Editor’s Choices

Mortality in the Vertebroplasty Population • R.J. McDonald, S.J. Achenbach, E.J. Atkinson, L.A. Gray, H.J. Cloft, L.J. Melton III, and D.F. Kallmes
More controversy with regard to vertebroplasty: Do vertebroplasties affect mortality rates? These well-seasoned investigators compared 524 vertebroplasty patients with refractory osteoporotic fractures with 589 patients not treated by the procedure. When compared with the general population, vertebroplasty patients showed 77% of the expected survival and when compared with patients with symptomatic or asymptomatic vertebral fractures, vertebroplasty recipients retained a 17% greater mortality risk. Conclusion: mortality rates were worse for vertebroplasty patients when compared with those of patients with untreated asymptomatic fractures, and similar if compared with patients with untreated symptomatic fractures.

Cerebral Ischemia Complicating Intracranial Aneurysm: A Warning Sign of Imminent Rupture? • B. Guillon, B. Daumas-Duport, O. Delaroche, K. Warin-Fresse, M. Sévin, F. Hérisson, E. Auffray-Calvier, and H. Desal
Here is another indication that an aneurysm may be close to rupture: ischemic stroke in the same territory distal to it. Although distal infarctions are known to occur with giant thrombosed aneurysms, these authors describe similar findings in 9 patients with small, non-thrombosed aneurysms. Thus infarctions in this situation are rare, but generally precede SAH and acute management with embolization is needed. Caveat: many of these patients will necessitate thrombolysis for their strokes, an issue that complicates the management of the aneurysms.

Carotid Plaque Enhancement and Symptom Correlations: An Evaluation by Using Multidetector Row CT Angiography • L. Saba and G. Mallarini
CT offers the possibility of obtaining CTA and at the same time evaluating the substance of carotid artery plaques. In this investigation, 97 patients underwent CTA and their plaques were assessed for contrast enhancement and correlated with symptoms. Plaque contrast enhancement was seen in nearly 75% of noncalcified lesions and its presence strongly correlated with neurologic symptoms. Contrast enhancement was more common in fatty than in mixed density plaques.

Fellows’ Journal Club

Tectorial Membrane Injury: Frequently Overlooked in Pediatric Traumatic Head Injury • A. Meoded, S. Singhi, A. Poretti, A. Eran, A. Tekes, and T.A.G.M. Huisman
Tectorial membrane injury is uncommon and may be associated with the presence of retroclival epidural hematoma. These authors retrospectively reviewed 10 children with this type of epidural hematoma to determine the rate of tectorial membrane rupture and correlated it with imaging and clinical findings. Seventy percent of subjects showed tectorial membrane damage, none had injuries to the brain stem, spinal cord, vertebrae, or subluxations, and symptoms were minimal. Although most tectorial membrane injuries initially may be managed conservatively, some will necessitate craniocervical fixation to avoid instability.

Follow-Up MR Imaging of the Alar and Transverse Ligaments after Whiplash Injury: A Prospective Controlled Study • N. Vetti, J. Kråkenes, T. Ask, K.A. Erdal, M.D.N. Torkildsen, J. Rørvik, N.E. Gilhus, and A. Espeland
Whiplash injuries may damage the anterior longitudinal ligament, which is not critical because as long as the injury is isolated the spine remains stable. These authors studied 91 patients acutely and 12 months after whiplash injury with special attention to damaged transverse and alar ligaments. High proton density signal was seen in both injured and control patients with similar prevalence. Moreover, in those with a history of whiplash injury, these areas of high signal were seen in identical numbers acutely and on follow-up studies. Thus, these high signal areas, commonly assumed to represent injury to the ligaments, cannot be solely explained by trauma.

A Comprehensive Review of MR Imaging Changes following Radiosurgery to 500 Brain Metastases • T.R. Patel, B.J. McHugh, W.L. Bi, F.J. Minja, J.P.S. Knisely, and V.L. Chiang
Many times we are called to assess the effects of gamma knife treatment on tumors. Here, the authors evaluated more than 500 metastases treated by this method with MRI and measured tumor volumes over time. One-third of patients showed increased tumor size 6 weeks to 15 months after treatment while the others had lesions that remained stable or decreased in size. Those patients with tumors that increased in size had survival periods nearly twice as long as the others. Thus, gamma knife surgery may result in lesion “pseudoprogression.”