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18 October 2020, 5:00 pm
jross

Fellows’ Journal Club

The authors present 5 cases that illustrate varying imaging presentations of acute encephalopathy in patients with coronavirus disease 2019. MR features include leukoencephalopathy, diffusion restriction that involves the GM and WM, microhemorrhages, and leptomeningitis.

Summary

Coronavirus disease 2019 was declared a global pandemic by the World Health Organization on March 11, 2020. There is a scarcity of data on coronavirus disease 2019–related brain imaging features. We present 5 cases that illustrate varying imaging presentations of acute encephalopathy in patients with coronavirus disease 2019. MR features include leukoencephalopathy, diffusion restriction that involves the GM and WM, microhemorrhages, and leptomeningitis. We believe it is important for radiologists to be familiar with the neuroradiologic imaging spectrum of acute encephalopathy in the coronavirus disease 2019 population.

Read this article: https://bit.ly/3k24KTL

The post Imaging Features of Acute Encephalopathy in Patients with COVID-19: A Case Series appeared first on AJNR Blog.


17 October 2020, 5:00 pm
jross

Editor’s Choice

The authors retrospectively reviewed tentorial venous anatomy of the head using CTA/CTV performed for routine care or research purposes in 238 patients. Tentorial vein development was related to the ring configuration of the tentorial sinuses. There were 3 configurations: Groups 1A and 1B had ring configuration, while group 2 did not. Group 1A had a medialized ring configuration, and group 1B had a lateralized ring configuration. Measurements of skull base development were predictive of these groups. The ring configuration of group 1 was related to the presence of a split confluens, which correlated with a decreased internal auditory canal-petroclival fissure angle. Configuration 1A was related to the degree of petrous apex pneumatization.

Abstract

BACKGROUND AND PURPOSE

A new transtentorial venous system consisting of medial, intermediate, and lateral tentorial veins, connecting infra- and supratentorial compartments, was recently shown in 2 cadaver dissections and 2 patient scans. We sought to characterize the venous patterns within the tentorium and their relation to measures of skull development in a cohort of healthy adults.

MATERIALS AND METHODS

We retrospectively reviewed tentorial venous anatomy of the head using CTA/CTV performed for routine care or research purposes in 238 patients. Included studies had adequate contrast opacification of venous structures and a section thickness of ≤2 mm; we excluded cases with space-occupying lesions and vascular pathologies. Tentorial angle, dural sinus configurations, and measures of skull base development were assessed as predictors of tentorial venous anatomy variation via Cramér V association, the binary encoded Pearson correlation, and nearest-point algorithm with the Euclidean distance metric for clustering.

RESULTS

Tentorial vein development was related to the ringed configuration of the tentorial sinuses (P < .005). There were 3 configurations. Groups 1A and 1B (n = 50/238) had ringed configuration, while group 2 did not (n =

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11 October 2020, 5:00 pm
jross

Fellows’ Journal Club

This was a retrospective study performed at a large academic hospital in the United States. A total of 641 patients presented to the authors’ institution between March 3, 2020 and May 6, 2020, for treatment of coronavirus disease 2019, of whom, 150 underwent CT and/or MR imaging of the brain. CT and/or MR imaging examinations were evaluated for the presence of hemorrhage, infarction, and leukoencephalopathy. Of the 150 patients, 26 (17%) had abnormal CT and/or MR imaging findings, with hemorrhage in 11 of the patients (42%), infarction in 13 of the patients (50%), and leukoencephalopathy in 7 of the patients (27%). Significant associations were seen between abnormal CT/MR imaging findings and intensive care unit admission, intubation, and acute kidney injury.

Abstract

BACKGROUND AND PURPOSE

Coronavirus disease 2019 (COVID-19) is increasingly being recognized for its multiorgan involvement, including various neurological manifestations. We examined the frequency of acute intracranial abnormalities seen on CT and/or MR imaging in patients with COVID-19 and investigated possible associations between these findings and clinical parameters, including length of hospital stay, requirement for intubation, and development of acute kidney injury.

