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Hybrid PET/MR
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123
Hybrid PET/MR Neuroimaging
Ana M. Franceschi • Dinko Franceschi
Editors

Hybrid PET/MR Neuroimaging

A Comprehensive Approach
Editors
Ana M. Franceschi Dinko Franceschi
Donald and Barbara Zucker School of Medicine Stony Brook University Hospital
at Hofstra/Northwell, The Feinstein Institutes Stony Brook, NY
for Medical Research USA
Manhasset, NY
USA

ISBN 978-3-030-82366-5    ISBN 978-3-030-82367-2 (eBook)

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Foreword

I am excited and honored to write the foreword for the book Hybrid PET/MR Neuroimaging:
A Comprehensive Approach edited by the father and daughter team, Dinko and Ana Franceschi
(my trainee!). Dinko has 30 years’ experience in nuclear medicine and has clearly recognized
hybrid PET-MRI is an important new technology that will completely change our practice
futures. I helped train Ana in neuroradiology and PET-MRI – in just a few years, Ana has
become a recognized early expert and champion for using this technology in routine clinical
practice, first in the New York City area, and now at national meetings for neuroradiology and
nuclear medicine. Ana and Dinko have collaborated with established and emerging leaders in
this new field to cover the expanding scope and impact of hybrid PET-MRI. My only complaint
is that I actually needed this book in the summer of 2012! Now there will be an excellent
resource for physicians with different training and clinical backgrounds who are interested in
learning more about the utility and interpretation of hybrid PET-MRI for neurological
diseases.
My own early personal experience with PET-MRI may be instructive to readers interested
in getting started since NYU was one of the first programs to use PET-MRI for clinical prac-
tice – i.e. what it was like in the “old days” before this helpful book was available. I suspect
many of the chapter authors can tell similar stories. When I arrived at NYU in August 2012
fresh out of fellowship, we had just installed a hybrid PET-MRI scanner in the main outpatient
radiology facility. Yvonne Lui, my section chief, asked me to be the neuroradiology liaison for
PET-MRI clinical and research studies. After neuroradiology fellowship training, I was quite
familiar with the role of MRI in the clinical management of epilepsy and dementia, was an
“authorized user,” and had decent trainee-level experience with FDG PET for cancer imaging
(maybe 50 cases). My proudest accomplishment in nuclear medicine though may have been
my autographed copy of Mettler’s textbook obtained when he visited UCSF during boards
preparation. At that point, I had read three FDG PET brain studies in my “career” – one of
those was for the radiology board exam in a hotel room in Louisville in 2011 and to this day I
think I failed that case! We were unsure how to apply this new technology, but started using a
research protocol that allowed us to pay for a cab and transport patients after their routine FDG
PET-CT at the NYU cancer center across midtown Manhattan to be reimaged on the PET-MRI
scanner at the radiology outpatient facility on First Avenue using the original decaying FDG
dose.
It began as a trickle of patients. Over the next 2 years, I learned on the job how to really
analyze and interpret FDG PET from Kent Friedman, chief of NYU nuclear medicine. Kent
and I reviewed the MRI and FDG PET images together once a week in a dual-readout format
and prepared two separate reports. We were lucky not to have turf wars between sections and
combined our expertise to interpret these studies. It was a time of discovery as we encountered
real patients that forgot to read the textbooks before they showed up for imaging and we
always had lots of questions – it was perhaps my limited knowledge of the FDG PET literature
in the 1970–1980s that led me to “rediscover” key features for PET interpretation in epilepsy
patients. After only seven patients had consented to both PET-CT and PET-MRI studies, the
NYU level IV epilepsy center stopped ordering PET-CT for their patients and switched exclu-
sively to PET-MRI studies. Eighteen months later in summer 2014, we opened the “­ floodgates”

v
vi Foreword

and agreed to use this new technology to image patients with suspected cognitive impairment
from the NYU Pearl Barlow memory and aging center. Our volume immediately doubled, then
doubled again over the next 18 months. Today, we typically interpret 25–30 clinical neurora-
diology PET-MRI studies a week (~1200 per year) – a volume dominated by cognitive impair-
ment workup, but we also image patients weekly for epilepsy, autoimmune encephalitis, brain,
and neck tumors. Last time I checked in 2016, overall brain PET FDG volume was up 300%
from 2012. We were one of the few sites to contribute to the original IDEAS study with hybrid
PET-MRI data using amyloid tracers and routinely use multiple additional radiotracers in clini-
cal practice and research (e.g., Dotatate, Tau, and TSPO tracers). I would predict that the recent
FDA approval of Aduhelm, the amyloid-lowering immunotherapy from Biogen, also may
increase our volume substantially.
Hybrid PET-MRI has changed our practice and actually changed the way I interpret MRI
even without simultaneous PET. Over time those subtle MRI calls on epilepsy studies I was
wary of mentioning in a conference at a well-known level IV epilepsy center for fear of my life
were corroborated by the simultaneously acquired FDG PET, then subsequent intracranial
EEG and surgical pathology. It is quite humbling to realize that subtle hippocampal sclerosis
you were so excited to detect was just the tip of the iceberg in epilepsy patients and many of
those “icebergs” were not even detectable with state-of-the-art MRI sequences. Conversely,
MRI findings redirected us to recognize subtle extra-temporal FDG abnormalities we missed
on an initial review that correlated well with semiology, EEG, and eventually surgical pathol-
ogy. NYU referrers became very reliant on the PET-MRI reads we provide. Next Monday at
our weekly multidisciplinary conference all four epilepsy patients considering surgery will
have had hybrid FDG PET-MRI first. We had a similar experience changing the workup for
neurodegenerative disease – instead of equivocating on ambiguous FDG PET findings or using
MRI only to assess white matter disease, mass, and hydrocephalus, we started providing con-
stellations of multimodal imaging findings to support workup for specific diagnoses.
Particularly for dementia, we observed a changing role for radiologists in the triage of patients.
Busy general neurology referrers that may not have expertise or time on the initial visit to
distinguish the causes for word-finding difficulty would change their follow-up evaluations
and management based on our PET-MRI report. Conversely, experts in primary progressive
aphasia would use such reports to focus their practice, time, and resources. In epilepsy, neuro-
degenerative disease, and autoimmune encephalitis, you learn quickly you cannot hide from
the limits of sensitivity and specificity for MRI findings we proudly teach residents once you
see the much more obvious findings on simultaneously acquired FDG PET. Previous groups
had shown the advantages of reinterpreting separately acquired PET and MRI together in epi-
lepsy and dementia respectively [1, 2] – we were just turning that into daily clinical practice
with a single efficient imaging session that patients, referrers, and the interpreting radiologists
clearly preferred. I expect this phenomenon to continue and to expand to other common neu-
rologic diseases as the technology and radiochemistry develop.
The biggest challenge to this new paradigm is finding physicians comfortable reading these
studies by themselves, but this also results in the most powerful diagnostic confidence and
efficient workflow. Our rapidly increasing volume showed quite clearly that hybrid PET-MRI
was addressing an unmet need for our referrers – I would come back from 2 weeks of relaxing
summer vacation with 30–40 cases waiting for me! An individual reader needs to be knowl-
edgeable in several diverse areas that Ana, Dinko, and their chapter authors have made sure are
well-covered by this book – neuroanatomy, PET physics and artifacts, potential compromises
in imaging physics associated with hybrid PET-MRI (e.g., attenuation correction), FDG and
various common radiotracers, software visualization tools and limitations. In 2013–15, I’m not
convinced anyone came out of training with that complete skillset. Faculty with dual fellow-
ship training in nuclear medicine and neuroradiology were as common as unicorns with zebra
stripes (that is now changing). Very few nuclear medicine fellowship training programs are
exposing trainees to even 50 FDG PET brain studies per year. I feel there remains a strong need
and responsibility to train more people, and this book will be a tremendous help to that p­ rocess.
Foreword vii

