Malhotra A, Gandhi D, eds. Mukherji SK, consulting ed. Neuroimaging Clinics of North America: Evidence-Based Vascular Neuroimaging.; 2021;31(2):139–264; $397.00

cover of Malhotra and Gandhi

The May 2021 issue of the Neuroimaging Clinics of North America concerns neurovascular imaging and is entitled Evidence-Based Vascular Neuroimaging. Edited by Drs. Malhotra and Gandhi, this issue contains 10 chapters with contributions from 25 authors.

What makes this publication valuable is that it addresses issues and topics that neuroradiologists face multiple times each day, such as detecting and dealing with unruptured intracranial aneurysms, imaging of vasospasm, extracranial vascular disease (with emphasis on plaque imaging), subarachnoid hemorrhage without a known cause, ischemic stroke with common parameters on MRI and CT, spontaneous intracerebral hemorrhage, AVMs, vessel wall imaging in intracranial vascular disease, and the use of CT algorithms in acute ischemic stroke.

While the chapter on unruptured intracranial aneurysms (UIAs) reviews some important points such as those related to eventual rupture/growth or key factors in describing aneurysms, the lack of any images to illustrate the authors’ points is a disappointment. There are innumerable features the authors describe but apparently decided not to show; such illustrations would have resulted in a greater impact of this material. On the other hand, the authors summarize the literature (evidence-based data) on UIAs. It is clear by the volume of studies in the literature and criteria used that many unanswered questions on management and aneurysm evaluation remain.

Documenting vasospasm and diagnosing delayed cerebral ischemia (DCI) are briefly discussed and important points re: Doppler US, DSA, CTA, and pCT are made. Better depiction of vasospasm should have been made, using larger formatted DSA imaging combined with properly placed labels.

The segment on extracranial vascular disease discusses and illustrates the important observations regarding arterial narrowing and plaque formation. The authors of this chapter do not illustrate important items (they are only discussed), such as dissection, FMD, webs, and perivascular inflammation (carotidynia). Those entities should have been included to increase the educational value of this chapter. Despite that drawback, guidance is given in diagnosing the more common arterial findings.

The patterns and incidence of SAH of unknown cause are reviewed along with the typical imaging. As nicely shown, there are 4 patterns: perimesencephalic (the most common), aneurysmal pattern (with no aneurysm seen), convexity SAH, and isolated intraventricular hemorrhage.  As the authors point out, it is important to not only recognize these patterns but also know how to initially work these up and how to follow them.

In dealing with acute ischemic stroke (AIS), the authors rely solely on MRI-based protocols in this next chapter. Another chapter later in the book has material on CT in AIS with the familiar CTA, pCT, and metric analysis. Nonetheless, in the MRI chapter, there are the protocols and the features of various sequences related to AIS (DWI, ADC, GRE, MRA, MR perfusion). Clinical applications and approaches (thrombolysis, EVT) put imaging into context. A nice addition to this chapter is material on mimics of AIS and what the authors term “cryptogenic strokes.” The chapter contains valuable “take-home points” that can be used in daily practice.

A review of what one should look for in spontaneous intracerebral hemorrhage (sICH) is valuable because it is likely that many of the features of ICH (which is approximately 10–20% of strokes) are either not appreciated or are overlooked in the daily rush to get through a large number of cases.

Imaging in treatment planning for AVMs and the utility of imaging in monitoring the response to treatment contains useful information that ties together radiology and INR/NSG.

A topic of increasing interest is that of vessel wall imaging in intracranial vascular pathology. What is particularly useful is an exact description of how to perform these studies, what to look for (with good examples), and comments on why this type of imaging beyond standard MRI and MRA is useful and under what clinical conditions it is useful.

The book ends with a chapter on imaging of aneurysms treated in various manners—coiling, stents, clipping, and flow diverters. For many neuroradiologists, this will be a good review and an up-to-date summary of what options are available and under which conditions they are used by our neurosurgical colleagues.

Overall, this is an important addition to the Neuroimaging Clinics because it deals with practical subjects and situations with which we commonly deal. It is highly recommended for both personal and sectional/departmental libraries.

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