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This issue of Neuroimaging Clinics focuses on the endovascular treatment of fistulas, carotid stenosis, acute ischemic stroke, vascular malformations, and more. Elsevier Health Sciences Medical Books, ebooks and journals - UK Pathology in Adults and Children, An Issue of Neuroimaging Clinics.
Table of contents

They observed significant, voxelwise quadratic relationships between cerebrovascular reactivity from BOLD imaging and the brain thermal response and baseline brain temperatures, concluding that brain thermal response is a potential noninvasive biomarker for cerebrovascular impairment. Neurosonology and Neuroimaging of Stroke: Neurosonology and Neuroimaging of Stroke , written by 4 neurologists and 1 neuroradiologist, is an exhaustive review of stroke imaging, with a special emphasis on vascular ultrasound. As stated in the preface, it is based on the combined teaching experience gained by the authors over the last 15 years.

The book is divided in 2 parts. In each chapter, schematic diagrams, pictures, and multimodality images, which are thoughtfully labeled and adequately described, beautifully depict the subject matter. The supplemental online material includes high-quality videos that illustrate both arterial and venous ultrasound examinations.

The cases range from commonly encountered entities such as atherosclerotic disease, to rarer and more elusive diagnoses such as arteriovenous dural fistula, postpartum angiopathy, and diffuse cerebral angiomatosis.

Acute Stroke Imaging Research Roadmap

Each case is accompanied by high-resolution ultrasound images, which are exquisitely correlated to other cross-sectional modalities and are well-annotated. Finally, the discussions are well-written and thorough, with a strong emphasis on clinical management. Forsting M, Jansen O. Brain, Spine, Peripheral Nerves. This page hardcover book intends to serve as a reference manual for neuroimaging interpretation.

As suggested by the title, the book is divided into 3 sections: The first 2 sections have an introductory chapter on anatomy. MRI appearance of different structures is the focus, with several illustrations that lay a good foundation for the material to come. The chapters conclude with an abridged description of normal variants, which, if more inclusive, could have further benefitted a practitioner less familiar with neuroimaging.

The chapter on brain anatomy is followed by 9 others covering a broad range of common and unusual conditions. Pediatric neuroimaging is dealt with in a dedicated chapter. The third section includes a concise discussion of magnetic resonance neurography and neuropathies in the final 8 pages. Most pathological conditions are described under the subheadings of epidemiology, clinical manifestations and treatment, pathology, MRI findings, and differential diagnosis.

This systematic approach, paired with a straightforward index, makes it very easy to navigate the text. The highlight of this book is the excellent quality of the images it uses to depict the pathology described. Multiple sequences and planes are routinely used to characterize the findings. The annotations are descriptive and easily comprehensible. The authors often discuss the best techniques and ideal sequences for optimal evaluation of imaging findings. Differential Diagnosis in Neuroimaging: With an unprecedented trifecta, Dr. Steven Meyers from the University of Rochester Medical Center has single-handedly authored and simultaneously published 3 books: Brain and Meninges pages , Differential Diagnosis in Neuroimaging: Spine pages , and Differential Diagnosis in Neuroimaging: Head and Neck pages.

The set up in each book is similar and follows the same format, which in turn adds to the appeal of these 3 publications. Pathological cases are presented in well-defined sections, each containing abundant and well-chosen images that are combined with tables that list each disease and adjacent to columns containing findings and comments on the disease under consideration.

This is not a common way of presenting material; however, it is effective, allowing a substantial amount of material to be discussed in a compact space. It also allows a nice separation of imaging findings from other important clinical and pathologic information. I do find it amazing that Dr. Meyers was able to obtain all of these images from his own files and collate them so completely. The chapters in Brain are: The chapters in Spine are: Buchfelder M, Guaraldi F, eds. Imaging in Endocrine Disorders. Frontiers of Hormone Research ; vol Imaging in Endocrine Disorders , edited by Drs.

Buchfelder and Guaraldi, with 20 other authors, is a short, informative hardcover pages in length.

Most all chapters should be of interest to neuroradiologists because the material deals with structures we evaluate on a daily basis pituitary, parasella, thyroid, parathyroid or structures we note when there is spine imaging adrenal, pancreas, paraspinal. Particularly well done is the chapter on MRI of the pituitary and pituitary tumors. The explanations are succinct and the images are beautiful.