Every year the NYU fellowship program trains 6–7 fellows to read PET-MRI with each fellow
reading more than 100 cases during the year. Some may argue the PET is a waste of time for
“regular” neuroradiologists, but it teaches them humility regarding the limitations of MRI and
makes them better readers. Often we would see something or a question would come up during
read up that I did not have a good answer for or could easily find in the PET literature – this
book offers an up-to-date comprehensive resource for those frequent situations! In a messianic
tone, I always foretell to the fellows that behind the current noise of deep learning, PET-MRI
will revolutionize our field and that if they plan to practice for more than 10 years they will be
reading PET-MRI studies. Ana Franceschi was the fellow who actually listened to me!
With this excellent introductory and first book focused on hybrid PET-MRI in neuroimag-
ing, the secret should be out. I can finally retire my lecture titled “PET-MRI will change neu-
roradiology practice” that I have given over the past 7 years on podcasts and at many US
institutions, national, and international meetings. When reading the chapters of this book, I
encourage readers to think about our collective future. We all may be anxious about “deep
learning” where clinical diagnosis and management are replaced by inscrutable layered algo-
rithms from Skynet based just on existing MRI protocols… yet all the deep learning in the
world could not solve the longitude navigation problem in the 1700s without an accurate clock
(i.e., the right data). PET tracers increase the dimensionality of imaging data and are already
being used to complement big data approaches to clinical imaging challenges in neurological
diseases. The underlying reality is that hybrid PET-MRI is already starting to transform imag-
ing for patients with neurological disease. It is not hard to see areas where imaging can improve
in 2021; the MS patient with stable-appearing MRI that no longer walks unassisted into their
follow-up scan, the young adult patient with smoldering autoimmune encephalitis or TBI that
everyone thinks is just depressed, or patients in the early stages of movement disorders with
normal-appearing MRI. Research with hybrid PET-MRI in carefully characterized clinical
patients should validate new biomarkers particularly with novel MRI contrasts and quantitative
approaches. MRI also transforms PET with dose reduction and increased spatial resolution
using joint reconstruction techniques. The development of new PET tracers will only acceler-
ate this holistic and synergistic process between two dynamic imaging technologies. Ana and
Dinko have picked the perfect time to create a book introducing us to this promising new
technology. I hope you find this book helpful and exciting for the future of diagnostic
neuroimaging.

New York, NY, USA Tim Shepherd

June 2021 Associate Section Chief, NYU Neuroradiology

References
1. Salamon et al. FDG-PET/MRI coegistration improves detection of cortical dysplasia in patients with
epilepsy. Neurology. 2008;71(20):1594-601.
2. Shaffer et al. Predicting cognitive decline in subjects at risk for Alzheimer’s disease by using combined cere-
brospinal fluid, MR imaging, and PET biomarkers. Radiology. 2013;266(2):583-91.
Contents

Part I Introduction to PET/MRI

1 Physics of PET/MRI Systems�������������������������������������������������������������������������������������   3

Paul Vaska and Lemise Saleh
2 PET Radiopharmaceutical Development�����������������������������������������������������������������   9
Peter M. Smith-Jones
3 Attenuation Correction and Quantitative PET Analysis����������������������������������������� 17
Mario Serrano-Sosa, Ana M. Franceschi, and Chuan Huang
4 Motion Correction in PET/MRI ������������������������������������������������������������������������������� 27
Mario Serrano-Sosa and Chuan Huang
5 The Use of Dual Modality PET/MRI in Population Studies:
Considerations on Exposures, Economics, Strengths, and Limitations����������������� 35
Minos Kritikos and Sean A. P. Clouston
6 Introduction to Molecular Neuroimaging Applications ����������������������������������������� 45
Elizabeth Tong and Ghiam Yamin
7 Advanced Neuroimaging for Prevention of Brain Aging ��������������������������������������� 57
Diana A. Hobbs and Cyrus A. Raji
8 AI for Decision Support in Molecular Neuroimaging��������������������������������������������� 67
Guido A. Davidzon and Henry Li
9 Future Trends of PET/MR and Utility of AI in Multi-Modal Imaging����������������� 79
Sheng-Che Hung, Mingxia Liu, Pew-Thian Yap, Dinggang Shen, Weili Lin,
and Mauricio Castillo

Part II Radiotracers in Neurologic PET/MRI

10 [18F]-FDG PET/MR Neuroimaging: Focus on Neuro-Oncology

Applications����������������������������������������������������������������������������������������������������������������� 89
Hossein Shooli, Majid Assadi, and Mariam Aboian
11 Amyloid Imaging in Dementia and Neurodegenerative Disease ��������������������������� 99
Maria Rosana Ponisio, Pooya Iranpour, and Tammie L. S. Benzinger
12 Tau Imaging in Neurodegenerative Dementia��������������������������������������������������������� 111
Maria Rosana Ponisio, Pooya Iranpour, and Tammie L. S. Benzinger
13 FDOPA in Movement Disorders and Neuro-Oncology ����������������������������������������� 121
Maria Rosana Ponisio, Pooya Iranpour, and Tammie L. S. Benzinger

ix
x Contents

14 Amino Acid PET/MRI in Neuro-oncology��������������������������������������������������������������� 137

Hossein Shooli, Majid Assadi, S. Ali Nabavizadeh, and Mariam Aboian
15 Radioligands for Serotonin Receptors and Transporter PET Imaging����������������� 167
Diane J. Kim and Chuan Huang
16 Radioligands for Imaging of the CNS Acetylcholinergic System��������������������������� 179
Mark Slifstein and Anissa Abi-Dargham
17 Microglial Activation and Neuroinflammation ������������������������������������������������������� 191
William Charles Kreisl
18 15O PET Imaging: Methods and Applications ��������������������������������������������������������� 197
Hongyu An, Manu S. Goyal, and William J. Powers
19 [68Ga]-DOTATATE PET in the Central Nervous System��������������������������������������� 217
Michelle Roytman and Jana Ivanidze

Part III Dementia and Neurodegenerative Disease

20 Neurology Evaluation in Dementia and Neurodegenerative Disease��������������������� 227

Luca Giliberto
21 Neuropsychology Assessment in Dementia and
Neurodegenerative Disease����������������������������������������������������������������������������������������� 247
Shawn Mordhorst, Kelly Coulehan, and Emily C. Roseman
22 Alzheimer’s Disease ��������������������������������������������������������������������������������������������������� 257
Michelle Roytman, Marc L. Gordon, and Ana M. Franceschi
23 Cerebral Amyloid Angiopathy����������������������������������������������������������������������������������� 273
Nelly Joseph-Mathurin and Cyrus A. Raji
24 Posterior Cortical Atrophy����������������������������������������������������������������������������������������� 283
Michelle Roytman and Jana Ivanidze
25 Dementia with Lewy Bodies��������������������������������������������������������������������������������������� 291
Jenifer Pitman and Gloria C. Chiang
26 Behavioral Variant Frontotemporal Dementia ������������������������������������������������������� 303
Jeremy Ford and Gloria C. Chiang
27 Logopenic Variant Primary Progressive Aphasia ��������������������������������������������������� 313
Michelle Roytman and Gloria C. Chiang
28 Semantic Variant Primary Progressive Aphasia ����������������������������������������������������� 323
Marc L. Gordon and Ana M. Franceschi
29 Nonfluent-Agrammatic Variant Primary Progressive Aphasia ����������������������������� 337
Michelle Roytman, Marc L. Gordon, and Ana M. Franceschi
30 Progressive Supranuclear Palsy��������������������������������������������������������������������������������� 347
Jenifer Pitman and Jana Ivanidze
31 Multiple System Atrophy������������������������������������������������������������������������������������������� 361
Carlos Zamora, Mitchel A. Muhleman, and Mauricio Castillo
32 Corticobasal Degeneration ��������������������������������������������������������������������������������������� 373
Martin Niethammer
Contents xi

