Southwestern Neuroradiological Society: 14th Annual Meeting, October 25-27, 1990, Sarasota, FL

Powell Williams described a series of patients with acute symptoms (back pain) in whom the only MR findings were Schmorl node defects in the lumbar vertebral bodies and end plates. The evolution from acute edema (T2-weighted images) to fat-replaced marrow corresponded with relief of symptoms. Frank Earnest described a series of patients who had patho­ logic changes in the marrow space. He showed the adjunctive value of fat-suppressed pulse sequences in distinguishing pathologic lesions from degenerative lesions, lesions caused by radiation therapy, and posttraumatic lesions (where fatty marrow accumulates) and the use of such sequences in a range of pathologic lesions of marrow (metastatic disease, hyperplastic marrow state, myeloproliferative disease). The fat-suppressed images are visually less appealing but do increase conspicuity of lesions evident on gadolinium-en­ hanced T1-weighted MR images. Fred Vines presented data from a level I trauma center illustrating the value of adding 30° oblique films to the routine three-film series and compared the supplemented series with the traditional five-film set, which includes 45° oblique films. The 30° oblique films offered improved resolution of vertebral arch fractures over both the three-film and the standard five­ film sets. This was especially true in the lower cervical and upper thoracic area. The benefit of the 30° oblique films was to obviate routine CT for screening the cervicothoracic junction . lnterventional Neuroradiology Ronald Quisling described a series of patients who had either WADA testing or intracerebral embolotherapy who had angiographic evaluations both before and immediately after intraarterial injections of Brevital (sodium methohexital). These studies revealed no evidence of vasospasm, and none of the patients had seizures. Brevital had significant advan­ tages over Amytal (amobarbital) in provocative testing before embolotherapy because it provoked acute neurologic deficits in normally perfused regions at low doses (1-2 mg). The deficits were of short duration (less than 5 min) and created little drowsiness in the patient. Susan Peterman and Samual Feaster (in separate presen­ tations) shared their experience with using temporary carotid occlusion during provocative testing before carotid sacrifice. Dr. Peterman illustrated the value of Ceretec in showing diminished flow after temporary (15 min) occlusion . Dr. Feaster, however, suggested that similar information could be achieved by using transcranial sonography in conjunction with transient external compression of the carotid artery. Of note, Dr. Peterman found that one (20%) of five patients who had normal results on carotid provocative testing later had cere­ bral infarction after carotid sacrifice. The value of such testing remains equivocal. Michael Brothers described a series of patients who had angioplasty of intracerebral arteries that were in severe vaso­ spasm. He showed that dilatation of A1/A2 and M1fM2 vessel segments was possible. He found angiographic evidence of increased cross-sectional luminal diameter of proximal arter­ ies, and the procedure provided stabilization of or arrested symptomatic decline in most patients. In addition, one patient had improvement in vasospasm-related symptoms after an­ gioplasty. Robert Ferguson presented a state-of-the-art lecture in which he reviewed several aspects of interventional neurora­ diology. He indicated that transtorcular wire-coil embolother­ apy continues to offer a means ·of stabilization and palliation of two forms of galenic fistulae (choroidal and deep types). Jeffrey Landman described three patients with choroidal-type galenic fistulae who required both transtorcular and wire-coil occlusion of the choroidal artery for control of symptoms. Dr. Ferguson, in a separate talk, discussed the use of ethanol in controlling the growth of meningiomas. Progressive decrease in the size of basilar meningiomas was observed, as was loss of contrast enhancement on MR. Wayne Cail reviewed the use of a gamma knife for treating pial arteriovenous malformations. The results were 33% cure at 1 year and 85% at 2 years in patients in whom the entire nidus was incorporated within the field of radiation . The findings were similar to those in the Linac experience.