American Society of Neuroimaging
34th Annual Meeting JANUARY 20-23, 2011 SANIBEL HARBOUR RESORT & SPA FORT MYERS, FL WELCOME TO THE 34th ANNUAL MEETING OF THE AMERICAN SOCIETY OF NEUROIMAGING
Sanibel Harbour Resort & Spa Fort Myers, FL January 20-23, 2011
ASN Mission Statement Table of Contents
The American Society of Neuroimaging (ASN) is Board & Committee Members Page 3 an international, professional organization representing neurologists, neurosurgeons, Program at a Glance Page 4 neuroradiologists, and other neuroscientists who are dedicated to the advancement of any Meeting Floor Plan Page 5 technique used to image the nervous system. The ASN supports the right of qualified Events Page 6 physicians to utilize neuroimaging modalities for the evaluation and management of their 2011 Course Directors and Faculty Page 7 patients, and the rights of patients with neurological disorders to have access to appropriate neuroimaging modalities and to Meeting Program Pages 8-18 physicians qualified in their use and interpretation. Faculty Disclosures Page 19
The goal of the ASN is to promote the highest CME Information Page 20 standards of neuroimaging in clinical practice, thereby improving the quality of medical care for Presidential Address & Awards Luncheon Agenda Pages 21-22 patients with diseases of the nervous system. This goal is accomplished through: January 16, 2010 Minutes Pages 23-24 •Presenting scientific and educational programs at an annual meeting and through the promotion of fellowships, preceptorships, 2011 Awards Page 25-26 tutorials and seminars related to neuroimaging; Program Abstracts Pages 272 -3 •Publishing a scientific journal; •Formulating and promoting high standards of practice and setting training guidelines; •Evaluation of physician competency through examinations.
Emphasis is placed on the correlation between clinical information and neuroimaging data to provide the cost effective and efficient use of imaging modalities for the diagnosis and evaluation of diseases of the nervous system.
The ASN will continue to develop training and practice guidelines related to neuroimaging for: 1) physicians in practice who currently use neuroimaging; 2) physicians in residency or fellowship training; 3) physicians in practice who wish to use neuroimaging; and 4) healthcare entities responsible for defining or allocating professional privileges and credentialing to individual physicians.
ASN Board & Committee Leaders
EXECUTIVE COMMITTEE JOURNAL OF NEUROIMAGING OVERSIGHT COMMITTEE PRESIDENT Laszlo Mechtler, MD Lawrence Wechsler, MD PRACTICE GUIDELINES COMMITTEE VICE PRESIDENT Lawrence Wechsler, MD Dara Jamieson, MD PRACTICE ISSUES COMMITTEE SECRETARY Michael Hutchinson, MD, PhD Marc Malkoff, MD MCKINNEY AWARD COMMITTEE TREASURER Jesse Weinberger, MD Edward Feldmann, MD OLDENDORF AWARD COMMITTEE IMMEDIATE PAST PRESIDENT Ruben Kuzniecky, MD Camilo Gomez, MD QURESHI AWARD COMMITTEE Joseph Masdeu, MD BOARD OF DIRECTORS Madhureeta Achari, MD AMERICAN SOCIETY OF NEUROIMAGING EDUCATION FOUNDATION Vernice Bates, MD EXECUTIVE OFFICERS/BOARD OF DIRECTORS: Kevin Crutchfield, MD PRESIDENT Neeraj Dubey, MD Camilo Gomez, MD Jeffrey Greenberg, MD VICE PRESIDENT Michael Hutchinson, MD, PhD John Chawluk, MD Tudor Jovin, MD TREASURER David Liebeskind, MD Charles Tegeler, MD Bret Lindsay, MD MEMBERS William Preston, MD Leon Prockop, MD Adnan Qureshi, MD Joseph Masdeu, MD, PhD Michael Sloan, MD Many thanks to the ASN Program Committee for their efforts in Editor-in-Chief - JON developing this year's program: Joseph Masdeu, MD, PhD Dara Jamieson, MD, Chair Madhureeta Achari, MD BOARD ADVISORS Andrei Alexandrov, MD, RVT Andrei Alexandrov, MD, RVT Robert Bermel, MD Rohit Bakshi, MD Allan Burke, MD John Chawluk, MD John Chawluk, MD Frank Hussey, MD Neeraj Dubey, MD Jack Greenberg, MD Camilo Gomez, MD Francis Kittredge, MD David Liebeskind, MD Joseph Masdeu, MD, PhD Bret Lindsay, MD Lazlo Mechtler, MD Paul Maertens, MD Leon Prockop, MD Marc Malkoff, MD Charles Tegeler, MD Laszlo Mechtler, MD Mircea Morariu, MD COMMITTEE CHAIRS Erasmo Passaro, MD PROGRAM COMMITTEE Leon Prockop, MD Dara Jamieson, MD Adnan Qureshi, MD CERTIFICATION COMMITTEE Alexander Razumovsky, PhD, FAHA Joseph Masdeu, MD, PhD Michael Sloan, MD CORPORATE RELATIONS Charles Tegeler, MD William Preston, MD NEUROSONOLOGY EXAMINATION COMMITTEE Andrei Alexandrov, MD, RVT MEMBERSHIP COMMITTEE David Liebeskind, MD NOMINATING COMMITTEE Camilo Gomez, MD EUROPEAN EDITOR - JOURNAL OF NEUROIMAGING Jean Claude Baron, MD
2011 ASN Annual Meeting Program 3 Program at a Glance
THURSDAY, JANUARY 20, 2011
8:00 am – 4:00 pm ASN Committee and Board Meetings 3:00 pm – 7:00 pm Registration Open Registration 3 6:00 pm – 7:00 pm Welcome/Poster Stand-by Reception Royal/Sabal Ballroom 7:00 pm – 9:00 pm Symposium: Patent Foramen Ovale Diagnosis and Treatment Queen Ballroom
FRIDAY, JANUARY 21, 2011
6:30 am – 5:00 pm Registration Open Registration 3 7:00 am – 8:30 am Breakfast Seminar: Perfusion Imaging Queen Ballroom 7:00 am – 8:30 am Breakfast Seminar: Applied Principles of Gardens Ballroom Ultrasound Physics and Fluid Dynamics 8:30 am – 4:00 pm Exhibits and Posters Royal/Sabal Ballroom 8:30 am – 9:00 am BREAK Royal/Sabal Ballroom 9:00 am – 6:00 pm Current Topics in MR Imaging (Part I) Queen Ballroom 9:00 am – 6:00 pm Current Topics in Neurosonology (Part I and II) Gardens Ballroom 10:30 am – 10:45 am BREAK Royal/Sabal Ballroom 1:00 pm – 2:00 pm LUNCH – Exhibit Area Royal/Sabal Ballroom 3:30 pm – 3:45 pm BREAK Royal/Sabal Ballroom 7:00 pm – 10:00 pm MRI Hands-On Workshop Everglades B Ballroom 7:00 pm – 10:00 pm Neurosonology Hands-On Workshop Royal Ballroom
SATURDAY, JANUARY 22, 2011
7:00 am – 4:00 pm Registration Open Registration 3 7:00 am – 8:30 am Breakfast Seminar: Symptomatic Intracranial Atherosclerotic Queen Ballroom Disease: Stroke Mechanisms and Stratifying Stroke Risk with Transcranial Doppler 7:00 am – 8:30 am Breakfast Seminar: Ultrasound of Peripheral Nerve and Muscle Gardens Ballroom 8:30 am – 9:00 am BREAK Palm Foyer 9:00 am – 1:00 pm Current Topics in MR Imaging (Part II) Queen Ballroom 9:00 am – 1:00 pm Current Topics in Neurosonology (Part II contd.) Gardens Ballroom 10:45 am – 11:00 am BREAK Palm Foyer 1:15 pm – 2:45 pm Presidential Address and Awards Luncheon Queen Ballroom 3:00 pm – 4:00 pm Advocacy - A Review of the Impact of Regulatory and Queen Ballroom Legislative Changes that Occurred During 2010 4:00 pm – 5:30 pm Neuroimaging Jeopardy Gardens Ballroom 5:30 pm – 8:00 pm Sanibel Harbour Boat Cruise Sanibel Marina
SUNDAY, JANUARY 23, 2011
7:00 am – 11:00 am Registration Open Registration 3 7:00 am – 8:30 am Breakfast Seminar: Neuroimaging of Cognitive and Queen Ballroom Behavioral Disorders 7:00 am – 8:30 am Breakfast Seminar: Metabolic Disorders in Adults and Children: Gardens Ballroom Clinical Neuroimaging Case Studies 7:00 am – 8:30 am Neuroimaging Self-Assessment Examination Sabal Ballroom 8:30 am – 9:00 am BREAK Palm Foyer 9:00 am – 11:30 am Advances in Diagnosis and Management of Queen Ballroom Cerebrovascular Dissections Symposium 9:30 am – 3:30 pm Neurosonology Examination Offsite
Speaker Ready Room – Azalea
2011 ASN Annual Meeting Program 4 Meeting & Banquet Facility Floor Plan
17260 HARBOUR POINTE DRIVE, FORT MYERS, FLORIDA 33908 (239) 466-4000 WWW.SANIBEL-RESORT.COM
2011 ASN Annual Meeting Program 5 Events
Thursday, January 20, 2011 Welcome Reception 6:00 pm - 7:00 pm Royal/Sabal Ballroom Please join us for the Welcome and Poster Stand-By Reception. The Reception is complimentary for all registered attendees; guests are welcome with a $50.00 registration fee. Please visit the Registration Desk to register your guest prior to the reception.
Saturday, January 21, 2011 Presidential Address & Awards Luncheon 1:15 pm - 2:45 pm Queen Ballroom Please join us for the annual Presidential Address and Awards Luncheon, complimentary to all registered attendees. Important issues in the field of neuroimaging and ASN's position in creating change will be addressed. The Luncheon will also include a presentation of the 2011 awards.
Sanibel Harbour Boat Cruise 5:30 pm - 8:00 pm Sanibel Marina Join your colleagues on a 100-foot private luxury yacht and enjoy a relaxing voyage highlighted by delicious cuisine and magnificent views of Florida’s southwest Gulf Coast. You’ll enjoy a lavish buffet complete with several entrees and a tempting selection of desserts. You also have a choice of settings from which to take in the view, the outdoor observation deck or two indoor, air-conditioned salons. Tickets are $75.00.
Please Note: The boat will depart from the Sanibel Marina promptly at 5:45 pm
2011 ASN Annual Meeting Program 6 2011 Course Directors and Faculty
Patrick Capone, MD, PhD Sebastian Koch, MD Alexander Razumovsky, PhD, FAHA Winchester Neurological University of Miami School of Medicine Sentient Medical Systems, Inc. Winchester, Virginia Miami, Florida Cockeysville, Maryland
Stafford Conway, MD David S. Liebeskind, MD Jose Romano, MD Conway Neurology Specialties, PA UCLA University of Miami School of Medicine Denison, Texas Los Angeles, California Miami, Florida
Neeraj Dubey, MD Bret Lindsay, MD Tatjana Rundek, MD, PhD The Commonwealth Medical Center Glacier Neurological University of Miami Scranton, Pennsylvania Kalispell, Montana Miami, Florida
Zsolt Garami, MD Eric Lindzen, MD, PhD Steven Shook, MD The Methodist Hospital East Carolina Neurology Cleveland Clinic Houston, Texas Greenville, NC Cleveland, Ohio
Eduardo Gonzalez-Toledo, MD Paul Maertens, MD Gabriella Szatmary, MD, PhD LSU Health Sciences Center University of South Alabama Hattiesburg Clinic Shreveport, Louisiana Mobile, Alabama Hattiesburg, Mississippi
Joseph Masdeu, MD, PhD Geoffrey Hartwig, MD Robert Taylor, MD National Institutes of Health Hattiesburg Clinic University of Minnesota Bethesda, Maryland Hattiesburg, Mississippi Minneapolis, Minnesota
Laszlo Mechtler, MD Michael Hutchinson, MD, PhD Charles Tegeler, MD SUNY at Buffalo New York University School of Medicine Wake Forest University School of Medicine Buffalo, New York New York, New York Winston-Salem, North Carolina
Erasmo Passaro, MD Dara Jamieson, MD John Volpi, MD Bayfront Medical Center/ Weill Cornell Medical College The Methodist Hospital Florida Center for Neurology New York, New York Houston, Texas St. Petersburg, Florida
Tudor Jovin, MD Catherine Weymann McKinney, MD Eric Potts, MD University of Pittsburgh Medical Center Neurology Associates West Tennessee Neurosciences Pittsburgh, Pennsylvania Hickory, North Carolina Jackson, Tennessee
Neil Kleiman, MD Mohammed Zafar, MD, FAAN Adnan Qureshi, MD The Methodist Hospital Kalamazoo Nerve Center University of Minnesota Houston, Texas Kalamazoo, Michigan Minneapolis, Minnesota
Joshua Klein, MD Craig Zaidman, MD Brigham and Women's Hospital St. Louis Children's Hospital Boston, Massachusetts St. Louis, Missouri
A special thank you to all ASN Course Directors and Faculty for their donation of time and personal resources to the success of this meeting.
2011 ASN Annual Meeting Program 7 2011 Annual Meeting Program
Thursday, January 20, 2011
Patent Foramen Ovale Diagnosis and Treatment Symposium Queen Ballroom 7:00 - 9:00 pm Director: Zsolt Garami, MD Faculty: Zsolt Garami, MD, Laszlo Mechtler, MD, Neil Kleiman, MD and John Volpi, MD CME: 2 Hours
Cardiologists and Neurologists will review the Patent Foramen Ovale (PFO)/ Right to left cardiac shunt (RTLCS) diagnostic methods and will discuss treatment options. Transcranial Doppler (TCD) bubble tests have been shown to have a higher sensitivity for right to left cardiac shunt detection compared to echocardiographic techniques (TTE, TEE). Integration of the protocols and grading systems can improve correlation and accuracy to detect RTL; it is important to learn the objective reproducibility of these diagnostics tests. MRI techniques could be the tie breaker in cases of conflicting ultrasound results and could also make the test “more “comfortable without any sedation for patients. This course will review the TCD – RTLCS grading systems: Spencer and International Consensus with case reviews.
7:00 – 7:25 pm Patent Foramen Ovale Detection (Echo & TCD protocols & interpretations) Zsolt Garami, MD
7:25 – 7:50 pm PFO Detection by MRI Laszlo Mechtler, MD
7:50 – 8:15 pm PFO Closure and Treatment Options Neil Kleiman, MD
8:15 – 8:40 pm Evidence Based Treatment Options John Volpi, MD
8:40 – 9:00 pm Discussion
This course is intended to provide an objective overview of the diagnostic tests and review of recent controversial data.
