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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

02/28/2026

AJNR Junior Editorial Board Call for applications!

Interested in gaining in-depth experience with editorial and peer review processes?

Goals:
Improve peer review training and experience
Offer a broad understanding of the publishing process
Provide mentorship and networking opportunities
Provide publication opportunities
Share cutting-edge knowledge in neuroradiology

Apply by March 16, 2026!

https://www.ajnr.org/content/ajnr-junior-editorial-board

02/26/2026

Check one of our Editor’s choice for the month:
‘The Impact of Different CT Perfusion Software on Patient Stratification Strategies in Ischemic Stroke’

This study compared 2 commercially available CT perfusion software packages to assess differences in ischemic core estimation and their impact on eligibility for endovascular treatment. Among 109 patients with stroke, the software programs produced significantly different core volumes across all tested thresholds, which in turn led to meaningful discrepancies in EVT stratification—particularly when applying DAWN criteria. Although using more conservative thresholds reduced these differences, clinicians should be aware that software choice may directly influence treatment decisions.

https://www.ajnr.org/content/47/2/329

02/25/2026

Check our last Editor’s choice for the month: ‘Brain Plasticity Induced by MR-Guided Focused Ultrasound Correlates with Tremor Improvement in Essential Tremor: A Prospective Cohort Study’

The authors of this study evaluated long‑term brain structural changes in 26 patients with essential tremor following MR‑guided focused ultrasound, using MRI both before treatment and 1 year afterward. Patients showed significant decreases in gray matter volume in the left postcentral gyrus, left thalamus, and right superior temporal gyrus, along with GMV increases in several cerebellar regions. Additional region‑based analyses identified GMV reductions in the globus pallidus and specific thalamic nuclei. GMV changes in multiple clusters were significantly correlated with tremor improvement, suggesting that MRgFUS induces neuroplastic remodeling in both adjacent and remote brain regions.

https://www.ajnr.org/content/47/2/409

02/24/2026

Check one of our Editor’s choice for the month: ‘Maximizing the Conspicuity of CSF-Venous Fistulas on CT Myelography: Assessment of Contrast Density and Timing Effects’

This study evaluated how timing of image acquisition and contrast density in the subarachnoid space affect the visualization of CSF‑venous fistulas on CT myelography. Both higher contrast density and shorter acquisition time significantly improved CVF conspicuity, with contrast density having a 4‑fold greater influence than timing. An increase of 100 HU in attenuation corresponded to a 14.3% greater likelihood of fistula detection, with an optimal density threshold of 836 HU. These findings suggest prioritizing maximizing contrast density—potentially through positioning strategies—to enhance CVF detection more effectively than timing adjustments alone.

https://www.ajnr.org/content/47/2/537

02/22/2026

Check one of our Fellows’ Journal Club choice of the month: ‘Risk Stratification for Traumatic SAH Enlargement and Surgical Intervention: Guides to Follow-Up Imaging in Patients with Trauma’

SAH is a common traumatic finding and presents diagnostic challenges, particularly in determining which patients require repeat imaging. In this retrospective review of traumatic SAH, enlargement occurred in 18% of patients who had followup imaging and progression was strongly associated with intraparenchymal hemorrhage, coagulopathy, and lower Glasgow Coma Scale scores. Surgical intervention was more likely in cases with midline shift or severe traumatic brain injury. The findings indicate that most traumatic SAH remains stable, and riskbased imaging strategies may optimize care while reducing unnecessary followup scans.

https://www.ajnr.org/content/47/2/503

02/20/2026

Check our Fellows’ Journal Club choice of the month: ‘A Systematic Approach to the Evaluation of Lumbosacral Plexus MRI: Indications, Protocol, Anatomy, and Pathology’

The complex anatomy of the lumbosacral plexus requires a structured, systematic approach to ensure accurate interpretation of the MRI examination. Optimized imaging protocols, detailed knowledge of relevant anatomy and pathology, and stepwise evaluation—including assessment of image quality, nerve morphology, denervation patterns, and potential mimics—are critical for maximizing diagnostic utility. Because this examination is uncommon, ongoing education and focused review are important for helping radiologists maintain proficiency.

https://www.ajnr.org/content/47/2/300

02/19/2026

Check one of our Fellows’ Journal Club choice of the month: ‘Neuroimaging Spectrum of GM1 Gangliosidosis with Description of Novel Imaging Signs’

Infantile and lateinfantile GM1 gangliosidosis typically presents with a predominant leukodystrophy pattern on MRI, while juvenile-and adult-onset forms more often show dorsal putaminal T2 hyperintensity and globus pallidus mineralization. Thalamic T2 hypointensity involving the anterior and lateral nuclei is a consistent imaging feature across all subtypes. Internal hypertrophy of the occipitomastoid sutures was present in more than half of infantile and lateinfantile cases, suggesting it may represent a shared radiologic marker among lysosomal storage disorders.

https://www.ajnr.org/content/47/2/489

02/10/2026

We are now accepting submissions for AJNR: Clinical Practice!

As announced in the fall of 2025, AJNR: Clinical Practice is a new journal that represents the next chapter of Neurographics, within the AJNR family of journals. This journal is dedicated to providing high-quality, peer-reviewed, practice-oriented educational content to support lifelong learning in neuroradiology. AJNR: Clinical Practice will publish image-rich articles on diagnostic imaging techniques, disease-specific imaging features, and radiologic-pathologic correlations across adult brain, pediatrics, spine, and head and neck. Each article aims to offer practical, clinically relevant insights for radiologists at every career stage, with topics regularly updated to reflect the latest advancements in the field.

Thank you for your support, and we look forward to your participation and your engagement with our new journal!

Lubdha Shah, Editor-in-Chief of AJNR: Clinical Practice
Max Wintermark, Editor-in-Chief of AJNR

02/09/2026

Check out our , featuring a curated selection of educational neuroradiology cases from across the community!

We are also actively accepting submissions!

Visit us at ajnr.org to view the collection and at bit.ly/ajnrcasecollection to submit your interesting case!

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

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Tuesday	8:30am - 4:30pm
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Thursday	8:30am - 4:30pm
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http://www.ajnr.org/

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