33 Creutzfeldt-Jakob Disease����������������������������������������������������������������������������������������� 387

Ilhami Kovanlikaya and Gloria C. Chiang
34 Amiotrophic Lateral Sclerosis����������������������������������������������������������������������������������� 397
Andrew D. Schweitzer and A. John Tsiouris
35 Huntington’s Disease ������������������������������������������������������������������������������������������������� 411
Carlos Zamora, Mitchel A. Muhleman, and Mauricio Castillo
36 Parkinson’s Disease����������������������������������������������������������������������������������������������������� 421
Martin Niethammer and Ana M. Franceschi
37 Vascular Cognitive Impairment��������������������������������������������������������������������������������� 441
Anand V. Patel and Richard B. Libman
38 Normal Pressure Hydrocephalus������������������������������������������������������������������������������� 459
Ilhami Kovanlikaya and Gloria C. Chiang
39 Crossed Cerebellar Diaschisis����������������������������������������������������������������������������������� 469
Michael Clifton, Kiyon Naser-Tavakolian, and Ana M. Franceschi
40 Traumatic Brain Injury and Chronic Traumatic Encephalopathy����������������������� 479
Mateus Rozalem Aranha, Artur Martins Coutinho, Claudia da Costa Leite,
and Carlos Alberto Buchpiguel

Part IV Epilepsy

41 Epilepsy Localization: Introduction������������������������������������������������������������������������� 495

Andrew Chiu and Michael Zeineh
42 Developmental Disorders and Pediatric Epilepsy��������������������������������������������������� 499
Andrew Chiu and Michael Zeineh
43 Acquired Pathology ��������������������������������������������������������������������������������������������������� 507
Andrew Chiu and Michael Zeineh
44 Treatment Planning ��������������������������������������������������������������������������������������������������� 519
Andrew Chiu and Michael Zeineh
45 Future Trends in Epilepsy Imaging��������������������������������������������������������������������������� 523
Andrew Chiu and Michael Zeineh

Part V Neuro-Oncology

46 Neuro-Oncology: Imaging Diagnosis ����������������������������������������������������������������������� 527

Otto Rapalino
47 Primary Brain Neoplasms����������������������������������������������������������������������������������������� 539
Salma O. Abbas, Sohil H. Patel, and Sugoto Mukherjee
48 Intracranial Metastatic Disease��������������������������������������������������������������������������������� 565
David Joyner and Jeffrey Hooker
49 Treatment Planning ��������������������������������������������������������������������������������������������������� 579
Otto Rapalino
50 Treatment Response��������������������������������������������������������������������������������������������������� 589
Tuba Kalelioglu and Sohil H. Patel
xii Contents

Part VI CNS Inflammatory and Infectious Disease

51 Infectious Disease ������������������������������������������������������������������������������������������������������� 599

Sanaz Ghaderi Niri, Prashant Raghavan, and Max Wintermark
52 Inflammatory Disease������������������������������������������������������������������������������������������������� 611
Sanaz Ghaderi Niri, Prashant Raghavan, and Max Wintermark
53 Demyelinating Disease ����������������������������������������������������������������������������������������������� 617
Sanaz Ghaderi Niri, Prashant Raghavan, and Max Wintermark
54 Vasculitis ��������������������������������������������������������������������������������������������������������������������� 621
Sanaz Ghaderi Niri, Prashant Raghavan, and Max Wintermark

Part VII Hybrid Imaging in Head and Neck

55 Role of PET/MR in Squamous Cell Cancer Staging����������������������������������������������� 627

Gagandeep Choudhary and Houman Sotoudeh
56 Squamous Cell Cancer: Mucosal, Nodal and Extranodal Disease������������������������� 639
Claudia F. E. Kirsch
57 Metastatic Disease in the Head and Neck����������������������������������������������������������������� 657
Houman Sotoudeh and Gagandeep Choudhary
58 Orbital Pathology������������������������������������������������������������������������������������������������������� 671
Vikas Jain, Osama Ahmed, and Ana M. Franceschi
59 Salivary Gland Pathology������������������������������������������������������������������������������������������� 689
Vikas Jain, Osama Ahmed, Mohit Agarwal, and Ana M. Franceschi

Part VIII Spine PET/MRI

60 Spinal Neoplasms ������������������������������������������������������������������������������������������������������� 713

Jolie Jean and Jana Ivanidze
61 Non-Neoplastic Spinal Pathologies��������������������������������������������������������������������������� 723
Jolie Jean, David J. Hastie, and Jana Ivanidze

Part IX Pediatric PET/MRI Neuroimaging

62 Pediatric PET/MRI Neuroimaging: Overview��������������������������������������������������������� 737

Christian Pedersen, Steven Messina, Heike Daldrup-Link, and Mariam Aboian
63 Pediatric Epilepsy: Non-oncologic Applications of PET/MRI������������������������������� 741
Steven Messina, Christian Pedersen, Heike Daldrup-Link, and Mariam Aboian
64 Pediatric Brain and Head-Neck Oncology��������������������������������������������������������������� 753
Christian Pedersen, Steven Messina, Heike Daldrup-Link, and Mariam Aboian
65 Pediatric Spine������������������������������������������������������������������������������������������������������������ 765
Christian Pedersen, Heike-Daldrup Link, and Mariam Aboian
Contents xiii

Part X Vascular Hybrid Imaging

66 Cerebral Small Vessel Disease����������������������������������������������������������������������������������� 781

Bhanu Gogia, Richard B. Libman, and Anand V. Patel
67 Aneurysms and Vascular Malformations����������������������������������������������������������������� 793
Tanvir Rizvi
68 Genetic Stroke Syndromes����������������������������������������������������������������������������������������� 805
Anand V. Patel, Chilvana V. Patel, and Richard B. Libman
69 Perfusion PET and Cerebrovascular Reactivity with Acetazolamide Versus CO2
Challenge��������������������������������������������������������������������������������������������������������������������� 827
Farshad Moradi and Audrey P. Fan
70 Advanced MR Perfusion Techniques ����������������������������������������������������������������������� 839
Jeffers Nguyen and Jana Ivanidze
71 Imaging of Glymphatic Flow and Neurodegeneration ������������������������������������������� 849
Christopher G. Filippi and Richard Watts
Index������������������������������������������������������������������������������������������������������������������������������������� 861
Contributors

Salma O. Abbas Department of Radiology and Medical Imaging, University of Virginia