The material on the pituitary includes separate chapters on Intraoperative MR for adenomas and molecular imaging eg, nuclear of pituitary pathology. While the material on the thyroid is sufficient, the parathyroid section is skimpy and leaves out a number of imaging aspects of that organ and its pathology. Overall, the book gives a summary look at endocrine tumors; certainly the images are worth reviewing.

Written primarily for residents and fellows in neuroradiology, Neuroimaging: The Essentials covers the basic areas of neuroimaging. The collected information including the source or raw imaging data will be deidentified.

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Also, the potential for unblinding during the analysis of the scans collected in the imaging repository will be considered. The data collected in the repository will be made accessible to qualified researchers worldwide, based on the recommendations of a scientific committee that will evaluate proposed research projects.

Contributors will be offered suitable reassurance over the uses to which their data may be put, the acknowledgement that they as individuals and their institutions will be granted for ensuing projects and developments, and an opportunity both to assist with the academic leadership of the consortium and to access the repository for projects of their own. Adequate funding will be required to implement a data quality control program and to coordinate successful communication among participating sites.

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The cost of local study coordination, data collection, and image transfer will need to be compensated. The consortium will require financial resources to reimburse centers for performance of additional images or tests that are not otherwise clinically indicated, facilitate communication with sites and data transfer, organize regular investigator meetings, support centralized analysis, recruit services of dedicated stroke neuroimaging biostatisticians and technology assessment experts, and develop the technical infrastructure for the repository.

Diverse partnerships will be explored with the NIH, private foundations, and industry. Many researchers believe that delay-insensitive or delay-compensated deconvolution methods that take recirculation into account, with automatic selection of 1 global or several local arterial input functions AIF and of a venous output function to correct for partial volume averaging in the AIF , are the most appropriate approach to process these datasets. However, a formal comparison with other analysis techniques eg, nondeconvolution based or maximal slope methods is required to demonstrate the superiority of this approach for predicting tissue fate and clinical outcome.

This systematic comparison will also determine which parameters have, or do not have, a significant impact in terms of accurately representing acute perfusion status and predicting subsequent tissue outcome. Parameters studied will include cerebral blood flow, cerebral blood volume, and mean transit time, among others. The optimal method s should be most immune against slight raw image quality differences resulting from the use of different scanner hardware ie, detector size configuration for multidetector CT scanners, magnetic field strengths, RF coils, scan parameters, injection protocols, and contrast agents used.

Still undetermined are the perfusion imaging parameters that indicate that tissue is at risk for infarction or that adequate reperfusion has taken place to prevent infarction. It will establish the value of baseline perfusion imaging in predicting final infarct size, using tissue fate as the outcome variable.

Analysis will adjust for recanalization and reperfusion status, considered as a key determinant of tissue outcome and one that can be influenced by treatment. Emphasis will be placed on quantitative approaches. A consensus on the appropriate timing for deciding on the final infarct volume will be developed. Similarly, standard definitions for recanalization ie, changes in the degree of arterial patency and reperfusion ie, changes in the amount and spatial extent of perfusion changes will be established before the final analysis.

This analysis will incorporate patient characteristics at the time of scan acquisition, such as heart rate, blood pressure, glucose level, and hematocrit, which may have a significant impact on the distribution of contrast within collateral fields, and NIHSS which may reflect penumbral tissue shifting in and out of electric dysfunction. Imaging data in patients who have undergone reperfusion therapy and in those who have not will be analyzed separately to determine whether the results are the same for both groups.

One of the greatest challenges raised by pilot projects 1 and 2 is on the lack of consensus with respect to the optimal timing of outcome scans.

Acute Stroke Imaging Research Roadmap

This would represent a significant advance in the field of stroke imaging. The third study will determine the optimal timing to perform imaging 48 hours, 1 week, 2 weeks, 1 month, 2 months, 3 months to predict clinical outcomes at varying time points in the course of stroke recovery eg, 30 days, 3 months, 6 months, 12 months. The optimal imaging modality MRI versus CT should be identified many researchers believe that T2-FLAIR is the current best imaging modality for the identification of final infarct, but this requires validation. Clinical outcomes will be documented using measures of global disability eg, the Modified Rankin Scale [mRS] , instrumental activities of daily living eg, Barthel Index [BI] , neurological deficit eg, NIHSS , cognitive function neuropsychological testing , and quality of life.

