Table of Contents
Perspectives
Review Article
Practice Perspectives
General Contents
- White Matter Changes Related to Subconcussive Impact Frequency during a Single Season of High School Football
Seventeen male athletes (mean age, 16 years) underwent MR imaging before and after the football season. Changes in fractional anisotropy across the white matter skeleton were assessed with Tract-Based Spatial Statistics and ROI analysis. The mean number of impacts over a 10-g threshold sustained was 414. Voxelwise analysis failed to show significant changes in fractional anisotropy across the season or a correlation with impact frequency, after correcting for multiple comparisons. ROI analysis showed significant decreases in fractional anisotropy in the fornix-stria terminalis and cingulum hippocampus, which were related to impact frequency. The authors conclude that subclinical neurotrauma related to participation in American football may result in white matter injury and that alterations in white matter tracts within the limbic system may be detectable after only 1 season of play at the high school level.
- Feasibility of Brain Atrophy Measurement in Clinical Routine without Prior Standardization of the MRI Protocol: Results from MS-MRIUS, a Longitudinal Observational, Multicenter Real-World Outcome Study in Patients with Relapsing-Remitting MS
Brain atrophy outcomes of 590 patients were analyzed by the percentage brain volume change measured by structural image evaluation with normalization of atrophy on 2D-T1WI and 3D-T1WI and the percentage lateral ventricle volume change, measured by VIENA on 2D-T1WI and 3D-T1WI and NeuroSTREAM on T2-FLAIR examinations. The median annualized percentage brain volume change was -0.31% on 2D-T1WI and -0.38% on 3D-T1WI. The median annualized percentage lateral ventricle volume change was 0.95% on 2D-T1WI, 1.47% on 3D-T1WI, and 0.90% on T2-FLAIR. The authors conclude that brain atrophy was more readily assessed by estimating the percentage lateral ventricle volume change on T2-FLAIR compared with the percentage brain volume change or percentage lateral ventricle volume change using 2D- or 3D-T1WI.
- Noninvasive Assessment of Intracranial Pressure Status in Idiopathic Intracranial Hypertension Using Displacement Encoding with Stimulated Echoes (DENSE) MRI: A Prospective Patient Study with Contemporaneous CSF Pressure Correlation
Nine patients with suspected elevated intracranial pressure and 9 healthy control patients were included in this prospective study. Control patients underwent DENSE MR imaging through the midsagittal brain while patients underwent DENSE MR imaging followed immediately by lumbar puncture with opening pressure measurement, CSF removal, closing pressure measurement, and immediate repeat DENSE MR imaging. All patients had elevated opening pressure (median, 36.0 cm water), decreased by the removal of CSF to a median closing pressure of 17.0 cm water. Measured CSF pressure in patients pre= and post=lumbar puncture correlated significantly with pontine displacement. The authors conclude that DENSE MR imaging may providing a method to noninvasively assess intracranial pressure status in idiopathic intracranial hypertension.
- Feasibility of Permanent Stenting with Solitaire FR as a Rescue Treatment for the Reperfusion of Acute Intracranial Artery Occlusion
From January 2011 through January 2016, among 2979 patients with acute ischemic stroke, the authors identified 27 patients who underwent permanent stent placement (13 patients with the Solitaire FR and 14 patients with other self-expanding stents). The postprocedural modified TICI grade and angiographic and clinical outcomes were assessed. Stent placement was successful in all cases. Modified TICI 2b=3 reperfusion was noted in 84.6% of the Solitaire group and in 78.6% of the other stent group. They conclude that permanent stent placement with the Solitaire FR compared with other self-expanding stents appears to be feasible and safe as a rescue tool for refractory intra-arterial therapy.
- Lymphographic-Like Technique for the Treatment of Microcystic Lymphatic Malformation Components of <3 mm
A retrospective analysis of a prospectively collected lymphatic malformation data base was performed that included 16 patients (5 males, 11 females; mean age, 15 years; range, 1=47 years). Patients with at least 1 microcystic lymphatic malformation component demonstrated on MR imaging treated by lymphographic-like technique bleomycin infusion were included in the study. Patient interviews and MR imaging were performed to assess subjective and objective clinical improvement (microcystic lymphatic malformation size decrease of >30%). The authors observed no major and 3 minor complications: 1 eyelid infection, 1 case of severe postprocedural nausea and vomiting, and 1 case of skin discoloration. MR imaging objective improvement was observed in 5/16 (31%) patients; overall improvement of clinical symptoms was obtained in 93% of treated patients. Bleomycin lymphographic-like technique for microcystic lymphatic malformations was safe and feasible with objective improvement in about one-third of patients.
- Clinical and Radiologic Characteristics of Deep Lumbosacral Dural Arteriovenous Fistulas
Twenty patients with deep lumbosacral spinal dural arteriovenous fistulas were included in this series. Cord T2 hyperintensity and contrast enhancement were present in most cases. The filum vein and/or lumbar veins were dilated in 95% of patients. Time-resolved contrast-enhanced dynamic MRA indicated a spinal DAVF at or below the L5 vertebral level in 7/8 (88%) patients who received time-resolved contrast-enhanced dynamic MRA before DSA. A bilateral arterial supply of the fistula was detected via DSA in 5 (25%) patients. The authors conclude that time-resolved contrast-enhanced dynamic MRA facilitates the detection of the drainage vein and helps to localize deep lumbosacral-located fistulas with a high sensitivity before DSA. Definite detection remains challenging and requires conventional spinal angiography.
