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American Journal of Neuroradiology
October 2019; Vol. 40, No. 10

Perspectives

Stephen L.G. Rothman
AJNR Am J Neuroradiol 2019; 40:1609 doi:10.3174/ajnr.P0071
http://www.ajnr.org/content/40/10/1609


Practice Perspectives

Board Certification Characteristics of Practicing Neuroradiologists
A.B. Rosenkrantz, G.N. Nicola, J.A. Hirsch and R. Duszak, Jr.
AJNR Am J Neuroradiol 2019; 40:1610-1616 doi:10.3174/ajnr.A6225
http://www.ajnr.org/content/40/10/1610.abstract

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

Virtual Monoenergetic Images from Spectral Detector CT Enable Radiation Dose Reduction in Unenhanced Cranial CT
R.P. Reimer, D. Flatten, T. Lichtenstein, D. Zopfs, V. Neuhaus, C. Kabbasch, D. Maintz, J. Borggrefe and N. Große Hokamp
AJNR Am J Neuroradiol 2019; 40:1617-1623 doi:10.3174/ajnr.A6220
http://www.ajnr.org/content/40/10/1617.abstract

PACS Integration of Semiautomated Imaging Software Improves Day-to-Day MS Disease Activity Detection
A. Dahan, R. Pereira, C.B. Malpas, T. Kalincik and F. Gaillard
AJNR Am J Neuroradiol 2019; 40:1624-1629 doi:10.3174/ajnr.A6195
http://www.ajnr.org/content/40/10/1624.abstract

Cerebral Damage after Carbon Monoxide Poisoning: A Longitudinal Diffusional Kurtosis Imaging Study
Y. Zhang, T. Wang, J. Lei, S. Guo, S. Wang, Y. Gu, S. Wang, Y. Dou and X. Zhuang
AJNR Am J Neuroradiol 2019; 40:1630-1637 doi:10.3174/ajnr.A6201 OPEN ACCESS ARTICLE
http://www.ajnr.org/content/40/10/1630.abstract

An Introduction to Kurtosis Fractional Anisotropy
B. Hansen
AJNR Am J Neuroradiol 2019; 40:1638-1641 doi:10.3174/ajnr.A6235
http://www.ajnr.org/content/40/10/1638

White Matter Abnormalities in Multiple Sclerosis Evaluated by Quantitative Synthetic MRI, Diffusion Tensor Imaging, and Neurite Orientation Dispersion and Density Imaging
A. Hagiwara, K. Kamagata, K. Shimoji, K. Yokoyama, C. Andica, M. Hori, S. Fujita, T. Maekawa, R. Irie, T. Akashi, A. Wada, M. Suzuki, O. Abe, N. Hattori and S. Aoki
AJNR Am J Neuroradiol 2019; 40:1642-1648 doi:10.3174/ajnr.A6209 OPEN ACCESS ARTICLE
http://www.ajnr.org/content/40/10/1642.abstract

Perfusion MRI-Based Fractional Tumor Burden Differentiates between Tumor and Treatment Effect in Recurrent Glioblastomas and Informs Clinical Decision-Making
M. Iv, X. Liu, J. Lavezo, A.J. Gentles, R. Ghanem, S. Lummus, D.E. Born, S.G. Soltys, S. Nagpal, R. Thomas, L. Recht and N. Fischbein
AJNR Am J Neuroradiol 2019; 40:1649-1657 doi:10.3174/ajnr.A6211
http://www.ajnr.org/content/40/10/1649.abstract

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 a nd 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.


Regional Cerebral Blood Flow in the Posterior Cingulate and Precuneus and the Entorhinal Cortical Atrophy Score Differentiate Mild Cognitive Impairment and Dementia Due to Alzheimer Disease
B. Thomas, R. Sheelakumari, S. Kannath, S. Sarma and R.N. Menon
AJNR Am J Neuroradiol 2019; 40:1658-1664 doi:10.3174/ajnr.A6219 OPEN ACCESS ARTICLE
http://www.ajnr.org/content/40/10/1658.abstract

Lateral Posterior Choroidal Collateral Anastomosis Predicts Recurrent Ipsilateral Hemorrhage in Adult Patients with Moyamoya Disease
J. Wang, Y. Yang, X. Li, F. Zhou, Z. Wu, Q. Liang, Y. Liu, Y. Wang, S. Na, X. Chen, X. Zhang and B. Zhang
AJNR Am J Neuroradiol 2019; 40:1665-1671 doi:10.3174/ajnr.A6208 OPEN ACCESS ARTICLE
http://www.ajnr.org/content/40/10/1665.abstract

