American Journal of Neuroradiology   August 2019; Vol. 40, No. 8 Perspectives Bejoy Thomas AJNR Am J Neuroradiol 2019; 40:1251 doi:10.3174/ajnr.P0057 http://www.ajnr.org/content/40/8/1251 Practice Perspectives Risk Factors for Perceptual-versus-Interpretative Errors in Diagnostic Neuroradiology S.H. Patel, C.L. Stanton, S.G. Miller, J.T. Patrie, J.N. Itri and T.M. Shepherd AJNR Am J Neuroradiol 2019; 40:1252-1256 doi:10.3174/ajnr.A6125 http://www.ajnr.org/content/40/8/1252.abstract General Contents Intrathecal Use of Gadobutrol for Glymphatic MR Imaging: Prospective Safety Study of 100 Patients C.S. Edeklev, M. Halvorsen, G. Løvland, S.A.S. Vatnehol, Ø. Gjertsen, B. Nedregaard, R. Sletteberg, G. Ringstad and P.K. Eide AJNR Am J Neuroradiol 2019; 40:1257-1264 doi:10.3174/ajnr.A6136 http://www.ajnr.org/content/40/8/1257.abstract The authors performed a prospective safety and feasibility study in 100 consecutive patients undergoing glymphatic MR imaging from September 2015 to August 2018. Short- and long-term serious and nonserious adverse events were registered clinically and by interview after intrathecal administration of 0.5 mL of gadobutrol (1.0 mmol/mL) along with 3 mL of iodixanol (270 mg I/mL). One serious adverse event (anaphylaxis) occurred in a patient with known allergy to iodine-containing contrast agents (1%). The main nonserious adverse events during the first 1–3 days after contrast injection included severe headache (28%) and severe nausea (34%), though the frequency depended heavily on the diagnosis. They conclude that intrathecal administration of gadobutrol in conjunction with iodixanol for glymphatic MR imaging is safe and feasible. Gadolinium Retention in the Brain: An MRI Relaxometry Study of Linear and Macrocyclic Gadolinium-Based Contrast Agents in Multiple Sclerosis Y. Forslin, J. Martola, Å. Bergendal, S. Fredrikson, M.K. Wiberg and T. Granberg AJNR Am J Neuroradiol 2019; 40:1265-1273 doi:10.3174/ajnr.A6112 http://www.ajnr.org/content/40/8/1265.abstract Signal Hyperintensity on Unenhanced T1-Weighted Brain and Cervical Spinal Cord MR Images after Multiple Doses of Linear Gadolinium-Based Contrast Agent G. Barisano, B. Bigjahan, S. Metting, S. Cen, L. Amezcua, A. Lerner, A.W. Toga and M. Law AJNR Am J Neuroradiol 2019; 40:1274-1281 doi:10.3174/ajnr.A6148 http://www.ajnr.org/content/40/8/1274.abstract Convolutional Neural Network for Automated FLAIR Lesion Segmentation on Clinical Brain MR Imaging M.T. Duong, J.D. Rudie, J. Wang, L. Xie, S. Mohan, J.C. Gee and A.M. Rauschecker AJNR Am J Neuroradiol 2019; 40:1282-1290 doi:10.3174/ajnr.A6138 OPEN ACCESS ARTICLE http://www.ajnr.org/content/40/8/1282.abstract This convolutional neural network was retrospectively trained on 295 brain MRIs to perform automated FLAIR lesion segmentation. Performance was evaluated on 92 validation cases using Dice scores and voxelwise sensitivity and specificity, compared with radiologists' manual segmentations. The authors' model demonstrated accurate FLAIR lesion segmentation performance (median Dice score, 0.79) on the validation dataset across a large range of lesion characteristics. Across 19 neurologic diseases, performance was significantly higher than existing methods (Dice, 0.56 and 0.41) and approached human performance (Dice, 0.81). White Matter Lesion Penumbra Shows Abnormalities on Structural and Physiologic MRIs in the Coronary Artery Risk Development in Young Adults Cohort I.M. Nasrallah, M.