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22 March 2017, 4:00 pm

Federle MP, Rosado-de-Christenson ML, Raman SP, Carter BW, Woodward PJ, Shaaban AM. Imaging Anatomy: Chest, Abdomen, Pelvis. 2nd ed. Elsevier; 2016; 1192 pp; $329.99

Federle et al cover

For anyone predominantly or exclusively involved in neuroradiology, having a high-quality, well-illustrated, and readily available text covering the chest, abdomen, and pelvis is desirable. Those parts of the body have a nasty way of occasionally making the interpretations of spine imaging more difficult. Enter the second edition of Imaging Anatomy: Chest, Abdomen, Pelvis (2017), published by Elsevier and edited by Drs. Federle, Rosado-de-Christenson, Raman, Carter, Woodward, and Shaaban. As with all the books in this series, the drawings, the imaging, and the bullet point written material in this hardcover book is outstanding in quality.

The chest section is divided into 16 chapters, the abdomen into 17 chapters, and the pelvis into 8 chapters. The emphasis throughout, as the title implies, is on anatomy; however, in some sections (e.g., in the abdomen) there is more pathologic imaging than in others. Nearly all of the material is pertinent to our interpretation of spine imaging when large fields of view are included (or even if the FOVs are narrow). Nowhere is this more pertinent than when viewing thoracic lumbar spine imaging (CTs in particular) and analyzing the abdominal contents when required. Here would be a ready reference to help resolve questions related to anatomy and pathology incidentally seen on neuroimaging. The same can be said for the imaging of the pelvis. Here (as in the entire book) the illustrations of the anatomy are outstanding. These help to further one’s appreciation of the accompanying CT anatomy, although MR and US are included to a lesser extent. There are areas that will not be troublesome when viewing spine or lumbosacral plexus studies, such as detailed imaging anatomy of the heart …

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19 March 2017, 5:30 pm

Fellows’ Journal Club

MR imaging and MRV images from 63 patients with idiopathic intracranial hypertension and 96 controls were reviewed by using 3 independent procedures. MRV images were graded for the presence and degree of stenosis of the transverse sinus. Postgadolinium coronal T1-weighted sequences were evaluated independent of MRV. The dimensions of the proximal and distal transverse sinus were measured. Transverse sinus stenosis was identified bilaterally on MRV in 94% of patients with IIH and in 3% of controls. On coronal T1 postgadolinium MR images, transverse sinus stenosis was identified in 83% of patients with IIH and 7% of controls. The authors conclude that transverse sinus stenosis is the most useful and sensitive imaging indicator of this disease state.


Figure 1 from paper
A–C, Transverse sinus stenosis on coronal T1 postgadolinium MR imaging. A and B, Images from a 43-year-old female patient with idiopathic intracranial hypertension. CSF opening pressure was 380 mm H2O. Postgadolinium coronal 3D fast-spoiled gradient recalled images, section thickness = 2.4 mm, demonstrate stenosis of the transverse sinuses bilaterally (arrows). The expected Δ configuration is distorted and collapsed bilaterally (A). This is more easily appreciated on images from within the same study by comparing with the images of the same sinuses more posteriorly (B). C and D, Images from a 36-year-old female patient with IIH. CSF opening pressure was 370 mm H2O. Postgadolinium T1-weighted image (C) with coronal reformatting from a 3D acquisition, with a section thickness = 2 mm, TR = 650 ms, TE = 12 ms; and oblique projectional image from a gadolinium-bolused MRV sequence, with TR = 3.83 ms and TE = 1.39 ms. Stenoses of the transverse sinuses are evident on both images (arrows). E and F, Coronal T1-weighted image from a

The post Transverse Sinus Stenosis Is the Most Sensitive MR Imaging Correlate of Idiopathic Intracranial Hypertension appeared first on AJNR Blog.

18 March 2017, 5:30 pm

Editor’s Choice

This Level 1 expedited report was a pragmatic, multicenter, parallel, randomized (1:1) trial evaluating patients who were at high risk of aneurysm recurrence after endovascular treatment, including patients with large aneurysms (Patients Prone to Recurrence After Endovascular Treatment PRET-1) or with aneurysms that had previously recurred after coiling (PRET-2). The trial was stopped once 250 patients in PRET-1 and 197 in PRET-2 had been recruited because of slow accrual. A poor primary outcome occurred in 44.4% of those in PRET-1 allocated to platinum compared with 52.5% of patients allocated to hydrogel and in 49.0% in PRET-2 allocated to platinum compared with 42.1% allocated to hydrogel. Adverse events and morbidity were similar. The authors conclude that coiling of large and recurrent aneurysms is safe but often poorly effective according to angiographic results. Hydrogel coiling was not shown to be better than platinum.


