Editor’s Choices
Diagnostic Accuracy of PET for Recurrent Glioma Diagnosis: A Meta-Analysis • T. Nihashi, I.J. Dahabreh, and T. Terasawa
These authors compared the diagnostic accuracy of PET with that of CT and MRI in the diagnosis of recurrent glioma in 26 previously published articles. PET studies with either FDG or carbon methionine were obtained once glioma recurrence was suspected on CT and/or MRI. Diagnostic accuracies were heterogeneous and studies did not compare PET with other imaging modalities. Despite these limitations, PET with both tracers appears to have a moderately good accuracy as an add-on test for diagnosing recurrent glioma.
Cognitive Impairment in Mild Traumatic Brain Injury: A Longitudinal Diffusional Kurtosis and Perfusion Imaging Study • E.J. Grossman, J.H. Jensen, J.S. Babb, Q. Chen, A. Tabesh, E. Fieremans, D. Xia, M. Inglese, and R.I. Grossman
DTI, diffusional kurtosis, and arterial spin-labeling were used in an attempt to detect abnormalities in 20 patients shortly after mild traumatic brain injury. These patients were also evaluated for attention, concentration, executive functioning, memory, learning, and information processing. At 1 and 9 months after injury, all patients showed significant abnormalities in gray and white matter by using all techniques and thus these methods may be useful in investigating cognitive impairment after brain injury.
Postoperative Changes in Cerebral Metabolites Associated with Cognitive Improvement and Impairment after Carotid Endarterectomy: A 3T Proton MR Spectroscopy Study • H. Saito, K. Ogasawara, H. Nishimoto, Y. Yoshioka, T. Murakami, S. Fujiwara, M. Sasaki, M. Kobayashi, K. Yoshida, Y. Kubo, T. Beppu, and A. Ogawa
This study assessed the use of metabolites seen on MRS as markers of change in cognitive status after carotid artery surgery. MRS and neurocognitive testing were obtained before and after surgery in 100 patients. The results showed that cognition remained unchanged in 80%, improved in 10%, and was impaired in 10% of patients postoperatively and that in these last 2 groups, NAA/Cr correlated well the clinical status. Thus, NAA/Cr may serve as a marker of neurologic status after carotid artery surgery (see accompanying editorial by Lövblad and Pereira).
Fellows’ Journal Club
Diagnostic Evaluation in Patients with Intractable Epilepsy and Normal Findings on MRI: A Decision Analysis and Cost-Effectiveness Study • E. Widjaja, B. Li, and L. Santiago Medina
Here is an investigation designed to determine cost-effectiveness of diagnostic tests on patients with focal epilepsy and normal MRI. Studies compared were PET, ictal SPECT, and MEG, individually and in various combinations. PET + MEG and SPECT were the preferred imaging modalities and PET + MEG was favored when the willingness to pay was less than US $10,000, while SPECT was favored when the willingness to pay was above $10,000.
Angioarchitecture of Brain AVM Determines the Presentation with Seizures: Proposed Scoring System • J.J.S. Shankar, R.J. Menezes, B. Pohlmann-Eden, C. Wallace, K. terBrugge, and T. Krings
This group of authors came up with a scoring system to predict seizures in patients with brain AVMs. They retrospectively reviewed imaging studies of 1299 patients and found 33 with unruptured AVMs and seizures and 45 with unruptured lesions without seizures. Features that predicted seizures included: arterial dilation, pial recruitment, fistula, intranidal aneurysm, pial long draining vein, pseudophlebitic pattern, venous outflow obstruction, and venous ectasia. Because seizures are associated with significant morbidity, AVMs with these features may be targeted for treatment with surgery and/or embolization.
Yield of CT Angiography and Contrast-Enhanced MR Imaging in Patients with Dizziness • S. Fakhran, L. Alhilali, and B.F. Branstetter IV
Which is the preferred imaging modality in patients presenting with isolated dizziness? These authors retrospectively evaluated CTA, contrast-enhanced MRI of the brain, and contrast-enhanced MRI of the internal auditory canals and temporal bones in a large group of patients and showed that all 3 are unlikely to identify significant findings that will lead to a change in clinical management in this situation.