MATERIALS AND METHODS

This was a retrospective study performed at a large academic hospital in the United States. A total of 641 patients presented to our institution between March 3, 2020, and May 6, 2020, for treatment of coronavirus disease 2019, of whom, 150 underwent CT and/or MR imaging of the brain. CT and/or MR imaging examinations were evaluated for the presence of hemorrhage, infarction, and leukoencephalopathy. The frequency of these findings was correlated with clinical variables, including body mass index, length of hospital stay, requirement for intubation, and development of acute kidney injury as documented in the electronic medical record.

RESULTS

Of the 150 patients, 26 (17%) had abnormal CT and/or MR imaging findings,

The post Clinical and Neuroimaging Correlation in Patients with COVID-19 appeared first on AJNR Blog.


10 October 2020, 5:00 pm
jross

Editor’s Choice

The aims of this study were to: 1) to design a new method of postprocessing time-intensity curves, which renders normalized curves, and 2) to test its feasibility and performance on the diagnosis of primary central nervous system lymphoma. Time-intensity curves of enhancing tumor and normal-appearing white matter were obtained for each case. Enhancing tumor time-intensity curves were normalized relative to normal-appearing white matter. The authors performed pair-wise comparisons for primary central nervous system lymphoma against the other tumor type. The best discriminatory time points of the curves were obtained through a stepwise selection. Logistic binary regression was applied to obtain prediction models. A total of 233 patients were included in the study with 47 primary central nervous system lymphomas, 48 glioblastomas, 39 anaplastic astrocytomas, 49 metastases, and 50 meningiomas. The classifiers satisfactorily performed all bilateral comparisons in the test subset. They conclude that the proposed method for DSC-PWI time-intensity curve normalization renders comparable curves beyond technical and patient variability. Normalized time-intensity curves performed satisfactorily for the presurgical identification of primary central nervous system lymphoma.

Abstract

BACKGROUND AND PURPOSE

DSC-PWI has demonstrated promising results in the presurgical diagnosis of brain tumors. While most studies analyze specific parameters derived from time-intensity curves, very few have directly analyzed the whole curves. The aims of this study were the following: 1) to design a new method of postprocessing time-intensity curves, which renders normalized curves, and 2) to test its feasibility and performance on the diagnosis of primary central nervous system lymphoma.

MATERIALS AND METHODS

Diagnostic MR imaging of patients with histologically confirmed primary central nervous system lymphoma were retrospectively reviewed. Correlative cases of glioblastoma, anaplastic astrocytoma, metastasis, and meningioma, matched by date and number, were retrieved for comparison. Time-intensity curves of enhancing tumor and normal-appearing white matter were obtained for each case.

The post Presurgical Identification of Primary Central Nervous System Lymphoma with Normalized Time-Intensity Curve: A Pilot Study of a New Method to Analyze DSC-PWI appeared first on AJNR Blog.


9 October 2020, 6:35 pm
bookreviews

Srinivasan A, ed. Mukherji SK, consulting ed. Neuroimaging Clinics of North America: State of the Art Evaluation of the Head and Neck. Elsevier; 2020;30(3):261–392; $397.00

cover of Srinivasan

Coming nearly in a coordinated fashion with the just-ended virtual American Society of Head and Neck Radiology Annual Meeting, the current issue of Neuroimaging Clinics develops a number of themes that are pertinent to the practice of head and neck radiology or will soon become incorporated into interpretation and reporting of head and neck cases.

Edited by Dr. Ashok Srinivasan from the University of Michigan and authored/co-authored by 33 contributors, there are 9 chapters, which delve into some of the major areas of imaging of the head and neck. After a review of the general principles of DWI, the chapter on diffusion MR imaging shows, with good examples, how DWI can be useful in differential diagnosis, and more importantly, how separation of some malignant versus benign lesions can be suggested by findings on DWI. Shown are examples where the DWI/ADC findings are typical for malignancy but also where relying on those criteria alone could be misleading (as in the example of chondrosarcoma). Beyond the conventional DWI, this chapter explores diffusion tensor imaging and diffusion kurtosis imaging while showing classic examples of how these and routine DWI can be helpful in diagnosis. The illustrations illuminate the points made in the text.

Whether MR spectroscopy ever becomes more than a rarely used technique is a matter of conjecture, but the chapter entitled “MR Spectroscopy of the Head and Neck” could serve as a platform for those attempting to utilize spectroscopy in their practice.

The need to continually improve image quality in the head and neck by applying new or modified sequences is the theme of the chapter “Technical Improvements in Head and Neck Imaging: At the …

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