Hemorrhagic Factors of Moyamoya Disease
X. Lv
AJNR Am J Neuroradiol 2019; 40:1672-1673 doi:10.3174/ajnr.A6217
http://www.ajnr.org/content/40/10/1672

Identification of the Bleeding Point in Hemorrhagic Moyamoya Disease Using Fusion Images of Susceptibility-Weighted Imaging and Time-of-Flight MRA
A. Miyakoshi, T. Funaki, Y. Fushimi, T. Kikuchi, H. Kataoka, K. Yoshida, Y. Mineharu, J.C. Takahashi and S. Miyamoto
AJNR Am J Neuroradiol 2019; 40:1674-1680 doi:10.3174/ajnr.A6207
http://www.ajnr.org/content/40/10/1674.abstract

Paracoccidioidomycosis of the Central Nervous System: CT and MR Imaging Findings
M. Rosa Júnior, A.C. Amorim, I.V. Baldon, L.A. Martins, R.M. Pereira, R.P. Campos, S.S. Gonçalves, T.R.G. Velloso, P. Peçanha and A. Falqueto
AJNR Am J Neuroradiol 2019; 40:1681-1688 doi:10.3174/ajnr.A6203 OPEN ACCESS ARTICLE
http://www.ajnr.org/content/40/10/1681.abstract

Multinodular and Vacuolating Posterior Fossa Lesions of Unknown Significance
A. Lecler, J. Bailleux, B. Carsin, H. Adle-Biassette, S. Baloglu, C. Bogey, F. Bonneville, E. Calvier, P.-O. Comby, J.-P. Cottier, F. Cotton, R. Deschamps, C. Diard-Detoeuf, F. Ducray, L. Duron, C. Drissi, M. Elmaleh, J. Farras, J.A. Garcia, E. Gerardin, S. Grand, D.C. Jianu, S. Kremer, N. Magne, M. Mejdoubi, A. Moulignier, M. Ollivier, S. Nagi, M. Rodallec, J.-C. Sadik, N. Shor, T. Tourdias, C. Vandendries, V. Broquet, J. Savatovsky
AJNR Am J Neuroradiol 2019; 40:1689-1694 doi:10.3174/ajnr.A6223
http://www.ajnr.org/content/40/10/1689.abstract

Empty Sella Is a Sign of Symptomatic Lateral Sinus Stenosis and Not Intracranial Hypertension
A. Zetchi, M.-A. Labeyrie, E. Nicolini, M. Fantoni, M. Eliezer and E. Houdart
AJNR Am J Neuroradiol 2019; 40:1695-1700 doi:10.3174/ajnr.A6210
http://www.ajnr.org/content/40/10/1695.abstract

Diagnostic Impact of Intracranial Vessel Wall MRI in 205 Patients with Ischemic Stroke or TIA
J.D. Schaafsma, S. Rawal, J.M. Coutinho, J. Rasheedi, D.J. Mikulis, C. Jaigobin, F.L. Silver and D.M. Mandell
AJNR Am J Neuroradiol 2019; 40:1701-1706 doi:10.3174/ajnr.A6202
http://www.ajnr.org/content/40/10/1701.abstract

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.


Impact of Vessel Wall MR Imaging in the Work-Up for Ischemic Stroke
J.W. Song
AJNR Am J Neuroradiol 2019; 40:1707-1708 doi:10.3174/ajnr.A6241
http://www.ajnr.org/content/40/10/1707

Effect of Time Elapsed since Gadolinium Administration on Atherosclerotic Plaque Enhancement in Clinical Vessel Wall MR Imaging Studies
A. de Havenon, H.J. Muhina, D.L. Parker, J.S. McNally and M.D. Alexander
AJNR Am J Neuroradiol 2019; 40:1709-1711 doi:10.3174/ajnr.A6191 OPEN ACCESS ARTICLE
http://www.ajnr.org/content/40/10/1709.abstract

Increased Diameters of the Internal Cerebral Veins and the Basal Veins of Rosenthal Are Associated with White Matter Hyperintensity Volume
A.L. Houck, J. Gutierrez, F. Gao, K.C. Igwe, J.M. Colon, S.E. Black and A.M. Brickman
AJNR Am J Neuroradiol 2019; 40:1712-1718 doi:10.3174/ajnr.A6213 OPEN ACCESS ARTICLE
http://www.ajnr.org/content/40/10/1712.abstract

