Joseph Scott McNally

The qMATCH technique enables high-resolution 3D multi-contrast evaluation of carotid atherosclerosis, but the optimal acquisition orientation for reproducible image quality remains unclear. This prospective study compared image quality, motion robustness, and reproducibility between transverse and coronal qMATCH acquisitions. Thirty participants with moderate-to-severe carotid stenosis each underwent two scans, totaling 60 imaging sessions. Coronal imaging demonstrated significantly fewer motion artifacts compared with transverse imaging (34.7% vs 41.5%, p < 0.05) and yielded higher image quality scores (2.78 vs 2.72, p < 0.05) and arterial wall aSNR (5.10 vs 4.36, p < 0.05). In motion-corrupted images, coronal imaging also showed superior image quality (2.75 vs 2.65, p < 0.05) and arterial wall aSNR (4.89 vs 4.03, p < 0.05). Reproducibility for T1/T2 quantification was better for coronal acquisitions, particularly in motion-affected cases. These findings suggest that coronal qMATCH is more robust for motion-prone patients and better suited for longitudinal carotid imaging studies. ABBREVIATIONS: aCNR＝apparent contrast-to-noise ratio; aSNR＝apparent signal-to-noise ratio; ICC＝Intraclass Correlation Coefficient; LoA＝limits of agreement; qMATCH＝Quantitative Multi-Contrast Atherosclerosis Characterization.

Intimate partner violence (IPV) is a significant, global public health concern. Women, individuals with historically underrepresented identities, and disabilities are at high risk for IPV and tend to experience severe injuries. There has been growing concern about the risk of exposure to IPV-related head trauma, resulting in IPV-related brain injury (IPV-BI), and its health consequences. Past work suggests that a significant proportion of women exposed to IPV experience IPV-BI, likely representing a distinct phenotype compared with BI of other etiologies. An IPV-BI often co-occurs with psychological trauma and mental health complaints, leading to unique issues related to identifying, prognosticating, and managing IPV-BI outcomes. The goal of this review is to identify important gaps in research and clinical practice in IPV-BI and suggest potential solutions to address them. We summarize IPV research in five key priority areas: (1) unique considerations for IPV-BI study design; (2) understanding non-fatal strangulation as a form of BI; (3) identifying objective biomarkers of IPV-BI; (4) consideration of the chronicity, cumulative and late effects of IPV-BI; and (5) BI as a risk factor for IPV engagement. Our review concludes with a call to action to help investigators develop ecologically valid research studies addressing the identified clinical-research knowledge gaps and strategies to improve care in individuals exposed to IPV-BI. By reducing the current gaps and answering these calls to action, we will approach IPV-BI in a trauma-informed manner, ultimately improving outcomes and quality of life for those impacted by IPV-BI.

Objective: Diffusion tensor imaging (DTI) is a promising technique for ischemic stroke evaluation; however, acquisition time is longer than DWI. Simultaneous multislice (SMS) imaging acquires multiple slices together and reduces scan time. This study compared conventional and SMS DTI for ischemic stroke workup. Methods: Following IRB approval, the departmental stroke protocol was supplemented with SMS DTI on a clinical 1.5T MRI. Cases suspicious for ischemic stroke outside the treatment window were included. Standard DTI (STD-DTI, 20-direction, b = 2000 s/mm2), was followed by SMS-2-DTI (two slices simultaneously imaged). Two blinded neuroradiologists independently assessed image quality and DTI-trace status (positive/negative = stroke/other). Average image quality, interrater reliability (κ), receiver operating characteristic area under the curve (AUC), signal-to-noise ratio (SNR = DTI-source min/max/average), coefficient of variation (CV), mean diffusivity (MD), and fractional anisotropy (FA, of DTI-trace) were compared using two-tailed t-tests and a p < .05. Results: 41 patients were evaluated. SMS-2-DTI decreased DTI time by 132.17 ± 15.33 s, a 45% reduction. SMS-2-DTI reduced image quality (STD-DTI 4.7 ± 0.5 vs SMS-2-DTI 3.8 ± 0.6, p < .001). Diagnostic accuracy persisted, AUC was high for observer 1 (STD-DTI 0.95, 95%CI = 0.88–1.00 vs SMS-2-DTI 0.94, 95%CI = 0.87–1.00, p = .86) and observer 2 (STD-DTI 0.89, 95%CI = 0.79–0.99 vs SMS-2-DTI 0.86, 95%CI = 0.76–0.97, p = .66). Interrater reliability was high for STD-DTI (κ = 0.80, 95%CI = 0.61–0.98) and SMS-2-DTI (κ = 0.84, 95%CI = 0.67–1.00). SMS-2-DTI significantly decreased average SNR (STD-DTI 42.85 ± 4.44 vs SMS-2-DTI 32.58 ± 4.30, p < .001), and CV MD (STD-DTI 0.23 ± 0.03 vs 0.20 ± 0.04, p < .001). CV FA and CV DTI-trace were not statistically different. Conclusions: This study supports using SMS to accelerate DTI for ischemic stroke workup at 1.5T in the non-hyper-acute setting. Advances in knowledge: This study highlights the feasibility of accelerated multislice DTI for faster diagnostic DTI-trace images capable of ischemic stroke detection.

