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American Journal of Neuroradiology

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American Journal of Neuroradiology

The Journal of Diagnostic and Interventional Neuroradiology (Official Journal: ASNR, ASFNR, ASHNR, AS
(229)

Published by the American Society of Neuroradiology (ASNR), the American Journal of Neuroradiology (AJNR) publishes original articles pertaining to the clinical imaging, therapy, and basic science of the central and peripheral nervous system. In a typical year, AJNR publishes more than 350 fully reviewed Original Research papers, Review Articles, and Technical Notes. Subject matter covers the spectrum of diagnostic and functional imaging of the brain, head, neck, spine, and organs of special sense, including: aging and degenerative diseases; anatomy; the cervicothoracic junction; contrast media; experimental studies; functional imaging; iatrogenic disorders; imaging techniques and technology (including all advanced imaging modalities); inflammatory diseases; interventional techniques and related technology; the larynx and lymphatics; molecular imaging; the nasopharynx and skull base; neoplastic diseases; the nose and paranasal sinuses; oral and dental imaging; ophthalmologic and otorhinolaryngologic imaging; pediatric ENT radiology; pediatric neuroradiology and congenital malformations; the phakomatoses; radionuclide imaging; the salivary glands; seizure disorders; cancer, stroke, and cerebrovascular diseases; the temporal bone; and tissue characterization and trauma. AJNR is abstracted and/or indexed by PubMed/Medline, BIOSIS Previews, Current Contents (Clinical Medicine and Life Sciences), EMBASE, Google Scholar, HighWire Press, Q-Sensei, RefSeek, Science Citation Index, and SCI Expanded. Twelve issues per year, peer-reviewed, approximately 200 pages per issue. OFFICIAL JOURNAL: American Society of Neuroradiology, American Society of Functional Neuroradiology, American Society of Head and Neck Radiology, American Society of Pediatric Neuroradiology, American Society of Spine Radiology

02/01/2026

Check our Fellows’ journal Club choice ‘Uncommon Faces of Disc Herniation: Atypical Imaging Presentations and Mimics ∙ Maria-José Galante, et al’

This article highlights atypical imaging presentations of disc herniation and mimics that can lead to diagnostic errors. The variants presented can resemble tumors, infections, or postoperative changes. Multimodality imaging (MRI + CT ± PET-CT) is essential; CT is critical for detecting calcification, gas, and cement leakage. Awareness of rare presentations improves diagnostic accuracy, prevents failed back surgery, and guides appropriate management.

https://www.ajnr.org/content/early/2025/12/18/ajnr.A8929

01/27/2026

1/The hardest thread yet! Are you up for the challenge?

How stroke perfusion imaging works!

Ever wonder why it’s Tmax & not Tmin?

Here’s what to know from SCANtastic!

https://www.ajnr.org/content/47/1/28

2/Perfusion imaging is based on one principle: When you inject CT or MR intravenous contrast, the contrast flows w/blood & so contrast can be a surrogate marker for blood.

This is key, b/c we can track contrast—it changes CT density or MR signal so we can see where it goes.

3/So if we can track how contrast gets to the tissue (by changes in CT density or MR signal), then we can approximate how BLOOD is getting to the tissue.

And how much blood is getting to the tissue is what perfusion imaging is all about.

4/Clinically, there are 2 main perfusion parameters used:
(1)Cerebral blood flow (CBF) = how FAST blood gets to the tissue

(2) Tmax or time to max residue function. Everyone knows Tmax is for penumbra, but does anyone know what it really is??? You will now

5/Let’s start w/CBF. CBF is how FAST blood gets to tissue.

We could estimate it by measuring how fast contrast accumulates in tissue—make a curve of the amount of contrast in a tissue over time.

If the slope is steep, contrast/blood is being delivered fast & CBF is high

6/Unfortunately, it’s not that simple.

You can’t just measure the contrast curve slope in tissue to get CBF.

