Table of Contents
Perspectives
Review Articles
Radiology-Pathology Correlation
Health Care Reform Vignette
General Contents
- High Spatiotemporal Resolution 4D Flow MRI of Intracranial Aneurysms at 7T in 10 Minutes
The authors used pseudospiral Cartesian undersampling with compressed sensing reconstruction to achieve high spatiotemporal resolution (0.5mm isotropic, ∼30 ms) in a scan time of 10 minutes. They analyzed the repeatability of accelerated 4D-flow scans and compared flow rates, stroke volume, and the pulsatility index with 2D-flow and conventional 4D-flow MR imaging in a flow phantom and 15 healthy subjects. Mean flow-rate bias compared with 2D-flow was lower for accelerated than for conventional 4D-flow MR imaging. Pulsatility index bias gave similar results. Stroke volume bias showed no difference from accelerated bias for conventional 4D-flow MR imaging. Repeatability for accelerated 4D-flow was similar to that of 2D-flow MR imaging. They conclude that highly accelerated high-spatiotemporal-resolution 4D-flow MR imaging at 7T in intracranial arteries and aneurysms provides repeatable and accurate quantitative flow values.
- Cervicofacial Venous Malformations Are Associated with Intracranial Developmental Venous Anomalies and Dural Venous Sinus Abnormalities
Sixty-three consecutive patients who presented to the authors' institution with cervicofacial venous malformations and underwent postcontrast MR imaging were studied. Three neuroradiologists reviewed brain MRIs for the presence of developmental venous anomalies, dural venous sinus ectasia, and cavernous malformations. The prevalence of developmental venous anomalies in this patient population was compared with an age- and sex-matched control group without venous malformations. The overall presence of developmental venous anomalies in patients with venous malformations was 36.5% (23/63) compared with 7.9% (10/126) in controls. The prevalence of dural venous sinus ectasia was 9.5% (6/63) compared with 0% for controls. The authors show a significant association between cervicofacial venous malformations and cerebral developmental venous anomalies as well as between cervicofacial venous malformations and dural venous sinus abnormalities.
Commentary
- Posttreatment Imaging in Patients with Head and Neck Cancer without Clinical Evidence of Recurrence: Should Surveillance Imaging Extend Beyond 6 Months?
The authors performed a retrospective data base search that queried neck CT reports with Neck Imaging Reporting and Data Systems scores of 2–4 from June 2014 to March 2018. The electronic medical records were reviewed to determine outcomes of clinical and radiologic follow-up, including symptoms, physical examination findings, pathologic correlation, and clinical notes within 3 months of imaging. A total of 255 cases all with NIRADS scores of 2 or 3 met the inclusion criteria. Fifty-nine patients (23%) demonstrated recurrence, and 21 patients (36%) had clinically occult recurrence. The median overall time to radiologically detected, clinically occult recurrence was 11.4 months from treatment completion. They conclude that imaging surveillance beyond the first posttreatment baseline study was critical for detecting clinically occult recurrent disease in patients with head and neck squamous cell carcinoma. More than one-third of all recurrences were seen in patients without clinical evidence of disease.
Commentary
- Automatic Machine Learning to Differentiate Pediatric Posterior Fossa Tumors on Routine MR Imaging
This retrospective study included preoperative MR imaging of 288 pediatric patients with pediatric posterior fossa tumors, including medulloblastoma (n=111), ependymoma (n=70), and pilocytic astrocytoma (n=107). Radiomics features were extracted from T2-weighted images, contrast-enhanced T1-weighted images, and ADC maps. Models generated by standard manual optimization by a machine learning expert were compared with automatic machine learning via the Tree-Based Pipeline Optimization Tool for performance evaluation. The authors conclude that automatic machine learning based on routine MR imaging classified pediatric posterior fossa tumors with high accuracy compared with manual expert pipeline optimization and qualitative expert MR imaging review.
- Intra-Arterial Chemotherapy for Retinoblastoma in Infants ≤10 kg: 74 Treated Eyes with 222 IAC Sessions
Intra-arterial chemotherapy (IAC) for retinoblastoma (Rb) has dramatically altered the natural history of the disease. Cure rates, globe salvage, and vision preservation have dramatically increased. This retrospective chart review evaluated 207 Rb tumors of 207 eyes in 196 consecutive patients who underwent 658 IAC infusions overall. Patient weights were ≤10 kg in 69 (35.2%) and >10 kg in 127 (64.8%) patients. Comparison (≤10 kg versus >10 kg) revealed that the total number of IAC infusions was 222 versus 436. Periprocedural complications were not significantly different. The authors conclude that intra-arterial chemotherapy in patients weighing ≤10 kg is a safe and effective treatment.
- Spine MRI in Spontaneous Intracranial Hypotension for CSF Leak Detection: Nonsuperiority of Intrathecal Gadolinium to Heavily T2-Weighted Fat-Saturated Sequences
The authors performed a retrospective study of patients with spontaneous intracranial hypotension examined from February 2013 to October 2017. The spine MR imaging was reviewed by 3 blinded readers for the presence of epidural CSF using 3 different sequences (T2WI, 3D T2WI fat-saturated, T1WI gadolinium). In patients with leaks, the presumed level of the leak was reported. They conclude that intrathecal gadolinium-enhanced spine MR imaging does not improve the diagnostic accuracy for the detection of epidural CSF. Gadolinium myelography lacks a rationale to be included in the routine spontaneous intracranial hypotension work-up. Heavily T2-weighted images with fat saturation provide high accuracy for the detection of an epidural CSF collection.