BACKGROUND AND PURPOSE: Cognitive improvement has been reported after carotid revascularization and attributed to treating stenosis and correcting hypoperfusion. This study investigated the effect of carotid intraplaque hemorrhage on postintervention cognition. MATERIALS AND METHODS: In this institutional review board–approved single-center study, consecutive patients scheduled for carotid surgery were recruited for preoperative carotid MR imaging (MPRAGE) and pre- and postintervention cognitive testing using the Repeatable Battery for the Assessment of Neuropsychological Status. Pre- and postintervention scores were compared using t tests and multivariable linear regression. RESULTS: Twenty-three participants were included, with endarterectomy performed in 20 (87%) and angioplasty/stent placement, in 3 (13%). Overall, statistically significant improvements occurred in the pre- versus postintervention mean Total Scale score (92.1 [SD, 15.5] versus 96.1 [SD, 15.8], P = .04), immediate memory index (89.4 [SD, 18.2] versus 97.7 [SD, 14.9], P < .001), and verbal index (96.1 [SD, 14.1] versus 103.0 [SD, 12.0], P = .002). Intraplaque hemorrhage (+) participants (n = 11) had no significant improvement in any category, and the attention index significantly decreased (99.4 [SD, 18.0] versus 93.5 [SD, 19.4], P = .045). Intraplaque hemorrhage (−) participants (n = 12) significantly improved in the Total Scale score (86.4 [SD, 11.8] versus 95.5 [SD, 12.4], P = .004), immediate memory index (82.3 [SD, 14.6] versus 96.2 [SD, 14.1], P = .002), delayed memory index (94.3 [SD, 14.9] versus 102.4 [SD, 8.0], P = .03), and verbal index (94.3 [SD, 13.2] versus 101.5 [SD, 107.4], P = .009). Postintervention minus preintervention scores for intraplaque hemorrhage (+) versus (−) groups showed statistically significant differences in the Total Scale score (−0.4 [SD, 6.8] versus 8.0 [SD, 8.5], P = .02), attention index (−5.9 [SD, 8.5] versus 4.3 [SD, 11.9], P = .03), and immediate memory index (4.2 [SD, 6.7] versus 12.2 [SD, 10.2], P = .04). CONCLUSIONS: Cognitive improvement was observed after carotid intervention, and this was attributable to intraplaque hemorrhage (−) plaque. MR imaging detection of intraplaque hemorrhage status may be an important determinant of cognitive change after intervention.

Neurovascular MR angiography is a critical component in the evaluation of neurologic disorders, and a detailed understanding of MR angiographic techniques helps radiologists maximize its diagnostic... Neurovascular MR angiography (MRA) is an evolving imaging technique and is crucial for the workup of numerous neurologic disorders. While CT angiography (CTA) provides a more rapid imaging assessme...

SUMMARY: Coronavirus disease 2019 (COVID-19) myelitis is a rare condition, most commonly presenting with nonenhancing central expansile cord T2 signal changes. A single case report has also described longitudinal involvement of the dorsal columns. We present 5 cases of COVID-19-associated myelitis with tract-specific involvement of the dorsal and lateral columns and discuss potential pathophysiologic pathways for this unique pattern.

