American Journal of Neuroradiology

10/27/2025

Check our Fellows Journal Club for the month: ‘MR Imaging versus Noncontrast CT for Selecting Patients with Acute Ischemic Stroke of Large Vessel Occlusion for Endovascular Thrombectomy: A Systematic Review and Meta-Analysis’
Though EVT was safer and tended to be more effective in patients selected by MRI, the differential outcomes based on the treatment window deserve attention and highlight the importance of timely intervention. More advanced imaging is typically used in practice to refine patient selection in the extended time window. Yet, results of this study suggest that beyond 6 hours, the choice of imaging technique may actually become less impactful on overall outcomes. This suggests that in extended time windows, the focus should perhaps shift more toward ensuring rapid access to EVT rather than the choice of imaging technique. Access to treatment and avoiding exclusion of patients with LVO who may benefit from EVT should be prioritized. In that sense, NCCT remains a valid option because of its rapid acquisition and widespread availability. While MRI may refine patient selection and reduce the chances of futile recanalization, it can overestimate the size of the ischemic core and lead to inappropriate exclusion from treatment of patients who can benefit from reperfusion. Future research should further investigate the merits of these 2 imaging modalities, balancing precision with accessibility and the competing interests of reducing rates of futile recanalization while maximizing the identification of good candidates for EVT. https://www.ajnr.org/content/46/10/2026 ☢️

10/26/2025

Check our Fellows Journal Club for the month: ‘Clinical Impact of Sinus CT Surveillance Imaging among Febrile Neutropenic Patients: A Retrospective Observational Study’ Most CT sinus examinations performed for febrile neutropenia showed no evidence of acute sinusitis or revealed stable or improving disease. Many patients had more than 1 CT sinus examination in a 3-month period. Furthermore, imaging results, positive or negative, did not directly influence adjustments in antimicrobial management. Otorhinolaryngology consultations were requested based on positive imaging findings but in the absence of clinical features of sinusitis were unrevealing as to source of fever, which underscores the relatively low specificity of imaging findings for sinusitis in the absence of supportive clinical features. For these reasons, broad use of routine sinus CT as a screening method may be considered low-yield in the setting of febrile neutropenia. However, what defines appropriate value-based imaging in this vulnerable population is an evolving concept that requires further analysis and discourse. https://www.ajnr.org/content/46/10/2162

10/24/2025

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10/24/2025

10/23/2025

Check one of Editor’s choice for October:
‘Differentiation between Nonenhancing Tumor in Glioblastoma and Vasogenic Edema Using Diffusion-Weighted and Dynamic Susceptibility Contrast MR Imaging’

This study highlights the utility of diffusion- and perfusion-weighted MR imaging in differentiating nonenhancing glioblastoma from vasogenic edema. Nonenhancing glioblastomas have significantly lower ADC values and higher rCBV values compared with vasogenic edema, reinforcing their potential as imaging biomarkers. Additionally, while ADC values were comparable between perilesional nonenhancing T2-FLAIR hyperintensity around enhancing glioblastomas and vasogenic edema, rCBV remained a distinguishing factor, with values above 0.42 suggesting potential tumor infiltration.
These findings provide clinically relevant insights into glioblastoma lesion characterization, potentially enabling more precise, image-guided management. They may also improve the preoperative differentiation of glioblastomas from metastases by assessing perilesional ADC and rCBV values. However, given the variability in tumor infiltration and the continuous nature of perfusion and diffusion changes, these threshold values should be applied with caution in broader clinical settings.

https://www.ajnr.org/content/46/10/2116.

10/14/2025

We are thrilled to announce the launch in early 2026 of AJNR: Clinical Practice, a new journal, as the next chapter of Neurographics within the AJNR family of journals.

This journal will focus on delivering high-quality, peer-reviewed, practice-oriented educational content to advance lifelong learning in neuroradiology.

We warmly invite you to join one of upcoming town halls to share your thoughts and help shape this exciting initiative.

https://www.asnr.org/ajnr-clinical-practice/

09/28/2025

Check our Fellows’ Journal club choice:’ Large Core Trial’

The shift toward a more proximal occlusion in large core trials compared with the HERMES collaboration and the measurement of ischemic core with ASPECTS markedly imbalances the ratio between salvageable tissue and ischemic core in an unpredictable way, limiting the external validation of the results of large core trials.
Based on the previous points, a systematic review and meta-analysis at the patient level with a subgroup evaluation regarding the effect of a large core related to the site of occlusion is mandatory to unveil a potential misinterpretation based on the results of these RCTs. In addition, a potential way to overcome this misinterpretation may be to change the definition of a large core from the ASPECTS to perfusion imaging that is not limited to the MCA territory, and it’s more reliable and precise, being by nature a more detailed measurement.

https://www.ajnr.org/content/46/9/1749

09/28/2025

Check our Fellows’ Journal Club choice for the month: ‘Prevertebral Hematoma: A Potential Biomarker for the Severity of Upper Cervical Spine Trauma and a Predictor for the Need for Surgical Intervention’

In this study, among patients with UCST, prevertebral hematomas were identified in more than 50% of the subjects. The presence of prevertebral hematoma was significantly associated with CCJ subluxation/dislocations, subaxial disco-ligamentous injuries, and simultaneous injuries of the upper and subaxial segments including ligamentous injuries and epidural hematomas. Furthermore, prevertebral hematomas were frequently identified in patients who underwent surgical therapy for cervical trauma and presented with neurologic disability at discharge.

https://www.ajnr.org/content/46/9/1943

09/27/2025

Check our Fellows’ Journal Club choice:
‘Contrast-Enhanced Brain MRI for Ambulatory Evaluation of Headache: Comprehensive or Excessive?’

Postcontrast imaging of headache in the absence of specific clinical red flags has overall low yield with less than 2% of cases in our study demonstrating findings for which contrast was theoretically helpful. When blinded review was performed of a selection of these cases with and without contrast, sensitivity for actionable intracranial pathology was not substantially increased. This suggests that even in scenarios where contrast is useful (SIH and intra-axial masses), it rarely improves detection. However, given the limitations of time-of-flight MR venography, contrast should be used when there is high concern for CVST.
Meanwhile, contrast increases the detection of incidentals unrelated to headache, particularly small pituitary lesions and meningiomas. Operationally, contrast administration is more resource intensive, timing-consuming, and costly. For all these reasons,it is believed that most brain MRI for initial headache work-up should be performed without contrast except when there is high concern for CVST, SIH, cranial nerve symptomatology, infection/inflammation, or malignancy.

https://www.ajnr.org/content/46/9/1780

09/23/2025

Check our Editor’s choice for the month: ‘Evaluation of Spontaneous Intracranial Hypotension Probabilistic Brain MRI Scoring Systems in Normal Patients’

Brain MRI-based probabilistic scoring systems are valuable tools in the diagnostic work-up of patients with clinically suspected SIH. However, certain parameters of these systems, specifically subtle decreases in CSF cistern measurements, are common in normal patients and should not be used in isolation to justify advanced myelography in patients with equivocal clinical presentation for SIH. This study encourages a comprehensive evaluation of the full clinical picture before proceeding to advanced myelography, by using brain MRI scoring systems as one of several important factors.

https://www.ajnr.org/content/46/9/1925