Health System, Charlottesville, VA, USA
Anissa Abi-Dargham Department of Psychiatry and Behavioral Health, Renaissance School
of Medicine, Stony Brook University,, Stony Brook, NY, USA
Mariam Aboian Yale University School of Medicine, New Haven, CT, USA
Section of Neuroradiology and Nuclear Medicine, Yale School of Medicine, New Haven, CT,
USA
Mohit Agarwal Department of Radiology, Medical College of Wisconsin, Milwaukee, WI,
USA
Osama Ahmed Department of Radiology, Stony Brook University Hospital, Stony Brook,
NY, USA
Hongyu An Mallinckrodt Institute of Radiology, Washington University School of Medicine
in St. Louis, St. Louis, MO, USA
Mateus Rozalem Aranha Laboratory of Magnetic Resonance in Neuroradiology (LIM 44),
Institute of Radiology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São
Paulo (HC-FMUSP), São Paulo, SP, Brazil
Laboratory of Nuclear Medicine (LIM 43), Center of Nuclear Medicine, Institute of Radiology,
Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),
São Paulo, SP, Brazil
Majid Assadi The Persian Gulf Nuclear Medicine Research Center, Department of Molecular
Imaging and Radionuclide Therapy (MIRT), Bushehr Medical University Hospital, Faculty of
Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
Tammie L. S. Benzinger Mallinckrodt Institute of Radiology, Washington University School
of Medicine in St. Louis, St. Louis, MO, USA
Carlos Alberto Buchpiguel Laboratory of Nuclear Medicine (LIM 43), Center of Nuclear
Medicine, Institute of Radiology, Hospital das Clínicas, Faculdade de Medicina da Universidade
de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
Mauricio Castillo Division of Neuroradiology, Department of Radiology, University of
North Carolina School of Medicine, Chapel Hill, NC, USA
Gloria C. Chiang Department of Radiology, NewYork Presbyterian-Weill Cornell Medicine,
New York, NY, USA
NewYork Presbyterian-Weill Cornell, Department of Radiology, New York, NY, USA
Andrew Chiu Stanford University, Department of Radiology, Stanford, CA, USA
Gagandeep Choudhary Department of Radiology, University of Alabama at Birmingham
(UAB), Birmingham, AL, USA

xv
xvi Contributors

Michael Clifton, MD Department of Radiology, Stony Brook Renaissance School of

Medicine/University Hospital, Stony Brook, NY, USA
Sean A. P. Clouston Renaissance School of Medicine, Stony Brook University, Stony Brook,
NY, USA
Artur Martins Coutinho Laboratory of Nuclear Medicine (LIM 43), Center of Nuclear
Medicine, Institute of Radiology, Hospital das Clínicas, Faculdade de Medicina da Universidade
de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
Claudia da Costa Leite Laboratory of Magnetic Resonance in Neuroradiology (LIM 44),
Institute of Radiology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São
Paulo (HC-FMUSP), São Paulo, SP, Brazil
Renaissance School of Medicine at Stony Brook University, Health Sciences Center, Level 4,
Stony Brook, NY, USA
Heike Daldrup-Link Department of Radiology and Molecular Imaging Program at Stanford
(MIPS), Stanford School of Medicine, Stanford, CA, USA
Guido A. Davidzon Division of Nuclear Medicine & Molecular Imaging, Department of
Radiology, Stanford University, Stanford, CA, USA
Audrey P. Fan Department of Neurology, University of California, Davis, CA, USA
Christopher G. Filippi Department of Radiology, Tufts Medical Center, Tufts University
School of Medicine, Boston, MA, USA
Jeremy Ford NewYork Presbyterian-Weill Cornell, Department of Radiology, New York,
NY, USA
Ana M. Franceschi Donald and Barbara Zucker School of Medicine at Hofstra/Northwell,
The Feinstein Institutes for Medical Research, Manhasset, NY, USA
Division of Neuroradiology, Department of Radiology, Lenox Hill Hospital, Northwell Health,
New York, NY, USA
Dinko Franceschi Division of Nuclear Medicine, Department of Radiology, Stony Brook
University Hospital, Renaissance School of Medicine at Stony Brook University, Stony Brook,
NY, USA
Luca Giliberto Litwin-Zucker Center for the Study of Alzheimer’s Disease and Memory
Disorders, Feinstein Institutes for Medical Research and Institute for Neurology and
Neurosurgery, Northwell Health System, Manhasset, NY, USA
Bhanu Gogia Department of Neurology, University of Texas Medical Branch, Galveston,
TX, USA
Marc L. Gordon Zucker Hillside Hospital, Donald and Barbara Zucker School of Medicine
at Northwell/Hofstra, The Litwin-Zucker Research Center, The Feinstein Institutes for Medical
Research, Manhasset, NY, USA
Manu S. Goyal Mallinckrodt Institute of Radiology, Washington University School of
Medicine in St. Louis, St. Louis, MO, USA
David J. Hastie Tufts University School of Medicine, Boston, MA, USA
Diana A. Hobbs Department of Radiology, Washington University School of Medicine, St.
Louis, MO, USA
Jeffrey Hooker Department of Radiology and Medical Imaging, University of Virginia
Health System, Charlottesville, VA, USA
Contributors xvii

Chuan Huang Department of Psychiatry and Behavioral Health, Renaissance School of

