AJNR Podcast

In this AJNR Author Interview episode, Dr. Francis Deng speaks with Dr. Mona Gad about arterial spin labeling in code-stroke patients who actually had seizures. They discuss ASL’s sensitivity, perfusion patterns, concordance with EEG and structural MRI, and cases that illustrate how ASL may complement DWI, FLAIR, and assessment in acute care.Featured article: Diagnostic Utility of Arterial Spin-Labeling MRI in Straight to MRI Code Stroke Patients for Seizure Detection: A Comparison with FLAIR, DWI, and EEG

In this podcast episode, Dr. Vilanilam discusses "Indeterminate T1-Hypointense Spine Lesions: Prevalence of Malignancy in the Absence of Aggressive Imaging Features," by first author Barkovich. Indeterminate low-T1-signal vertebral lesions are commonly encountered on spine MRI, but deciding which lesions require additional imaging or follow-up can be challenging. This study examines the outcomes of 278 such lesions and finds an overall malignancy rate of only 2%, with all malignant lesions representing metastases in patients with known or concurrently diagnosed extraskeletal metastatic disease and no primary malignant bone tumors identified. Dr. Vilanilam reviews the imaging features of these lesions, the importance of incorporating the patient's oncologic history into risk assessment, and the implications for follow-up recommendations. The findings suggest that short-interval imaging may be appropriate when there is meaningful concern for metastatic disease, while follow-up may not be necessary for low-risk patients without aggressive imaging features or extraskeletal metastatic disease.

In this AJNR Article Summary, Dr. George Vilanilam discusses the article, "Sinking Flap Syndrome: Risk Factors, Outcomes, and the Role of Neuroradiology in Cranioplasty Timing." Sinking flap syndrome is a common yet frequently underrecognized complication of decompressive craniectomy, with imaging findings often preceding clinical deterioration. Recognition and reporting of key features - including a markedly sunken flap, ventricular compression, and significant midline shift (8 mm or greater) were associated with a two-fold reduction in time to cranioplasty highlighting the important role neuroradiologists can play in expediting definitive treatment and improving patient care.

In this AJNR Article Summary, Dr. George Vilanilam discusses the article, "Maximizing the Conspicuity of Cerebrospinal Fluid–Venous Fistulas on Computed Tomography Myelography: Assessment of Contrast Density and Timing Effects." Contrast density, not just timing, plays the dominant role in detecting CSF-venous fistulas, with higher subarachnoid contrast significantly improving diagnostic confidence. These findings support prioritizing contrast pooling strategies during CT myelography to enhance fistula detection in patients with spontaneous intracranial hypotension.

In this AJNR Author Interview, Dr. Francis Deng speaks with Dr. Cynthia Greene about her article, "Posttreatment Follow-Up MR Imaging Biomarkers of Collateral Status Are Associated with Short-Term Outcomes in Large-Vessel Acute Ischemic Stroke." In a retrospective study of follow-up MRI after anterior-circulation large-vessel occlusion stroke, a greater burden of FLAIR hyperintense vessels was associated with worse short-term neurologic outcomes, even among successfully reperfused patients, suggesting persistent FLAIR hyperintense vessels may mark ongoing perfusion abnormality or possible no-reflow physiology.

In this AJNR Podcast Author Interview, Dr. Francis Deng and Dr. Amy Juliano discuss how CT can subtype Menière disease by assessing the vestibular aqueduct and adjacent bone. During normal childhood, the angular trajectory of the vestibular aqueduct progressively narrows; an angle greater than 120 degrees after age 12 indicates adult-persistent hypoplasia and thus the hypoplastic endolymphatic sac endotype rather than normal maturation. A retrolabyrinthine bone thickness of at least 1.2 mm serves as a practical surrogate for a mature vestibular aqueduct orientation, reliably excluding the hypoplastic endotype and identifying ears that do not belong to this high-risk subgroup. In contrast, in the degenerative endotype of Menière disease, retrolabyrinthine bone thickness is more variable and does not follow this simple threshold pattern, so CT features must be interpreted in a broader clinical and imaging context. Read the AJNR articles mentioned in this episode: "Postnatal Development of the Vestibular Aqueduct Trajectory on CT: Establishing Age-Specific Norms to Distinguish Normal from Arrested (Hypoplastic) Development" "Retrolabyrinthine Bone Thickness as a Radiologic Marker for the Hypoplastic Endotype in Menière Disease".

In this AJNR Fellows' Journal Club article summary, Dr. Francis Deng and Dr. Amir Khadivi discuss the article by Proner et al., "Impact of Clinical and Radiologic Factors on CTP Timing in Acute Ischemic Stroke." They discuss the authors' findings that cardiac arrhythmias and older age are independent predictors of nondiagnostic CTP exams. Specifically, these factors often lead to the truncation of reference vessel time-attenuation curves that fail to reach equilibrium within a 45-second acquisition window.

In this AJNR Author Interview, Dr. Francis Deng discusses with Dr. Babatunde Akinpelu the article "Assessing the Accuracy of Artificial Intelligence in Detecting Intracranial Aneurysms in a Clinical Setting Relative to Neuroradiologists." Neuroradiologists performed better than a commercial AI program for intracranial aneurysm detection in sensitivity and accuracy, while achieving comparable specificity. Common failure modes are reviewed.

In this AJNR article summary, Dr. Francis Deng reviews an article by Dr. Andrew Callen and colleagues entitled "Enhancing Clarity in Dynamic Myelography Reporting: Results of a Survey of Patients and Referring Providers Evaluating a Standardized Reporting System in the Myelographic Workup of Patients with Suspected Spontaneous Intracranial Hypotension". The SIH-RADS system provides a structured manner of reporting results of dynamic CT myelography that are clear, actionable, and preferred by both patients and providers.

Podcast editor Francis Deng explores a recent AJNR article, "Diagnostic Performance of Ultrasound in Neck Node NIRADS Category 2." Bottom line is: Ultrasound, with targeted FNA, can accurately determine tumor recurrence in patients with NI-RADS 2 (low suspicion) lymph node findings during surveillance of head and neck cancer.

In this AJNR Podcast author interview, Dr. Francis Deng is joined by leading expert Dr. Ana Franceschi, lead author of the recent AJNR State of the Practice paper on brain PET for Alzheimer disease. Dr. Franceschi breaks down everything clinicians need to know about this new era of molecular neuroimaging relevant to Alzheimer disease diagnostics and response assessment, from scan interpretation to the practical logistics of scaling up services.

Dr. Hiatt and Dr. Vilanilam discuss four papers from the July issue of AJNR in this episode. Be sure to visit our website to watch the video version of this podcast. (29:42)