Ischemic events related to carotid disease are far more strongly associated with plaque instability than stenosis. 3D high‐resolution diffusion‐weighted (DW) imaging can provide quantitative diffusion measurements on carotid atherosclerosis and may improve detection of vulnerable intraplaque hemorrhage (IPH). The 3D DW‐stack of stars (SOS) sequence was implemented with 3D SOS acquisition combined with DW preparation. After simulation of signals created from 3D DW‐SOS, phantom studies were performed. Three healthy subjects and 20 patients with carotid disease were recruited. Apparent diffusion coefficient (ADC) values were statistically analyzed on three subgroups by using a two‐group comparison Wilcoxon–Mann–Whitney U test with p values less than 0.05: symptomatic versus asymptomatic; IPH‐positive versus IPH‐negative; and IPH‐positive symptomatic versus asymptomatic plaques to determine the relationship with plaque vulnerability. ADC values calculated by 3D DW‐SOS provided values similar to those calculated from other techniques. Mean ADC of symptomatic plaque was significantly lower than asymptomatic plaque (0.68 ± 0.18 vs. 0.98 ± 0.16 x 10⁻³ mm²/s, p < 0.001). ADC was also significantly lower in IPH‐positive versus IPH‐negative plaque (0.68 ± 0.13 vs. 1.04 ± 0.11 x 10⁻³ mm²/s, p < 0.001). Additionally, ADC was significantly lower in symptomatic versus asymptomatic IPH‐positive plaque (0.57 ± 0.09 vs. 0.75 ± 0.11 x 10⁻³ mm²/s, p < 0.001). Our results provide strong evidence that ADC measurements from 3D DW‐SOS correlate with the symptomatic status of extracranial internal carotid artery plaque. Further, ADC improved discrimination of symptomatic plaque in IPH. These data suggest that diffusion characteristics may improve detection of destabilized plaque leading to elevated stroke risk.

BACKGROUND AND PURPOSE: Cerebral amyloid angiopathy (CAA) is a known risk factor for ischemic stroke though angiographic imaging is often negative. Our goal was to determine the relationship between vessel wall enhancement (VWE) in acute and future ischemic stroke in CAA patients. MATERIALS AND METHODS: This was a retrospective study of patients with new-onset neurologic symptoms undergoing 3T vessel wall MR imaging from 2015 to 2019. Vessel wall enhancement was detected on pre- and postcontrast flow-suppressed 3D T1WI. Interrater agreement was evaluated in cerebral amyloid angiopathy–positive and age-matched negative participants using a prevalence- and bias-adjusted kappa analysis. In patients with cerebral amyloid angiopathy, multivariable Poisson and Cox regression were used to determine the association of vessel wall enhancement with acute and future ischemic stroke, respectively, using backward elimination of confounders to P < .20. RESULTS: Fifty patients with cerebral amyloid angiopathy underwent vessel wall MR imaging, including 35/50 (70.0%) with ischemic stroke and 29/50 (58.0%) with vessel wall enhancement. Prevalence- and bias-corrected kappa was 0.82 (95% CI, 0.71–0.93). The final regression model for acute ischemic stroke included vessel wall enhancement (prevalence ratio = 1.5; 95% CI, 1.1–2.2; P = .022), age (prevalence ratio = 1.02; 95% CI, 1.0–1.05; P = .036), time between symptoms and MR imaging (prevalence ratio = 0.9; 95% CI, 0.8–0.9; P < .001), and smoking (prevalence ratio = 0.7; 95% CI, 0.5–1.0; P = .042) with c-statistic = 0.92 (95% CI, 0.84–0.99). Future ischemic stroke incidence with cerebral amyloid angiopathy was 49.7% (95% CI, 34.5%–67.2%) per year over a total time at risk of 37.5 person-years. Vessel wall enhancement–positive patients with cerebral amyloid angiopathy demonstrated significantly shorter stroke-free survival with 63.9% (95% CI, 43.2%–84.0%) versus 32.2% (95% CI, 14.4%–62.3%) ischemic strokes per year, chi-square = 4.9, P = .027. The final model for future ischemic stroke had a c-statistic of 0.70 and included initial ischemic stroke (hazard ratio = 3.4; 95% CI, 1.0–12.0; P = .053) and vessel wall enhancement (hazard ratio = 2.5; 95% CI, 0.9–7.0; P = .080). CONCLUSIONS: Vessel wall enhancement is associated with both acute and future stroke in patients with cerebral amyloid angiopathy.

Traumatic brain injury (TBI) is a widespread and expensive problem globally. The standard diagnostic workup for new TBI includes obtaining a noncontrast computed tomography image of the head, which provides quick information on operative pathologies. However, given the limited sensitivity of computed tomography for identifying subtle but meaningful changes in the brain, magnetic resonance imaging (MRI) has shown better utility for ongoing management and prognostication after TBI. In recent years, advanced applications of MRI have been further studied and are being implemented as clinical tools to help guide care. These include functional MRI, diffusion tensor imaging, MR perfusion, and MR spectroscopy. In this review, we discuss the scientific basis of each of the above techniques, the literature supporting their use in TBI, and how they may be clinically implemented to improve the care of TBI patients.