Traumatic SAH Risk Stratification

In this AJNR Article Summary, Dr. George Vilanilam discusses the article, "Risk Stratification for Traumatic Subarachnoid Hemorrhage Enlargement and Surgical Intervention: Guides to Follow-Up Imaging in Patients with Trauma." Not all traumatic subarachnoid hemorrhages behave the same - risk factors such as coagulopathy, concurrent intracranial hemorrhage, and low Glasgow Coma Scale scores predict hemorrhage progression and need for intervention. A risk-stratified imaging approach may reduce unnecessary repeat CT scans while focusing surveillance on patients most likely to deteriorate.

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 Author Interview, Dr. Francis Deng speaks with Dr. Jimmy Moon about his article, "Use of CTA in Strangulation Evaluation". In a retrospective review, the yield of CTA neck for blunt cerebrovascular injury in patients who presented after strangulation was 1 in 138 (0.7%), suggesting the broad use of CTAs in this setting may be of low value.

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 Article Summary, Dr. George Vilanilam discusses the article, "Biphasic Progression of Radiation-Induced Carotid Stenosis: The Predictive Role of Low-Density Plaque". Low‑density carotid plaque on imaging may signal accelerated stenosis progression in post‑radiation patients, highlighting the need for earlier intervention and a shift toward evaluating plaque composition, not just degree of narrowing, to help prevent stroke in this high‑risk group.

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.

Dr. Francis Deng discusses the article by Vankawala et al. entitled "Evaluating the Role of Imaging Markers in Predicting Stroke Risk and Guiding Management after Vertebral Artery Injury: A Retrospective Study." The Biffl grading scale assess blunt cerebrovascular injury severity, but its prognostic validity for vertebral artery injuries with respect to stroke risk remains controversial.

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 a study, from corresponding author Dr. Katherine Reinshagen, entitled "Retrospective Review of MR Findings in Sudden Sensorineural Hearing Loss and Associated Clinical Features". In this large cohort, the yield of MRI for relevant findings was 5.9%, including tumors in less than 3%. The spectrum of pathology is illustrated

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.