All clinical outcome assessments should be undertaken in a standardized manner and blinded to imaging and vice versa. Inclusion of generic and stroke-specific quality of life scores, and measures that identify values important to the patient patient-derived recovery targets , are considered critical. For this third pilot project, follow-up imaging studies will be obtained at multiple time points. All datasets should be contributed to the central repository. The goals of these 3 pilot projects, based on the clinical and imaging data from the central repository, will be to provide investigators with:.

Overall, these deliverables will be accommodated in the clinical workflow of institutions using them and represent minimal impediment to enrollment of acute stroke patients in treatment protocols. The deliverables outlined above, and the datasets stored in the central repository, will be available for further analyses. The initial focus will be on identifying the parameters that optimize the selection of acute stroke patients who benefit from reperfusion therapy. Other parameters of interest include aspects that will improve our understanding of collateral perfusion, including determinants of tissue fate and clinical outcome, and predictors of hemorrhagic transformation.

A consensus on the definition of clinically meaningful hemorrhagic transformation will need to be developed. At this stage, the efforts of the Acute Stroke Imaging Consortium will set the stage for 1 or more clinical trials. They will all apply standardized imaging acquisition protocols, and use the same toolbox to process images and apply the same optimized criteria to interpret these processed images. This process will significantly minimize any source of variation other than the specific intervention ie, drug or device that will be tested in the clinical trial.

The performance of the toolbox will be fully documented, facilitating sample size calculations for such trials. Initially, the identified imaging biomarkers will need to be validated in clinical trials with conventional clinical primary end points. Subsequently, it is anticipated that sample sizes will be reduced by the increased power afforded by the use of imaging biomarkers. In addition, if validated, the shorter follow-up periods that will be tested as part of the pilot projects will reduce loss to follow-up and minimize variation in clinical outcome due to unrelated events.

This will greatly increase the feasibility and decrease the duration and cost of stroke treatment clinical trials. Among the future stroke treatment clinical trials considered, particular interest has focused on 2 that have the potential to increase the proportion of acute stroke patients that are treated.

The first trial is 1 of image-guided recanalization therapy in an extended time window 3 to 6 or 9 hours ; the second one would assess image-guided recanalization therapy in wake-up stroke patients. Neuroprotective agents and collateral enhancement could also be tested by the consortium, and future analyses should include attention to tissue repair, neurogenesis from stem cells, neurovascular remodeling, and stroke recovery.

This consortium would provide an expertise structure in which methodological issues in stroke imaging can be addressed and consensus reached among different groups of researchers and care providers. Initially, the consortium would create a central repository of imaging studies and clinical data obtained from acute stroke patients and develop a standardized image analysis toolbox. These could subsequently benefit clinical trials of acute stroke treatments, including, but not limited to, treatment of stroke patients in an extended time window, treatment of patients with wake-up stroke or those with long intervals between the time last seen well and time of symptom discovery, and neuroprotective, collateral enhancement, and neuroplasticity-stimulating therapies.

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Collaboration between academia, the NIH, the FDA, and industry is integral to the successful realization of these aims. Special acknowledgement and thanks for the members of the organizing committee of the meeting: Giles, UK; Neil C. Molina, MD, Neurovascular Unit. Hospital Universitario Dr Josep Trueta. Kirby Research Center; J.

National Center for Biotechnology Information , U. Author manuscript; available in PMC Jul Max Wintermark , Gregory W. Albers , Andrei V. Alexandrov , Jeffry R. Demaerschalk , Colin P. Derdeyn , Geoffrey A. Donnan , James D. Eastwood , Jochen B. Fiebach , Marc Fisher , Karen L. Furie , Gregory V. Goldmakher , Werner Hacke , Chelsea S. Kidwell , Stephan P. Lees , Michael H.

Recommended Timing for Research Imaging Studies in Acute Stroke Patients

Lev , David S.