2011 ASN Annual Meeting Program 8 Friday, January 21, 2011
Breakfast Seminar: Perfusion Imaging Queen Ballroom 7:00 – 8:30 am Director: David Liebeskind, MD Faculty: David Liebeskind, MD and Tudor Jovin, MD CME: 1.5 Hours
This seminar will introduce and explore the vast potential of perfusion imaging methods in current and future clinical practice scenarios ranging from stroke to neuro-oncology. The basic concepts of various perfusion modalities, including CT, MRI and angiography, will be described. The technical aspects and mathematics will be presented from the clinical perspective, exploring how these tools can be used to detail microvascular changes in the blood-brain barrier and complex hemodynamics. Practical applications in acute stroke and chronic neurovascular disorders will be outlined. The course is designed for all neuroimaging enthusiasts that encounter blood flow alterations in clinical practice.
7:00 – 7:35 am Principles and Potential of Perfusion Imaging: David Liebeskind, MD Realizing Cerebral Blood Flow from Hemodynamics to Permeability
7:35 – 7:45 am Discussion
7:45 – 8:20 am Use of CT and MRI Perfusion from Acute to Chronic Ischemia Tudor Jovin, MD
8:20 – 8:30 am Discussion
Upon completion of this seminar, attendees will have a firm understanding of:
1) Basic concepts involved in imaging blood flow in the brain 2) Current and evolving perfusion imaging modalities 3) How the mathematics of perfusion imaging translate into specific hemodynamic measures 4) Applications from acute stroke to prevention of hemodynamic compromise
The course is intended for those individuals interested in first learning about perfusion imaging to those focused on specific aspects that impact clinical practice. Discussion of innovative approaches to perfusion imaging will underscore the mounting enthusiasm for these neuroimaging modalities.
Breakfast Seminar: Applied Principles of Ultrasound Physics and Fluid Dynamics Gardens Ballroom 7:00 – 8:30 am Directors and Faculty: Zsolt Garami, MD and John Volpi, MD CME: 1.5 Hours
This seminar is being offered to review ultrasound physics and fluid dynamics, demonstrate typical imaging artifacts and waveforms that interpreting physicians and sonographers need to identify and correct and to interact with the audience and answer questions about these typical findings. Course faculty will discuss applied principles of ultrasound physics and fluid dynamics using a set of approximately 50 typical images/waveforms. Discussion format includes brief case/symptom presentation and an ultrasound image. Faculty will ask the audience to interpret the image, and engage in discussion of differential diagnosis and common pitfalls that are linked to ultrasound physics and fluid dynamics.
Upon completion of this activity, participants will be able to:
1) Review most common ultrasound imaging artifacts and spectral waveforms. 2) Learn key principles of applied ultrasound physics and fluid dynamics that are responsible for these findings. 3) Learn how to differentiate, optimize and interpret typical ultrasound imaging artifacts and spectral waveforms.
2011 ASN Annual Meeting Program 9 Current Topics in MR Imaging (Part I) Queen Ballroom 9:00 am - 6:00 pm Directors: Bret Lindsay, MD and Neeraj Dubey, MD Faculty: David Liebeskind, MD, Bret Lindsay, MD, Erasmo Passaro, MD, Mohammed Zafar, MD, Neeraj Dubey, MD, Eric Lindzen, MD, Joshua Klein, MD, Laszlo Mechtler, MD, and Stafford Conway, MD CME: 7.5 Hours
Faculty will present MR imaging principles of intracranial hemorrhage, congenital anomalies, demyelinating disease, disease states of the basal ganglia , CNS infections, vascular anomalies, epilepsy, ischemic infarction, intracranial neoplasm, and interesting neuroimaging case studies.
9:00 - 10:00 am Ischemic Infarction David Liebeskind, MD
10:00 - 10:30 am Congenital Anomalies Bret Lindsay, MD
10:30 - 10:45 am Break Royal/Sabal Ballroom
10:45 - 11:45 am Epilepsy Erasmo Passaro, MD
11:45 am - 12:15 pm Basal Ganglia Mohammed Zafar, MD
12:15 - 1:00 pm Vascular Anomalies Joshua Klein, MD
1:00 - 2:00 pm Lunch Royal/Sabal Ballroom
2:00 - 2:45 pm Infectious Disease Neeraj Dubey, MD
2:45 - 3:30 pm Intracranial Hemorrhage Eric Lindzen, MD, PhD
3:30 - 3:45 pm Break Royal/Sabal Ballroom
3:45 - 4:30 pm Demyelinating Disease Joshua Klein, MD
4:30 - 5:30 pm Intracranial Neoplasm Laszlo Mechtler, MD
5:30 - 6:00 pm Interesting Case Studies Stafford Conway, MD
Upon completion of the course, physicians will:
1) Understand the MR imaging findings in intracranial hemorrhage. 2) Understand the MR imaging findings in various congenital anomalies of the CNS. 3) Understand the MR imaging findings of ischemic stroke. 4) Understand the MR imaging of demyelinating diseases. 5) Understand the typical MR imaging of CNS infections. 6) Understand the MR imaging of Epilepsy. 7) Understand the imaging of the Basal Ganglia in various disease states. 8) Understand the imaging appearance of various intracranial neoplasms. 9) Understand the MR imaging findings in vascular anomalies. 10) Review interesting neuroimaging findings in case study format.
2011 ASN Annual Meeting Program 10 Current Topics in Neurosonology (Part I and II) Gardens Ballroom 9:00 am - 6:00 pm Director: Alexander Razumovsky, PhD, FAHA Faculty: Charles Tegeler, MD, Alexander Razumovsky, PhD, FAHA, Tatjana Rundek, MD, PhD, and Zsolt Garami, MD CME: 7.5 Hours
This course is for individuals interested in performing and interpreting Neurosonology (carotid and transcranial Doppler (TCD) ultrasound) studies. The faculty will discuss carotid and TCD ultrasound physics and technique, interpretation and clinical application of both techniques. Ample time will be left for questions and discussion. Upon completion of this course, participants will be able to identify the physics, technique, interpretation and clinical applications of carotid and TCD ultrasound. The course material is designed for participants seeking basic knowledge of Neurosonology.
9:00 – 9:45 am Carotid Ultrasound: Physics & Technique Charles Tegeler, MD
9:45 – 10:30 am Carotid Ultrasound: Interpretation & Clinical Application Charles Tegeler, MD
10:30 – 10:45 am Break Royal/Sabal Ballroom
10:45 – 11:45 am Transcranial Doppler Ultrasound: Physics and Technique Alexander Razumovsky, PhD, FAHA
11:45 am – 12:45 pm Transcranial Doppler Ultrasound: Alexander Razumovsky, PhD, FAHA Interpretation & Clinical Application
12:45 – 1: 00 pm Q & A
1:00 – 2:00 pm Lunch Royal/Sabal Ballroom
Neurosonology Course Part II
This course is for individuals interested in performing and interpreting advanced carotid duplex studies for assessment of carotid intima-media thickness, carotid atherosclerosis and risk evaluation for cerebrovascular disease. transcranial doppler (tcd) ultrasound studies for specific applications, like for patients after ischemic stroke and cryptogenic stroke, role of sonothrombolysis, application and interpretation of TCD for patients after SAH due to the aneurysm rupture or due to the traumatic brain injury will be discussed. Ample time will be left for questions and discussion. Upon completion of this course, participants will be able to identify interpretation and clinical applications of abovementioned specific neurosonology applications. The course material is designed for participants seeking advanced knowledge of neurosonology and its clinical applications.
2:00 – 3:45 pm Neurosonology Interpretation Charles Tegeler, MD Alexander Razumovsky, PhD, FAHA Tatjana Rundek, MD, PhD Zsolt Garami, MD
3:45 – 4:00 pm Break Royal/Sabal Ballroom
4:00 – 6:00 pm Neurosonology Interpretation (contd.) Charles Tegeler, MD Alexander Razumovsky, PhD, FAHA Tatjana Rundek, MD, PhD Zsolt Garami, MD
2011 ASN Annual Meeting Program 11
MRI Hands-On Workshop Everglades B Ballroom 7:00 – 10:00 pm Director: Geoffrey Hartwig, MD Faculty: Geoffrey Hartwig, MD, Patrick Capone, MD, and Catherine Weymann McKinney, MD CME: 3 Hours
Workshop participants will rotate among reading stations supervised by the course faculty. After a brief review of the expert's approach to interpreting brain and spine MRI studies, the students will read a selection of scans brought in by the faculty. Course participants will be expected to present mock dictations of the MRI studies and will be critiqued by their peers and professors. Controversial cases will be discussed among the entire group of participating faculty and students. This workshop is designed for participants with some practical experience in interpreting brain and spine MRI scans. Those with less experience may wish to participate, although they may find the workshop to be exceptionally challenging.
Upon completion of the workshop attendees will:
1) Have been exposed to a representative cross-section of neurological MRI studies encountered by MRI neuroimagers in a typical work environment; 2) Have observed the experienced MRI expert’s approach to scan interpretation; 3) Have acquired personal experience interpreting neurological MRI studies; and 4) Have been supervised and directed in improving their reading skills at their own workplaces.
Neurosonology Hands-On Workshop Royal Ballroom 7:00 – 10:00 pm Director: Zsolt Garami, MD Faculty: Zsolt Garami, MD, Charles Tegeler, MD, Alexander Razumovsky, PhD, FAHA, Tatjana Rundek, MD, PhD and John Volpi, MD CME: 3 Hours
This workshop will provide structured hands-on and question and answer sessions in carotid/vertebral duplex and specific transcranial Doppler techniques complete testing, emboli detection, right-to-left shunt detection and assessment of vasomotor reactivity. Both the beginner and experienced users are encouraged to attend. The workshop will also provide an opportunity to try the latest equipment, to meet experts and to discuss various aspects of neurosonology in small groups. The workshop is designed to meet the need for basic and advanced knowledge of insonation techniques, technological advances, and practical aspects of cerebrovascular testing.
Upon completion of the workshop attendees will:
1) Review complete scanning protocols for diagnostic carotid/vertebral duplex and TCD examinations, vasomotor reactivity, emboli detection, right-to-left shunt testing, and monitoring procedures (thrombolysis, head-turning, peri-operative testing), and IMT measurements. 2) Review equipment and expertise requirements in performing selected tasks with faculty using hands-on, instructional video or real time case recordings.
2011 ASN Annual Meeting Program 12 Saturday, January 22, 2011
Breakfast Seminar: Symptomatic Intracranial Atherosclerotic Disease: Stroke Mechanisms and Stratifying Stroke Risk with Transcranial Doppler Queen Ballroom 7:00 - 8:30 am Director: Sebastian Koch, MD Faculty: Sebastian Koch, MD and Jose Romano, MD CME: 1.5 Hours
This course will provide an overview of ways in which transcranial Doppler [TCD] may supplement the evaluation and management of patients with symptomatic intracranial stenosis. The epidemiology of intracranial disease, stroke mechanisms and risk factors for recurrent stroke will be reviewed initially to provide a basis for the subsequent discussions of the role of TCD in managing intracranial disease. The diagnostic accuracy of TCD for high grade intracranial stenosis will be examined including a review of TCD vasoreactivity, emboli detection testing, and serial TCD flow velocity measurements to assess disease progression. Comparisons to similar testing in extracranial disease will be drawn and potential applications of these forms of TCD in the prediction of risk of stroke recurrence will be outlined. The course will conclude with an introduction to the Mechanisms of Stroke in Intracranial Stenosis [MoSIS] study. This study has been funded by the NIH as a sub-study to Stenting vs. Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis [SAMPRIS] and may be instrumental in defining the role of TCD in the management of intracranial disease.
7:00 - 7:05 am Welcome and Introduction Sebastian Koch, MD
7:05 - 7:25 am Symptomatic Intracranial Stenosis: Stroke Mechanisms and Identifying Risk Factors for Stroke Recurrence Jose Romano, MD
7:25 - 7:30 am Questions and Discussion
7:30 - 7:40 am TCD in Intracranial Stenosis Sebastian Koch, MD
7:40 - 7:50 am TCD Emboli Detection in Patients With Intracranial Disease Sebastian Koch, MD
7:50 - 8:00 am Vasoreactivity Testing in Patients with Intracranial Disease Sebastian Koch, MD
8:00 - 8:10 am Monitoring Intracranial Disease Progression and Sebastian Koch, MD Re-Stenosis after Endovascular Treatment
8:10 - 8:15 am Questions and Discussion
8:15 - 8:25 am Introduction to MoSIS Jose Romano, MD
8:25 - 8:30 am Questions and Discussion
Course Objectives:
1) To raise awareness of the use of transcranial Doppler (TCD) in the assessment of stroke patients with intracranial stenosis. 2) Understand mechanisms of stroke in intracranial atherosclerotic disease and how TCD may contribute to risk stratification and follow up of patients with intracranial atherosclerosis on medical treatment or after stent deployment. This will include a review of TCD vasoreactivity and emboli detection testing, and serial TCD flow velocity measurements to assess disease progression. 3) Introduce Mechanisms of Stroke in Intracranial Stenosis (MoSIS), a SAMPRIS affiliated study, with emphasis on the role of transcranial Doppler. The study assesses ultrasonographic risk factors for stroke recurrence, through serial monitoring of flow velocities in the symptomatic vessel, baseline vasoreactivity measurements and emboli detection studies.
2011 ASN Annual Meeting Program 13 Breakfast Seminar: Ultrasound of Peripheral Nerve and Muscle: How Can I Use it to Help My Patients? Gardens Ballroom 7:00 – 8:30 am Director: Steven Shook, MD Faculty: Steven Shook, MD and Craig Zaidman, MD CME: 1.5 Hours
This breakfast seminar will familiarize participants with the role of high-resolution ultrasound (US) for neuromuscular assessment and diagnosis in clinical practice. The faculty will review the benefits and limitations of this technology, ultrasonographic appearance of normal nerve and muscle, and expected findings in various disease states, including entrapment neuropathies, peripheral nerve tumors and trauma, muscular dystrophies, and inflammatory myopathies.
Upon completion of the seminar, attendees will be able to:
1) Understand benefits and limitations of neuromuscular US. 2) Appreciate the normal ultrasonographic appearance of nerve and muscle. 3) Identify specific indications for which US is proven useful in clinical practice, based on the most up-to-date literature.
This course is intended for neurologists, neurosurgeons, physiatrists, radiologists, fellows and residents interested the role of US in the diagnosis of disorders affecting the peripheral nervous system.
Current Topics in MR Imaging (Part II) Queen Ballroom 9:00 am - 1:00 pm Directors: Bret Lindsay, MD and Neeraj Dubey, MD Faculty: Eric Potts, MD, Laszlo Mechtler, MD, and Gabriella Szatmary, MD CME: 3.75 Hours
Faculty will present the MR principles and imaging findings in degenerative spine disease, neoplastic spine disease, neuroophthalmology, and interesting case studies.
