Internal Capsule on Diffusion Tensor Tractography as an Early Imaging Predictor of Motor Outcome after Stroke • J. Puig, S. Pedraza, G. Blasco, J. Daunis-i-Estadella, F. Prados, S. Remollo, A. Prats-Galino, G. Soria, I. Boada, M. Castellanos, and J. Serena
Practical applications of diffusion tensor imaging are few, but this seems to be an interesting and a potentially important one: can it be used to predict motor outcome after stroke? Sixty patients within 12 hours of stroke were assessed with tractography at 5 different locations in the corticospinal tracts at admission, and at days 3 and 30. Patients with acute damage to the posterior limb of the internal capsule had the worst outcome and clinical severity at presentation. Conclusions: In the acute setting, tractography is promising for stroke mapping to predict motor outcome. Acute corticospinal tract damage at the level of the posterior limb of the internal capsule is a significant predictor of unfavorable motor outcome.

Value of MR Venography for Detection of Internal Jugular Vein Anomalies in Multiple Sclerosis: A Pilot Longitudinal Study • R. Zivadinov, R. Galeotti, D. Hojnacki, E. Menegatti, M.G. Dwyer, C. Schirda, A.M Malagoni, K. Marr, C. Kennedy, I. Bartolomei, C. Magnano, F. Salvi, B. Weinstock-Guttman, and P. Zamboni
The role of chronic venous insufficiency in multiple sclerosis is controversial. The diagnosis is generally made with Doppler sonography and/or invasive catheter venography. Here, the authors assessed the role of MR venography in this situation. Ten patients with MS were assessed and compared with controls. Six patients with MS were treated with angioplasty and evaluated 6 months thereafter; similarly 6 controls were re-assessed at 6 months. Two different MRV methods were used. Although the agreement between Doppler and both MRV studies was high, there was a 60-70% lack of agreement between both MRV studies and catheter venography. Therefore, both pre- and posttreatment, MRV was of little value in the diagnosis of chronic venous insufficiency.

Potential of Integrated [18F] Fluorodeoxyglucose Positron-Emission Tomography/CT in Identifying Vulnerable Carotid Plaques • R.M. Kwee, M.T.B. Truijman, W.H. Mess, G.J.J. Teule, J.W.M. ter Berg, C.L. Franke, A.G.G.C. Korten, B.J. Meems, M.H. Prins, J.M.A. van Engelshoven, J. E. Wildberger, R.J. van Oostenbrugge, and M.E. Kooi
It is known that risk of cerebrovascular accident is not only associated with degree of carotid artery stenosis but probably more importantly with type of plaque: vulnerable vs stable. Myriad studies have looked at this issue with high-resolution MR imaging but the present one used FDG-PET and CT. Fifty patients with transient ischemic attack/stroke who had ipsilateral stenosis and plaque along with contralateral asymptomatic plaque were imaged. High uptake was seen in ipsilateral plaques when compared with contralateral asymptomatic ones but these differences were not significant. CT also showed larger lipid-rich necrotic cores and thicker arterial walls in symptomatic plaques, but again these differences were not significant. Thus, it remains to be determined if the combination of FDG-PET/CT is valuable.

Fellows’ Journal Club

Cerebral Blood Flow Thresholds for Tissue Infarction in Patients with Acute Ischemic Stroke Treated with Intra-Arterial Revascularization Therapy Depend on Timing of Reperfusion • K. Mui, A.J. Yoo, L. Verduzco, W.A. Copen, J.A. Hirsch, R.G. González, and P.W. Schaefer
These investigators sought to determine if cerebral blood flow thresholds for tissue infarction depend on the timing of recanalization in patients with acute stroke treated with intra-arterial thrombolysis. In 26 such patients they obtained CBF ratios in the core, penumbra that infarcted, and penumbra that did not infarct. CBF ratios in tissues that reperfused before 6 hours were compared with those that reperfused at more than 6 hours. The authors found CBF thresholds for tissue infarction in patients with acute stroke are lower in tissue that reperfused at earlier time points, so these thresholds may be useful in selecting patients who may benefit from thrombolysis.

Is It Possible to Recognize Cervical Artery Dissection on Stroke Brain MR Imaging? A Matched Case-Control Study • O. Naggara, F. Soares, E. Touze, D. Roy, X. Leclerc, J.-P. Pruvo, J.-L. Mas, J.-F. Meder, and C. Oppenheim
Arterial dissections are not uncommonly found in patients with acute stroke. Do we need a special protocol or can these be diagnosed on the standard brain MR imaging study? In 103 consecutive patients, the authors were able to identify 77 in whom the fat-suppressed T1 images showed mural internal carotid artery clot. These studies were retrospectively reviewed by 2 blinded observers who looked at 5 different sequences from the 77 patients and 77 controls. Seventy-seven percent of patients and 95% of controls were correctly classified. Thus, initial brain MR imaging can correctly suggest cervical arterial dissection in more than two-thirds of cases. This may have practical implications in patients with stroke and delayed cervical MR angiography or in those who are not initially suspected of having CAD.

Is Fasting Necessary for Elective Cerebral Angiography? • O.-K. Kwon, C.W. Oh, H. Park, J.S. Bang, H.-J. Bae, M.K. Han, S.-H. Park, M.H. Han, H.-S. Kang, S.-K. Park, G. Whang, B.-C. Kim, and S.-C. Jin
Did the patient eat breakfast? Can the angiogram be done as planned? This is something that we still grapple with and it affects our daily diagnostic angiogram schedule. We have all been taught that a patient has to fast before cerebral angiography, but is it really necessary? In this study, more than 2500 patients were given the choice of fasting or not before the procedure and were evaluated for nausea, vomiting, and pulmonary aspiration during the 24 hours postprocedure. If these effects occurred within 1 hour of the angiogram they were considered to be associated with it. The incidence of nausea/vomiting was 1% and no aspirations occurred. This article suggests that fasting may not be necessary for patients who undergo elective cerebral angiography.