Optimizing CSF-Venous Fistula Detection

In this AJNR Podcast article summary, Dr. Francis Deng walks through the article by Dr. Sammy Allaw et al., entitled "The Infundibulum-Aneurysm Conundrum: A Longitudinal Single-Center Analysis." Over more than 1,000 lesion-years of follow-up, neither unequivocal infundibula nor lesions initially labeled "aneurysm versus infundibulum" showed growth, rupture, or need for intervention. The findings suggest that the “aneurysm versus infundibulum” label often reflects interpretive uncertainty rather than a distinct potentially unstable lesion, and that expert application of morphologic criteria for infundibula may reduce unnecessary surveillance.

In this AJNR author interview episode, Dr. Evgenia Grik speaks with Dr. Rami Eldaya about his recently published ASSR white paper on reporting of spinal metastases with a focus on the contents of the proposed structured system and rationale behind its creation. We discuss what neurosurgeons and radiation oncologists need to know from radiology reports for spinal metastatic disease and walk through an example case.Featured Article: Spinal Metastasis Reporting: Evidence-Based Recommendation on Behalf of the American Society of Spine Radiology Education and Standards Committee

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 “Cerebral Proliferative Angiopathy: Imaging Spectrum and Diagnostic Insights,” by first author Rai.Cerebral proliferative angiopathy is a rare cerebrovascular malformation that can mimic an arteriovenous malformation but has a fundamentally different vascular architecture and underlying physiology. This comprehensive review of 75 studies and 153 patients highlights its characteristic multimodal imaging features, including a diffuse vascular network intermingled with normal brain, absence of a compact nidus or dominant arterial feeders, frequent transdural recruitment, relatively limited early venous drainage, and evidence of chronic hypoperfusion.Dr. Vilanilam reviews the key CT, MRI, perfusion, and angiographic findings that help distinguish cerebral proliferative angiopathy from conventional arteriovenous malformations and other vascular mimics. Recognizing this distinction is critical because normal functioning brain is incorporated within the abnormal vascular network, substantially influencing treatment decisions and emphasizing the importance of accurate imaging diagnosis.Featured Article: Cerebral Proliferative Angiopathy: Imaging Spectrum and Diagnostic Insights

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 Podcast author interview, Dr. Francis Deng speaks with Dr. Caline Azzi about recent studies identifying imaging and clinical predictors of expansion in traumatic subdural, subarachnoid, and intraparenchymal hemorrhage. Hemorrhage size, multicompartment injury, coagulopathy, mass effect, and neurologic status may help determine which patients truly need routine repeat CT. Related Articles: Risk Stratification for Traumatic SAH Enlargement and Surgical Intervention: Guides to Follow-Up Imaging in Patients with Trauma Predictive Factors for Traumatic Intraparenchymal Hemorrhage Expansion and Its Clinical Outcomes Improving the management of acute subdural hematomas; identifying characteristics associated with acute subdural hematoma size and expansion

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. Francis Deng reviews CTA-based Carotid Plaque-RADS and its role beyond stenosis grading. He explains the key imaging features that define plaque vulnerability, then highlights two AJNR studies showing that the system is learnable, reproducible, and clinically meaningful for predicting future stroke risk, especially in patients with only mild or moderate carotid stenosis. Visit the website to read the related articles. Carotid Plaque-RADS: Inter- and Intrareader Agreement and Learning Curve Analysis in CTA CTA-Based Carotid Plaque-RADS Classification Improves Risk Stratification for Ischemic Cerebrovascular Events

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 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.