9:00 - 10:00 am Degenerative Spine Eric Potts, MD
10:00 - 10:45 am Neoplastic Spine Disease Laszlo Mechtler, MD
10:45 - 11:00 am Break Palm Foyer
11:00 am - 12:00 pm Neuroophthalmology Gabriella Szatsmary, MD
12:00 - 1:00 pm Interactive Case Studies Faculty
Upon completion of the course, attendees will:
1) Understand the MR imaging principles and imaging findings in orbital and visual pathway disease. 2) Understand the MR imaging principles and specific imaging findings in degenerative disease of the spine. 3) Understand MR imaging typical of neoplastic spine disease. 4) Review specific MR imaging findings in case-study format.
2011 ASN Annual Meeting Program 14 Current Topics in Neurosonology (Part II contd.) Gardens Ballroom 9:00 am - 1:00 pm Director: Alexander Razumovsky, PhD, FAHA Faculty: Charles Tegeler, MD, Alexander Razumovsky, PhD, FAHA, and Tatjana Rundek, MD, PhD CME: 3.75 Hours
9:00 – 9:45 am Carotid Intima-Media Thickness and Risk Prediction Charles Tegeler, MD
9:45 – 10:30 am Carotid Atherosclerosis: The Next ankle Brachial Index? Tatjana Rundek, MD, PhD
10:30 – 10:45 am Coffee Break Palm Foyer
10:45 – 11:30 am Specific TCD Application for Patients with Stroke Alexander Razumovsky, PhD, FAHA
11:30 am – 12:30 pm Specific TCD Applications for Patients with Vasospasm of Different Etiology, Including Traumatic Alexander Razumovsky, PhD, FAHA
12:30 – 1:00 pm Q & A
Advocacy - A Review of the Impact of Regulatory and Legislative Changes that Occurred During 2010 Queen Ballroom 3:00 - 4:00 pm Director: Michael Hutchinson, MD, PhD CME: 1 Hour
The purpose of this coures is to provide ASN members with an understanding of the regulatory and legislative activities of 2010 that will impact the practice of neuroimaging in the future. 2010 was a year of major new health care legislation, the continued roll out of the Medicare Patients and Providers Improvement Act of 2008 and continued regulatory pressure on advanced medical imaging. It is critically important for ASN members to understand this rapidly changing environment.
Course Objectives:
1) Provide Attendees with a clear understanding of the Impact of the Patient Protection and Affordability Act and its Impact on In-Office Imaging 2) Provide an update on MedPAC proposed studies of In-Office Imaging and the potential outcomes of this effort 3) Provide an overview of regulatory and other Goverment Initiatives for 2010 and their impact on clinical imaging
Neuroimaging Jeopardy Gardens Ballroom 4:00 - 5:30 pm Director: Paul Maertens, MD CME: 1.5 Hours
Experts who perform and interpret various neuroimaging modalities will be asked to interact and test their knowledge on a wide array of neurologic disorders affecting adults and children. On the basis of clinical history, findings on clinical examination and neuroimaging features, the audience will be asked to participate and create their own interpretation for selected cases as each case will follow the jeopardy template. Real cases will be presented and the final diagnosis may not always be known.
Upon completion of this course, attendees will:
1) Be able to develop a strategy in diagnosing various neurologic conditions using neuroimaging 2) Become familiar with neuroimaging tools that improve diagnostic precision 3) Become familiar with clinical applications of diverse neuroimaging modalities
2011 ASN Annual Meeting Program 15
This activity is intended for neurologists, physicians, psychiatrists, nurses, technicians and other healthcare professionals involved in the care of children and adults presenting acutely, sub-acutely or chronically with mental changes, ataxia, weakness, involuntary movements, migraine or seizures.
Sunday, January 23, 2011
Breakfast Seminar: Neuroimaging of Cognitive and Behavioral Disorders Queen Ballroom 7:00 - 8:30 am Director: Joseph Masdeu, MD, PhD Faculty: Eduardo Gonzalez-Toledo, MD, PhD and Joseph Masdeu, MD, PhD CME: 1.5 Hours
This course will review the neuroimaging findings in dementia and other cognitive disorders. In particular, the availability in the clinical setting of amyloid imaging will make an impact in the usefulness of neuroimaging in dementia prognosis in the short term and may help accelerate the discovery of new therapies. In this course, after two lectures, several cases will be discussed with the audience.
7:00 - 7:30 am Neuroimaging of Psychiatric Disorders Eduardo Gonzalez-Toledo, MD, PhD
7:30 - 8:00 am Neuroimaging of Dementia Joseph Masdeu, MD, PhD
8:00 - 8:30 am Neuroimaging Cases of Cognitive Faculty and Behavioral Disorders
Upon completion of this seminar, attendees should be able to:
1) List the imaging modalities most helpful for the evaluation of patients with cognitive disturbances or dementia. 2) Indicate the role of amyloid imaging in the evaluation of dementia. 3) Describe the most common findings in the neuroimaging evaluation of cognitive impairment.
This course is intended for neurologists, radiologists, fellows and residents interested in brain imaging.
Breakfast Seminar: Metabolic Disorders in Adults and Children: Clinical Neuroimaging Case Studies Gardens Ballroom 7:00 - 8:30 am Director and Faculty: Paul Maertens, MD CME: 1.5 Hours
In a case study format the presentations will cover a wide array of hereditary and acquired metabolic disorders that are difficult to diagnose without adequate knowledge of their neuroimaging characteristics. On the basis of clinical history, findings on clinical examination and neuroimaging features, the audience will be asked to participate and create their own interpretation for selected cases as each case will follow the jeopardy template. Special attention will be paid to conditions in which prompt initiation of adequate therapy will improve survival and quality of life. Usefulness of magnetic resonance spectroscopy in diagnosing and treating selected metabolic diseases will be presented.
Upon completion of this breakfast seminar, attendees will:
1) Be able to recognize characteristic neuroimaging features of metabolic disorders caused by vitamin deficiency 2) Become familiar with metabolic diseases affecting primarily white matter or both gray and white matter 3) Become familiar with magnetic spectroscopy findings in selected metabolic disorders
2011 ASN Annual Meeting Program 16 This activity is intended for neurologists, physicians, psychiatrists, nurses and other healthcare professionals involved in the care of children and adults presenting acutely, sub-acutely or chronically with mental changes, ataxia, weakness, involuntary movements, migraine or seizures.
Neuroimaging Self-Assessment Evaluation Sabal Ballroom 7:00 - 8:30 am Director: Eric Lindzen, MD, PhD Faculty: Eric Lindzen, MD, PhD, Dara Jamieson, MD, and Patrick Capone, MD, PhD CME: 1.5 Hours
The Neuroimaging Self-Assessment Examination (SAE) is intended to be a Neuroimaging self-assessment tool, providing participants a structured opportunity to gain insight into their own personal strengths and weaknesses relative to their peers in the provision and clinical evaluation of Neuroimaging studies. Knowledge and skills to be assessed in this setting will include identification of normal anatomical structures, accuracy in the identification of specific pathologies on MRI and CT studies, formulation of Neuroimaging differential diagnoses, basic MRI and CT physics knowledge, and the ability to correlate imaging findings with clinical history. Subject matter covered by the SAE will include diagnostic neuroimaging of common neurological disorders such as cerebrovascular disease, multiple sclerosis, CNS trauma, tumors and cysts, infections, toxic/metabolic disorders and diseases of the spinal cord and surrounding tissues. Knowledge of basic MRI and CT physics principles essential for protocol design, safety, recognition of artifact and differentiation of tissue types based upon CT density and MRI signal characteristics will also be assessed.
The target audience includes residents, fellows and attending physicians in the fields of neurology, neurosurgery and radiology who wish to address potential gaps between their own performance levels and commonly accepted standards of care in the provision of Neuroimaging interpretations.
The SAE will be presented in a multiple choice Powerpoint format projected on a screen to the audience with 1.5 minutes allotted per question. The subject matter will span 30 clinical Neuroimaging cases and 20 imaging physics and technology related questions. Each question will consist of a short text passage describing a clinical vignette or specific imaging related parameters, accompanied by images or diagrams, followed by six multiple choice answer options. Attendees will mark the single best answer to each question on a provided answer sheet, which will be passed in for grading at the end of the 90 minute course period. Clinical cases will incorporate detailed, high resolution MRI and CT images of the brain and spine (including MR and CT angiography).
Individual exam scores will be anonymous to all participants except for each individual examinee, who will be able to access his or her score online within 7 days of the exam using a random alphanumeric code provided with each score sheet. Anonymous scores will be statistically analyzed by the course directors for validation and exam improvement purposes. None of the material to be used in this self-assessment exercise shall have been previously copyrighted.
Upon completion of the course, attendees will:
1) Become more familiar with personal strengths and weaknesses in the identification of normal versus abnormal imaging findings. 2) Become more familiar with personal strengths and weaknesses in formulating a differential diagnosis pertaining to specific imaging presentations. 3) Achieve greater levels of confidence in acquiring and interpreting MRI and CT studies in common neurological disorders such as MS, stroke, tumor and trauma. 4) Be able to identify areas of future study to increase levels of competence in the interpretation of diagnostic Neuroimaging cases. 5) Be able to identify areas of future study to increase levels of competence in MRI and CT physics.
This course is a self-assessment exercise and not a board review.
2011 ASN Annual Meeting Program 17 Advances in Diagnosis and Management of Cerebrovascular Dissections Queen Ballroom 9:00 - 11:30 am Director: Adnan Qureshi, MD Faculty: Adnan Qureshi, MD, Dara Jamieson, MD, and Robert Taylor, MD CME: 2.5 Hours
9:00 - 9:25 am Overview of Neurovascular Arterial Dissections Adnan Qureshi, MD
9:25 - 9:50 am Diagnostic Work-Up and Imaging of Arterial Dissections and Implications for Treatment Robert Taylor, MD
9:50 - 10:15 am Medical Treatment and Recurrent Stroke Risk Dara Jamieson, MD
10:15 - 10:40 am Interventional Treatment for Neurovascular Arterial Dissections: TBD Indications and Outcomes
10:40 - 10:50 am Break Palm Foyer
10:50 - 11:30 am Case Presentations and Panel Discussion Adnan Qureshi, MD
2011 ASN Annual Meeting Program 18 2011 Faculty & Program Committee Disclosures
In accordance with the guidelines of the Accreditation Council for Continuing Medical Education (ACCME), ASN requires disclosure of any interests or affiliations with corporate organizations of Faculty (indicated below with F), Program Committee Members (indicated below with PC), and ASN staff members (indicated below with S).
Madhureeta Achari, MD (PC) Speaker: Biogen Idec Andrei Alexandrov, MD, RVT (PC) Advisory Board: Cerevast Therapeutics, Advisory Board and Speaker: Genentech, Inc Robert Bermel, MD (PC) Consultant and Speaker: Biogen Idec, Teva Neuroscience Allan Burke, MD (PC) No relationships Stafford Conway, MD (F) Speaker: Boehringer Ingelheim Patrick Capone, MD, PhD (F) No relationships John Chawluk, MD (PC) Speaker: GSK, Novartis, Astellas, Zogenix, Biogen Idec; Medical Director: Schuykill Open MRI, Providence Place Retirement Community Neeraj Dubey, MD (F, PC) No relationships Zsolt Garami, MD (F) No relationships Camilo Gomez, MD (PC) Scientific Advisor: Alsius Corporation; Guidant Corporation; Cordis Corporation; W.L. Gore, Inc; Accumetrics, Inc. Consultant: Alsius Corporation; Guidant Corporation; Boston-Scientific Corporation; Bristol-Myers Squibb/Sanofi Pharmaceuticals; Investigator: Alsius Corporation; Guidant Corporation; Boston-Scientific Corporation; Cordis Corporation; CoAxia, Inc.; Accumetrics, Inc.; Abbot Vascular; Bristol-Myers Squibb/Sanofi Pharmaceuticals; Abbott Laboratories, Inc.; Parke-Davis Laboratories; Astra-Zeneca Pharmaceutical; Bayer Pharmaceuticals; Speaker: Bristol-Myers Squibb/Sanofi Pharmaceuticals; Abbott Laboratories, Inc.; Boehringer-Ingelheim Pharmaceuticals; Solvay Pharmaceuticals; USP Pharma Eduardo Gonzalez-Toledo, MD, PhD (F) No relationships Geoffrey Hartwig, MD (F) No relationships Michael Hutchinson, MD, PhD (F) No relationships Dara Jamieson, MD (F, PC) No relationships Tudor Jovin, MD (F) Consultant: Ev3 Concentric Med Inc; Advisory Board: Axia, Inc; Speaker’s Bureau: Association ED for Journal of Neuroimaging Tisha Kehn (S) No relationships Neil Kleiman, MD (F) No relationships Joshua Klein, MD (F) No relationships Sebastian Koch, MD (F) No relationships David Liebeskind, MD (F, PC) Consultant: Concentric Medical, CoAxia Bret Lindsay, MD (F, PC) Speaker: Biogen Idec, Teva Neuroscience Eric Lindzen, MD, PhD (F) No relationships Paul Maertens, MD (F, PC) No relationships Marc Malkoff, MD (PC) No relationships Joseph Masdeu, MD, PhD (F) No relationships Laszlo Mechtler, MD (F, PC) Speaker: Glaxo Smith Kline, Merck, Forest Pharmaceuticals, Zogenix, INC Mircea Morariu, MD (PC) No relationships Leslie Orvedahl (S) No relationships Erasmo Passaro, MD (F, PC) Speaker: UCB, Glaxo Smith Kline, Forest Pharmaceuticals, Pfizer Eric Potts, MD (F) No relationships Leon Prockop, MD (PC) No relationships Adnan Qureshi, MD (PC, F) Principal Investigator: NIH, AHA Alexander Razumovsky, PhD, FAHA (F, PC) FTE: Sentient NeuroCare Services, Inc. Jose Romano, MD (F) No relationships Tatjana Rundek, MD, PhD (F) Speaker: Sanofi/Aventis; Consultant: NHSi Inc Steven Shook, MD (F) No relationships Michael Sloan, MD (PC) No relationships Gabriella Szatmary, MD, PhD (F) No relationships Robert Taylor, MD (F) No relationships Charles Tegeler, MD (F, PC) No relationships John Volpi, MD (F) No relationships Catherine Weymann McKinney, MD (F) No relationships Shannon Wild (S) No relationships Mohammed Zafar, MD, FAAN (F) Speaker: Teva Neurosciences Craig Zaidman, MD (F) No relationships
AMERICAN SOCIETY OF NEUROIMAGING CME MISSION STATEMENT The American Society of Neuroimaging (ASN) is an international professional organization representing neurologists, neurosurgeons, neuroradiologists, and other neuroscientists who are dedicated to the advancement of any technique used to image the nervous system. Its purpose is to promote the highest standards of neuroimaging in clinical practice, thereby furthering ongoing improvement in the delivery of medical care. ASN’s Annual Meeting educational activities are planned to meet the educational needs of physicians in practice and training in regard to the study of the nervous system with techniques including x-ray angiography and computed tomography, Magnetic Resonance Imaging, ultrasound, positron emission tomography and single photon emission computed tomography and near infra-red spectroscopy. Emphasis is placed on the correlation of the clinical data with information derived from the various methods used to image the nervous system and related structures (integrated neuroimaging) and on the updating of algorithms leading to a cost effective and efficient use of imaging modalities for the different disorders of the nervous system. The Society further supports and promotes Fellowships, Preceptorships, Tutorials, and Seminars related to neuroimaging held throughout the country. The courses address advances in the role of MRI, CT, and Neurosonology in Neurology and are designed to help practitioners and trainees improve their interpretation skills.
