Table of Contents
Perspectives
Practice Perspectives
- Board Certification Characteristics of Practicing Neuroradiologists
Of 3769 included radiologists ever subspecialty certified, 84.1% are currently subspecialty certified. Of 1777/3769 radiologists ever subspecialty-certified and with lifetime primary certificates, only 66.6% are currently subspecialty certified. Of 3341 included most-practice neuroradiologists (>50% clinical work effort in neuroradiology based on work relative value unit–weighted national Medicare claims), 73.0% were ever subspecialty certified; of these, 89.1% are currently subspecialty certified. More than one-quarter of most-practice neuroradiologists never obtained neuroradiology subspecialty certification. Even when initially obtained, that certification is commonly not maintained, particularly by lifetime primary certificate diplomates and those in nonacademic and smaller practices.
General Contents
- Perfusion MRI-Based Fractional Tumor Burden Differentiates between Tumor and Treatment Effect in Recurrent Glioblastomas and Informs Clinical Decision-Making
Forty-seven patients with high-grade gliomas (primarily glioblastoma) with recurrent contrast-enhancing lesions on DSC-MR imaging were retrospectively evaluated after surgical sampling. Histopathologic examination defined treatment effect versus tumor. Normalized relative CBV thresholds of 1.0 and 1.75 were used to define low, intermediate, and high fractional tumor burden classes in each histopathologically defined group. Performance was assessed with an area under the receiver operating characteristic curve. Mean low fractional tumor burden, high fractional tumor burden, and relative CBV of the contrast-enhancing volume were significantly different between treatment effect and tumor with tumor having significantly higher fractional tumor burden and relative CBV and lower fractional tumor burden. High fractional tumor burden and low fractional tumor burden define fractions of the contrast-enhancing lesion volume with high and low blood volume, respectively, and can differentiate treatment effect from tumor in recurrent glioblastomas. Fractional tumor burden maps can also help to inform clinical decision-making.
- Diagnostic Impact of Intracranial Vessel Wall MRI in 205 Patients with Ischemic Stroke or TIA
This was a single-center, retrospective study of 205 consecutive patients who were referred for vessel wall MR imaging to clarify the etiology of an ischemic stroke or TIA. An expert panel classified stroke etiology before and after incorporating vessel wall MR imaging results using a modified Trial of Org 10172 in Acute Stroke Treatment system. Vessel wall MR imaging altered the etiologic classification in 55% (112/205) of patients. The proportion of patients classified as having intracranial arteriopathy not otherwise specified decreased from 31% to 4% (64/205 versus 9/205) and the proportion classified as having intracranial atherosclerotic disease increased from 23% to 57%. When vessel wall MR imaging is performed to clarify the etiology of a stroke or TIA, it frequently alters the etiologic classification, which is the basis for therapeutic decision-making.
- Cerebral Venous Thrombosis: MR Black-Blood Thrombus Imaging with Enhanced Blood Signal Suppression
Twenty-six participants underwent conventional imaging methods followed by 2 randomized black-blood thrombus imaging scans, with a preoptimized DANTE preparation switched on and off, respectively. The signal intensity of residual blood, thrombus, brain parenchyma, normal lumen, and noise on black-blood thrombus images were measured. The thrombus volume, SNR of residual blood, and contrast-to-noise ratio for residual blood versus normal lumen, thrombus versus residual blood, and brain parenchyma versus normal lumen were compared between the 2 black-blood thrombus imaging techniques. The new black-blood thrombus imaging technique provided higher thrombus-to-residual blood contrast-to-noise ratio, significantly lower thrombus volume, and substantially improved diagnostic specificity and agreement with conventional imaging methods.
- Safety and Efficacy of Transvenous Embolization of Ruptured Brain Arteriovenous Malformations as a Last Resort: A Prospective Single-Arm Study
Twenty-one consecutive patients with ruptured brain AVMs who underwent transvenous embolization were prospectively followed between November 2016 and November 2018. Complete AVM nidus obliteration was shown in 16 (84%) of 19 patients. One (5%) patient with a small residual nidus after treatment showed complete obliteration at 13-month follow-up. There were 5 hemorrhages and 1 infarction; 4 patients' symptoms improved gradually. Transvenous embolization can be performed only in highly selected hemorrhagic brain AVMs with high complete obliteration rates, but it should not be considered as a first-line treatment.
- Comparison of [18F] FDG-PET/MRI and Clinical Findings for Assessment of Suspected Lumbar Facet Joint Pain: A Prospective Study to Characterize Candidate Nonanatomic Imaging Biomarkers and Potential Impact on Management
Ten patients with clinically suspected facetogenic low back pain were prospectively recruited with a designation of specific facet joints implicated clinically. Subsequently, patients underwent an FDG-PET/MR imaging examination with gadolinium. Each facet joint was graded for perifacet signal change on MR imaging and FDG activity. The frequency and correlation of MR imaging, FDG-PET, and clinical findings were determined. There was low concordance of perifacet signal change and FDG activity with clinically implicated facet joints. This could indicate either the potential to change patient management or a lack of biomarker accuracy.
Online Features
Letters
Erratum