The Internal Cerebral Vein: New Classification of Branching Patterns Based on CTA
K. Brzegowy, M.P. Zarzecki, A. Musiał, H.M. Aziz, T. Kasprzycki, R.S. Tubbs, T. Popiela and J.A. Walocha
AJNR Am J Neuroradiol 2019; 40:1719-1724 doi:10.3174/ajnr.A6200
http://www.ajnr.org/content/40/10/1719.abstract

Cerebral Venous Thrombosis: MR Black-Blood Thrombus Imaging with Enhanced Blood Signal Suppression
G. Wang, X. Yang, J. Duan, N. Zhang, M.M. Maya, Y. Xie, X. Bi, X. Ji, D. Li, Q. Yang and Z. Fan
AJNR Am J Neuroradiol 2019; 40:1725-1730 doi:10.3174/ajnr.A6212 OPEN ACCESS ARTICLE
http://www.ajnr.org/content/40/10/1725.abstract

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.


Carotid Intraplaque-Hemorrhage Volume and Its Association with Cerebrovascular Events
L. Saba, G. Micheletti, W. Brinjikji, P. Garofalo, R. Montisci, A. Balestrieri, J.S. Suri, J.K. DeMarco, G. Lanzino and R. Sanfilippo
AJNR Am J Neuroradiol 2019; 40:1731-1737 doi:10.3174/ajnr.A6189
http://www.ajnr.org/content/40/10/1731.abstract

Carotid Artery Tortuosity Is Associated with Connective Tissue Diseases
J.P. Welby, S.T. Kim, C.M. Carr, V.T. Lehman, C.H. Rydberg, J.T. Wald, P.H. Luetmer, D.M. Nasr and W. Brinjikji
AJNR Am J Neuroradiol 2019; 40:1738-1743 doi:10.3174/ajnr.A6218
http://www.ajnr.org/content/40/10/1738.abstract

Safety and Efficacy of Transvenous Embolization of Ruptured Brain Arteriovenous Malformations as a Last Resort: A Prospective Single-Arm Study
Y. He, Y. Ding, W. Bai, T. Li, F.K. Hui, W.-J. Jiang and J. Xue
AJNR Am J Neuroradiol 2019; 40:1744-1751 doi:10.3174/ajnr.A6197 OPEN ACCESS ARTICLE
http://www.ajnr.org/content/40/10/1744.abstract

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.


Application of High-Resolution C-Arm CT Combined with Streak Metal Artifact Removal Technology for the Stent-Assisted Embolization of Intracranial Aneurysms
T.-F. Li, J. Ma, X.-W. Han, P.-J. Fu, R.-N. Niu, W.-Z. Luo and J.-Z. Ren
AJNR Am J Neuroradiol 2019; 40:1752-1758 doi:10.3174/ajnr.A6190 OPEN ACCESS ARTICLE
http://www.ajnr.org/content/40/10/1752.abstract

A Multicenter Pilot Study on the Clinical Utility of Computational Modeling for Flow-Diverter Treatment Planning
B.W. Chong, B.R. Bendok, C. Krishna, M. Sattur, B.L. Brown, R.G. Tawk, D.A. Miller, L. Rangel-Castilla, H. Babiker, D.H. Frakes, A. Theiler, H. Cloft, D. Kallmes and G. Lanzino
AJNR Am J Neuroradiol 2019; 40:1759-1765 doi:10.3174/ajnr.A6222
http://www.ajnr.org/content/40/10/1759.abstract

Low-Profile Intra-Aneurysmal Flow Disruptor WEB 17 versus WEB Predecessor Systems for Treatment of Small Intracranial Aneurysms: Comparative Analysis of Procedural Safety and Feasibility
L. Goertz, T. Liebig, E. Siebert, M. Herzberg, L. Pennig, M. Schlamann, J. Borggrefe, B. Krischek, F. Dorn and C. Kabbasch
AJNR Am J Neuroradiol 2019; 40:1766-1772 doi:10.3174/ajnr.A6183
http://www.ajnr.org/content/40/10/1766.abstract