TARGET AUDIENCE The material presented at the 34th Annual Meeting is appropriate for neurologists, radiologists, and other physicians and health care professionals involved in the diagnosis and treatment of patients with neurologic disease.
ACCREDITATION The American Society of Neuroimaging is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
CREDIT DESIGNATION The ASN designates this live activity for a maximum of 25.75 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
CME CERTIFICATES AND EVALUATIONS CME certificates will be issued after the conclusion of the 2011 Annual Meeting. In order to receive your CME certificate you will need to submit an evaluation form for each course attended. In an ongoing effort to move to paperless format, evaluations will only be available online. All meeting attendees will receive an email after the meeting with a link to the evaluation.
Please note: You will only receive CME credits for the courses for which you have registered.
PRESIDENTIAL ADDRESS & AWARDS LUNCHEON ASN Business Meeting AGENDA ■ Sanibel Harbour Resort – Fort Myers, FL Saturday, January 22, 2011 ■ 1:15-2:45 pm
1. Call to Order
2. Approval of Minutes – January 16, 2010 Business Meeting
3. President’s Report – Lawrence Wechsler, MD a) Recognition of Dr. Jamieson’s service as Vice President b) Recognition of Dr. Achari’s’s service as a Board Member c) Recognition of Dr. Lindsay’s service as Board Member d) Recognition of Dr. Qureshi’s service as Board member e) Slate of Candidates: Dara Jamieson, MD – President Laszlo Mechtler, MD – Vice President John Choi, MD – Board Position Eric Lindzen, MD – Board Position Erasmo Passaro, MD, FAAN – Board Position
4. Program Committee Report – Dara Jamieson, MD 2012 Annual Meeting: Marriott Biscayne Bay, Miami, FL - January 26-29, 2012
5. Treasurer’s Report – Edward Feldmann, MD
6. Practice Issues Committee Report –Michael Hutchinson., MD, PhD
7. Journal of Neuroimaging Report – Joseph Masdeu, MD, PhD
8. Fellowship/Training Committee Report – Lazlo Mechtler, MD
9. John and Sophie Prockop Memorial Lectureship - Leon Prockop, MD Presented to: Marc Ribo, MD, PhD Intra-arterial Administration of Microbubbles and Continuous 2-MHz Ultrasound Insonation to EnhanceIntra- arterial Thrombolysis
10. Presentation of the Qureshi Award – Adnan Qureshi, MD Presented to: Ameer Hassan, DO Long-term clinical and angiographic outcomes in patients with spontaneous cervico-cranial arterial dissections treated with stent placement
11. Presentation of Oldendorf Award – Lawrence Wechsler, MD Presented to: Chun-Yi Wen, PhD The Diffusion Pattern of Healthy and Myelopathic Cervical Spinal Cord - A Template-based Analysis
2011 ASN Annual Meeting Program 21
12. Presentation of McKinney Award – Lawrence Wechsler, MD Presented to: Arvind Sharma, MD Does Age have an impact on arterial recanalization in acute ischemic stroke?
13. Presentation of Trainee Travel Awards – Lawrence Wechsler, MD Presented to: Chun Huang, MD, Carey Taute, MD and Ashkan Mowla, MD
14. Recognition of Dr. Wechsler’s Service as President – Dara Jamieson, MD
15. Passing of Gavel – Lawrence Wechsler, MD
16. New Business
17. Adjourn
2011 ASN Annual Meeting Program 22
PRESIDENTIAL ADDRESS & AWARDS LUNCHEON ASN Business Meeting Palace Hotel – San Francisco, CA Saturday, January 16, 2010 ■ 1:15-2:45 pm MINUTES
The meeting was called to order by Dr. Lawrence Wechsler, President.
On a motion seconded and carried, the minutes from the January 2009 meeting were approved as submitted.
President’s Report
Dr.Wechsler thanked Drs. Hartwig and Morariu for their service on the Board of Directors and announced the new slate of candidates. He then recognized Dr. Vikram Penumalli as the winner of the Greenberg Fellowship Award.
On a motion seconded and carried, the membership approved the appointment of Drs. Vernice Bates and Kevin Crutchfield to the Board of Directors.
Dr. Wechler then presented a summary of ASN activities including: • Educational activities offered at the Annual Meeting including courses, symposia, semiars and a joint symposium with SVIN • The Journal of Neuroimaging and the increased impact factor • Advocacy efforts put forth by Ed Eichorn • Certification in Neuroimaging, Neuroimaging fellowships and a Neuroimaging self-assessment which is in process for the 2011 meeting • Resident education training guidelines have been sent to the American Academy of Neurology for review • ASN continues to explore the relationship between it and the AAN
Dr. Wechsler encouraged those present at the Business Meeting to support the ASN in some way, whether it be attending the Annul Meeting, the recruitment of new members or financially contributing the the Ed Eichorn Advocacy fund.
Program Committee Report
Dr. Jamieson indicated that there were 156 people registered for the meeting. She announced that the 2011 Annual Meeting will be held at the Sanibel Harbour Resort in Fort Myers, Florida from January 19-23, 2011.
Dr. Jamieson thanked the faculty members for their intellectual and financial contributions, and noted that many of the faculty members contributed their honoraria to the Ed Eichorn Advocacy fund.
Treasurer’s Report Dr. Wechsler reported for Dr. Feldmann. The 2010 budget balanced, with the exception of Ed Eichorn’s Advocacy expenses. The ASN will need to use some the ASN reserves to cover these expenses. Dr. Wechsler requested donations be made to the Ed Eichorn Advocacy fund after the Business Meeting at the registration desk.
2011 ASN Annual Meeting Program 23 Practice Issues Committee Report
Dr. Hutchinson gave a preview of the issues that will be discussed in Ed Eichorn’s “Update on the Current Status of Healthcare Legislation and its Impact on Clinical Imagers” presentation. This presentation will describe ASN’s strategy and efforts to advocate for the right of properly trained neuroimagers to provide imaging services for their patients during 2009, report on the current status of health care legislation at the time of the meeting, and the developing advocacy issues for 2010.
Journal of Neuroimaging Report
Dr. Masdeu reported that the quality of articles submitted continues to improve. The financial success of the JON is greatly enhanced by having supplemental issues. The cost to sponsor a supplement is approximately $30,000. Anyone interested in sponsoring a supplement is encouraged to contact Dr. Masdeu.
Fellowship/Training Committee Report
Dr. Lindzen reported for Dr. Mechtler. As of 2013 the UCNS plans to eliminate the practice track and only allow eligibility to sit for the MRI/CT Exam under the fellowship track. The ASN is seeking a two year extension of the practice track. Currently there are five fellowships affiliated with ASN; two of those are UCNS certified. The two UCNS approved fellowships are at SUNY Buffalo and Winchester Neurological. DENT has an application into UCNS and should be notified of the approval status by July 1, 2010. Dr. Lindzen reported that semi-weekly webinars are still being offered. The interactive webinars consist of a lecture on a specific topic followed by thirty minutes of interesting cases.
Awards The annual awards were presented. Dr. Prockop presented the John and Sophie Prockop Memorial Lectureship to Mohit Neema, MD, Dr. Qureshi presented the Qureshi Award to Foad Abd Allah, MD, Dr. Wechsler presented the Oldendorf Award to Belen Pascual, PhD, and Dr. Wechsler presented the McKinney Award to Joseph Sebastian, MD. Dr. Wechsler presented the Trainee Travel Awards to Lama Chahine, MD and Daniel Dees, MD.
There being no further business, the meeting was adjourned.
Respectfully submitted,
Shannon Wild Associate Executive Director
SLW:lao
2011 ASN Annual Meeting Program 24 2011 Award Winners
Awards will be presented Saturday, January 22, 2011 during the Presidential Address and Awards Luncheon.
John and Sophie Prockop Memorial Lectureship The John and Sophie Memorial Lectureship was established to enhance the scholarly and educational missions of the Society by honoring outstanding contributions made to the Society’s peer-reviewed journal, the Journal of Neuroimaging. The recipient of the Lectureship is the first author of a manuscript published in the journal that has been judged to have outstanding value to the development and success of the journal, or the highest quality manuscript published in the prior year as judged by the American Society of Neuroimaging Education Foundation Board of Directors.
2011 John and Sophie Prockop Memorial Lectureship Recipient Marc Ribo, MD, PhD Autònoma de Barcelona Barcelona, Spain Intra-arterial Administration of Microbubbles and Continuous 2-MHz Ultrasound Insonation to EnhanceIntra-arterial Thrombolysis (Volume 20 Issue 3 Pages 224-227, July 2010)
Qureshi Award The Qureshi Award is for the best manuscript based on research in diagnostic angiography or endovascular procedures.
2011 Qureshi Award Recipient Ameer Hassan, DO Endovascular Surgical Neuroradiology Fellow Department of Neurology University of Minnesota Minneapolis, MN Long-term clinical and angiographic outcomes in patients with spontaneous cervico-cranial arterial dissections treated with stent placement
Oldendorf Award The Oldendorf Award is for the best manuscript based on research in CT, MRI, SPECT or PET.
2011 Oldendorf Award Recipient Chun-Yi Wen, PhD Department of Orthopaedics and Traumatology The University of Hong Kong Hong Kong, Hong Kong The Diffusion Pattern of Healthy and Myelopathic Cervical Spinal Cord - A Template-based Analysis
McKinney Award The McKinney Award is for the best manuscript based on research in neurosonology.
2011 McKinney Award Recipient Arvind Sharma, MD Clinical Stroke Fellow Department of Neurology University of Alberta Edmonton, Alberta, Canada Does Age have an impact on arterial recanalization in acute ischemic stroke?
2011 ASN Annual Meeting Program 25 2011 Award Winners
Trainee Travel Awards The Trainee Travel awards are presented to the three top-ranked abstracts submitted by a resident/fellow for poster presentations.
2011 Resident Travel Award Recipients
Chun Huang, MD
University of Southern Alabama
Mobile, AL Poster #12 Brain MRI in Roberts Syndrome: a Cohesinopathy
Carey Taute, MD Pediatric Neurology Cleveland Clinic Foundation Cleveland, OH Poster #34 Choroid Plexus Hyperplasia in a Child with Tetrasomy 9p
Ashkan Mowla, MD Methodist Neurological Institute Department of Neurology Houston, TX Poster #33 Screening for Intracranial Stenosis: Comparison of Transcranial Doppler with MR Angiogram
2011 ASN Annual Meeting Program 26 a vena cava filter was placed. Steroids and verapamil were combinations of CT-P findings associated with increased 2011 ASN Abstracts tapered. She was treated with aggressive hydration and risk of poor outcome. subcutaneous heparin. Her speech and limb strength Results: There were 40 patients (mean age 64.6 ± 16 years) significantly improved within 24 hours of the latter with a median NIHSS score of 5.4 ± 2, treated with IVTPA. treatments. There was no correlation with MTT (p = 0.23), rCBF Conclusion: RCVS may present with simultaneous (p = 0.21), or rCBV (p = 0.4) values with poor outcomes at 1. Long-term Clinical and hemorrhagic and ischemic strokes. In this patient, aggressive discharge. The only predictors found were age and NIHSS hydration and low intensity anticoagulation were temporally score at admission. No association between the presence of Angiographic Outcomes in Patients associated with significant improvement but steroids and a combination of perfusion deficit and decreased rCBV with Spontaneous Cervico-Cranial verapamil were not. Further studies are required to define (p = 0.4) and poor outcome was found in the analysis. the optimal treatment options for this condition. Conclusion: We were unable to identify any CT-P findings Arterial Dissections Treated With that can reliably identify patients with mild to moderate Stent Placement Ameer E. Hassan, 3. Atherosclerotic Aortic Arch severity ischemic strokes who are at risk for poor outcomes despite IVTPA. Haralabos Zacharatos, Gustavo J. Plaques in Acute Ischemic Rodriguez, M. Fareed K. Suri, Nauman Stroke Foad AbdAllah, Randa Deif, 5. Atypical Clinical and MRI Tariq, Gabriela Vazquez, Ramachandra Mohamed El-Sayed Changes of Neurosyphilis P. Tummala, Robert A. Taylor, Adnan Neurology Department, Cairo Mimicking Herpes Simplex I. Qureshi University, Cairo, Egypt Encephalitis Shazia Alam, Aarti
University of Minnesota, Minneapolis, Background: Atherosclerotic aortic arch plaques (AAP) Sarwal, Ken Uchino Minnesota, United States have been linked to an increased risk of thromboembolic Cleveland Clinic, Cleveland, OH, events as a cause of acute ischemic stroke of undetermined etiology. United States Introduction: Limited data exists regarding the long-term Objectives: To find out the presence of atherosclerotic clinical and angiographic outcomes following stent plaques in aortic arch and their potential role as a source of Introduction: The typical radiologic findings of placement among patients with spontaneous cervico-cranial embolism in cerebral infarction of undetermined etiology. neurosyphilis include cerebral infarctions, nonspecific white arterial dissection. Our objective was to report the Methods: We performed transesophageal matter lesions, cerebral gummas, or arteritis. Temporal lobe immediate and long-term clinical and angiographic echocardiography (TEE) and multislice computerized hyperintensity on MRI T2-weighted and FLAIR images is outcomes of patients who underwent stent placement for tomography (MSCT) of the aortic arch on 30 patients with considered to be a classic finding for HSV encephalitis. We spontaneous cervico-cranial arterial dissection. acute ischemic stroke of undetermined cause from a total report a case of neurosyphilis mimicking HSV encephalitis. Patients (or Materials) and Methods: We reviewed series of 150 non-selected patients with acute ischemic Patients (or Materials) and Methods: Case report and clinical and angiographic data on consecutive stent treated, stroke studied prospectively by clinical evaluation, imaging. spontaneous cervico-cranial arterial dissection patients. laboratory investigations, cranial computed tomography, Results: 68 year old male with no past medical history Patients with recurrent ischemic symptoms or severe color coded duplex ultrasonography of the carotid arteries presented with several weeks history of cognitive changes hemodynamic compromise despite maximal medical and transcranial Doppler (TCD). followed by acute onset left-sided numbness, weakness, and therapy or those with compressive symptoms due to Results: Using transesophageal echocardiography eight dysarthria. All sensorimotor symptoms resolved within 24 expanding pseudoaneurysms were considered. Follow-up patients (29.6%) had atherosclerotic aortic arch plaques, hours. FLAIR and T2-weighted images showed confluent angiography and intravascular ultrasound (in selected while using multislice computerized tomography abnormal hyperintensity in the subcortical white matter in patients) was performed to detect in-stent restenosis, intimal atherosclerotic aortic arch plaques were revealed in twelve large portion of the right temporal lobe with apparent flap, or pseudo-aneurysm. patients (40%). Atherosclerotic aortic arch plaques were sparing of the cortex on T2, supratentorial volume loss, and Results: A total of 14 patients were identified. Complete significantly