-K. Hsieh, G. Erus, H. Battapady, S. Dolui, J.A. Detre, L.J. Launer, D.R. Jacobs, C. Davatzikos and R.N. Bryan AJNR Am J Neuroradiol 2019; 40:1291-1298 doi:10.3174/ajnr.A6119 OPEN ACCESS ARTICLE http://www.ajnr.org/content/40/8/1291.abstract The Interpeduncular Angle: A Practical and Objective Marker for the Detection and Diagnosis of Intracranial Hypotension on Brain MRI D.J. Wang, S.K. Pandey, D.H. Lee and M. Sharma AJNR Am J Neuroradiol 2019; 40:1299-1303 doi:10.3174/ajnr.A6120 http://www.ajnr.org/content/40/8/1299.abstract MRIs of 30 patients with intracranial hypotension and 30 age-matched controls were evaluated by 2 neuroradiologists for classic findings of intracranial hypotension and the interpeduncular angle. Group analysis was performed with a Student t test, and receiver operating characteristic analysis was used to identify an ideal angle threshold to maximize sensitivity and specificity. The interpeduncular angle had excellent interobserver reliability (intraclass correlation coefficient value = 0.833) and was significantly lower in the intracranial hypotension group compared with the control group (25.3° versus 56.3°). There was significant correlation between the interpeduncular angle and the presence of brain stem slumping. With a threshold of 40.5°, sensitivity and specificity were 80% and 96.7%, respectively. Cytotoxic Lesions of the Corpus Callosum Caused by Thermogenic Dietary Supplements J.A. Galnares-Olalde, A.J. Vázquez-Mézquita, G. Gómez-Garza, D. Reyes-Vázquez, V. Higuera-Ortiz, M.A. Alegría-Loyola and A. Mendez-Dominguez AJNR Am J Neuroradiol 2019; 40:1304-1308 doi:10.3174/ajnr.A6116 http://www.ajnr.org/content/40/8/1304.abstract Manganese-Enhanced MRI of the Brain in Healthy Volunteers D.M. Sudarshana, G. Nair, J.T. Dwyer, B. Dewey, S.U. Steele, D.J. Suto, T. Wu, B.A. Berkowitz, A.P. Koretsky, I.C.M. Cortese and D.S. Reich AJNR Am J Neuroradiol 2019; 40:1309-1316 doi:10.3174/ajnr.A6152 OPEN ACCESS ARTICLE http://www.ajnr.org/content/40/8/1309.abstract The Association between FLAIR Vascular Hyperintensity and Stroke Outcome Varies with Time from Onset W.J. Shang, H.B. Chen, L.M. Shu, H.Q. Liao, X.Y. Huang, S. Xiao and H. Hong AJNR Am J Neuroradiol 2019; 40:1317-1322 doi:10.3174/ajnr.A6142 OPEN ACCESS ARTICLE http://www.ajnr.org/content/40/8/1317.abstract Leukoaraiosis May Confound the Interpretation of CT Perfusion in Patients Treated with Mechanical Thrombectomy for Acute Ischemic Stroke S. Rudilosso, C. Laredo, C. Vivancos, X. Urra, L. Llull, A. Renú, V. Obach, Y. Zhao, J.L. Moreno, A. Lopez-Rueda, S. Amaro and Á. Chamorro AJNR Am J Neuroradiol 2019; 40:1323-1329 doi:10.3174/ajnr.A6139 OPEN ACCESS ARTICLE http://www.ajnr.org/content/40/8/1323.abstract One-Stop Management with Perfusion for Transfer Patients with Stroke due to a Large-Vessel Occlusion: Feasibility and Effects on In-Hospital Times A. Brehm, I. Tsogkas, I.L. Maier, H.J. Eisenberger, P. Yang, J.-M. Liu, J. Liman and M.-N. Psychogios AJNR Am J Neuroradiol 2019; 40:1330-1334 doi:10.3174/ajnr.A6129 OPEN ACCESS ARTICLE http://www.ajnr.org/content/40/8/1330.abstract The authors report the first 15 consecutive transfer patients with stroke with externally confirmed large-vessel occlusions who underwent flat panel detector CT perfusion and thrombectomy in the same room. Preinterventional imaging consisted of noncontrast flat panel detector CT and flat panel detector CT perfusion, acquired with a biplane angiography system. The flat panel detector CT perfusion was used to reconstruct a flat panel detector CT angiography to confirm the large-vessel occlusions. After confirmation of the large-vessel occlusion, the patient underwent mechanical thrombectomy. Fifteen transfer patients underwent flat panel detector CT perfusion and were treated with mechanical thrombectomy from June 2017 to January 2019. The median time from symptom onset to admission was 241 minutes. Median door-to-groin time was 24 minutes. Compared with 23 transfer patients imaged with multidetector CT, time was reduced signi ficantly (24 minutes versus53 minutes). A Standardized Aspiration-First Approach for Thrombectomy to Increase Speed and Improve Recanalization Rates D. O'Neill, E. Griffin, K.M. Doyle, S. Power, P. Brennan, M. Sheehan, A. O'Hare, S. Looby, A.M. da Silva Santos, R. Rossi and J. Thornton AJNR Am J Neuroradiol 2019; 40:1335-1341 doi:10.3174/ajnr.A6117 http://www.ajnr.org/content/40/8/1335.abstract Distal Balloon Angioplasty of Cerebral Vasospasm Decreases the Risk of Delayed Cerebral Infarction M.