Many things change how fast contrast travels besides just blood flow

If you inject more contrast or inject it faster—it increases how fast contrast washes in

7/If we can’t measure how fast contrast washes in to get CBF, we’ll measure how it washes out! If you want to measure river velocity, dropping in dye & measuring how fast it washes out gets the same answer as watching it wash in. But we can’t drop contrast directly in the brain!
8/So we must back calculate. Pretend we want to know how fast a kitchen prepares food—Restaurant Continental Breakfast Flow or rCBF. If we know when ingredients arrive & we know when food gets on our table, we can back calculate kitchen speed--& that’s what we do for the real CBF
9/When the ingredients arrive is the arterial input function. We measure over a cerebral artery to see when blood first arrives. It’s equal to how long it takes the restaurant to get ingredients from the supplier—how long it takes the artery to get blood after injection
10/How fast food is building up on our table is tissue concentration. We measure in brain parenchyma to detect the buildup of contrast. How long it takes for blood to get from injection to tissue is equal to how long it takes ingredients to be turned into food on our table
11/Time for the kitchen to turn ingredients to food for the table is CBF. We want to find CBF by dropping contrast right in a brain artery & seeing how fast it washes out to tissue. This is kitchen time--how long for a blood drop to wash out from artery (kitchen) to tissue (table)
12/If we know the time for blood to get from injector to artery & time to get from injector to tissue, we can back calculate how long it takes to get from artery to tissue. So we use the arterial input function & tissue concentration to back calculate the artery to tissue time
13/This back-calculated artery to tissue time simulates dropping blood into a brain artery & watching it wash out—like our dye & river—the best way to find CBF. This back-calculated function is the residue function—it’s not a real measurement in the brain, but a calculated entity
14/So residue function is what you would get if you dropped a perfectly tight bolus of blood into an artery & then watched it washout into tissue as it is replaced by fresh blood. It is exactly what we wanted to do w/dye in the river
15/The function is maximized the second you drop all that blood into the artery—before any washes out. This is equal to the time it takes for blood to hit the artery—none has washed out. So Tmax (time to max residue function) is the time it takes blood to reach the artery
16/The height of the residue function is CBF—b/c it represents the blood being dropped right into the artery & timing how long it takes to wash out. So we calculate CBF by measuring the height of the residue function
17/Since Tmax is the time it takes for blood to reach the artery, it doesn’t take into account the time it takes blood to travel through the microvasculature to the tissue. So it isn’t affected by microvascular pathology—making it a great indicator of large vessel occlusion (LVO)
18/In this month’s , Proner et al. looked at factors affecting quality in CT perfusion and found arrhythmias could cause non diagnostic imaging. This is understandable, as it affects the delivery of contrast. These pts need longer scan times.
19/Now you know how perfusion imaging works! Hopefully this Tmax-ed out your knowledge!!

But this just scratches the surface. Follow and check it out for yourself:
https://www.ajnr.org/content/47/1/28

01/27/2026

The hardest post yet! Are you up for the challenge? How stroke perfusion imaging works! Ever wonder why it’s Tmax & not Tmin? Here’s what to know from SCANtastic!https://www.ajnr.org/content/47/1/28. Clinically, there are 2 main perfusion parameters used:
(1)Cerebral blood flow (CBF) = how FAST blood gets to the tissue
(2) Tmax or time to max residue function. Everyone knows Tmax is for penumbra, but does anyone know what it really is??? You will now. Pretend we want to know how fast a kitchen prepares food—Restaurant Continental Breakfast Flow or rCBF. If we know when ingredients arrive & we know when food gets on our table, we can back calculate kitchen speed—& that’s what we do for the real CBF. When the ingredients arrive is the arterial input function. We measure over a cerebral artery to see when blood first arrives. It’s equal to how long it takes the restaurant to get ingredients from the supplier—how long it takes the artery to get blood after injection.
In this month’s ,Proner et al. looked at factors affecting quality in CT perfusion and found arrhythmias could cause non diagnostic imaging. This is understandable, as it affects the delivery of contrast. These pts need longer scan times. Now you know how perfusion imaging works! Hopefully this Tmax-ed out your knowledge!!