related to older age, male gender, white matter changes . No corresponding restricted resolution of stenosis was achieved in 10 patients hypertension, ischemic heart disease and low-grade diffusion or contrast enhancement was noted. CSF analysis immediately post-procedure. Clinical follow-up ranged from atherosclerotic carotid lesions. Multislice computerized revealed lymphocytic pleocytosis with WBC 63, Protein 74, 26–900 days, during which there was 1 TIA (7%), 1 minor tomography of the aortic arch was more sensitive than RBC 6, glucose 72. Acyclovir was started empirically on ischemic stroke (7%), and 1 (7%) in hospital death secondary transesophageal echocardiography in detecting the site, size suspicion of HSV encephalitis. Electroencephalogram to pre-morbid conditions. Stroke-free survival was 93% at and characters of atherosclerotic aortic arch plaques. showed cerebral dysfunction in right temporal region with both 1 month and 6 months after the procedure. Follow up mild diffuse encephalopathy. CSF HSV PCR was negative Conclusion: Atherosclerotic aortic arch plaques are a > angiography did not reveal any in-stent restenosis. frequent finding in patients with acute ischemic stroke of while CSF VDRL was reactive with confirmatory IgG 8. Conclusion: This study demonstrates the feasibility, safety, undetermined cause supporting the hypothesis that aortic Patient was treated with Penicillin. and intermediate term effectiveness of endovascular stent plaques have embolic potential. In addition, multislice Conclusion: The above case illustrates atypical clinical and reconstruction of spontaneous cervico-cranial arterial computerized tomography is more sensitive than radiological features of neurosyphllis mimicking herpes dissection. transesophageal echocardiography in detecting simplex encephalitis. This awareness is important because atherosclerotic aortic arch plaques and better of the potential implications on treatment choices and characterization of these plaques especially relevant one. mortality. Neurosyphllis should be included in differential 2. Simultaneous Hemorrhagic and diagnosis of encephalitis picture with temporal lobe Ischemic Strokes in a Patient With 4. Does Computed Tomographic hyperintensity. Reversible Cerebral Perfusion Findings in Mild Severity 6. Imaging Changes in Natalizumab Vasoconstriction Syndrome Brian Acute Ischemic Stroke Treated Associated Progressive Multifocal 1 2 2 Silver, Renzo Figari, Komal Ashraf, With Intravenous Thrombolysis Leukoencephalopathy before and 1 Rhode Island Hospital, Providence, Predict Outcome? Ameer E. Hassan, after Treatment M. Zuheir ALKAWI 2 RI, United States, Henry Ford Gustavo J. Rodriguez, Haralabos KFSH&RC, RIYADH, Saudi Arabia Hospital, Detroit, MI, United States Zacharatos, Gabriela Vazquez, M. Introduction: Progressive Multifocal Leukoencephalopathy Introduction: First described in 1988, the reversible Fareed K. Suri, Robert A. Taylor, (PML) is a rare complication of treatment with natalizumab. cerebral vasoconstriction syndrome (RCVS) is an Ramachandra P. Tummala, Mustapha Patients: This is a case report of a 49 years old patient with uncommon cerebrovascular disorder with typical Multiple Sclerosis who received 28 monthly doses of 300 presentations including recurrent thunderclap headache and A. Ezzeddine, Adnan I. Qureshi mg Natalizumab. He developed seizures, encephalopathy a beading pattern on neuroimaging. Patients may and right side neglect six weeks after the last dose of experience ischemic or hemorrhagic stroke. We describe a University of Minnesota, Minneapolis, Natalizumab. CSF showed pleocytosis and high protein. patient in the post-partum period who presented with both Minnesota, United States Diagnosis was confirmed by JC virus PCR test on CSF. He hemorrhagic and ischemic strokes. received four sessions of plasma exchange. There was Patients (or Materials) and Methods: A 34-year old Introduction: Multiple protocols use NIHSS score ≥10 to clinical stabilization. woman with five previously uncomplicated pregnancies select patients for endovascular treatment following IV Results: Magnetic Resonance Imaging (MRI) done in eight presented 10 days after delivering her sixth child. thrombolysis (IVTPA). There are patients with NIHSS < 10 days interval before and after plasma exchange (PLEX) Symptoms included a severe headache. She was seen at who are anticipated to have poor outcome despite IVTPA showed initially confluent high T2 signal changes in the another hospital and discharged home with analgesic and may be candidates for endovascular treatment. Our subcortical parietal and temporal regions in the left medications. She returned 24 hours later with right objective was to evaluate whether computed tomographic hemisphere with mild edematous changes. Changes hemiplegia and aphasia. perfusion (CT-P) findings can predict poor outcomes in regressed after PLEX. Results: Initial CT scan showed a medium-sized acute ischemic stroke patients with an NIHSS < 10. Conclusion: Although PML is usually described as causing hemorrhage in the frontal lobe. Cerebral angiography Patients (or Materials) and Methods: All IVTPA patients no mass effect the current case shoed that there are demonstrated segmental narrowing of vessels in both who had CT-P scan as part of their initial evaluation were edematous changes in the involved areas that are rapidly hemispheres. She was initially treated with intravenous identified through a retrospective chart review of reversible after therapy. steroids and verapamil with mild improvement in her consecutive patients from two comprehensive stroke centers aphasia but not limb strength. Ten days after admission, she over a 3 year period. The relationship between CT-P 7. NIH Stroke Scale and Acute developed visual impairment on the left side. MRI showed findings including Mean Transit Time (MTT), regional a new infarction in the right posterior temporal lobe. Cerebral Blood Flow (rCBF), and regional Cerebral Blood Magnetic Resonance Imaging in Increased edema was seen around the original hemorrhage. Volume (rCBV) with unfavorable outcome at discharge Right Middle Cerebral Artery Two days later, a CT showed a new left ACA infarction. (defined by modified Rankin score (mRS) ≥3) was She also was found to have a pulmonary embolus for which analyzed. TREE analysis was used to identify various Stroke Sarabjit Atwal, Ken Uchino,
2011 ASN Annual Meeting Program 27
Copyright ◦C 2010 by the American Society of Neuroimaging 95 Mei Lu angiotensin-converting-enzyme (ACE) level. Other from atrophy or chronic ischemic stroke. Magnetic immunological markers would be helpful in the diagnostic resonance imaging (MRI) is considered the most sensitive Cleveland Clinic, Cleveland, OH, evaluation of sarcoidosis. imaging modality for detecting and aging an ICH. Here we United States Materials and Methods: We report a patient presenting describe a case of patient with an acute ICH on CT, in with diffuse leptomeningeal disease and an elevated soluble whom MRI showed a second subacute ICH which was not Introduction: The NIH Stroke Scale (NIHSS) is widely interleukin 2 receptor (sIL-2R) level, which helped point apparent on repeat CT. used scale to evaluate neurological impairment in a patient towards the diagnosis of neurosarcoidosis. Patient and Methods: A 65-year-old female with experiencing an acute stroke. The NIHSS and diffusion Results: 28-year-old African-American female presented hypertension, diabetes and hyperlipidemia, presented with weighted MR imaging (DWI) may be used collectively to with fluctuating headache, vomiting and confusion for one acute headache and emesis. CT showed a 22 mL left predict patient outcome. However, imaging can year. On examination she was drowsy with meningeal signs, cerebellar ICH. MRI the following day demonstrated the occasionally be misleading and portend a worse outcome but demonstrated no other neurological deficits. MRI brain cerebellar ICH and a right parietal lesion, which was than is realized by the patient. showed diffuse symmetric leptomeningeal enhancement hyperintense on both T1 and T2 sequences consistent with Patients (or Materials) and Methods: This is a case throughout the convexities, cerebellum, and brainstem subacute hemorrhage. Thus, the patient had a report of a patient with a large right middle cerebral artery without hydrocephalus or parenchymal invasion. Serial transesophageal echocardiogram to assess for possible distribution ischemic stroke. lumbar punctures showed CSF pleocytosis, low glucose, and embolic stroke. A repeat CT only revealed the cerebellar Results: A 62 year old left handed female presented with elevated protein, but were negative for infection and hemorrhage. the acute onset of aphasia, left hemiplegia, right gaze malignancy. Right parietal brain and meningeal biopsy Results: MRI detected hemosiderin from the subacute ICH preference and left visual field cut. Her initial NIHSS was showed no evidence of tumor, inflammation or granulomas. missed on initial and subsequent CT which changed patient 25. She received IV TPA and underwent mechanical Her serum and CSF ACE levels were also normal. As management. thrombectomy of a distal right internal carotid artery and sarcoidosis was still suspected, a sIL-2R level was drawn. Conclusion: The density of an ICH decreases daily on CT, + proximal right middle cerebral artery thrombus. Her initial IL-2 is secreted by activated CD4 T cells, which are one of leading to clot resolution and residual hemosiderin, which the pathological hallmarks of sarcoidosis; sIL-2R levels have may be undetectable by the human eye. Hemosiderin is MRI showed faint scattered hyperintensities in the R MCA ∗ territory. Post procedure, her NIHSS improved to 10, but been used to detect active systemic sarcoidosis. The patient’s easily recognizable on gradient-echo and T2 MRI her MRI looked significantly worse with extension of the sIL-2R level returned as markedly elevated, leading to a CT sequences. As access to MRI becomes more prevalent, restricted diffusion and essentially involving most of the R chest, which showed supraclavicular, mediastinal and hilar further studies are needed to investigate whether all patients MCA territory. Six weeks after the stroke, her NIHSS lymphadenopathy. Subsequent mediastinoscopy-guided with an ICH should get an MRI during their hospitalization, improved to 1. She continued to experience mild aphasia biopsy revealed noncaseating granulomas consistent with as the additional findings may change patient care. and scored 2 on the modified Rankin Score and 100 on the sarcoidosis. The patient returned to baseline status after Barthel Index. initiation of steroid treatment. 12. Brain MRI in Roberts’ Conclusion: Neurologic impairment measured by the Conclusion: In patients with suspected neurosarcoidosis NIHSS and the burden of ischemic injury on DWI MR and negative ACE levels, an elevated sIL-2R level may aid Syndrome: a Cohesinopathy Chun imaging do not always correlate, and thus should be used in guiding the evaluation and treatment plan. judiciously to prognosticate final patient outcomes. Huang, Paul Maertens, Renay Drinkard 10. Correlations Between Imaging University of South Alabama, Mobile, 8. Extensive Cervical Cord Grade 3 Findings and Clinical Presentation AL, United States Anaplastic Astrocytoma in Rasmussen Encephalitis Vasu Introduction: Cohesinopathies are genetic developmental Masquerading as Myelitis. Manasi disorders caused by defects of the cohesin pathway (CP). Gooty, Sanjeev Kothare, Tobias The CP serves to facilitate cohesion between replicated Gahlot, Sunanda Nanduri, Sandeep Loddenkemper sister chromatids and also is involved at the interface Rana, Lara Kunschner between DNA repair and sister chromatid cohesion. Children’s Hospital Boston, Boston, Cohesinopathies are characterized by short limbs, Allegheny General Hospital, Pittsburgh, Massachusetts, United States microcephaly, facial dysmorphy, developmental defects, Pennsylvania, United States mental retardation and seizures. Cornelia de Lange Introduction: Rasmussen Encephalitis (RE) is a rare syndrome, microcephalic osteodysplastic primordial dwarfism type II (MOPD2) and Roberts’ syndrome (RS) are Introduction: Spinal cord tumors are rare tumors immune-mediated disorder characterized by chronic examples of cohesinopathies. accounting for 2–4% of all CNS tumors. About 30% are cerebral inflammation associated with progressive Patients (or Materials) and Methods: We reviewed high grade lesions. We present an unusual case of 74 year neurological deterioration and refractory seizures. imaging studies in the only patient identified as carrying a old female with grade 3 astrocytoma involving entire Neuroimaging features include unilateral cerebral atrophy diagnosis of cohesinopathy seen at the University of South cervical spinal cord, brain stem, bilateral thalami, basal with grey and white matter hyperintensities on T2 and Alabama from 2005 to 2010. Our patient is a 31 year-old ganglia and hypothalamus masquerading as myelitis. FLAIR images. We correlated neuroimaging findings with male with RS. He suffers from congenital cataract, Patients (or Materials) and Methods: 74 year old RHCF clinical and pathological findings. microcephaly, mental retardation, ataxia, mesomelic with history of rheumatoid arthritis (RA) presented with Patients (or Materials) and Methods: We retrospectively dwarfism and severe uncontrollable epilepsy. Sequencing of progressively increasing left sided parasthesias, hemiparesis reviewed data of epilepsy admissions from January 1994 to ESCO2 gene demonstrates the presence of one sequence and urinary retention over one month. Cervical cord MRI May 2010 for patients with RE based on pathology and change on each chromosome: the first mutation in the splice revealed heterogeneously enhancing T2 hyperintensity characterized MRI – findings, clinical features, and EEG. acceptor region of intron 6 (IVS6–7A > G) and the second throughout the cervical cord extending to the medulla. Due Results: Eleven patients (5 boys) with a median age of 138 mutation resulting in a cystine to tyrosine change in the to the known history RA, an inflammatory myelitis was felt months (42- 420 months) and confirmed RE based on functional domain (C1175G > A). to be the likely etiology. Her CSF studies, NMO and histopathology were identified. Patients presented with = = Results: Sagittal MRI of brain shows a large face with small inflammatory serology were negative. Initiation of hemiparesis (n 11), ophthalmoplegia (n 2), and = cerebrum, hypoplastic vermis and with large cistern magna, dexamethasone improved her symptoms. She was cerebellar signs (n 2). All patients had T2 signal and short corpus callosum with foci of demyelination. On discharged to rehabilitation with appropriate follow ups. abnormalities, and 9 patients (82%) had T2 abnormalities on the Axial and coronal MRI, patchy calcifications of She returned with confusion, mild right sided weakness and the first MRI. Two additional patients had signal cerebellar foliae are associated with cerebellar atrophy. worsening left sided weakness. Brain MRI revealed T2 abnormalities on the second MRI with a mean of 1.7 Diffuse white matter demyelination with patchy cavitation hyperintensity involving the hypothalamus, basal ganglia months between the first and second MRI. EEG showed spares subcortical U-fibers. Prominent