Predicting Factors of Angiographic Aneurysm Occlusion after Treatment with the Woven EndoBridge Device: A Single-Center Experience with Midterm Follow-Up
F. Cagnazzo, R. Ahmed, R. Zannoni, C. Dargazanli, P.-H. Lefevre, G. Gascou, I. Derraz, C. Riquelme, A. Bonafe and V. Costalat
AJNR Am J Neuroradiol 2019; 40:1773-1778 doi:10.3174/ajnr.A6221
http://www.ajnr.org/content/40/10/1773.abstract

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
V.T. Lehman, F.E. Diehn, S.M. Broski, M.A. Nathan, B.J. Kemp, N.B. Larson, R.A. Shelerud, J.S. Brault, M.P. Halasy and T.P. Maus
AJNR Am J Neuroradiol 2019; 40:1779-1785 doi:10.3174/ajnr.A6224
http://www.ajnr.org/content/40/10/1779.abstract

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.


Transforaminal Insertion of a Thermocouple on the Posterior Vertebral Wall Combined with Hydrodissection during Lumbar Spinal Radiofrequency Ablation
R. Lecigne, J. Garnon, R.L. Cazzato, P. Auloge, D. Dalili, G. Koch and A. Gangi
AJNR Am J Neuroradiol 2019; 40:1786-1790 doi:10.3174/ajnr.A6233
http://www.ajnr.org/content/40/10/1786.abstract


Online Features

Letters

Chimeric Antigen Receptor T-Cell Neurotoxicity Neuroimaging: More Than Meets the Eye
J. Gust and G.E. Ishak
AJNR Am J Neuroradiol 2019; 40:E50-E51 doi:10.3174/ajnr.A6184 OPEN ACCESS ARTICLE
http://www.ajnr.org/content/40/10/E50

Chimeric Antigen Receptor T-Cell Therapy: Are Neuroradiologists Prepared?
S.A. Nabavizadeh
AJNR Am J Neuroradiol 2019; 40:E52 doi:10.3174/ajnr.A6186
http://www.ajnr.org/content/40/10/E52

Reply:
H.A. Valand, F. Huda and R.K. Tu
AJNR Am J Neuroradiol 2019; 40:E53 doi:10.3174/ajnr.A6231
http://www.ajnr.org/content/40/10/E53

Hardly a Tweet Storm
P. Charkhchi, S. Sahraian, E. Beheshtian and D.M. Yousem
AJNR Am J Neuroradiol 2019; 40:E54 doi:10.3174/ajnr.A6187
http://www.ajnr.org/content/40/10/E54

Reply:
G. D'Anna, M.M. Chen, J. McCarty, A. Radmanesh and A.L. Kotsenas
AJNR Am J Neuroradiol 2019; 40:E55 doi:10.3174/ajnr.A6214
http://www.ajnr.org/content/40/10/E55

Increasing Social Media Involvement around the American Society of Neuroradiology Annual Meeting
T. Garg
AJNR Am J Neuroradiol 2019; 40:E56 doi:10.3174/ajnr.A6185
http://www.ajnr.org/content/40/10/E56

Reply:
G. D'Anna, M.M. Chen, J. McCarty, A. Radmanesh and A.L. Kotsenas
AJNR Am J Neuroradiol 2019; 40:E57 doi:10.3174/ajnr.A6215
http://www.ajnr.org/content/40/10/E57

An Important Pitfall in Diagnosing Intracanalicular Vestibular Schwannoma
A. Hakim and F. Wagner
AJNR Am J Neuroradiol 2019; 40:E58-E59 doi:10.3174/ajnr.A6192
http://www.ajnr.org/content/40/10/E58

Challenges in Differentiating Pediatric Autoimmune CNS Diseases with Similar Clinical and Imaging Phenotypes
B.P. Kelley, P.A. Caruso and P.W. Schaefer
AJNR Am J Neuroradiol 2019; 40:E60-E61 doi:10.3174/ajnr.A6196
http://www.ajnr.org/content/40/10/E60

Reply:
E. Bulut, J. Karakaya, S. Salama, M. Levy, T.A.G.M. Huisman and I. Izbudak
AJNR Am J Neuroradiol 2019; 40:E62 doi:10.3174/ajnr.A6216
http://www.ajnr.org/content/40/10/E62


Erratum

Erratum
AJNR Am J Neuroradiol 2019; 40:E63 doi:10.3174/ajnr.A6206
http://www.ajnr.org/content/40/10/E63


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