But this just scratches the surface. Follow and check it out for yourself: https://www.ajnr.org/content/47/1/28

01/20/2026

Check our Fellows’ Journal Club choice for the month: ‘Impact of Clinical and Radiologic Factors on CTP Timing in Acute Ischemic Stroke’
This study evaluated how clinical and radiologic factors influence CTP timing in acute ischemic stroke. Cardiac arrhythmias and older age were identified as independent predictors of nondiagnostic CTP exams due to delayed bolus arrival and curve truncation, while factors like large vessel occlusion, white matter lesions, and arterial calcifications were not significant. Patients with arrhythmias showed markedly prolonged arterial and venous time-to-peak values, emphasizing the need for individualized scan durations rather than fixed protocols. Findings suggest most patients can be accurately assessed with shorter acquisitions (

01/19/2026

Check one of our Editor’s choice for the month:
‘Predicting 10-Year Clinical Outcomes in MS with Radiomics-Based Machine Learning Models’

This study showed that the multidimensional analysis of clinical brain MRI scans, including the systematic investigation of volumetric, radiomic, and disconnection features, leads to long-term prognostic models, potentially informing patients’ stratification and clinical decision-making.

https://www.ajnr.org/content/47/1/100

01/18/2026

Check one of our Fellows’ Journal Club for the month: ‘Why 2D Matters: Comparative Evaluation of 2D and 3D T1-Weighted Imaging of the Skull Base and Neck’

In a retrospective review comparing conventional 2D T1-weighted turbo spin-echo imaging with 3D T1-weighted imaging for head and neck MR protocols, the image quality and quantitative measures were analyzed. Results in the study show that 2D T1-WI provided superior soft-tissue contrast, fat visualization, parotid architecture, tumor margin delineation, and muscle definition compared with 3D imaging (all P < .001). While 3D sequences reduced pulsation artifacts and offered thinner slices, they introduced more susceptibility artifacts and did not add diagnostic value through multiplanar reformatting. Quantitatively, 2D images had higher fat-to-muscle and tumor-to-muscle signal ratios.

https://www.ajnr.org/content/47/1/131

01/17/2026

Check our Editor’s choice for the month: ‘Suggested Parameters for Clinical Infant Brain Imaging Using an Ultra-Low-Field Portable MRI System’

This single-center study provides recommended scanning parameters for clinical brain MRI in infants by using a portable, ultra-low-field, 0.064T MRI system.
The optimized protocol presented in this study achieves shorter, clinically feasible scan times using in-line processing, supporting a comprehensive imaging set.

https://www.ajnr.org/content/47/1/208

01/15/2026

Check our Editors’ choice for the month: ‘Suggested Parameters for Clinical Infant Brain Imaging Using an Ultra-Low-Field Portable MRI System’

This single-center study provides recommended scanning parameters for clinical brain MRI in infants by using a portable, ultra-low-field, 0.064T MRI system.
The optimized protocol presented in this study achieves shorter, clinically feasible scan times using in-line processing, supporting a comprehensive imaging set.

https://www.ajnr.org/content/47/1/208

01/11/2026

Check one of Editor’s Choice for January: ‘Biphasic Progression of Radiation-Induced Carotid Stenosis: The Predictive Role of Low-Density Plaque’

This study provides significant insights into the natural progression of carotid artery disease in patients with HNC after RT. It introduces a novel biphasic progression model, revealing that LDP detection accelerates stenosis, with rapidly-progressing LDP serving as a critical biomarker for a high-risk phase. This model demands intensified surveillance through annual or biannual contrast-enhanced CT scans and prompt intervention, such as carotid endarterectomy or stent placement, for vessels meeting guideline-recommended stenosis thresholds to prevent occlusion and cerebrovascular events.

https://www.ajnr.org/content/47/1/22

12/31/2025

Check our last Fellows’ Journal Club choice for the year: ‘Systematic Review of the Predictive Value of Negative Brain or Low Probability Brain MRIs in Patients with CSF-Venous Fistulas’

CSF-venous fistulas (CVFs) are increasingly diagnosed in patients with spontaneous intracranial hypotension, but their likelihood in cases with negative brain MRI is unclear. This review of 9 studies found that a negative brain MRI has a high negative predictive value (89%) for excluding CVF. As some cases of CVF may still have negative imaging, patients with strong clinical suspicion for CSF leak may require further invasive imaging despite negative MRI findings.

https://www.ajnr.org/content/46/12/2673

12/29/2025

Check our Fellows’ Journal Club choice for the month: ‘ Machine Learning–Based Prediction of Delayed Neurologic Sequelae in Carbon Monoxide Poisoning Using Automatically Extracted MR Imaging Features’

This review article highlights the evolution of imaging findings as cervical artery dissections progress from the acute to the chronic phase, the effects of the perivascular environment dissection pathogenesis, and recent changes in medical and endovascular management.

https://www.ajnr.org/content/46/12/2468

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