Virchow-Robin and thalami. ipsilateral (3/11) or bilateral (6/11) slowing, and ipsilateral perivascular spaces are seen in the white matter, thalami and Results: Diagnostic stereotactic needle biopsy of the right (6/11) or bilateral (3/11) sharp waves. All patients were on basal ganglia. There is bilateral mesial temporal sclerosis. thalamus revealed grade 3 anaplastic astrocytoma. Due to antiepileptic drugs (AEDs), and two tried additional Conclusion: MRI in RS shows a unique pattern of brain the severe decline in the functional status and poor immunomodulatory therapy but had incomplete seizure lesions. Mental retardation and ataxia are due to cerebral prognosis associated with diagnosis patient opted for control. Six (75%) of the 8 surgically resected patients had and cerebellar atrophy and diffuse white matter disease. hospice care. complete seizure freedom after 18 months follow up. Epilepsy results from mesial temporal atrophy. Conclusion: Spinal cord astrocytomas are very rare Conclusion: Patients in whom RE is suspected should neoplasms and can mimic myelitis both in clinical and undergo MRI due to early detection on first MRI (82%). We radiological features. Neoplasm should be suspected if CSF recommend closely spaced follow up MRIs in case of a 13. Advanced Neuroimaging is normal, NMO serology is negative and the neurologic non-conclusive first MRI. Although AEDs are used, the deficits worsen despite treatment with steroids in a patient main line of treatment is surgical resection due to its high Revolutionizes Diagnosis and with unbiopsied, inflammatory appearing “myelitis”. success rates. Prognosis of Delayed Cerebral Ischemia After Subarachnoid 9. Soluble Interleukin 2 Receptor 11. Deceptive Imaging: MRI Brain Hemorrhage. Gregory Kapinos (sIL-2R) Level Helps in Diagnosis of Demonstrates Subacute Intracranial NYPH/Columbia & Cornell U., Leptomeningeal Sarcoidosis With Hemorrhage Missed on CT Ryan New York, United States Normal Angiotensin Converting Hakimi, Sarah Welte, Eppie Bass Enzyme (ACE) Partha Ghosh, Jinny University of Oklahoma Health Introduction: Randomized clinical trials use dissimilar criteria to define vasospasm (VSP), delayed infarcts and Tavee Sciences Center, Oklahoma City, OK, delayed cerebral ischemia (DCI) after aneurysmal United States subarachnoid hemorrhage. Cleveland Clinic, Cleveland, Ohio, Patients (or Materials) and Methods: We systematically United States Introduction: Non-contrasted computed tomography (CT) reviewed the last twenty years of English medical literature is the standard for initial imaging of intracranial for the input of multimodal neuroimaging in characterizing Introduction: Neurosarcoidosis presenting as isolated hemorrhage (ICH) and subsequently to assess expansion or VSP and DCI. In the form of question-answer, we leptomeningeal disease can be difficult to diagnose in the resolution. An ICH will eventually resolve on CT leaving condensed the recent qualitative and quantitative data absence of systemic findings and a negative serum an area of encephalomalacia, which is difficult to distinguish suggesting a role for structural, sonographic, angiographic,
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96 Journal of Neuroimaging Vol 21 No 1 2011 diffusion, perfusion, permeability, vasoreactivity, flow (MPKUS) Paul Maertens, Chun Huang Diagnosis is aided by neuroimaging and serology. heterogeneity and metabolic imaging, in helping clinicians Traditionally described as a paraneoplastic syndrome, comprehend VSP/DCI. University of South Alabama, Mobile, immune mediated forms are being increasingly recognised Results: What constitutes acute brain injury (ABI)? and deemed potentially reversible. Non-contrast CT, DSA, CTP, MRP, DWI, T2, permeability, AL, United States Methods: We present three cases of LE suspected on metabolic and spectroscopic studies demonstrate cerebral Introduction: The maternal phenylketonuria (PKU) clinical exam with diagnosis aided by neuroimaging and insult due to global transient hypoperfusion, pial syndrome is caused by high blood phenylalanine (Phe) auto-antibody testing. microthrombotic events, blood-brain-barrier disruption, levels during pregnancy, leading to a host of birth defects, Results: Case 1: 54-year-old male presented with subacute global vasogenic edema and rarely, ultra-early vasospasm. especially facial dysmorphism, microcephaly, development cognitive decline, SIADH, and seizures.MRI showed Can we quantify ABI and correlate its severity to delay, learning difficulties and congenital heart disease. FLAIR hyperintensity without enhancement or restricted neurological presentation, development of DCI and predict Previous MRI studies in MPKUS showed that brain white diffusion in bilateral mesial temporal lobes. Case 2: outcome? matter was relatively spared with the exception of corpus 35-year-old female presented with flu-like symptoms, Acute non-contrast CT, CTP, MRP, DWI and T2 can callosum which was described as hypoplastic. We aimed to SIADH and seizures. MRI showed T2/FLAIR quantify the injury, classify patterns of infarcts and edema analyze brain anatomy in the offspring of women with PKU hyperintensity involving left caudate head, basal forebrain, and this correlates to neurologic, cognitive and functional on non-restricted diet during pregnancy. and cingulate gyrus with restricted diffusion and no contrast outcomes. Patients (or Materials) and Methods: A 9 year-old male enhancement on T1; hypermetabolism noted on FDG-PET. Can perfusion imaging in the acute/subacute phase detect is the product of a 23 year-old G6P1M5 PKU female who Anti-thyroperoxidase/thyroglobulin antibodies were also VSP/DCI earlier than TCD, DSA/CTA or clinical exam? was on a non-restricted diet before or during pregnancy. He positive. All imaging changes resolved after treatment. Case Three studies support qualitative analysis of perfusion had congenital microcephaly and bilateral cataract at birth. 3: 52-year-old female with refractory depression and rapidly defects for early detection of DCI. Ten studies found Development was slow as he only sat up at age 2, said first progressive cognitive decline. MRI showed bilateral thresholds accurately diagnostic for VSP/DCI. Quantifying word and walked at age 3. He is severely retarded with restiform body hyperintensities on FLAIR with mild the depth of hypoperfusion is entertained by three studies to narrow forehead and small ears. He suffers from restricted diffusion but no enhancement. FDG-PET showed help decision about medical perfusion optimization vs self-abusive and aggressive behavior towards other. He has right temporal hypermetabolism. All three cases had serum angioplasty. One study of admission CTP found a threshold poor fine motor skills. He never had seizures and his voltage-gated potassium channel antibody (VGKC) predicting subsequent DCI. electroencephalogram is normal. positive; no underlying cancer or other etiology was Conclusion: A breadth of robust neuroimaging data Results: MRI of brain shows a large face with small detected despite extensive workup. Combination of plasma elucidates ABI, predicts DCI, delineates categories for the cerebrum and short corpus callosum. The right temporal exchange and steroids was used in all cases. multifaceted VSP/DCI and refines prognostic significance lobe and hippocampus are dysplasic. There is relative Conclusion: This series elucidates the clinical and with therapeutic implications. sparing of the cerebellum. radiological spectrum of immune-mediated LE. High index Conclusion: Mental retardation in children born to PKU of suspicion should be maintained in patients presenting 14. The Relationship Between the female on nonrestricted diet is caused by cerebral with cognitive symptoms and limbic changes on hypoplasia most prominent over temporal regions due to neuroimaging. Potential reversibility makes early diagnosis Degree of Hyperintensity on MRI persistent teratogenic effect of Phe on the developing brain. pertinent hence auto-antibodies should be sought in addition to cancer surveillance in all LE cases. T2 Image and Clinical Correlates in Normal Korean Subjects Do Hoon 16. The Use of Hyperacute 18. Optic Nerve Sheath † Kim, M.D., Ph.D.,1 Yoo Sun Moon, Diffusion Weighted MR Imaging as Cerebrospinal Fluid Flow Dynamics M.D., Ph.D., M.P.H.,2 Selection Criteria for Successful in Idiopathic Intracranial 1Department of Psychiatry, College of Endovascular Therapy in a Hypertension Gabriella Szatmary1 Medicine, Hallym University, Centenarian Johanna Morton, Tatjana Polgar,1 Beddhu Murali,2 Chuncheon 2Department of Family Christopher Cummings, Tom Masaryk, Geoffrey Hartwig,1 Medicine, College of Medicine, Hallym Irene Katzan, M. Shazam Hussain 1Hattiesburg Clinic PA, Hattiesburg, University, Chuncheon Cleveland Clinic, Cleveland, Ohio, United States, 2The University of United States Background: The brain imaging techniques have Southern Mississippi, Hattiesburg, developed to detect silent brain lesion in healthy elderly, Introduction: Age alone is often exclusion criteria for United States including white matter changes. These silent brain lesions thrombolysis in acute ischemic stroke. However, the implicate the possibility of brain cerebrovasculopathy, guidelines are less clear and literature more sparse for Introduction: Patients with idiopathic intracranial which are also suggestive of having risk factors for geriatric intra-arterial and endovascular therapy in the oldest of old hypertension (IIH) by diagnostic criteria have normal MRI depression, decrease in cognitive function, cerebral patients. This case highlights the use of imaging, not age, as apart from dilatation of the optic nerve sheath (ONS) with infarction and vascular dementia. This study investigated selection criteria for endovascular therapy in acute ischemic indentation of the optic nerve head at the posterior globe prevalence and clinical characteristics of patients with stroke secondary to large vessel occlusion in this age group. and empty sella. It is believed that IIH patients have a hyperintesities on MRI (Magnetic Resonance Imaging) T2 Patients (or Materials) and Methods: A 100 year-old compartment syndrome similar to idiopathic and Chiari I image in normal healthy adults. right-handed female presented to the ED with left malformation related syringomyelia where abnormal Method: Eighty-nine adults above age of 20 were studies hemiparesis and dysarthria after being found down, last cerebrospinal fluid (CSF) flow dynamics were found in vivo who took health examinations including brain MRI. known well three hours prior. Her initial NIHSS score was utilizing MRI CSF cine study. Therefore, we hypothesize Hyperintensities on brain MRI were categorized by a neuro 10. Noncontrast head CT was negative for early ischemic that there is abnormal ONS CSF flow pattern in IIH. Thus, radiologist according to Fazekas classification. All subjects changes. CT angiography shortly thereafter revealed a right we sought to visualize CSF flow dynamics in the ONS. filled out Zung’s depression scale (SDS) and BEPSI (Brief distal M1 occlusion. IV tPA was not given due to the Patients (or Materials) and Methods: 10 consecutive IIH Encounter Psychosocial Instrument). Past histories of patient’s age. MRI was completed at 5 hours from symptom patients recruited from the neuro-ophthalmology clinic and hypertension and diabetes mellitus, antihypertensive drug onset. compared with 10 age and sex-matched normal controls. medication history, smoking, alcohol drinking, and height, Results: Diffusion weighted imaging (DWI) sequences Two neuroimagers independently analyzed the imaging body weight, BMI (body mass index), systolic and diastolic revealed areas of restricted diffusion in the right basal dataset and were blinded to patient identity. blood pressure, fasting blood sugar, serum lipids ganglia and caudate head, without cortical involvement. Results: CSF flow velocity and pattern are altered in (cholesterol, triglyceride, HDL-C, LDL-C) were evaluated Given the large size of penumbral tissue at risk and minor patients with IIH compared with normal controls. in all subjects. The subjects were divided into three group ischemic changes present at 5 hours, she was taken to Conclusion: Our findings suggest that abnormal CSF flow according to the evaluation scores of hyperintensities on angiography. Successful mechanical thrombectomy of the dynamics as measured by phase-contrast MRI could be MRI (control group with 0 score, hyperintensity 1 group right M1 occlusion was obtained with complete used as a surrogate imaging marker in the evaluation of with evaluation score of 1, hyperintesity 2 group with recanalization. MRI post-procedure day two showed few patients with IIH. evaluation score of 2 or 3). ANOVA (Post Hoc test; Scheffe) punctuate foci of restricted diffusion, but no further or χ2 tests were carried out in three groups with the expansion of the original subcortical infarct and no 19. Multimodal Imaging Aids in significance level of 0.05. intracranial hemorrhage. NIHSS score on discharge was 4. Results: Hyperintensities on MRI T2 image were found in Conclusion: This case highlights the successful use of Diagnosis of Foix-Alajouanine relatively old age groups, and systolic blood pressures were hyperacute diffusion weighted MR imaging to select a higher in these groups. Serum cholesterol and triglycerides patient with salvageable penumbra that would otherwise Syndrome Waimei Tai, Nerses were higher in hyperintensity 1 and 2 group than normal have been excluded from endovascular therapies based Sanossian control group, but there was no statistical significance. The solely on her markedly advanced age. amount of alcohol drinking and smoking were not University of Southern California, Los significantly different in three groups. Angeles, CA, United States Conclusion: Normal healthy subjects with hyperintensities 17. Limbic Encephalitis: A Case on MRI T2 image in normal healthy people would need to Series of Immune Mediated Introduction: Arterial-venous fistulas (AVF) often arise as be treated if they have concurrent risk factors of Encephalitides Christopher Newey, late sequelae from traumatic injury. Complications from cerebrovascular disease such as hypertension. Normal AVF include venous thrombosis, aneurysm, vascular steal healthy adults with hyperintensities on MRI should be Aarti Sarwal, MaryAnn Mays phenomenon, venous hypertension and hemorrhage. followed up for long-term to investigate incidence of clinical Patients (or Materials) and Methods: A 67 year old man infarct and depressive symptoms, change in cognitive Cleveland Clinic, Cleveland, OH, with history of diabetes, hypertension and history of motor function. United States vehicle accident nine years prior presented with progressive bilateral weakness of the arms and legs. The patient 15. Brain MRI in Maternal Introduction: Limbic encephalitis (LE) is a clinically reported claw fingers of his hands following acute cervical challenging diagnosis. It can present with altered mental injury related to the motor vehicle accident. In the 6 months Phenylketonuria Syndrome status, seizures, psychiatric symptoms or sleep disturbances. prior to admission, the patient reported progressive