Figure 2 from paper
Subgroup analysis of primary outcome in PRET groups.


Some patients are at high risk of aneurysm recurrence after endovascular treatment: patients with large aneurysms (Patients Prone to Recurrence After Endovascular Treatment PRET-1) or with aneurysms that have previously recurred after coiling (PRET-2). We aimed to establish whether the use of hydrogel coils improved efficacy outcomes compared with bare platinum coils.


PRET was an investigator-led, pragmatic, multicenter, parallel, randomized (1:1) trial. Randomized allocation was performed separately for patients in PRET-1 and PRET-2, by using a Web-based platform ensuring concealed allocation. The primary outcome was a composite of a residual/recurrent aneurysm, adjudicated by a blinded core laboratory, or retreatment, intracranial bleeding, or mass effect during the 18-month follow-up. Secondary outcomes included adverse events, mortality, and morbidity (mRS > 2). The hypothesis was that hydrogel would decrease the primary outcome from 50% to 30% at 18 months, necessitating 125 patients per group (500

The post Hydrogel versus Bare Platinum Coils in Patients with Large or Recurrent Aneurysms Prone to Recurrence after Endovascular Treatment: A Randomized Controlled Trial appeared first on AJNR Blog.

17 March 2017, 6:12 pm
Benjamin Huang

The Radiology Department at the University of North Carolina has an unexpected opening for our fellowship in Neuroradiology for the 2017-18 academic year. Applicants must have completed an ACGME accredited residency in diagnostic radiology prior to the start of the fellowship on July 1, 2017.

The fellowship is an ACGME accredited 1 year fellowship which trains 4 fellows annually. Fellows work closely with 6 full-time, board certified diagnostic neuroradiologists, including division chief, Dr. Mauricio Castillo, former editor-in-chief of the AJNR, current president of the ARRS, and past president of the ASNR.

Our trainees rotate regularly through core services including Brain imaging, ENT/Spine imaging, and outpatient imaging throughout the year and also spend 6 weeks out of the year rotating on the neurointerventional service with 2 dedicated interventional neuroradiologists. During the second half of the year, trainees participate in a rotation dedicated to Spine Intervention and Pain Management and are given up to 3 weeks of time for electives.

Each fellow receives 3 weeks of paid vacation plus an additional week off over the winter holidays. Fellows may also take up to a week off for meeting attendance. Additional information regarding salary and benefits can be found on the UNC GME website at http://www.uncmedicalcenter.org/uncmc/professional-education-services/office-of-graduate-medical-education.

Interested individuals should send a curriculum vitae and references to:
Benjamin Huang, MD, MPH
Director, Neuroradiology Fellowship
Associate Professor of Radiology
UNC School of Medicine

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17 March 2017, 4:00 pm

Brandão LA, ed. Mukherji SK, consulting ed. Neuroimaging Clinics of North America: Pediatric Brain Tumors Update. Elsevier; 2017;27(1):1–194; $365.00

Brandao cover

As a follow-up to the last issue (November 2016) of the Neuroimaging Clinics of North America, which dealt with adult brain tumors, the current issue, also edited by Dr. Lara Brandão, concerns an update on pediatric brain tumors. One hundred and ninety-four pages in length, the material covers not only standard imaging/findings in pediatric tumors, but also importantly includes advanced techniques both in the initial patient assessment and in posttherapy evaluation. The nine chapters of this issue are: posterior fossa tumors; supratentorial tumors; neonatal brain tumors; pineal region masses; sella and the parasellar region rumors; extraparenchymal lesions; tumors and tumor-like masses that involve multiple spaces; peptide-based vaccine therapies; and advanced MR imaging/clinical applications. For the seasoned neuroradiologist, the last two chapters will be of greatest interest; however, the entire volume addresses key imaging points in a wide spectrum of neoplastic brain disorders. Dr. Brandão has done a remarkable job (similar to the editorship of the prior volume) getting the 24 authors to contribute their experiences and expertise to this important issue. If one is not a Neuroimaging Clinics of North America subscriber, then this single issue is a recommended purchase for one’s personal collection or for a departmental library.…

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