Faculty Bibliography

OBJECTIVE: To assess the relationship between the degree of leukoaraiosis (LA), carotid intima-media thickness (IMT) and intima-media thickness variability (IMTV). MATERIALS AND METHODS: Sixty-one consecutive patients, who underwent a brain MRI examination and a carotid artery ultrasound, were included in this retrospective study, which conformed with the Declaration of Helsinki. Written informed consent was waived. In each patient, right/left carotid arteries and brain hemispheres were assessed using automated software for IMT, IMTV and LA volume. RESULTS: The mean hemispheric LA volume was 2,224 mm3 (SD 2,702 mm3) and there was no statistically significant difference in LA volume between the right and left hemispheres (p value = 0.628). The mean IMT and IMTV values were 0.866 mm (SD 0.170) and 0.143 mm (SD 0.100), respectively, without significant differences between the right and left sides (p values 0.733 and 0.098, respectively). The correlation coefficient between IMTV and LA volume was 0.41 (p value = 0.0001), and 0.246 (p value = 0.074) between IMT and LA volume. CONCLUSIONS: IMTV significantly correlates with LA volume. Further studies are warranted to verify whether this parameter can be used clinically as a marker of cerebrovascular risk. KEY POINTS: * Intima-media thickness variability (IMTV) significantly correlates with leukoaraiosis volume. * IMTV could be used as a marker for cerebrovascular risk. * IMTV seems to be a better predictor of weighted mean difference than IMT.

Introduction: Femoral artery closure devices allow for earlier mobilization and improved comfort for patients after vascular access. The Mynx device (Cardinal Health, Inc.) is an extravascular closure device that deploys a polyethylene glycol plug, and is maximally labeled for 6/7 French sheath closure. Here we report our experience using the device to close 8F sheaths in patients post endovascular treatment of ischemic stroke. Methods: We performed a retrospective analysis of all stroke cases where the 6/7F Mynx device was used with 8F sheaths. Operating room flowsheets, physician and nursing notes up to 2 weeks post angiography were reviewed and data on deployment and complications were analyzed. Results: 87 consecutive stroke embolectomy cases at an academic center were reviewed from 2014 through 2016. 8F short sheaths were utilized in 23 patients, and all 23 were closed with 6/7F Mynx device. Average compression time following Mynx deployment was 18 minutes. The mean patient age was 70.7 years. The average BMI was 27. Ten patients (38%) had received IV tPA; 6 patients were on anticoagulation(27%); and 2 patients had coagulapathies. Two (8%) patients had documented groin bruising post Mynx; both resolved spontaneously. No patients had loss of ipsilateral distal pulses post mynx; in 1 patient, distal pulses changed from palpable to dopplerable. No patient had significant pain or swelling at the site. There were no groin site infections. Conclusions: Off-Label use of 6/7F Mynx for 8F closure is safe and efficacious, and was not associated with an increased complication rate in our small cohort

BACKGROUND: There is substantial overlap between MRI of acute spinal cord lesions from neuromyelitis optica (NMO) and spinal cord infarct (SCI) in clinical practice. However, early differentiation is important since management approaches to minimize morbidity from NMO or SCI differ significantly. OBJECTIVE: To identify MRI features at initial presentation that may help to differentiate NMO acute myelitis from SCI. METHODS: 2 board-certified neuroradiologists, blinded to final diagnosis, retrospectively characterized MRI features at symptom onset for subjects with serologically-proven NMO (N=13) or SCI (N=11) from a single institution. Univariate and multivariate analyses were used to identify factors associated with NMO or SCI. RESULTS: SCI was more common in men and Caucasians, while NMO was more common in non-Caucasian women (P<0.05). MRI features associated with NMO acute myelitis (P<0.05) included location within 7-cm of cervicomedullary junction; lesion extending to pial surface; 'bright spotty lesions' on axial T2 MRI; and gadolinium enhancement. Patient's age, lesion length and cross-sectional area, cord expansion, and the "owl's eyes" sign did not differ between the two groups (P>0.05). CONCLUSION: Along with patient demographic characteristics, lesion features on MRI, including lesion location, extension to pial border and presence of 'bright spotty lesion' can help differentiate acute myelitis of NMO from SCI in the acute setting.

OBJECTIVES: To study the carotid artery plaque composition and its volume changes in a group of patients at baseline and 2 years after head and neck radiation therapy treatment (HNXRT). METHODS: In this retrospective study, 62 patients (41 males; mean age 63 years; range 52-81) who underwent HNXRT and 40 patients (24 males; mean age 65) who underwent surgical resection of neoplasm and did not undergo HNXRT were assessed, with 2-year follow-up. The carotid artery plaque volumes, as well as the volume of the sub-components (fatty-mixed-calcified), were semiautomatically quantified. Mann-Whitney and Wilcoxon tests were used to test the hypothesis. RESULTS: In the HNXRT group, there was a statistically significant increase in the total volume of the carotid artery plaques (from 533 to 746 mm3; p = 0.001), in the fatty plaques (103 vs. 202 mm3; p = 0.001) and mixed plaque component volume (328 vs. 419 mm3; p = 0.034). A statistically significant variation (from 21.8 % to 27.6 %) in the percentage of the fatty tissue was found. CONCLUSIONS: RESULTS: of this preliminary study suggest that HNXRT promotes increased carotid artery plaque volume, particularly the fatty plaque component. KEY POINTS: * HNXRT increases carotid plaque volume. * Plaque volume increase is mainly due to increase.in fatty plaque component * Patients who undergo HNXRT have a progression of carotid artery disease.

