Neuroradiological Approach Research Articles

Low-Field-Strength MRI and Ventilation-Perfusion Mismatch after Pediatric COVID-19

HomeRadiologyVol. 307, No. 3 Previous CommunicationsFree AccessErratumLow-Field-Strength MRI and Ventilation-Perfusion Mismatch after Pediatric COVID-19Harriet J. PaltielHarriet J. PaltielHarriet J. PaltielPublished Online:Apr 24 2023https://doi.org/10.1148/radiol.239009MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Originally published in:https://doi.org/10.1148/radiol.222360Low-Field-Strength MRI and Ventilation-Perfusion Mismatch after Pediatric COVID-19Harriet J. PaltielErratum in:https://doi.org/10.1148/radiol.239009A sentence was incorrect and corrected to: This condition is an immune-mediated disease that occurs in fewer than 0.1% of children 2–6 weeks following COVID-19 infection.Article HistoryPublished online: Apr 24 2023 FiguresReferencesRelatedDetailsAccompanying This ArticleLow-Field-Strength MRI and Ventilation-Perfusion Mismatch after Pediatric COVID-19Oct 11 2022RadiologyRecommended Articles Perceived Impact of COVID-19 on Pediatric Radiology Departments around the World: World Federation of Pediatric Imaging COVID-19 Task Force Survey Results from Six ContinentsRadiology: Cardiothoracic Imaging2020Volume: 2Issue: 5Low-Field-Strength MRI and Ventilation-Perfusion Mismatch after Pediatric COVID-19Radiology2022Volume: 306Issue: 3Thoracic Imaging Findings of Multisystem Inflammatory Syndrome in Children Associated with COVID-19: What Radiologists Need to Know NowRadiology: Cardiothoracic Imaging2020Volume: 2Issue: 4The 2017 RadioGraphics Monograph Issue: Pediatric ImagingRadioGraphics2017Volume: 37Issue: 6pp. 1609-1611Point-of-Care Bone Age Evaluation: The Increasing Role of US in Resource-limited PopulationsRadiology2020Volume: 296Issue: 1pp. 170-171See More RSNA Education Exhibits A Rational Approach to Pediatric MRI OptimizationDigital Posters2020The Top 10 Radiological Diagnosis for the Pediatric Emergency Room: A Practical and Pictorial Review from Head to ToeDigital Posters2019Understanding Pediatric Neuroimmune Disorders Conflicts: A Neuroradiological Approach in the Molecular EraDigital Posters2019 RSNA Case Collection Pediatric Idiopathic Intervertebral Disc CalcificationRSNA Case Collection2020 IntussusceptionRSNA Case Collection2021Subperiosteal AbscessRSNA Case Collection2021 Vol. 307, No. 3 Metrics Altmetric Score Open AccessThis article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.PDF download

Alternations and Applications of the Structural and Functional Connectome in Gliomas: A Mini-Review.

In the central nervous system, gliomas are the most common, but complex primary tumors. Genome-based molecular and clinical studies have revealed different classifications and subtypes of gliomas. Neuroradiological approaches have non-invasively provided a macroscopic view for surgical resection and therapeutic effects. The connectome is a structural map of a physical object, the brain, which raises issues of spatial scale and definition, and it is calculated through diffusion magnetic resonance imaging (MRI) and functional MRI. In this study, we reviewed the basic principles and attributes of the structural and functional connectome, followed by the alternations of connectomes and their influences on glioma. To extend the applications of connectome, we demonstrated that a series of multi-center projects still need to be conducted to systemically investigate the connectome and the structural–functional coupling of glioma. Additionally, the brain–computer interface based on accurate connectome could provide more precise structural and functional data, which are significant for surgery and postoperative recovery. Besides, integrating the data from different sources, including connectome and other omics information, and their processing with artificial intelligence, together with validated biological and clinical findings will be significant for the development of a personalized surgical strategy.