-A. Labeyrie, S. Gaugain, G. Boulouis, A. Zetchi, J. Brami, J.-P. Saint-Maurice, V. Civelli, S. Froelich and E. Houdart AJNR Am J Neuroradiol 2019; 40:1342-1348 doi:10.3174/ajnr.A6124 http://www.ajnr.org/content/40/8/1342.abstract A group of 392 patients was analyzed (160 before versus 232 after January 2015). Distal balloon angioplasty was associated with the following: higher rates of angioplasty (43% versus 27%) and intravenous milrinone (31% versus 9%); lower rates of postangioplasty delayed cerebral infarction (2.2% versus 7.5%) and new angioplasty (8% versus 19%) independent of the rate of patients treated by angioplasty and milrinone; and the same rates of stroke related to angioplasty (3.6% versus 3.1%), delayed cerebral infarction (7.7% versus 12.5%), mortality (10% versus 11%), and favorable outcome (79% versus 73%). The authors conclude that distal balloon angioplasty is safe and decreases the risk of delayed cerebral infarction and the recurrence of vasospasm compared with conventional angioplasty. It fails to show a clinical benefit possibly because of confounding changes in adjuvant therapies of vasospasm during the study period. Pretreatment Anterior Choroidal Artery Infarction Predicts Poor Outcome after Thrombectomy in Intracranial ICA Occlusion B.H. Baek, Y.Y. Lee, S.K. Kim and W. Yoon AJNR Am J Neuroradiol 2019; 40:1349-1355 doi:10.3174/ajnr.A6126 http://www.ajnr.org/content/40/8/1349.abstract GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery (GUARD) Technique during Thrombectomy Improves Reperfusion and Clinical Outcomes S.A. Ansari, M. Darwish, R.N. Abdalla, D.R. Cantrell, A. Shaibani, M.C. Hurley, B.S. Jahromi and M.B. Potts AJNR Am J Neuroradiol 2019; 40:1356-1362 doi:10.3174/ajnr.A6132 http://www.ajnr.org/content/40/8/1356.abstract Posterior Fossa Dural Arteriovenous Fistulas with Subarachnoid Venous Drainage: Outcomes of Endovascular Treatment L. Détraz, K. Orlov, V. Berestov, V. Borodetsky, A. Rouchaud, L.G. de Abreu Mattos and C. Mounayer AJNR Am J Neuroradiol 2019; 40:1363-1368 doi:10.3174/ajnr.A6140 http://www.ajnr.org/content/40/8/1363.abstract Twenty-six patients treated endovascularly for posterior fossa dural AVFs, type III, IV, or V, were included in this study. One hundred percent of the dural AVFs were occluded. A transarterial approach was performed in 23 dural AVFs; a combined transarterial and transvenous approach, in 2 dural AVFs; and a transvenous approach alone, in 1 dural AVF. The middle meningeal artery was the most common artery chosen to inject embolic liquid (12/26). Procedure-related morbidity was 15.4% at 24 hours, 7.7% at discharge, and 0% at 6 months. Procedure-related mortality was 0%. The authors conclude that endovascular treatment offers high occlusion rates for posterior fossa dural AVFs with low morbidity and mortality rates. Carotid Artery Stiffness Accurately Predicts White Matter Hyperintensity Volume 20 Years Later: A Secondary Analysis of the Atherosclerosis Risk in the Community Study A. de Havenon, K.