Medicine at Stony Brook University, Stony Brook, NY, USA
Department of Radiology, Renaissance School of Medicine at Stony Brook University, Stony
Brook, NY, USA
Sheng-Che Hung Division of Neuroradiology, Department of Radiology, University of North
Carolina School of Medicine, Chapel Hill, NC, USA
Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
Pooya Iranpour Richard L. Roudebush VA Medical Center, Department of Nuclear Medicine,
Indianapolis, IN, USA
Jana Ivanidze, MD, PhD Department of Diagnostic Radiology, Division of Molecular
Imaging and Therapeutics, Division of Neuroradiology, Molecular Imaging Innovations
Institute, Weill Cornell Medicine, Department of Radiology, New York, NY, USA
Vikas Jain MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH,
USA
Jolie Jean Tufts University School of Medicine, Boston, MA, USA
Nelly Joseph-Mathurin Mallinckrodt Institute of Radiology, Washington University School
of Medicine, Saint Louis, MO, USA
David Joyner Department of Radiology and Medical Imaging, University of Virginia Health
System, Charlottesville, VA, USA
Tuba Kalelioglu Department of Radiology and Medical Imaging, UVA Health System,
Charlottesville, VA, USA
Diane J. Kim Department of Psychiatry and Behavioral Health, Renaissance School of
Medicine at Stony Brook University, Stony Brook, NY, USA
Claudia F. E. Kirsch Department of Radiology Northwell Health, Zucker Hofstra School of
Medicine at Northwell, North Shore University Hospital, Manhasset, NY, USA
Ilhami Kovanlikaya NewYork Presbyterian-Weill Cornell, Department of Radiology, New
York, NY, USA
William Charles Kreisl The Taub Institute for Research on Alzheimer’s Disease and the
Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
Minos Kritikos Renaissance School of Medicine, Stony Brook University, Stony Brook, NY,
USA
Richard B. Libman Neurology, Vascular Neurology, Northwell Health Physician Partners
Neuroscience Institute at Great Neck, Great Neck, NY, USA
Henry Li Department of Radiology, Stanford University, Stanford, CA, USA
Heike-Daldrup Link Department of Radiology and Molecular Imaging Program at Stanford
(MIPS), Stanford School of Medicine, Stanford, CA, USA
Weili Lin Division of Neuroradiology, Department of Radiology, University of North Carolina
School of Medicine, Chapel Hill, NC, USA
Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
Mingxia Liu Biomedical Research Imaging Center, University of North Carolina, Chapel
Hill, NC, USA
Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
Steven Messina Radiology (Division of Neuroradiology), Mayo Clinic, Rochester, MN, USA
Other documents randomly have
different content
 heavier at south and
north-east.
6½ E. 21 6 8 61 N Very thick mist to the
north.
27 6 M. 21 7 0 59 NW All the air is covered
with clouds joined
together.
2 E. 21 6 7 64½ N Thick flat clouds
through all the air.
6½ E. 21 6 6 59¾ N Ditto.
28 6 M. 21 7 1 57¾ N Flying but scattered
clouds through all
the air, they come
from east and south.
12 N. 21 6 7 63 SW Thick clouds through all
the air, especially at
S. W.
2 E. 21 6 4 63¾ W by N Clouds throughout all
the air, but blackest
towards north-east,
and north.
6½ E. 21 6 3 61 N Thick clouds, which
come in great
quantities from the
north.
29 6 M. 21 6 7 57¾ WNW Clouds throughout all
the air, but thickest
towards west and
north-west.
12 N. 21 6 5 63½ N Large flying clouds
throughout all the air,
two currents of wind,
one from S. the other
from N.
2 E. 21 6 1 65 NNW Clouds closely united
throughout all the air.
6½ E. 21 6 4 61 N Clouds come from
north-east are very
 low and heavy.
30 6 M. 21 6 6 58 N All the air is covered
with clouds closely
united.
12 N. 21 6 6 61½ W Large clouds flying
through all the air,
they come from
north-west and
north-east.
2 E. 21 6 0 63 N All the air is covered
with clouds.
6½ E. 21 6 2 59½ N The clouds come from
north-east, and are
very thick.
31 6½ M. 21 6 6 58 NW All the air is covered
with clouds.
2 E. 21 6 2 61 WNW Thick united clouds
through all the air.
6½ E. 21 6 2 59 NNE Large flying clouds very
black especially in
the horizon at south
and north, loud
thunder and the sun
covered.
AUG.
1 6 M. 21 6 6 58 NNE Clouds flying
throughout the air.
12 N. 21 6 2 63 W S W Thick flying clouds from
the east, likewise
some come to meet
them from the west.
2 E. 21 5 9 64 W Rain for a few minutes.
6½ E. 21 5 9 60¾ N varying Thick clouds at north
to N N E they come from
north-east.
2 6 M. 21 6 4 57¾ W N W Thick flying clouds
throughout all the air.
2 E. 21 6 6 61½ N N E Rain.
 6½ E. 21 5 9 61½ NNW Great masses of clouds
at north-west.
3 6 M. 21 6 3 58 S W b N All the air is covered
with clouds.
12 N. 21 6 6 59 N It rained for some
minutes.
2 E. 21 6 1 59½ N Flying clouds
throughout the air.
6½ E. 21 6 2 59 N N E Rain, with clouds
united all over the
air.
4 6 M. 21 6 5 58 NW The clouds are joined
all over the air, and a
mist comes from
south.
12 N. 21 6 7 59 NE Heavy clouds
throughout the air, it
rains.
6½ E. 21 6 2 58 N The whole sky is
covered with clouds,
it rains.
5 6 M. 21 6 7 56 N by E All the air is covered
with clouds.
12 N. 21 6 5 60½ W Moderate rain, the
clouds cross from
north-west north and
south-east.
2 E. 21 6 2 58¾ N N E Large flying clouds at
north which come
from east.
6½ E. 21 6 1 58¾ ditto. Large clouds remain in
the horizon.
6 5½ M. 21 6 4 58 ditto. Flying clouds, they
come frequent all
over the air.
12 N. 21 6 4 59½ SW Large clouds all over
the air.
 2 E. 21 6 1 59 NW United clouds through
all the air, and are
very low, a stream of
mist goes constantly
to the S.
6½ E. 21 6 1 59 N All the sky is covered
with thick clouds, the
lowest come from
south very quickly.
7 6 M. 21 7 0 54¾ SW A thick mist covers the
whole air.
12 N. 21 6 5 58 W Ditto.
2 E. 21 6 2 61 SW The clouds heavier to
the south.
6½ E. 21 6 4 56 N b W The clouds are all
joined throughout
the air, there is a
stream of mist
coming from the
north.
8 6 M. 21 6 7 55½ N N W All the air is covered
with clouds, it rains.
12 N. 21 6 5 60 W varying Thick clouds through all
to W S W the air, they come
from south-east, and
north-east.
2 E. 21 6 2 62 S varying Ditto.
to S S W
6½ E. 21 6 2 57¾ N by W Thick clouds
throughout the air
especially at north,
they come from
south-east, small
rain.
9 6 M. 21 6 5 57 NE Thick clouds in great
masses through all
the horizon.
12 N. 21 6 3 60¾ NW Clouds flying
throughout all the air,
 they come from
north and south.
2 E. 21 6 1 61¾ W S W Rain from the north,
and very thick clouds