Letter: Robotic-Assisted Neuroendovascular Intervention: Great Potential and Halted Expansion

To the Editor: More and more studies imply the ongoing changes in the field of neuroradiology and management of stroke. Robotic neurovascular procedures were first reported in 2007 by Dabus et al.1 These modalities were first designed for cardiac and peripheral vascular settings. However, some recent case series reported its applicability in interventional neuroradiology with favorable outcomes similar to the conventional modalities.2 However, there are certain considerations to validating this technique in this field. There are various drawbacks to using robotic interventional neuroradiological approaches in the current literature. Although robotically assisted modalities are originally designated to enhance the efficacy of treatment and reduce the procedural time, it has been shown that robotic interventional neuroradiological modalities are associated with prolonged procedural time.3 However, it is still controversial whether this drawback is related to the clinician's experience or might be relevant to the structure and composition of the current modalities. Currently, there is no evidence regarding whether providing more training to physicians (to have more acquisition over using these interventions) would enhance the efficacy and shorten the procedural time. Therefore, it is logical that these approaches should not be used in critical settings and high-risk patients who need further interventions until further validation has been made. Accordingly, future investigations are aimed to standardize the experience of their included operators before assessing this outcome for an enhanced validation.4 It should also be noted that there are other drawbacks to be considered, being related to the technique regardless of the operator's experience. As robotic interventional modalities were initially developed to perform robotic percutaneous coronary interventions, evidence indicates many limitations to the developed neuroradiological ones. Therefore, many adaptations should be made to these modalities before being used in the relevant clinical settings. In 2018, the Food and Drug Administration cleared the second-generation CorPath GRX as an efficacious robotically assisted peripheral vascular intervention. However, there are many limitations to be considered to this modality. For instance, the current working length is 20 cm while it has been suggested that an optimal length of 40 cm would be more appropriate for neuroradiological applications. Moreover, the size, shape, and stiffness of used catheters also represent further limitations that should be addressed, being more unfavorable than conventional ones. In addition, the arm of the current CorPath GRX also has a limited range of movement. Furthermore, the disposable cassette of the CorPath GRX cannot be used to fit side-port catheters (including balloon-guided) properly. This approach has been reported to remarkably enhance catheterization for tortious neurovasculature. However, it still needs manual assistance and cannot manipulate over-the-wire devices. Besides, it has been shown that with many neurovascular events, implementing the triaxial approach of guiding catheter, microcatheter, and distal access catheter is not feasible with these modalities. Accordingly, overcoming these limitations might significantly enhance the efficacy of robotic interventional neuroradiology in future settings. Furthermore, in cardiac settings, a previous in vivo study reported that using artificial intelligence might favor the outcomes of robot-based interventions and reduce the risk of tissue manipulation and damage. This might suggest the application of such approaches in interventional neuroradiology to overcome the potential limitations and enhance the efficacy of therapy. Another limitation is the availability of these modalities because they are not widely used and not affordable in different settings. This might also limit the ability to conduct relevant investigations based on the complications above because the approach does not have significance over the conventional methods according to the current evidence. Finally, the setting-up for robotic interventions is different from the conventional method because the former requires the integration of two operator teams. Although robotic-based interventions show promising outcomes and easy-to-use practices, additional time is still needed to validate these approaches in different settings further to accommodate these approaches better based on the health status of patients and available resources. Future explorations should also include the addition of feedback and force-sensing technologies together with further automation for the navigational system.5

Anatomy of the Spinal Meninges.

