This issue is densely packed with practical information that will be relevant to all of us as we decide which imaging studies to perform (and when) and is intensely illustrated with instructive example neuroimages throughout each article.
This issue of Continuum was developed by Guest Editors Dr Laszlo L. Mechtler and Dr Joshua P. Klein to provide us with the most up-to-date tools to enhance what we all do multiple times a day: order, personally review, and interpret our patients’ neuroimaging studies within the context of their clinical presentations. From the start, I want to mention how indebted I am to Dr Mechtler, Continuum’s associate editor of neuroimaging, for successfully lobbying that a neuroimaging issue was overdue in the Continuum curriculum, and I also want to sincerely thank Dr Klein for taking on the task of co-guest editorship with Dr Mechtler. This issue, the product of their collaboration, is densely packed with practical information that will be relevant to all of us as we decide which imaging studies to perform (and when) and is intensely illustrated with instructive example neuroimages throughout each article.
The issue begins with an introduction to MRI for neurologists by Drs Ernst-Wilhelm Radue, Matthias Weigel, Roland Wiest, and Horst Urbach. Although the complicated nature of this topic makes the word primer a bit of a misnomer, a careful reading of the authors’ explanation of this very complex topic will provide neurologist readers with a conceptualization (which most of us do not have) of the physics underlying MRI and its various sequences that we review every day to assist in our patients’ neurologic diagnoses.
The issue then takes a whirlwind tour of the neuroimaging of specific clinical syndromes, disorders, and neuroanatomic regions. The first of these articles is by Drs Michelle P. Lin and David S. Liebeskind, who discuss the imaging of patients with ischemic stroke, immediately followed by a discussion of the imaging of hemorrhagic stroke by Drs Ryan Hakimi and Ankur Garg. Next, Drs Samuel Lapalme-Remis and Gregory D. Cascino review the many imaging considerations in evaluating adults with seizures and epilepsy, and Dr Jennifer W. McVige discusses and provides many illustrative imaging examples of congenital malformations. Dr Gabriella Szatmáry then reviews the imaging aspects of patients with symptoms related to dysfunction anywhere along the visual pathway.
Drs Mirza A. Baig, Joshua P. Klein, and Laszlo L. Mechtler review the imaging features of brain tumors, followed by a review of the imaging of intracranial cysts by Drs Bela Ajtai and John A. Bertelson and a discussion of the imaging characteristics of pituitary and parasellar disorders by Drs Robert Fenstermaker and Ajay Abad. Drs Karanbir Singh, Laszlo L. Mechtler, and Joshua P. Klein next review the imaging features of many spinal cord disorders, and Dr Konstantin Balashov provides us with an up-to-date review of the imaging features that assist in our contemporary diagnosis of central nervous system demyelinating disorders.
The preceding articles primarily emphasize structural neuroimaging modalities, especially MRI. However, other neuroimaging modalities, each with a place in our diagnostic armamentarium, are of relevance to neurologic practice. Dr Robert S. Miletich reviews the relevance of positron emission tomography (PET) and single-photon emission computed tomography (SPECT) studies in a variety of neurologic syndromes, including dementia, brain tumors, epilepsy, movement disorders, and stroke. Drs Georgios Tsivgoulis and Andrei V. Alexandrov review ultrasound as a diagnostic modality in neurology, including its role in assessment of cerebrovascular disease and movement disorders and its evolving role in diagnosis of peripheral nervous system disorders.
In the final review article of the issue, Drs Nandor K. Pinter, Joshua P. Klein, and Laszlo L. Mechtler provide us with a summary of the current information regarding potential safety issues related to the use of gadolinium-based contrast agents, an issue that all neurologists need to have on their radar despite (or perhaps because of) the limited information currently available about this developing topic.
This issue also presents the first Medicolegal Issues article in the newly renamed “Ethical and Medicolegal Issues” section, where articles about medicolegal themes will generally alternate with Continuum’s previously standard Ethical Issues articles, under the associate editorship of Dr Joseph S. Kass. In this issue’s debut of this feature, Ms Rachel V. Rose and Dr Kass review the legal implications of physician investment and ownership in health care enterprises, using imaging facilities as an apropos example. In the Practice Issues article, Dr Marcus Ponce de Leon discusses the current considerations we all need to be aware of with regard to the safety of MRI of patients with implanted medical devices. Drs Joseph V. Fritz and Bennett Myers next review (in the Coding article, which is online only in this issue) the imaging codes, indications, and documentation requirements neurologists need to be aware of with regard to neuroimaging of our patients.
As with every Continuum issue, several opportunities exist for CME. After reading the issue and taking the Postreading Self-Assessment and CME Test written by Drs Eduardo E. Benarroch and Adam G. Kelly (including a generous number of questions related to interpretation of neuroimages), you may earn up to 12 AMA PRA Category 1 Credits™ toward self-assessment and CME. The Patient Management Problem, written by Dr Riley Bove, describes the case of a 45-year-old man presenting with subacute bilateral lower extremity weakness and sensory loss. By following this patient’s case and answering multiple-choice questions corresponding to decision points (also including a number of neuroimaging decisions and interpretation of imaging features) along this patient’s course, you will have the opportunity to earn up to 2 AMA PRA Category 1 CME Credits.
I thank Drs Mechtler and Klein and each of their outstanding expert contributors for creating such a comprehensive and highly illustrated issue to inform our most up-to-date approaches to the ordering, performance, and interpretation of the neuroimaging studies that, following our neurologic histories and examinations, form such an important part of the diagnostic process in so many of our patients.
—Steven L. Lewis, MD, FAAN