throughout the air,
they come from
north and south.
6½ E. 21 6 1 58½ N varying Rain and thick clouds
to N W throughout the air.
Two currents of wind,
the one from the
south the other from
the north.
10 6 M. 21 6 9 56¾ NE Thick clouds cover all
the air.
12 N. 21 6 5 60½ W Clouds mixed with
large spaces of clear.
The clouds come
from the east with
great violence
against the wind.
2 E. 21 6 2 60 N N E Thick clouds
throughout the air,
two currents of wind,
one from north-east
the other from north-
west, cross one
another. Thunder in
the W.
6½ E. 21 6 3 58 N All the sky is covered
with thick clouds.
The upper current
from the east, the
next from north, and
the last so low as to
touch the earth.
They cross with great
velocity and force.
11 6 M. 21 6 6 56 NE Clouds cover the whole
face of the sky.
12 N. 21 6 4 61 SE Clouds throughout the
air, the wind in two
currents north and
south.
2 E. 21 6 3 59 N by E Moderate rain the
whole sky overcast
with clouds.
6½ E. 21 6 2 59 N varying Very thick clouds
to N E throughout the air.
Two currents of wind,
the highest from
north, the lowest
from north-east.
12 6½ M. 21 6 9 56½ N N E Light clouds cover the
sky like a veil.
13 12 N. 21 6 6 61¼ W Large clouds near the
horizon, especially at
north north-east.
2 E. 21 6 4 62 NW The sky is overcast
with thick clouds and
closely united at
south.
7½ E. 21 6 2 60 N Black clouds, and very
low in the horizon.
Two currents of
wind, the one east
south-east the other
north, which cross
each other.
14 6½ M. 21 6 9 55½ NE Clouds blowing about
the horizon, the
zenith clear.
12 N. 21 6 4 61½ ditto. A current of clouds
from north and
south, thunder and
 lightning through all
the sky.
2 E. 21 6 3 60 W varying Violent rain, it has
to N thundered two hours
without interval.
6½ E. 21 6 2 58 N N E Large flying clouds
throughout the air.
15 6½ M. 21 6 4 56 W Ditto.
12 N. 21 6 3 61½ N Clouds through all the
air, and it begins to
rain.
6½ E. 21 6 2 60¾ N N E Black clouds. Two
currents of air come
from the N. and S.
along the Mountain
of the Sun. It has
thundered and
lightned [sic] all
afternoon, and the
lightning runs in
sheets upon the
earth like water.
16 6½ M. 21 6 7 57 ditto. The sky overcast with
thick clouds.
12 N. 21 6 6 58 N Ditto.
2 E. 21 6 2 61¼ N N E The sky overcast with
clouds, excepting in
the south, west clear.
6½ E. 21 6 2 60 ditto. Thick clouds
throughout the air.
17 6 M. 21 6 8 56¼ ditto. Thin clouds like a veil
cover the sky.
12 N. 21 6 4 61¾ N Thick black clouds
cover the sky, and
come from N.
2 E. 21 6 3 61½ N varying Clouds as above but
to N N E thickest at south.
 6½ E. 21 6 3 60 N by E Black clouds
throughout the air,
especially at north
west.
18 6 M. 21 6 9 55¾ NE Thin clouds cover the
air like a veil.
12 N. 21 6 4 61¾ NW Very thick clouds
throughout the air, it
rains, clouds come
from north and
south.
2 E. 21 6 4 61¾ NW Ditto.
6½ E. 21 6 4 57¾ N N E Black clouds all over
the air.
19 6½ M. 21 6 8 56½ ditto. Small light clouds fly
throughout the air.
12 N. 21 6 5 61½ ditto. Rain, thunder, and
lightning.
2 E. 21 6 3 58 N by E Black clouds all over
the sky.
6½ E. 21 6 3 60 N N E Ditto.
20 6 M. 21 6 9 56½ ditto. Flying clouds cover the
whole air.
12 N. 21 6 5 61 N N W It begins to rain, clouds
very heavy, they
come from north and
south, and meet in
the zenith.
2 E. 21 6 3 62½ N Great clouds
throughout the air,
the S. W. is clear.
6½ E. 21 6 3 59 N N E Clouds throughout the
air, they come from
the N.
21 6 M. 21 6 9 55¼ ditto. Clear and cloudless.
12 N. 21 6 5 63½ N varying Thick clouds come from
to N N E the south, some
 small ones from the
north.
2 E. 21 6 3 64 NNW Thick clouds cover the
whole air, they come
with great violence
from the north.
6½ E. 21 6 5 59¾ N Thick clouds and very
low from the north,
thunder and rain
without ceasing.
22 12 N. 21 6 4 63 N Clouds with violent rain
thunder and
lightning.
6½ E. 21 6 4 58¾ N Broken clouds
throughout the air,
but black ones come
from the north.
23 6 M. 21 6 8 58 N Flying clouds cover the
air.
12 N. 21 6 4 59¼ N Thick clouds
throughout the air,
but thickest at north.
2 E. 21 6 3 61¾ N by E Thick clouds
throughout the air,
rain in the S.
6½ E. 21 6 3 60¾ NNE Rain and thick clouds.
24 7 M. 21 6 7 57 NE Clear, except a little
hazy at S. S. W.
12 N. 21 6 3 59½ N Thick clouds
throughout the air, it
rains at north.
2 E. 21 6 6 59½ N It rains at east.
6½ E. 21 6 3 58¾ N Rain and thick clouds
throughout the air,
especially in the
west.
25 7 M. 21 7 0 56½ NE Great clouds
throughout the air,
 especially at south
and north, a stream
of dark mist comes
from the south very
low.
12 N. 21 6 6 62 WSW Great and thick clouds
throughout the sky,
especially at south
and north.
2 E. 21 6 5 59½ ditto. Moderate rain, thick
clouds throughout
the sky.
6½ E. 21 6 6 57 N Dark clouds very low
throughout the air, it
is very cold.
26 6½ M. 21 7 0 55½ NNE Light clouds, but
frequent throughout
the air.
12 N. 21 6 7 58¾ W It rains violently
especially from the
south-west.
6½ E. 21 6 4 59 NW Very thick clouds
throughout the air, a
low stream comes
from north.
27 6¼ M. 21 6 8 56 N Light clouds fly
throughout the air,
they come from east
and west.
12 N. 21 6 5 61½ W by S Large thick clouds
especially at north,
the lowest come
from the west.
2½ E. 21 6 4 61½ N Thick clouds in the
horizon, it rains hard,
the air is all covered.
6½ E. 21 6 4 59½ N Thick clouds, all the air
is covered especially
 at south and north.
28 6 M. 21 6 8 57 NE All the air is cloudy.
12 N. 21 6 4 61 N Clouds as above a
stormy rain at north-
west.
2 E. 21 6 4 58 N Thick clouds in the
horizon.
29 6 M. 21 7 0 57 NE Large clouds flying
throughout the air,
especially at south.
12 N. 21 6 5 62 W Wandering clouds
throughout the air.
2 E. 21 6 4 62 NNW Clouds as above, but
thicker.
6½ E. 21 6 4 59 N Large masses of clouds
from the N. W.
30 6 M. 21 6 6 56¾ N Both east and west are
covered with thick
clouds.
12 N. 21 6 4 59 N Great clouds
throughout the air,
violent rain, thunder,
and lightning.
2 E. 21 6 3 63 NNE Large clouds
throughout the air,
and a moderate rain.
6½ E. 21 6 4 58¾ N Very thick clouds
through the whole
horizon, these go in
currents to the
south-west and
north-east, but leave
the zenith clear.
31 6 M. 21 6 5 57 N Light clouds throughout
the air.
12 N. 21 6 3 62 N Flying clouds, but dark
to the south.
 2 E. 21 6 3 64 N Large clouds especially
at south and north.
6½ E. 21 6 3 61 NNE Very thick black clouds
cover the air.
SEPT.
1 6 M. 21 6 8 56½ NE Clear and cloudless.
12 N. 21 6 5 62¾ N Thick clouds cover the