The spinal meninges have received less attention than the cranial meninges in the literature, although several points remain debatable and poorly understood, like their phylogenesis, their development, and their interactions with the spinal cord. Their constancy among the chordates shows their crucial importance in central nervous system homeostasis and suggests a role far beyond mechanical protection of the neuraxis. This work provides an extensive study of the spinal meninges, from an overview of their phylogenesis and embryology to a descriptive and topographic anatomy with clinical implications. It examines their involvement in spinal cord development, functioning, and repair. This work is a review of the literature using PubMed as a search engine on Medline. The stages followed by the meninges along the phylogenesis could not be easily compared with their development in vertebrates for methodological aspects and convergence processes throughout evolution. The distinction between arachnoid and pia mater appeared controversial. Several points of descriptive anatomy remain debatable: the functional organization of the arterial network, and the venous and lymphatic drainages, considered differently by classical anatomic and neuroradiological approaches. Spinal meninges are involved in neurodevelopment and neurorepair producing neural stem cells and morphogens, in cerebrospinal fluid dynamics and neuraxis functioning by the synthesis of active molecules, and the elimination of waste products of central nervous system metabolism. The spinal meninges should be considered as dynamic functional formations evolving over a lifetime, with ultrastructural features and functional interactions with the neuraxis remaining not fully understood.

Migraine with Visual Aura: A Clinical Manifestation of Cerebrovascular Disorders in Childhood

Cerebral vascular pathology mostly gets manifest in early adulthood. Bleeding, epileptic seizure, and focal neurologic deficits are the most common clinical presentations leading to the diagnosis. We present two children with migraine headache and visual aura as first symptoms. Case 1: A 7-year-old girl suffers from classical clinical symptoms of a migraine with visual aura. Cranial magnetic resonance imaging (MRI) scan revealed a large arteriovenous (AV) malformation in the right occipital lobe without signs of bleeding. As there were no epileptic seizures and just minimal restriction in the visual field, a watchful-waiting approach was preferred. In the 7 year follow-up, the clinical manifestation remained stable with variable amount of migraine attacks. Though the follow-up MRI showed an unchanged overall size of the AV malformation, the venous drainage and shunt volume raised and thereby the risk of bleeding. The possible and also risky therapeutic options versus further watchful-waiting approach are actually discussed with the family. Case 2: A 10-year-old boy suffers, since he is 7 years old, from left-sided temporal-parietal headache with visual aura and vertigo. As the frequency of the attacks significant rose (2-4 attacks/week), the boy sought medical advice. Cranial MRI and the following angiography showed a giant intracranial aneurysm of the cavernous part of the internal carotid (two aneurysm “pockets” with 1.5 cm diameter each) with local compression especially of the left optic nerve. Hints for an aneurysm associated illness or familiar burden were not found. After a positive occlusion test, a combined neuroradiological and neurosurgical approach with coiling and clipping of the left internal carotid was realized without complications. Conclusion: In children suffering from migraine with visual aura, which presents less often than migraine without aura, a cranial MRI should be considered, as it may be the first clinical sign of rare cerebrovascular disorders.

Diagnosis Please Certificates of Recognition Awarded to Three Individuals and to International and North American Radiology Resident Groups