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2011 ASN Abstract 97 difficulty walking with progressive weakness in his legs, Results: A Catheter angiogram was done which revealed 5 of the patients with pathology located in the middle ear or necessitating use of a wheelchair. dissection of the extracranial right ICA dissection with in cochlea had no certain differences in TCD Evaluation in the Emergency Department revealed occlusion and 75% stenosis, respectively. Extracranial left measurements. Labyrinthine ossification and osteoscleroses hyperdensity in the right cerebellum on non-contrast head vertebral artery (VA) showed a narrowing that could be demonstrated normal TCD findings despite the presence of CT scan. A follow-up MRI scan of the head and neck hypoplastic, versus dissection, and no abnormality was seen obvious unilateral clinical symptoms. Sclerotic sub acute obtained the following day demonstrated hyperintensity on in the right VA. On a repeat MRI with contrast and 2D inflammatory processes showed BFV asymmetry when FLAIR sequences extending from medulla to C6 consistent time-of-flight MR angiography, the ICA dissections were localized close to the carotid canal. with chronic ischemia. MRA head and neck revealed a confirmed with crescent sign. In addition, it revealed a long Conclusion: Different sclerotic pathologies located in large sinus-dural AV fistula with a varix in the area of segment of dissection involving the V2 segment of the right temporal pyramid, petrous apex and inner ear which middle cerebral peduncle and petrosal vein, later confimed VA, and a non-flow limiting dissection of the left VA at the clinically correspond to unilateral SNHL have no strong by catheter angiogram. The patient was taken for C4 level. correlation with BFV in the CS. Location of any pathologic embolization of this sinus-dural AV fistula. After successful Conclusion: MRI with MRA is a better reference standard process more close to the carotid artery canal may cause embolization, patient was transferred to rehabilitation. to diagnose spontaneous cervical dissection. Angiography is unilateral BFV disturbances. Results: needed to delineate the endovascular treatment option. TCD as a method of investigation in patients with Conclusion: Congestive venous myelopathy or monolateral SNHL and osteosclerosis presumed non (Foix-Alajounine Syndrome) is a rare complication of effective. post-traumatic fistulas. Myelopathic changes with associated 22. Diffuse Pachymeningeal vessel anomalies should make one think of this rare Enhancement in a Multiple condition. Failure to recognize this syndrome may lead to 24. Resolution of Occlusive progressive myelopathy resulting in respiratory failure and Sclerosis Patient with Ring Common Carotid Thrombus With possible death. Enhancing Lesions Dolora Wisco, Anticoagulation Alone as 20. The Diffusion Pattern of Alexander Rae-Grant Demonstrated by Sequential Healthy and Myelopathic Cervical Cleveland Clinic, Cleveland, OH, Imaging With B- Mode 2 Spinal Cord – A Template-based United States Ultrasonography Sarah Cherian, 2 Analysis Chun-Yi Wen, Yong Hu, Introduction: Pachymeningeal enhancement can be Tom Azhakath, Kathryn associated with benign and malignant causes. In a patient Kirchoff-Torres,3 Jesse Weinberger,1 Jiao-Long Cui, Kin-Cheung Mak, with Multiple Sclerosis undergoing immunosuppressive 1 Henry Ka-Fung Mak, Keith Dip-Kei therapy, there is the possibility for an underlying infection, Mount Sinai Hospital, New York, NY, carcinomatous meningitis, lymphoma, vasculitis, and also 2 Luk sarcoidosis. United States, Winthrop University The University of Hong Kong, Hong Patients (or Materials) and Methods: The patient is a 50 Hospital, Mineola, NY, United States, year old right-handed female with secondary progressive 3 Kong, Hong Kong multiple sclerosis diagnosed in 1997. She was on interferon Montefiore Medical Center, Bronx, beta-1 treatment from 1998 to 2007. Beginning 2004 she has NY, United States Introduction: Diffusion tensor imaging (DTI) permits the had episodes of relapses with remission, but with functional detection of water molecular diffusion movement inside decline to the point that she was wheelchair bound in 2009. The majority of carotid occlusions occur from spinal cord parenchyma. This study aimed to evaluate the MRI showed she had active demyelinating lesions, which atherosclerotic plaque rupture. Nonatherosclerotic occlusive diffusion patterns in myelopathic cord under the external remained after high dose methylprednisone treatment. Prior thrombus occurs at a rate of 0.4% of all carotid occlusions and/or internal pressures. to starting natalizumab infusion, MRI revealed ring and very little is known about the optimal management of Patients (or Materials) and Methods: A total of 45 enhancing lesions as well as diffuse pachymeningeal these patients. Currently these patients are managed with volunteers were recruited in this study with informed enhancement. She had no recent history of neurosurgery, endarterectomy, stenting or anticoagulation. consent including 25 healthy subjects (46 ± 17), 1 headache, and lumbar puncture. We present a case of a 73-year-old man with a history of syringomyelia patient (54 yrs), 13 cervical spondylotic Results: Work up for infectious causes, carcinomatous atrial fibrillation, not on anticoagulation, who presented myelopathy (CSM) patients (63 ± 12 yrs), 6 traumatic meningitis, lymphoma, vasculitis, and sarcoidosis were with transient episode of left facial and left hemiparesis central cord syndrome (TCCS) patients (61 ± 21 yrs). The negative. The patient received natalizumab infusion with lasting 30 minutes. B mode ultrasound was utilized to axial diffusion MR images of cervical spinal cord were stabilization of her symptoms. She had idiopathic visualize the carotid artery initially and sequentially every taken from C1 to C7 using pulsed gradient pachymeningeal enhancement. 4th day to monitor the progress of the thrombus. spin-echo-echo-planar imaging sequence with a 3T MR Conclusion: Pachymeningeal enhancement is an unusual Day 1: A spherical lesion in the CCA with a thin rim of low system. The regions of interest were defined based on a finding in a patient with active MS. When found, benign velocity flow around the thrombus in the distal R common template to cover the ventral, lateral, and posterior column and malignant causes of pachymeningeal enhancement carotid extending intothe R internal carotid artery indicated ofwhitematteraswellasgraymatterinFAmapsofspinal must be ruled out. This is especially important in a patient a near occlusion. This finding was confirmed on CT cord, then FA values were generated for comparison. who will be receiving immunosuppressive therapy. Angiography which demonstrated a string sign in distal Results: In healthy cord, FA values in posterior and lateral CCA. Transcranial Doppler (TCD) demonstrated columns were significantly higher than ventral column and retrograde flow across the anterior communicating artery to gray matter. Under slow and progressive external 23. Correlation of Carotid Syphon the anterior cerebral artery (ACA) and in the ophthalmic compression in CSM, FA of the posterolateral columns and MCA Blood Flow TCD artery. Anticoagulation with intravenous heparin was were mostly affected; in traumatic cases, FA of the ventral started and transitioned to warfarin. column and gray matter were more severely disturbed. In Measurements With Multislice CT Day 4: Low density tubular structure with peak systolic one case of syringomyelia, the lateral column and gray Results in Patients With Temporal velocity ratio of ICA to CCA (psv) 3.79 m/s, corresponding matter were involved. to 70–99% stenosis. Flow was still retrograde in the ACA Conclusion: The diffusion patterns of myelopathic cord and Petrous Osteosclerosis, and ophthalmic. were specific to various types of external and/or internal Day 8: Narrowing of the tubular structure, psv ratio1.49 pressures. A template-based analysis might delineate the Associated With Unilateral corresponds to 20 – 49% stenosis. injury patterns of myelopathic cord and contribute to the Sensoneuronal Hearing TCD flow now antegrade. in-depth understanding of the underlying pathomechanism. Day 12: Complete resolution of thrombus. Disorders Yunus Afandiyev, Lutfiyya Conclusion: Sequential B-mode imaging demonstrated the Khalilova course and mechanism of retraction of nonatherosclerotic 21. Long Vertebral Dissection May thrombus at the carotid bifurcation. Further randomized Look Like Hypoplastic Vertebral TUSI IMAGING CENTER, BAKU, controlled trials will be necessary to determine whether Azerbaijan medical or surgical management is superior, particularly in Artery on Catheter high risk patients. Angiography Dolora Wisco Aims of the study: Patients with unilateral sensoneuronal hearing disorders associated with temporal and pyramidal 25. Bruit on Transcranial Doppler Cleveland Clinic Foundation, osteosclerosis were the subjects of the investigation. Carotid Cleveland, Ohio, United States hemodynamics disturbances have been compared with the Ultrasonography in a Subarachnoid sclerotic findings on CT (compared with severity of Hemorrhage Patient With Introduction: Catheter angiography is the reference temporal sclerosis). standard for diagnosing dissection showing a double barrel Methods: 14 patients with unilateral hearing disturbances – Vasospasm. A Case Report. Bharath sign or a flame sign, but it may miss smaller dissections bilateral mastoid and temporal sclerosis (6), cochlear and Naravetla, Nerissa Ko, Smith Wade especially in the vertebral artery. MRI with MRA is a better fenestral otosclerosis (4), and labyrinthine ossificans (3) imaging modality in detecting subtle or asymptomatic diagnosed on CT underwent TCD. University of California at San vertebral artery dissection. Bilateral measurements of blood flow velocity (BFV) in Patients (or Materials) and Methods: A 31 year old Carotid Syphons (CS), and Middle Cerebral (MCA) Francisco, San Francisco/California, right-handed female who was 3-weeks post-partum arteries, have been compared with the contralateral side. United States presented with a two-week headache, new onset left arm Results: 5 of the patients with mastoid and temporal hypesthesia with transient episodes of inability to hold her sclerosis had differences of BFV in the carotid syphons. The Introduction: Transcranial Doppler ultrasonography baby with her left arm, and tinnitus in her left ear. She had a side of the increased BFV in CS (40–50% asymmetry) was (TCD) is increasingly being used to monitor vasospasm MRI with MRA at an outside hospital which showed right correlated with the side of hearing disorders. after subarachnoid hemorrhage (SAH). It is non-invasive MCA stroke, and four-vessel dissection. She was started on Only 1 patient had bilateral increased BFV in the MCA. and real-time, but various factors including artifacts could heparin. She was perfusion dependent with recurrence of Differences of hemodynamics in cochlear, fenestral and influence the results and hence the management. left hemiparesis, thus the right internal carotid artery (ICA) labyrinthine sclerosis were found in 1 of the patients with Patients (or Materials) and Methods: We report a case occlusion was stented. this pathology. with new occurrence of a transient bruit on TCD.
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98 Journal of Neuroimaging Vol 21 No 1 2011 Results: 52 year old man admitted with SAH had a Right-sided SSS were in 3 patients (18.8%), and bilateral Patients (or Materials) and Methods: Study population: negative computerized tomography angiography (CTA) and SSS was in one patient. While the “to and pro” flow of CLOTBUST database in U of A and NEUROFLOW data. digital subtraction cerebral angiography (DSA). Daily TCD basilar artery was observed in only 2 patients, 9 patients had Patients with pICAO on TCD were treated with iv detected vasospasm on day 7. Vasospasm was confirmed by increased pulsatile index in the contralateral vertebral t-PA/Neuro flow device or both. Alberta Stroke Program DSA which otherwise was unremarkable. He was treated artery, suggesting that the contralateral vertebral artery Early CT (ASPECT) Scores obtained at baseline. Criteria with vasopressors and hypervolemia. TCD on day 12 often compensates the lacked blood flow. Although all SSS for TCD-CT mismatch: patients with pICAO (MCA, TICA, showed resolution of vasospasm but detected a new bruit. patients had been underwent MRA, only 7 patients (46%) LICA, Tandem ICA/MCA) on TCD and CT ASPECT His repeat DSA was again unremarkable including for were recognized to have subclavian stenosis by the score≥6. TCD–CT match: patients with pICAO on TCD vasospasm. His clinical exam remained stable and bruit radiologist without the information of TCD. When the and CT ASPECT score < 6. Response determined: disappeared by next day with discontinuation of information of TCD was provided, MRA of the remained 9 complete recanalisation (CR) on TCD in 2 hrs from vasopressors. Hence bruit was presumed to be originating patients (56%) were recognized to have subclavian stenosis. symptoms onset. Good long term outcome: mRS (0–2) at 3 from vibration of relaxed blood vessel wall due to Conclusion: This result provides the clinical and months. vasopressors and hypervolemia in post vasospasm period. sonographical characteristics of SSS primarily detected by Results: Fifty nine patients analysed. Mean age: Conclusion: We recommend caution in the interpretation TCD. TCD provides an additional sensitivity for the 68.8 ± 15.1, Male: 41 (69.5%), mean baseline NIHSS: of a new onset bruit on TCD as an abnormal finding, which detection of SSS, which compensates false-negative 14.1 ± 6.5. 46 patients had TCD CT mismatch (78%) and could represent an artifact emanating from relaxed vessel in interpretations about the abnormal MR angiography. 13 had TCD-CT match (22%). the presence of vasopressors in the post vasospasm period. Univariate analysis: 14 of 46 patients with mismatch (30.4%) 28. Demographic, Clinical and achieved CR in 2 hrs from treatment compared to 1 (7.7%) 26. Methil Pradeep, Muhammed of 13 with matched (P = 0.152). 30 of 46 patients with Transcranial Doppler parameters mismatch (65.2%) had good outcome (3 months mRS 0–2) Mazarudheen, Ramakrishnan compared to 2 of 11 (18.2%) with matched group for Predicting Clinical and (P = 0.007). Chinnappan Angiographic Cerebral Vasospasm Multiple logistic regression (MLR) analysis (adjusting to K.G Hospital & Post Graduate Institute, common stroke risk factors): mismatch group has 2.1 times in Aneurysmal Subarachnoid of having CR in 2 hrs compared to matched group (OR: Coimbatore, Tamilnadu, India Hemorrhage Patients Joseph 2.1, 95%CI: 0.197–22) (P = 0.5) and 7.5 times of good long term outcome (OR: 7.5, CI: 0.62–91) (P = 0.113). Introduction: Case series of patients with mobile masses Sebastian, Carol Derksen, Khurshid Conclusion: TCD–CT Aspect mismatch concept may have reflected variable Incidence of outcomes. We Khan, Mohammad Ibrahim, Bilal predict response to IV tPA or Neuroflow device in AIS embarked on a retrospective study of the incidence of patients. By the time of meeting, larger sample size may mobile masses within the extracranial carotid artery in Hameed, Muzaffar Siddiqui, Michael better confirm our hypothesis. patients referred to our department from March 2005 to July 2009. Chow, Max Findlay, Ashfaq Shuaib, Patients (or Materials) and Methods: Extracranial Maher Saqqur arteries of 3000 patients with stroke or Transient ischemic 30. Does Age Have an Impact on attacks (TIAs) were examined with carotid duplex University of Alberta, Edmonton, ultrasonography. 