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- Centrally Reduced Diffusion Sign for Differentiation between Treatment-Related Lesions and Glioma Progression: A Validation Study
Images of 231 patients who underwent an operation for suspected glioma recurrence were reviewed. Patients with susceptibility artifacts or without central necrosis were excluded. The final diagnosis was established according to histopathology reports. Two neuroradiologists classified the diffusion patterns on preoperative MR imaging as the following: 1) reduced diffusion in the solid component only, 2) reduced diffusion mainly in the solid component, 3) no reduced diffusion, 4) reduced diffusion mainly in the central necrosis, and 5) reduced diffusion in the central necrosis only. A total of 103 patients were included (22 with treatment-related lesions and 81 with tumor progression). The diagnostic accuracy results for the centrally reduced diffusion pattern as a predictor of treatment-related lesions (“mainly central” and “exclusively central” patterns versus all other patterns) were: 64% sensitivity, 84% specificity, 52% positive predictive value, and 89% negative predictive value.
- Monro-Kellie Hypothesis: Increase of Ventricular CSF Volume after Surgical Closure of a Spinal Dural Leak in Patients with Spontaneous Intracranial Hypotension
Nineteen patients with spontaneous intracranial hypotension with a proved spinal CSF leak were investigated between July 2014 and 2017. Brain MR imaging-based volumetry at baseline and after surgery was performed with FreeSurfer. In addition, the spontaneous intracranial hypotension score, ranging from 0 to 9, with 0 indicating very low and 9 very high probability of spinal CSF loss, was calculated. The authors conclude that the study demonstrated a significant increase in ventricular CSF volume in the early follow-up after surgical closure of the underlying spinal dural breach, and may provide a causal link between spinal CSF loss and spontaneous intracranial hypotension. The concomitant decrease in the spontaneous intracranial hypotension score postoperatively implies the restoration of an equilibrium within the CSF compartment.
- Percutaneous CT-Guided Core Needle Biopsies of Head and Neck Masses: Technique, Histopathologic Yield, and Safety at a Single Academic Institution
This is a retrospective review of head and neck biopsies performed from January 2013 through December 2019. Clinical diagnosis and indication, patient demographics, mass location and size, biopsy needle type, technical approach, dose-length product, sedation details, complications, diagnostic histopathologic yield, and the use of iodinated contrast were recorded for each case. Twenty-seven CT-guided head and neck core needle biopsies were performed in 26 patients. The diagnostic sample rate was 100% (27/27). A concordant histopathologic diagnosis was obtained in 93% (25/27) of cases. There was a single complication of core needle biopsy, a small asymptomatic superficial hematoma.
Commentary
- Prognostic Accuracy of Fetal MRI in Predicting Postnatal Neurodevelopmental Outcome
The authors identified all fetal MR imaging performed at their institution during a 10-year period (n = 145) and assessed agreement between prenatal prognosis and postnatal outcome. Prenatal prognosis was determined by a pediatric neurologist who reviewed the fetal MR imaging report and categorized each pregnancy as having a favorable, indeterminate, or poor prognosis. Assessment of postnatal neurodevelopmental outcome was made solely on the basis of the child's Gross Motor Function Classification System score and whether the child developed epilepsy. Postnatal outcome was categorized as favorable, intermediate, or poor. There was 93.0% agreement between prenatal and postnatal imaging diagnoses. Prognosis was favorable in 44.2%, indeterminate in 50.0%, and poor in 5.8% of pregnancies. There was 93.5% agreement between a favorable prenatal prognosis and a favorable postnatal outcome.
- Variability of T2-Relaxation Times of Healthy Lumbar Intervertebral Discs is More Homogeneous within an Individual Than across Healthy Individuals
Using prospectively acquired T2-relaxometry data from 606 intervertebral discs in 101 volunteers without back pain in a narrow age range (25–35 years), the authors calculated intra- and intersubject variation in T2 times of IVDs graded by 2 neuroradiologists on the Pfirrmann scale. Intrasubject variation of IVDs was assessed relative to other healthy IVDs (Pfirrmann grade, #2) in the same individual. Multiple intersubject variability measures were calculated using healthy extraneous references ranging from a single randomly selected IVD to all healthy extraneous IVDs, without and with segmental stratification. They conclude that the study demonstrates a significantly higher variation in the T2 times of IVDs across subjects, and suggests that normative measures based on the T2 times of healthy lumbar IVDs from the same individual are likely to provide the most discriminating means of identifying degenerated IVDs on the basis of T2 relaxometry.
- Cauda Equina and Filum Terminale Arteriovenous Fistulas: Anatomic and Radiographic Features
Intradural AVF below the conus medullaris may develop either on the filum terminale or the cauda equina (lumbosacral and coccygeal radicular nerves). Only 3 detailed cauda equina AVFs have been reported in the literature. The authors present the angiographic and MR imaging findings of cauda equina and filum terminale AVF cases, supplemented with literature research to characterize the radiologic features of the 2 entities. On angiography, filum terminale AVFs were invariably supplied by the extension of the anterior spinal artery accompanied by a closely paralleling filum terminale vein. Cauda equina AVFs were fed by either a radicular or a spinal artery or both arteries, often with a characteristic wavy radicular-perimedullary draining vein.
35 Years Ago in AJNR
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