air, they come from
north and south.
2 E. 21 6 3 63 N N E Thunder at south-west.
6½ E. 21 6 4 60 N Dark clouds in the
horizon, especially at
S. W.
2 6 M. 21 6 9 57 NE Clear and cloudless.
12 N. 21 6 4 64 N Thick broken clouds,
they stream from
north and south.
2 E. 21 6 3 65¼ N Ditto.
6½ E. 21 6 3 61¾ —— Clear small clouds in
the horizon at N. W.
and S.
3 6 M. 21 6 6 58¾ N N E Clear.
12 N. 21 6 4 63¾ N Clouds throughout the
air especially at
north, thunder in the
east.
2 E. 21 6 4 63¾ N varying Moderate but constant
to N E rain, coming from the
north-west.
6½ E. 21 6 3 60 N N E Clouds in the horizon to
the north and north-
west.
4 6 M. 21 6 9 56½ N by E Clear.
12 N. 21 6 7 61 E N E Clouds throughout the
air especially at west,
violent thunder and
lightning.
 2 E. 21 6 4 60 NE Clouds throughout the
air, and rain which
seems to be violent
to the westward.
6½ E. 21 6 7 58¾ N Very thick clouds
throughout the air,
especially at east,
south, and south-
west.
5 6 M. 21 7 3 58 NNE All the air is covered
with light clouds.
12 N. 21 7 0 62 N Clouds which have
overcast all the air.
2 E. 21 6 5 63 NNW Ditto.
6½ E. 21 7 0 60¾ NNE Violent rain and clouds
everywhere
especially at N.
6 6 M. 21 7 1 57 NE Small clouds
throughout the air,
they come from the
south and north.
12 N. 21 6 6 63½ NNE Large clouds
throughout the
horizon.
2 E. 21 6 4 66 ditto. Ditto.
6½ E. 21 6 4 61 N Large dark clouds from
the north and east.
7 6 M. 21 6 8 57½ NE Light clouds flying
throughout the air.
12 N. 21 6 7 61½ W A most violent rain,
which began with
north-east winds, but
changed to west, and
ended in a hail
shower.
2 E. 21 4 0 62 NE Rain and thick clouds,
the rain comes most
 violently from north-
west.
6½ E. 21 6 4 60 N The clouds are united
through the whole
air.
8 6 M. 21 7 2 67 NE Light clouds in the
horizon.
12 N. 21 6 6 65 W N W Ditto.
2 E. 21 6 4 67 NW Ditto.
6½ E. 21 6 5 63½ N Low dark clouds in the
north-west and
south-west.
9 6½ M. 21 7 3 58¾ NE Small white clouds
scattered through
the horizon.
12 N. 21 6 7 67½ SE Light small clouds
through the air.
2 E. 21 6 5 68½ NE Great clouds through
all the horizon.
6½ E. 21 6 5 66 N N E Black clouds in the
horizon to the W. N.
W. and S. W.
10 6 M. 21 7 2 58¼ NW Clear and cloudless.
12 N. 21 6 6 68½ E varying Thick clouds
to N E throughout the air.
2 E. 21 6 5 69 N N E Small flying clouds
throughout the air.
6½ E. 21 6 6 64 ditto. Large clouds occupy
the air.
11 6 M. 21 7 0 60¾ N Ditto.
12 N. 21 6 5 66½ N N E Ditto.
2 E. 21 6 4 65 NE Violent rain from N. E.
and the whole sky
overcast.
6½ E. 21 6 5 69¼ N varying Thick clouds
to N E throughout the air.
12 6½ M. 21 7 0 57½ N Light clouds cover the
sky like a veil.
12 N. 21 6 5 65 N Clouds cover the air
which come from the
north-east.
6½ E. 21 6 5 61 N by E Light clouds towards
the zenith, heavy
ones towards the
horizon at north and
west, lightning at
west.
13 6 M. 21 6 9 67 N N E Clear.
12 N. 21 6 4 65¾ W S W White clouds fly
throughout the air,
which come from
north-east and
south-west.
2 E. 21 6 4 65 N Clouds as above but
more frequent.
6½ E. 21 6 3 62 N Large black clouds in
the horizon at south.
14 6 M. 21 6 9 58¾ N N E Clouds cover the whole
air.
12 N. 21 6 4 65 N N W Large clouds from N.
W. and S. E.
2 E. 21 6 3 65 ditto. Large clouds thro' the
whole air.
6½ E. 21 6 3 63 N varying Black clouds in the
to W horizon at north.
15 6¼ M. 21 6 8 59 N N E Ditto.
12 N. 21 6 4 66 S varying Ditto.
to S E
2 E. 21 6 3 66 N The clouds are lighter.
6½ E. 21 6 5 61 N All the air is covered
with thick clouds,
lightning at north-
west.
16 6½ M. 21 7 2 59 NNE The whole air is
covered with thick
clouds.
12 N. 21 6 7 61¾ W S W Ditto.
2 E. 21 6 4 65 ditto. Ditto.
6½ E. 21 6 5 61 N It rains violently, the
sky all overcast.
17 6 M. 21 7 2 58¼ N N E The sky clear, except a
small cloud in the
horizon at west.
12 N. 21 6 6 65 NW Great clouds cover the
air, which come
north-east and
south-west.
6½ E. 21 6 4 62 N Thick clouds to the
horizon.
18 6 M. 21 7 0 58¼ NE Clear.
12 N. 21 6 4 67 E Clouds fly through the
air.
2½ E. 21 6 4 67 N varying Ditto.
to N N W
6½ E. 21 6 4 62 N Ditto.
19 6 M. 21 6 8 58½ NE Clear.
12 N. 21 6 4 66 N by E Many clouds
throughout the air.
2 E. 21 6 4 64¾ ditto. Large clouds darken
the whole air.
6½ E. 21 6 4 63 ditto. All the air is covered
with clouds.
20 6 M. 21 6 8 59 NE Light clouds cover the
air thicker towards
the horizon.
12 N. 21 6 4 66 NW Thick clouds
throughout the air,
they come from
west.
6¼ E. 21 6 6 60½ NE Ditto.
21 6 M. 21 7 0 57 N by E Clear.
12 N. 21 6 5 60¾ NW A quantity of black
clouds throughout
the horizon, they
move from the north-
east.
2 E. 21 6 4 64 ditto. Ditto.
6½ E. 21 6 5 64 NE Thick clouds
throughout the air,
the lower current
comes from the
south the other from
north-east.
22 6 M. 21 6 7 57½ NE Clear everywhere,
excepting one cloud
in the horizon to the
west
12 N. 21 6 3 67 S A dark cloud is split
into many and covers
the whole air.
2 E. 21 6 3 68 NNE Flying white clouds
throughout the air.
6½ E. 21 6 3 63½ NE Small rain, the clouds
are thick and heavy,
they come with the
wind from north-
east.
23 6 M. 21 6 4 58 ditto. Clear small clouds to
the horizon at west.
12 N. 21 6 3 67 ditto. Thick heavy clouds
throughout the air,
which come from
north-east.
2 E. 21 6 4 65 NW Thick clouds and
thunder at west.
6¼ E. 21 6 3 61 NE Thick black clouds
throughout the air.
24 6 M. 21 6 8 58 ditto. Ditto.
 12 N. 21 6 3 65¾ SE Ditto.
2 E. 21 6 3 65¼ NW Ditto.
6¼ E. 21 6 3 63 N Thick heavy clouds
throughout the air,
especially at south
and west.
25 6 M. 21 6 4 59 NE Thin clouds cover the
whole air.
12 N. 21 6 3 66½ ENE Ditto.
2 E. 21 6 2 68 NW Ditto.
6½ E. 21 6 3 62 N The clouds are heavier.
26 6¼ M. 21 6 6 59 NE Ditto.
12 N. 21 6 3 68 E by N Strong squalls of wind
come in starts, white
clouds through the
air, coming from
north-east.
2 E. 21 6 2 68¾ NE Ditto.
6½ E. 21 6 2 65 N Clear.
27 6 M. 21 6 8 69¼ NNE Clear.
12 N. 21 6 3 68 E by N Ditto.—But a few flying
clouds.
2 E. 21 6 2 69¾ NE Thick clouds scattered
about the air.
6½ E. 21 6 3 63 WNW Black clouds in the
horizon to the S. and
W.
28 6 M. 21 7 1 57¾ NE Small black clouds
flying in the west.
12 N. 21 6 4 68 ditto. Small white clouds in
the north, north-east
and north-west.
2 E. 21 6 3 70 ditto. Ditto.
6½ E. 21 6 3 64 N Clear, excepting a few
small clouds to the
W.
29 6 M. 21 7 0 58 NE Clear.
12 N. 21 6 4 67¾ ESE Ditto.
2 E. 21 6 3 69 ditto. Ditto.
6½ E. 21 6 3 66½ N Flying clouds
throughout the air,
