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  • Journal Highlights

    The following are highlights from the current issues of RSNA’s two peer-reviewed journals.

    August 1, 2018


    Determinants of Cognitive Impairment in Patients with Multiple Sclerosis with and without Atrophy

    Multiple sclerosis (MS) is characterized by focal and diffuse damage in both the white matter (WM) and gray matter (GM). The relationship between structural damage and cognitive impairment is well established, with WM lesion volume, WM integrity damage and GM atrophy correlating with cognitive impairment. The large heterogeneity in cognitive symptoms, however, cannot be fully explained by GM atrophy alone.

    In an article published online in Radiology (RSNA.org/Radiology), Anand J.C. Eijlers, MD, VU University Medical Center, Amsterdam, and colleagues investigated why some MS patients with no atrophy may still develop severe cognitive impairment, whereas other patients are able to maintain preserved cognitive function in the presence of widespread atrophy.

    The retrospective imaging study included MRI data from 2008–2012, including 332 patients with MS who then underwent extensive neuropsychologic evaluation and additional MRI. Cognitive impairment was present in 42 of 132 patients without atrophy and in 49 of 65 patients with atrophy.

    In patients without atrophy, cognitive impairment was primarily determined by cognitive reserve (i.e., low level of education), but not by the amount of WM damage. An opposite pattern was visible in patients with GM atrophy, where patients with cognitive impairment showed a higher amount of concomitant WM damage than did patients with preserved cognitive function, with no effect of cognitive reserve. Regardless of these disparate effects of WM damage and cognitive reserve, all patients with cognitive impairment demonstrated a similar change in brain functioning: a more central position of the posterior cingulate cortex within the global functional brain network.

    “Patients with MS and GM atrophy have cognitive impairment related to WM damage; however, in patients without atrophy, cognitive impairment was primarily determined by cognitive reserve (i.e., low level of education). Abnormalities detected by functional MRI could serve as a marker of cognitive impairment, independent of atrophy,” the authors write.

     This article meets the criteria for AMA PRA Category 1 Credit™. SA-CME is available online only.


    Imaging of Acute Conditions of the Perineum

    A wide range of acute conditions can affect the perineum, from self-limited disease to conditions that are potentially life threatening or contribute to substantial patient morbidity if not promptly diagnosed and appropriately treated. Imaging is essential in the clinical management of perineal disease because it allows accurate anatomic localization of the origin and extent of the disease to be determined.

    In an article in the July-August issue of RadioGraphics (RSNA.org/RadioGraphics), Jihee Choe, MD, Brigham and Women’s Hospital, Harvard Medical School, Boston, and colleagues discuss how familiarity with complex perineal anatomy, appropriate use of imaging modalities and the spectrum of imaging findings seen in acute perineal conditions is crucial for radiologists to make a rapid and accurate diagnosis.

    Various imaging modalities are available to evaluate acute perineal conditions, each with their own advantages and disadvantages. CT is used most commonly in the acute setting because of its widespread availability and rapid image acquisition. Ultrasonography could be used to evaluate superficial and palpable abnormalities and is especially helpful for diagnosis of genital injuries. MRI exhibits superior tissue contrast resolution, provides excellent characterization of conditions and lacks ionizing radiation. Its role is increasing in the acute setting; however, MR imaging is not always readily available and is currently reserved for use as a problem- solving technique. Retrograde urethrography is the modality of choice for evaluating traumatic urethral injury.

    “Patients with a wide range of acute conditions that affect the perineum present in the emergency department. Radiologists must be familiar with the complex perineal anatomy and various acute perineal conditions, because some of them can be associated with high morbidity and mortality if not promptly diagnosed and appropriately treated. Imaging is crucial to providing accurate anatomic localization of the origin and assessment of the extent of the disease,” the authors conclude.

     This article meets the criteria for AMA PRA Category 1 Credit™. SA-CME is available online only.

     Radiology Podcasts 


    Listen to Radiology Editor David A. Bluemke, MD, PhD, discuss this month’s research you need to know. Podcasts summarize the importance and context of selected recent articles. Subscribe today at  RSNA.org/Radiology-Podcasts  and never miss a single episode.

     Highlights include: 

    “Reducing the Number of Measurements in Liver Point Shear-Wave Elastography: Factors that Influence the Number and Reliability of Measurements in Assessment of Liver Fibrosis in Clinical Practice,” Fang C, et al.

    “Increased Pancreatic Echogenicity with US: Relationship to Glycemic Progression and Incident Diabetes,” Hung CS, et al.

    “Renal Lesion Characterization with Spectral CT: Determining the Optimal Energy for Virtual Monoenergetic Reconstruction,” Schabel C, et al.


    Radiology Podcasts 


    Listen to RadioGraphics Editor Jeffrey S. Klein, MD, and authors discuss the following articles from recent issues of RadioGraphics at RSNA.org/RG-Podcasts. 

    “Incomplete Cord Syndromes: Clinical and Imaging Review,” by Vamsi K. Kunam, MBBS, and colleagues.

    “Pictorial Review of Digital Radiography Artifacts,” by Alisa I. Walz-Flannigan, PhD, and colleagues.

    “Automated Three-dimensional Breast US for Screening: Technique, Artifacts, and Lesion Characterization,” by Jan C. M. van Zelst, MD, MSc, and Ritse M. Mann, MD, PhD.

    Fig 1
    Images show differences in white matter (WM) integrity between patient groups, measured with diffusion imaging–derived fractional anisotrophy. A. Comparison between patients with preserved cognitive function with and without atrophy. B. Comparison between patients with cognitive impairment with and without atrophy. Eijlers, et al, Radiology 2018;InPress © RSNA 2018.

    Fig 2
    Perianal abscess in a 19-year-old man with a history of recurrent perianal abscesses who presented with rectal pain. Axial (a) and coronal (b) contrast material–enhanced CT images show a peripherally enhancing fluid collection in the right perineum (arrow). The patient underwent incision and drainage in the emergency department, with eventual placement of a seton. Choe et al, RadioGraphics 2018:38;4 © RSNA 2018.