-H. Wong, A. Elkhetali, J.S. McNally, J.J. Majersik and N.S. Rost AJNR Am J Neuroradiol 2019; 40:1369-1373 doi:10.3174/ajnr.A6115 http://www.ajnr.org/content/40/8/1369.abstract Carotid CTA at the Lowest Tube Voltage (70 kV) in Comparison with Automated Tube Voltage Adaption A. Eller, M. Wiesmüller, W. Wüst, R. Heiss, M. Kopp, M. Saake, M. Brand, M. Uder and M.M. May AJNR Am J Neuroradiol 2019; 40:1374-1382 doi:10.3174/ajnr.A6108 http://www.ajnr.org/content/40/8/1374.abstract Standardization of Temporal Bone CT Planes across a Multisite Academic Institution J.P. Guenette, L. Hsu, B. Czajkowski and D.B. Nunez AJNR Am J Neuroradiol 2019; 40:1383-1387 doi:10.3174/ajnr.A6111 http://www.ajnr.org/content/40/8/1383.abstract Prolapse of Orbital Fat through the Inferior Orbital Fissure: Description, Prevalence, and Assessment of Possible Pathologic Associations P.M. Bunch, K. Buch and H.R. Kelly AJNR Am J Neuroradiol 2019; 40:1388-1391 doi:10.3174/ajnr.A6113 http://www.ajnr.org/content/40/8/1388.abstract Detection of Local Recurrence in Patients with Head and Neck Squamous Cell Carcinoma Using Voxel-Based Color Maps of Initial and Final Area under the Curve Values Derived from DCE-MRI J.Y. Lee, K.L. Cheng, J.H. Lee, Y.J. Choi, H.W. Kim, Y.S. Sung, S.R. Chung, K.H. Ryu, M.S. Chung, S.Y. Kim, S.-W. Lee and J.H. Baek AJNR Am J Neuroradiol 2019; 40:1392-1401 doi:10.3174/ajnr.A6130 http://www.ajnr.org/content/40/8/1392.abstract Prevalence of Spontaneous Asymptomatic Facial Nerve Canal Meningoceles: A Retrospective Review J.C. Benson, K. Krecke, J.R. Geske, J. Dey, M.L. Carlson, J. Van Gompel and J.I. Lane AJNR Am J Neuroradiol 2019; 40:1402-1405 doi:10.3174/ajnr.A6133 http://www.ajnr.org/content/40/8/1402.abstract Evaluating Tissue Contrast and Detecting White Matter Injury in the Infant Brain: A Comparison Study of Synthetic Phase-Sensitive Inversion Recovery D.Y. Kim, W.S. Jung, J.W. Choi, J. Choung and H.G. Kim AJNR Am J Neuroradiol 2019; 40:1406-1412 doi:10.3174/ajnr.A6135 OPEN ACCESS ARTICLE http://www.ajnr.org/content/40/8/1406.abstract Comparison of CSF and MRI Findings among Neonates and Infants with E coli or Group B Streptococcal Meningitis S.F. Kralik, M.K. Kukreja, M.J. Paldino, N.K. Desai and J.G. Vallejo AJNR Am J Neuroradiol 2019; 40:1413-1417 doi:10.3174/ajnr.A6134 http://www.ajnr.org/content/40/8/1413.abstract Human Parechovirus Meningoencephalitis: Neuroimaging in the Era of Polymerase Chain Reaction–Based Testing A. Sarma, E. Hanzlik, R. Krishnasarma, L. Pagano and S. Pruthi AJNR Am J Neuroradiol 2019; 40:1418-1421 doi:10.3174/ajnr.A6118 http://www.ajnr.org/content/40/8/1418.abstract The Complex Spine in Children with Spinal Muscular Atrophy: The Transforaminal Approach—A Transformative Technique R. Towbin, C. Schaefer, R. Kaye, T. Abruzzo and D.J. Aria AJNR Am J Neuroradiol 2019; 40:1422-1426 doi:10.3174/ajnr.A6131 http://www.ajnr.org/content/40/8/1422.abstract MRI Predictors of Recurrence and Outcome after Acute Transverse Myelitis of Unidentified Etiology E. Bulut, T. Shoemaker, J. Karakaya, D.M. Ray, M.A. Mealy, M. Levy and I. Izbudak AJNR Am J Neuroradiol 2019; 40:1427-1432 doi:10.3174/ajnr.A6121 OPEN ACCESS ARTICLE http://www.ajnr.org/content/40/8/1427.abstract CT-Guided Block and Radiofrequency Ablation of the C2 Dorsal Root Ganglion for Cervicogenic Headache J.L. Chazen, E.J. Ebani, M. Virk, J.F. Talbott and V. Shah AJNR Am J Neuroradiol 2019; 40:1433-1436 doi:10.3174/ajnr.A6127 http://www.ajnr.org/content/40/8/1433.abstract Online Features Letters Epidural Spinal Injections in Spinal Stenosis due to Lipomatosis: With or without Steroids? J. Gossner AJNR Am J Neuroradiol 2019; 40:E40 doi:10.3174/ajnr.A6128 http://www.ajnr.org/content/40/8/E40 Blood-Brain Barrier Permeability in Patients with Systemic Lupus Erythematosus A. Lecler, J.C. Sadik and J. Savatovsky AJNR Am J Neuroradiol 2019; 40:E41 doi:10.3174/ajnr.A6137 http://www.ajnr.org/content/40/8/E41 Reply: J.M. Chi, M. Mackay, A. Hoang, K. Cheng, C. Aranow, J. Ivanidze, B. Volpe, B. Diamond and P.C. Sanelli AJNR Am J Neuroradiol 2019; 40:E42-E43 doi:10.3174/ajnr.A6166 http://www.ajnr.org/content/40/8/E42