Foreign material emboli following cerebral, cardiac, and peripheral catheterizations have been reported since the mid-1990s. Catheter coatings have been frequently implicated. The most recent surge of interest in this phenomenon within the neurointerventional community is associated with procedures using flow-diversion devices for the treatment of cerebral aneurysms. Following coil-supported Pipeline embolization in 4 cases and stent-supported coiling in 1, 5 patients developed multiple subcentimeter enhancing lesions, usually with surrounding edema and variable magnetic susceptibility in the vascular territories of the treated aneurysms. Conventional angiography findings were unrevealing. Laboratory work-up showed mild CSF protein elevation with no leukocytosis. Brain biopsy in 2 cases revealed granulomatous angiitis encasing foreign material, identical in stain appearance to a polyvinylpyrrolidone catheter coating. Corticosteroid administration typically produced clinical improvement. A heterogeneous radiographic and clinical course was noted, with rise and fall in the number of enhancing lesions in 2 patients and persistence in others. The etiology may be related to widespread adoption of increasingly sophisticated catheterization techniques.

Fungal sinusitis is characterized into invasive and noninvasive forms. The invasive variety is further classified into acute, chronic and granulomatous forms; and the noninvasive variety into fungus ball and allergic fungal sinusitis. Each of these different forms has a unique radiologic appearance. The clinicopathologic and corresponding radiologic spectrum and differences in treatment strategies of fungal sinusitis make it an important diagnosis for clinicians and radiologists to always consider. This is particularly true of invasive fungal sinusitis, which typically affects immuno compromised patients and is associated with significant morbidity and mortality. Early diagnosis allows initiation of appropriate treatment strategies resulting in favorable outcome.

OBJECTIVES: Contrast-enhanced fat-suppressed T1-weighted-2D-TSE and MPRAGE sequence with water excitation are routinely obtained to evaluate orbit pathology. However, these sequences can be marred by artifacts. The Radial-VIBE sequence is a motion-robust fat-suppressed T1W sequence which has demonstrated value in pediatric and body imaging. The purpose of our study is to evaluate its role in assessing the orbit, and to compare it with routinely acquired sequences. METHODS: A HIPAA-compliant and IRB-approved retrospective study was performed in 46 patients (age range: 1-81 years) who underwent orbit studies on a 1.5-T MRI using contrast-enhanced Radial-VIBE, MPRAGE and 2D-TSE sequences. Two radiologists blinded to the sequence analyzed evaluated multiple parameters of image quality including motion artifact, degree of fat-suppression, clarity of choroidal enhancement, intraorbital vessels, extraocular muscles, optic nerves, brain parenchyma and evaluation of pathology. Each parameter was assessed on a 5-point scale, with a higher score indicating the more optimal exam. Mix-model analysis of variance and interobserver variability were assessed. RESULTS: Radial-VIBE demonstrated superior quality (p<0.001) for all orbit parameters when compared to MPRAGE and 2D-TSE. Interobserver agreement demonstrated average fair-to -good agreement for: degree of motion artifact (0.745), fat suppression (0.678), clarity of choroidal enhancement (0.688), vessels (0.655), extraocular muscles (0.675), optic nerves (0.518), brain parenchyma (0.710), and evaluation of pathology (0.590). CONCLUSION: Radial-VIBE sequence demonstrates superior image quality when evaluating the orbits as compared to conventional MPRAGE and 2D-TSE sequences. Advances in knowledge: Radial-VIBE employs unique non-Cartesian k-space sampling in a radial or spoke-wheel fashion which provides superior image quality improving diagnostic capability in evaluation of the orbits.

OBJECTIVE: Several criteria for time-consuming volumetric measurements of progressive supranuclear palsy Richardson syndrome subtype (PSP-RS) have been proposed. These often require image reconstruction in different planes for proper assessment. The purpose of this study was to evaluate the cerebral peduncle angle as a simple and reproducible measure of midbrain atrophy in patients with PSP-RS. MATERIALS AND METHODS: The records of 15 patients with PSP-RS were retrospectively identified. The records of 31 age-matched healthy control subjects, 15 patients with multiple-system atrophy, and 22 patients with Parkinson disease were included for comparison. Two neuroradiologists individually assessed these studies for midbrain atrophy by evaluating the cerebral peduncle angle, that is, the angle between the two cerebral peduncles. RESULTS: The cerebral peduncle angle measurements were 62.1 degrees (SD, 6.8 degrees ) in PSP-RS patients, 51.2 degrees (SD, 10.1 degrees ) in healthy control subjects, 55.7 degrees (SD, 11.6 degrees ) in patients with multiple-system atrophy, and 53.7 degrees (SD, 8.5 degrees ) in patients with Parkinson disease. A statistically significant difference was found in the cerebral peduncle angle measurements (observer 1, p = 0.015; observer 2, p = 0.004) between the PSP-RS patients and the other subgroups. Bland-Altman analysis showed a bias of 0.6 degrees (95% limits of agreement, 6.9 degrees , -5.8 degrees ), and intraobserver variability analysis showed a bias of 0.5 degrees (4.1 degrees , -3 degrees ). CONCLUSION: The cerebral peduncle angle is a simple, easy-to-calculate, and reproducible measure of midbrain atrophy. It is a useful criterion for differentiating patients with PSP-RS from healthy persons and from patients with multiple-system atrophy or Parkinson disease.