HomeRadiologyVol. 253, No. 1 PreviousNext Diagnosis Please Certificates of Recognition Awarded to Three Individuals and to International and North American Radiology Resident GroupsHerbert Y. KresselHerbert Y. KresselHerbert Y. KresselPublished Online:Oct 1 2009https://doi.org/10.1148/radiol.2523090966MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References 1 Proto AV. Diagnosis Please certificates of recognition awarded to Eric L. Bressler, MD, Akira Fujikawa, MD, and to International and North American Radiology Resident Groups. Radiology 2007;245(2):309–312. Link, Google Scholar2 Proto AV. Diagnosis Please certificate of recognition awarded to Seyed Alireza Emamian, MD, PhD. Radiology 2000;216:617. Link, Google Scholar3 Proto AV. Diagnosis Please certificate of recognition awarded to Taro Shimono, MD, PhD. Radiology 2005;236:747. Link, Google Scholar4 Kressel HY. Diagnosis Please certificates of recognition awarded to three individuals and to international and North American radiology resident groups. Radiology 2008;249(3):728–730. Link, Google ScholarArticle HistoryPublished in print: Oct 2009 FiguresReferencesRelatedDetailsRecommended Articles Diagnosis Please Certificates of Recognition Awarded to Four Individuals and to International and North American Radiology Resident GroupsRadiology2021Volume: 301Issue: 3pp. 497-501Diagnosis Please Certificates of Recognition Awarded to Five Individuals and to International and North American Radiology Resident GroupsRadiology2020Volume: 297Issue: 2pp. 247-250Diagnosis Please Certificates of Recognition Awarded to Five Individuals and to International and North American Radiology Resident GroupsRadiology2016Volume: 281Issue: 2pp. 329-332RSNA Committee on International Radiology Education: 25 Years of Global Education OutreachRadioGraphics2020Volume: 40Issue: 7pp. 1938-1952Congratulations to the 2022 Editorial FellowsRadiology2022Volume: 0Issue: 0See More RSNA Education Exhibits Perfusion and Diffusion-Weighted Imaging of Pediatric Brain TumorsDigital Posters2019Understanding Pediatric Neuroimmune Disorders Conflicts: A Neuroradiological Approach in the Molecular EraDigital Posters2019A Comprehensive Review of the Valuable Role of Nuclear Myocardial Perfusion Imaging in Children with Heart ConditionsDigital Posters2018 RSNA Case Collection Primary Bone LymphomaRSNA Case Collection2020HepatoblastomaRSNA Case Collection2021Duodenal WebRSNA Case Collection2021 Vol. 253, No. 1 Metrics Downloaded 342 times Altmetric Score PDF download

Unaffected motor cortex remodeling after hemispherectomy in an epileptic cerebral palsy patient. A TMS and fMRI study

Here we describe pre- and post-operative neurophysiological and functional magnetic resonance imaging (fMRI) findings in a young epileptic girl with right hemiplegic cerebral palsy. Our findings demonstrate the feasibility of transcranial magnetic stimulation (TMS) and fMRI for predicting a post-surgical outcome and for evaluating functional cortical reorganization. We used TMS and fMRI to evaluate the excitability of the human motor cortex and cortical map representation before and after functional hemispherectomy. TMS was performed using single- and paired-pulse stimulation protocol. Cortical silent periods (CSPs), short interval intra-cortical inhibition (SICI), volume, area and center of gravity (CoG) of cortical map representation were studied before and after surgery. fMRI was done using the blood oxygenation level dependent (BOLD) technique with block-designed protocols. After surgery the patient showed an improvement of her clinical status and TMS and fMRI demonstrated a reshaping of cortical representation of motor cortex and a significant reduction of cortical silent periods. Before surgery, the combination of a clinical, neurophysiological and neuro-radiological approach may be predictable of the neurological outcome in epileptic patients. Moreover, the patient we describe provides new pieces of information in the mechanisms of plasticity underlying motor recovery after epilepsy surgery.

Lacunes and other Holes: Diagnosis, Pathogenesis, Therapy

Lacunar ischemic lesions are related to a pathology involving perforators, due to direct changes in the arteries or to an indirect mechanism, such as cardiac or artery to artery embolism, or to hypoperfusion in cases of cardiac failure, or proximal occlusion of large arteries. Changes involving the large intracranial arteries have progressively been taken into consideration as a cause of the disease. This latter aspect is interesting since possible endovascular treatment can be proposed in selected cases. In patients with lacunar syndrome an extended clinical and neuroradiological approach is indicated to choose the most appropriate therapy. Not all lesions recognizable on CT/MR are the expressions of ischemic lesions, this is another important aspect that should be considered in the differential diagnosis.

