Table of Contents
Perspectives
Patient Safety
Practice Perspectives
- Contextual Radiology Reporting: A New Approach to Neuroradiology Structured Templates
Contextual reporting is an alternative method of structured reporting that is specifically related to the disease or examination indication. These disease-specific reports provide content focused on the clinical diagnosis or symptom, discuss appropriate differential diagnoses, and highlight pertinent positives and negatives. The authors created a library of 50 contextual structured reports for neuroradiologists and emphasize their clinical value over noncontextual structured reporting.
General Contents
- Added Value of Spectroscopy to Perfusion MRI in the Differential Diagnostic Performance of Common Malignant Brain Tumors
From January 2013 to January 2016, fifty-five consecutive patients with histopathologically proved lymphomas, glioblastomas, and metastases were included in this study after undergoing MR imaging. The perfusion parameters (maximum relative CBV, maximum percentage of signal intensity recovery) and spectroscopic concentration ratios (lactate/Cr, Cho/NAA, Cho/Cr, and lipids/Cr) were analyzed individually and in optimal combinations. The highest differential diagnostic performance was obtained with the following combined classifiers: 1) maximum percentage of signal intensity recovery-Cho/NAA to discriminate lymphomas from glioblastomas and metastases; 2) relative CBV-Cho/NAA to discriminate glioblastomas from lymphomas and metastases; and 3) maximum percentage of signal intensity recovery-lactate/Cr and maximum percentage of signal intensity recovery-Cho/Cr to discriminate metastases from lymphomas and glioblastomas. The authors conclude that spectroscopy yielded an added performance value to perfusion using optimal combined classifiers of these modalities.
- Brain Perfusion Measurements Using Multidelay Arterial Spin-Labeling Are Systematically Biased by the Number of Delays
The authors assessed delay and transit time-uncorrected and transit time-corrected CBF maps in 87 healthy controls. Data analysis included voxelwise permutation-based between-sequence comparisons of 3-delay versus 7-delay, within-sequence comparison of transit time-uncorrected versus transit time-corrected maps, and average CBF calculations in regions that have been shown to differ. The 7-delay sequence estimated a higher CBF value than the 3-delay for the transit time-uncorrected and transit time-corrected maps in regions corresponding to the watershed areas. In the peripheral regions of the brain, the estimated delay was found to be longer for the 3-delay sequence while the inverse was found in the center of the brain. This study supports the necessity of standardizing acquisition parameters in multidelay arterial spin-labeling and identifying basic parameters as a confounding factor in CBF quantification studies.
- Primary Angioplasty without Stenting for Symptomatic, High-Grade Intracranial Stenosis with Poor Circulation
Thirty-five patients with high-grade, symptomatic intracranial stenosis and poor antegrade flow, treated with intracranial angioplasty without stent placement from January 2010 to December 2016, were retrospectively reviewed. The main outcomes included the changes in antegrade flow and residual stenosis and any stroke or death within 1 month. The average preprocedure stenosis was 88%. The immediate, average postprocedure stenosis rate was 25%, and the average postprocedure stenosis rate at last angiographic follow-up was 35%. The primary end point of major stroke or death at 30 days was observed in 1 patient (1/35, 2.9%), and no patient had intraprocedural complications. The authors conclude that primary balloon angioplasty was an effective treatment option for symptomatic intracranial stenosis with a high risk of stroke.
- Preoperative Mapping of the Supplementary Motor Area in Patients with Brain Tumor Using Resting-State fMRI with Seed-Based Analysis
Sixty-six patients with brain tumors were evaluated with resting-state fMRI using seed-based analysis of hand and orofacial motor regions. Rates of supplementary motor area localization were compared with those in healthy controls and with localization results by task-based fMRI. Localization of the supplementary motor area using hand motor seed regions was more effective than seeding using orofacial motor regions for both patients with brain tumor and controls. Bilateral hand motor seeding was superior to unilateral hand motor seeding in patients with brain tumor for either side. The authors conclude that in addition to task-based fMRI, seed-based analysis of resting-state fMRI represents an equally effective method for supplementary motor area localization in patients with brain tumors, with the best results obtained with bilateral hand motor region seeding.
- The Bone Does Not Predict the Brain in Sturge-Weber Syndrome
MR imaging of 139 children presenting with port-wine stain and/or Sturge-Weber syndrome between 1998 and 2017 was evaluated by 2 pediatric neuroradiologists for marrow signal abnormality and pial angioma and other Sturge-Weber syndrome features. Groups were divided into port-wine stain-only (without intracranial Sturge-Weber syndrome features) and Sturge-Weber syndrome (the presence of cerebral pial angioma). In the port-wine stain-only cohort, 78% had ipsilateral bony changes and 17% had no intraosseous changes. In the Sturge-Weber syndrome cohort, 84/99 had associated port-wine stain, 91% had bony changesipsilateral to the port-wine stain or had no bone changes in the absence of port-wine stain, and 77% had bony changes ipsilateral to a cerebral pial angioma. The authors conclude that intraosseous marrow changes are strongly associated with facial port-wine stain. No significant association was found between pial angioma and bone marrow changes.
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