20 patients (70% Male, 30% Female, mean Arterial Recanalization in Acute age 62 years) had mobile masses. One in common carotid Canada Ischemic Stroke? Arvind Sharma1 artery (CCA) and 19 in proximal Internal carotid artery Introduction:. In this study we aimed to identify clinical, 1 (ICA). All patients received anti thrombotics. 5 patients had Joseph Sebastian, Mohammad demographic and TCD parameters at baseline that can neurological deterioration and died during the same 1 2 predict late development of VSP. Ibrahim, Limin Zhao, Andrei admission. 10 of 15 survivors had repeated duplex Methods: We prospectively collected data of 134 SAH 2 3 ultrasound reformed within 8 months. In two patients mass Alexandrov, Vijay Sharma, Georgios patients admitted to the university hospital from January became organised and immobile, while in the remaining 4 1 2006 to December 2008. Baseline demographic and clinical patients the mass remained unchanged. At one year 8 Tsivgoulis, Khurshid Khan, Maher data included age, gender, Glasgow coma score (GCS), patients had no recurrent vascular events, but 7 had 1 admission systolic and diastolic blood pressures, Hunt and Saqqur recurrent vascular events (stroke, TIA). Hess grade, admission neurological signs (motor or speech 1 Results: The mobile masses are extremely rare in our series University of Alberta, Edmonton, involvement), and intracranial pressure (ICP) were of stroke population which represents a section of the south 2 measured daily. Complete TCD was performed daily from Canada, University of Alabama, Indian stroke population with incidence of 0.67%. day 2 to 14 from symptoms onset. All patients underwent 3 Conclusion: Presence of carotid mobile masses predicts a Birmingham, United States, National cerebral angiography on admission and 7 days following sub group of stroke patients with poor prognosis. Its onset of symptoms. The primary outcome measures were University Hospital, Singapore, presence is suspicious for cardiac source of embolism in our clinical vasospasm and angiographic moderate to severe 4 patients. Singapore, University of Thrace vasospasm. Results: Fourteen patients (10.5%) developed clinical School of Medicine, Alexandroupolis, 27. Primary Screening of vasospasm and 21 (15.9%) developed angiographic vasospasm. On unvaried analysis, female gender (13/14, Greece Subclavian Steal Syndrome by 93%, P = 0.008, t) and baseline TCD mean flow velocity in ≥ P = Introduction: Effectiveness of intravenous (IV) Using Transcranial Doppler: Single any intracranial vessel (MFV) 120 (8/14, 57% 0.004) recombinant tissue Plasminogen Activator (rt-PA) in elderly Center Transcranial Doppler were significantly associated with clinical and angiographic patients (≥80 years) of Acute Ischemic Stroke (AIS) is vasospasm..Late clinical assessment before the second subject of controversy. Our study’s goal is to assess if age angiography, focal neurological signs (focal motor Series. Soon-Tae Lee, Keun-Hwa P = has an effect on recanalization rate and clinical outcome in weakness: 9/14 64%, 0.06) and/or speech (13/14: 93%, AIS patients who receive IV thrombolysis. Jung, Do-Hyoung Kim, Jae-Kyu Roh P = 0.03) and GCS (mean GCS in VSP 12 ± 2vsnoVSP ± P = Patients (or Materials) and Methods: Retrospective Department of Neurology, Seoul 14 2, 0.014) were associated with VSP. In the analysis of AIS patients who received IV rt-PA, and had multivariable logistic regression model female gender (OR transcranial doppler (TCD) within 3 hours of symptoms National University Hospital, Seoul, 9.6, P = 0.03, 95% CI 1.18–77.82) and baseline TCD MFV ≥ P = onset. TCD interpreted using Thrombolysis in Brain Korea, Republic of 120 (OR 5.3, 0.006, 95% CI 1.61–17.526) are the Ischemia (TIBI) flow grading system as Persistent Arterial only baseline predictors of clinical VSP. Occlusion (PAO), Re-occlusion (ReO) or Complete Introduction: A high-grade stenosis of a subclavian artery Conclusion: Sex and baseline TCD MFV are predictive of Recanalization (CR). CR defined as TIBI 4 or 5, within 2 proximal to the vertebral artery origin cause siphoning of delayed clinical VSP. Prophylactic hypertensive. hours of IV rt-PA. Patients divided into 2 group based on blood away from its proper cranial destination toward the age (< 80 versus ≥ 80 yrs). Univaried analysis&Multiple ischemic arm, which is called subclavian steal syndrome 29. The Role of “TCD – CT Logistic Regression (MLR) analysis performed to define if (SSS). While Transcranial Doppler sonography (TCD) is age has any impact on clinical and TCD outcome. useful to confirm SSS in patients with clinical suspicion or Mismatch” in Predicting Early and Results: 361 patients{≥80 yrs = 85 (23.5%), < 80 yrs = 276 abnormal MR angiography (MRA), TCD often detect Late Response to Treatment With iv (76.5%)} were included, mean age: 68.8 ± 13 (85 pts ≥ 80 asymptomatic SSS during routine screening. We yrs), female{≥80 yrs 54 (63.5%), 114 (41.3%) < 80 yrs}, investigated the clinical and sonographic characteristics of tPA Treatment and Neuro Flow mean Baseline NIHSS: (17.5 ± 5.3 ≥80, 16.0 ± 5.5 < 80), SSS that are primarily detected in TCD laboratory. Device Arvind Sharma, Hayrapet median time to IVrt-PA in ≥80 is 139.7 ± 31.3 and Patients (or Materials) and Methods: From Jul. 2007 to 136.6 ± 37.4 < 80 (P = 0.088). Jun. 2010, total 4603 subjects with stroke risk factors were Kalashyan, Nisar Peace, Khurshid At end of IVrt-PA infusion, TCD comparison in: ≥80 analyzed by TCD. When early systolic decelerations or Khan, Carol Derksen, Ashfaq Shuaib, versus < 80 yrs group-PAO in 55 (64.7%) vs 156 (56.5%), retrograde flows were observed in vertebral artery flow ReO in 12 (14.1%) vs 4 (14.9%) and CR in 18 (21.2%) vs 79 analysis, the changes of vertebral artery flow in response to Maher Saqqur (28.6%) (P = 0.348). reactive hyperemia of the ipsilateral arm were monitored to No difference in mean time to recanalization (minutes) confirm SSS. The clinical profiles and MRA of the patients University of Alberta, Edmonton, based on age ≥80 (120.6 ± 60.6) vs < 80 (128.8 ± 69.5) with SSS were analyzed. Alberta, Canada (P = 0.146). Results: Total 16 patients (mean age = 70.8 ± 8.6, Long term clinical outcome: 45/85 patients in ≥80 yrs male = 11) were diagnosed as SSS, suggesting 0.35% Introduction: Efficient collaterals may maintain perfusion (68.2%) had poor long term outcome{(mRS ≥ 3) at 3 prevalence as detected by TCD. Among them, 14 patients in penumbra area preventing severe early ischemic changes months} and 112/276 in < 80 yrs (48.1%).(P < 0.004). were atherosclerotic stenosis of subclavian artery, and 2 on imaging despite persistent proximal occlusion. This In MLR analysis: Patients ≥80 have the adjusted OR of 2.5 patients were with Takayasu’s arteritis. Symptomatic study’s aim to evaluate whether patients with Acute (95%confidence interval (CI): 1.26 ± 4.95) (P = 0.008) for stenosis was in eight patients (50%), who had typical ischemic stroke (AIS) and proximal intracranial arterial poor outcome and 0.74 (CI: 0.40 ± 1.4) (P = 0.34) for CR. symptoms of SSS, including arm claudication, recurrent occlusion (pICAO) on TCD and good ASPECT score ≥6 Rate of sICH similar in both groups: 6/85 (7.1%) ≥ 80 vs dizziness provoked by arm exercise, and headache. (TCD–CT mismatch) respond better to iv tPA. 22/276 (8.0%) in < 80 yrs (P = 0.783).
2011 ASN Annual Meeting Program 31
2011 ASN Abstract 99 Conclusion: Elderly patient ≥80 with AIS have higher rate Status Epilepticus Undergoing Patients (or Materials) and Methods: A population of 388 of poor outcome despite good rate of CR and no increase patients were screened for inclusion into this comparison risk of sICH with IV rt-PA thrombolysis. Age should not Continuous EEG because they had received a recent TCD with adequate exclude patient from receiving IV thrombolysis. Monitoring. Prabhu Emmady, Vinita insonation of 9 intracranial arteries. In this population both MRA and TCD were obtained within 3 months of each 31. The Effect of Head Down Acharya, Jayant Acharya other in 81 patients. 3 patients were excluded due to poor quality of MRA from motion degradation. Position on the Cerebral Blood Penn State-Hershey Medical Center, Results: Among the 81 patients with both studies, we found Flow in Acute Ischemic Stroke: A Hershey, PA, United States significant agreement among both modalities. Of the 729 arteries, both studies were in agreement in 704. In the 25 Prospective Transcranial Doppler Introduction: Status epilepticus (SE) is a neurological arteries where there were discordant results, 19 (76%) Study Arvind Sharma, Carol Derksen, emergency associated with high mortality. Continuous EEG showed greater stenosis on MRA and insignificant stenosis monitoring (cEEG) has become the gold standard in the on TCD. Khurshid Khan, Ashfaq Shuaib, Maher management of SE. Although neuroimaging can be useful Conclusion: In this study, TCD and MRA show 96.5% Saqqur in identifying the etiology of epilepsy, its influence on the concordance for evaluation of intracranial stenosis. In cases clinical outcome of SE has not been established. where there is non-concordance, MRA shows higher degree University of Alberta, Edmonton, Methods: All adult patients in whom SE was identified on of stenoses in 76% of the cases. Alberta, Canada cEEG monitoring performed between 01/01/2007 and 03/15/2010 at Penn State University Hershey Medical 34. Choroid Plexus Hyperplasia in Introduction: The ideal Head Position (HP) in Acute Center were included in this retrospective study. a Child with Tetrasomy 9p Carey Ischemic Stroke (AIS) is hypothesized to be head down as Results: Among the 132 patients who underwent cEEG, 55 this enhance cerebral blood flow. Our study aims to had SE. There were 22 males and 33 females. The mean age Taute, Neil Friedman, Janet Reid ◦ determine if HP (0 and −15 ) in AIS patients with and of the patients at the time of SE was 60.7 years (range: Cleveland Clinic Foundation, without Intra/Extracranial arterial occlusion 22–89). Cranial CT was performed in 45 patients and brain (ICAO/ECAO) will augment cerebral blood flow (CBF) to MRI in 39 patients. 3 patients had no neuroimaging study. Cleveland, OH, United States the distal ischemic bed. Only 1 of the 15 patients with a normal MRI died (6%), Patients (or Materials) and Methods: Prospective cohort whereas 14 of the 24 patients with an abnormal MRI died Introduction: Tetrasomy 9p is a rare disorder that has been study of patients with TIA and AIS with and without (59%). Using the t-Test: Two-Sample Assuming Unequal associated with CNS abnormalities including ICAO/ECAO was performed in the University of Alberta. Variances with the combined results of CT and MRI, ventriculomegaly, hydrocephalus, Dandy-Walker anoxic injury (p < 0.005), midline shift (p < 0.005) and malformation, hypoplastic/absent cerebellar vermis, Diagnostic TCD defined the occlusion’s site. ECAO was < assessed by CTA, MRA or Carotid Doppler. TCD head intracranial tumor (p 0.001) were found to be significantly lissencephaly, and corpus callosum agenesis. Although associated with mortality, whereas there was no statistically choroid plexus cysts are commonly associated with frame was used to monitor the symptomatic and = asymptomatic middle cerebral artery in these patients significant association for encephalomalacia (p 0.10) and chromosomal abnormalities, choroid plexus hyperplasia is ◦ ◦ ◦ ◦ ◦ = during head of bed position 60 ,30 ,15 ,0 and −15 . intracranial hemorrhage (p 0.15) with mortality. rare. Mean flow velocities (MFV), PSV, EDV and PI of MCA Conclusions: Neuroimaging may play an important role in Patients (or Materials) and Methods: A 9-month old were recorded. the management and prognosis of patients with SE. A male presented with failure-to-thrive, developmental delay, Results: Our study included nineteen patients (26 vessels). normal MRI suggests a good outcome, whereas anoxic dysmorphisms, and hypertonia. He was previously Mean age: 68 (30–89), Male: 17 (89.5), mean bNIHSS: 8 injury, intracranial tumor and midline shift are associated diagnosed with mosaic tetrasomy 9p by chromosomal (0–25). Diagnostic TCD revealed: 6 (31.6%) patients with with high mortality. oligoarray. ICAO{M1–3 (50%), M2–2 (33.3%), LICA occlusion-1 Results: Head ultrasound at 9-months showed enlargement (16.7)} and 3 (15.8%) intracranial stenosis. 7 (36.8%) patients of the choroid plexus bilaterally with extension into the with ECAO. 33. Screening for Intracranial occipital and temporal horns. There were bilateral choroid ◦ Mean MFV of the MCA in all patients at 60 HP (23 ± 8.7), plexus cysts, some containing multiple septations. There ◦ ◦ ◦ 30 HP (24.4 ± 11.2), 15 HP (24.5 ± 11), 0 HP Stenosis; Comparison of was mild prominence of the lateral ventricles and the corpus ◦ (25.2 ± 10.6) and −15 HP (25.6 ± 11). callosum was complete. MRI at 11-months showed ◦ Transcranial Doppler with MR In ICAO patients, mean MFV at 60 HP (12.3 ± 1.9), prominent ventricles and cortical sulci with a normal corpus ◦ ◦ ◦ 30 HP (12.3 ± 1.9), 15 HP (12.6 ± 3.8), 0 HP (13.5 ± 3.1) Angiogram Ashkan Mowla, John J. callosum. On T2 weighted imaging there was notable ◦ and −15 HP (13.6 ± 3.9). hypertrophy of the choroid plexus bilaterally as well as ◦ Volpi, Zsolt Garami, Rasadul Kabir In ECAO patients mean MFV at 60 HP (24.8 ± 9.5), extra-axial CSF signal intensity collections located medial to ◦ ◦ ◦ 1 30 HP (26.3 ± 8.6), 15 HP (27.3 ± 10.3), 0 HP Department of Neurology, Methodist the right temporal lobe and superior to the left of the ◦ (29.1 ± 10.8) and −15 HP (28.1 ± 11.1). hippocampus suggesting extension of the choroid plexus ◦ ◦ − ◦ Neurological Institute, Houston, Texas, into the extra-axial space. Mean augmented MCA MFV in 60 to 0 and 15 HP in 2 ECAO was 2.4 ± 5 (10%) (P = 0.1) and 1.7 ± 4.4 (7%) United States, Methodist DeBakey Conclusion: Ventriculomegaly and hydrocephalus are (P = 0.3) and augmentation in ICAO was 1.2 ± 3 (10%) commonly documented in the literature as being associated (P = 0.4) and 1.1 ± 4.4 (8%) (P = 0.6). Heart & Vascular Center, Houston, with tetrasomy 9p. Choroid plexus hyperplasia however, Conclusion: In the presence or absence of ICAO or Texas, United States has only been described in two children with this disorder. ECAO, CBF in AIS patients get augmented by HP at 0 and Molecular cytogenetic studies have shown that the gene ◦ −15 . By the time of meeting, we will have larger sample of Introduction: Magnetic resonance angiography (MRA) carried on chromosome 9 could be involved in the patients to better confirm our hypothesis. and Transcranial Doppler regulation of the growth of the choroid plexus. This case (TCD) are both screening tests for intracranial stenosis. We illustrates that when a physician evaluates a child with 32. Prognostic Value of compared TCD findings with MRA in a population of developmental delay and choroid plexus hyperplasia is patients with TIA, stroke, or suspected vascular found on imaging, the diagnosis of tetrasomy 9p should be Neuroimaging in Patients With disease. considered.
2011 ASN Annual Meeting Program 32
100 Journal of Neuroimaging Vol 21 No 1 2011 AMERICAN SOCIETY OF NEUROIMAGING th ANNUAL 35 MEETING
M IAMI MARRIOTT BISCAYNE BAY, MIAMI FLORIDA
J ANUARY 26–29, 2012