they come from the
E. N. E. and S. E.
30 6 M. 21 6 7 58¾ NE Clear.
2 E. 21 6 3 70 ESE White clouds
throughout the air.
6½ E. 21 6 4 66 N Clear except a few
small clouds in the
horizon to the west.
OCT.
1 6 M. 21 6 9 58 NE Clear, only a few small
clouds at south-west.
12 N. 21 6 4 69 W Clouds cover the whole
air.
6½ E. 21 6 4 66 N by W Clear.
2 6 M. 21 6 8 59½ NE Ditto.
12 N. 21 6 4 69½ ditto. Ditto.
2 E. 21 6 3 69 N Clouds throughout the
whole air, clear in the
E.
6½ E. 21 6 4 66 N Clear, excepting a very
few small clouds at
south-east and
south-west.
3 6 M. 21 6 6 60 NNE Clear.
12 N. 21 6 3 69½ NE Ditto.
6½ E. 21 6 2 67½ N Ditto.
4 6 M. 21 6 4 60 NE Clear till mid-day, it
then overcast and
rained an hour with
violent thunder and
lightning.
 12 N. 21 6 3 64 N varying Thick clouds near the
to N W horizon at north-west
and south-west.
5 6 M. 21 6 7 60 N Light clouds throughout
the air.
12 N. 21 6 3 64 N Small rain, the whole
sky overcast; it
thunders.
2 E. 21 6 3 63 N Clouds throughout the
air, a little rain at S.
W.
6½ E. 21 6 2 61½ N Clouds throughout the
air.
6 6 M. 21 6 9 58 NE Ditto.
12 N. 21 6 2 68 E Ditto.
6½ E. 21 6 2 64 N by E Ditto.
7 6 M. 21 6 6 59 ditto. Clear.
12 N. 21 6 2 68½ NE Clouds flying through
the air.
2 E. 21 6 1 67 N by E The sky is overcast, but
the sun appears
sometimes.
3½ E. 21 6 1 67 NE Rain and violent large
hail, it lasted about
half an hour, and
came from the south
against the wind,
some of the hail
nearly half an inch
round. It lay upon
the Mountain of the
Sun near one hour
without melting.
6½ E. 21 6 2 61¾ N Many clouds through
the air.
8 6 M. 21 6 7 58½ N Light clouds flying
through the air.
12 N. 21 6 2 65½ NE Ditto.
 2 E. 21 6 1 67 NW Ditto.
6½ E. 21 6 0 61½ N Clear, unless some
clouds in the east
and west near the
horizon.
9 6½ M. 21 6 8 58 N Small clouds scattered
thro' the air.
12 N. 21 6 0 66 S Large clouds come
from south-west.
6½ E. 21 6 1 60 NE Dark clouds throughout
the air.
10 6½ M. 21 6 6 57¾ ditto. Clear.
12 N. 21 6 2 64 ditto. Clouds flying
throughout the air,
the sun covered.
6½ E. 21 6 3 61 ditto. Violent rain thunder
and lightning.
11 6½ M. 21 6 6 57¾ ditto. Clear, only some small
clouds in the horizon
at N. W. south and
south-west.
12 N. 21 6 4 63 SW White flying clouds
from the S. E. and
south-west.
2 E. 21 6 1 60¾ N The sky is overcast,
and there is
appearance of rain.
6½ E. 21 6 3 60 N The air overcast with
thick clouds.
12 6½ M. 21 6 8 56 NE Thin flying clouds
throughout the air.
12 N. 21 6 2 63¾ WSW Thin white clouds to
the west and to the
north.
2 E. 21 6 0 65¾ N Large moving clouds
throughout the air.
6½ E. 21 6 1 63½ NE Ditto.
13 12 N. 21 6 1 64¾ N by W Ditto, the sun covered.
14 6½ E. 21 6 0 63 N All the air is covered
with clouds.
15 6½ M. 21 6 2 58¾ NE Clear.
12 N. 21 6 1 66 ditto. Light flying clouds
throughout the air.
2 E. 21 6 0 65 N Clear.
16 6½ M. 21 6 5 58¾ NNE Ditto.
12 N. 21 6 2 66¾ NW Ditto.
2 E. 21 6 0 69½ W White clouds flying
throughout the air.
6½ E. 21 6 0 66 N Ditto.—They come from
south-east.
17 6½ M. 21 6 9 59 NE Clear.
12 N. 21 6 1 67 SW Cloudy.
2 E. 21 6 1 69 N White clouds come
from the south-east.
6½ E. 21 6 1 66 W Clear.
18 6½ M. 21 6 3 59 NE Ditto.
12 N. 21 6 1 67 NW Clouds throughout the
air.
2 E. 21 6 0 67¾ N by W Ditto.
6½ E. 21 6 0 65 N Clear.
19 6½ M. 21 6 1 59¾ N by E Thin clouds like a veil
cover the whole sky.
12 N. 21 6 1 67¼ ditto. White flying clouds
throughout the air.
2 E. 21 6 0 69½ SW Ditto.
6½ E. 21 6 0 65¾ NW Ditto.
20 6½ M. 21 6 4 58¾ NE Ditto.
12 N. 21 6 1 67 NNE Small flying clouds
throughout the air.
2 E. 21 6 0 67½ N by E Ditto.
6½ E. 21 6 1 65 N by E Ditto.
21 6½ M. 21 6 4 59½ NE Ditto.
 12 N. 21 6 0 67¾ NNE Ditto.
2 E. 21 6 0 69¾ NW Ditto.
6½ E. 21 6 1 67 N Ditto.
22 6½ M. 21 6 4 61 NE Clear.
12 N. 21 6 0 68¾ SSW White flying clouds
throughout the air,
the sun is sometimes
darkened.
2 E. 21 6 0 70 N Ditto.
6½ E. 21 6 0 67 N Clear.
23 6½ M. 21 6 1 61 N by E Ditto.
½ P. M. 21 6 0 69 SW White clouds flying
throughout the air.
2 E. 21 5 9 69¼ WSW There has fallen three
or four small
showers.
6½ E. 21 6 0 66¾ N Thick clouds
throughout the air.
24 6½ M. 21 6 2 61 NE Clear.
12 N. 21 6 0 66¼ N Flying clouds
throughout the air,
they come from N. E.
and S. E.
2 E. 21 5 8 66¾ NW The sky overcast, small
showers and thunder.
6½ E. 21 6 0 65 N Clear.
NOV.
20 12 M 21 4 9 71 N b N W Flying clouds
throughout the air.
2 E. 21 4 5 72 N N W Ditto.
6 E. 21 5 5 69½ N Black clouds near the
horizon.
21 6 M. 21 6 6 60 NE Clear.
12 N. 21 5 7 71 W varying Ditto.
to S W
 2 E. 21 5 1 73 W Little clouds flying
throughout the air,
they come from
north-east.
6 E. 21 5 7 69½ N Clear.
22 6 M. 21 6 7 61 NE Ditto.
12 N. 21 5 5 71 W Flying clouds
throughout the air.
2 E. 21 4 9 74 W Ditto.
6½ E. 21 5 7 69 NE Black clouds in the
horizon at west.
23 6 M. 21 6 5 61 ditto. Clear.
12 N. 21 5 4 71 W Light clouds throughout
the air.
2 E. 21 4 8 74 N by W Ditto.
6 E. 21 5 4 69 NW Clear.
24 6 M. 21 6 2 61 N by E Ditto.
12 N. 21 4 9 72 WSW White clouds flying
throughout the air,
they come from
north-east.
2 E. 21 4 7 71 W Ditto.
6 E. 21 5 3 70 NNW All the south is covered
with thick clouds.
25 6 M. 21 6 3 60½ NE Clear, only a thin veil
covers the sky south.
12 N. 21 5 2 70 NNE Ditto.
2 E. 21 4 8 71 NW Ditto.
6 E. 21 5 8 64½ SSW All the sky is covered
with very thick
clouds, which come
from north-east.
26 6½ M. 21 6 3 59 N Small spotted clouds
near the horizon, all
the rest clear.
12 N. 21 6 5 68 NNW The air is covered with
clouds which come
 from the south.
2 E. 21 5 0 70½ NE Small white clouds
throughout the
horizon.
6 E. 21 6 5 66 N N W Clear, only small clouds
in the horizon, at
north.
27 6½ M. 21 6 2 59½ N Ditto.
12 N. 21 5 6 60 W S W A quantity of clouds
thro' the whole air,
especially at south.
2 E. 21 5 2 69 NW Clouds as above, there
have been three
blasts of wind which
lasted for about half
a minute each, then
calmed.
6 E. 21 5 5 67 N N W Clear.
28 6½ M. 21 6 4 60½ N Clear, except a few
small clouds to the
W. S. W.
12 N. 21 5 8 69 N b W Flying clouds
throughout the air,
the sun is covered.
2 E. 21 5 2 71 ditto. Flying clouds from the
south.
6 E. 21 5 7 67 N N W Light clouds like a veil.
29 6½ M. 21 6 8 59 N N E Clear and cloudless.
12 N. 21 5 8 69 NW Clouds flying
throughout the air,
especially at south,
the sun is covered.
6 E. 21 5 8 65½ ditto. Clear and cloudless.
30 6½ M. 21 6 9 59 W N W Thin clouds throughout
the air.
12 N. 21 6 0 69½ N varying Thick clouds
to N W throughout the air,