Temporal Lobe Epilepsy in Children: Electroclinical Study of 77 Cases

Temporal lobe epilepsy (TLE) is probably more difficult to recognize in children than in adults. In fact, ictal symptoms in children are less stereotyped and less obvious, and the neuropathological substrate is more heterogeneous than in adults. The aim of this study is to examine the relationships between etiology, age at onset and electroclinical findings in 77 children with TLE, 32 of whom were surgically treated. Electroclinical study including video-EEG recording of seizures in 77 children with TLE. The investigation focused on the first five initial ictal symptoms. Age at onset was less than 3 years in 39 cases, between 3 and 6 years in 17 cases and older than 6 years in 21 cases. Auras also occurred in younger children but were more common after the age of 6 years. A peculiar initial ictal semiology consisted in staring with arrest, lip cyanosis, and very slight oral automatisms. In some cases, EEG recordings documented seizures starting independently on both temporal lobes. Based on electroclinical and neuroradiological features, we recognized three subgroups: symptomatic TLE due to cortical malformations or nonevolutive tumors, TLE with mesial temporal sclerosis, and cryptogenic TLE. A correct electroclinical and neuroradiological approach allows in several cases early recognition of TLE even when onset is earlier than the age of 6 years. A correct definition of the localization relies primarily on video-EEG recording of the seizures, possibly repeated during follow up in cases lacking obvious neuroradiological correlation.

Syndromes of the orbital fissure, cavernous sinus, cerebello- pontine angle, and skull base

This article outlines the clinical presentation, neuroradiological approach, and the application of helpful ancillary investigations in the diagnosis of a range of cranial nerve syndromes. These syndromes are characterised by...

Proceedings of the 10th International Conference on Neuroscience of HIV Infection: emerging issues.

The 10th International Conference on Neuroscience of HIV Infection was held conjointly with the 4th International Symposium on NeuroVirology. This review summarizes a number of important topics addressed at the conference including clinical aspects of HIV-1 associated dementia and peripheral nervous system pathology and their epidemiology in the era of highly active antiretroviral therapy. The neuropathogenesis was discussed with a special focus on different cellular compartments involved, viral and non-viral factors, immune activation, and alterations of the blood-brain barrier, animal models and their relevance for understanding HIV dementia. New aspects of antiretroviral therapy as well as immunization were covered. Neuroradiological approaches including new MR techniques and neuropsychological tests were presented. Viral opportunistic infections (e.g., JCV infection resulting in progressive multifocal leukoencephalopathy) as well as coinfection with hepatitis C represented a further topic.

Elimination of a cirsoid aneurysm of the scalp by direct percutaneous embolization with thrombogenic coils

Cirsoid aneurysms of the scalp are notoriously difficult lesions to manage. The authors report a patient in whom a large traumatic cirsoid aneurysm of the scalp was eliminated using a combined neurosurgical and interventional neuroradiological approach. Transarterial embolization was utilized to reduce arterial blood supply to the fistula. Thrombogenic Gianturco spring coils were then introduced via direct percutaneous puncture of the aneurysm. The aneurysm thrombosed and the multiple tortuous scalp vessels disappeared. One month after embolization, a small area of skin necrosis over the aneurysm necessitated surgical excision of the lesion. The thrombosed aneurysm was easily resected with minimal blood loss. Percutaneous embolization with thrombogenic coils in this case was a safe and effective ablative technique.

New research techniques for congenital malformations in the CNS. : 6. Neuroradiological approach for congenital anomalies of central nervous system

New research techniques for congenital malformations in the CNS. : 6. Neuroradiological approach for congenital anomalies of central nervous system

Principles of X-ray Diagnosis of the Skull

Radiographic Atlas of the Human Skull: Normal Variants and Pseudo-Lesions , by Gerhardt S. Schwartz and Charles R. Golthamer (trilingual ed), Axel Neiss and Carlos E. Parera Simonet (trans.), n p, New York: Hafner Publishing Co., 1965. As the name suggests, Principles of X-ray Diagnosis of the Skull deals with principles of diagnosis and does not include the classic basic approach of standard views with numerical identification of structures, etc. The book is directed at those who have basic knowledge of general radiology. The traditional neuroradiological approach is used, with chapters on the vault, the base, the sella, and intracranial calcification. There are separate chapters on facial bones and the nasopharynx, raised intracranial pressures, head injuries, and radiography. Illustrations are of good quality, and the captions are lengthy and specific. The author's own original observations are included and noted as such when they differ from those usually accepted. Many cross references