Clinical Neuroradiology最新文献

Background: Sex-related differences in outcomes after mechanical thrombectomy (MT) for distal medium vessel occlusion (DMVO) stroke remain uncertain. While unadjusted differences have been reported in stroke populations, it is unclear whether biological sex independently influences outcomes after accounting for major prognostic factors.

Methods: We performed a retrospective, multicenter analysis of the MAD-MT registry. Patients with acute DMVO who underwent MT were included. Propensity score matching (PSM) was employed. The primary outcome was functional independence (modified Rankin Scale [mRS] score 0-2) at 90 days. Secondary outcomes included excellent outcome (mRS 0-1), day 1 NIHSS shift, and reperfusion success. Safety outcomes included mortality and symptomatic intracerebral hemorrhage.

Results: Before matching, 1147 females and 1062 males were included. After 1:1 PSM (748 patients in each group), the groups were balanced in baseline characteristics. The median age was 75 years in both groups. At 90 days, 51% of females and 54% of males achieved mRS 0-2 (P = 0.38). NIHSS shift from baseline to day 1 was similar (median -2 in both groups), and successful reperfusion (Thrombolysis in Cerebral Infarction 2b-3) was achieved in 86% of females and 89% of males (P = 0.18). Mortality was 18.4% in females and 15.5% in males (P = 0.11). Symptomatic intracerebral hemorrhage occurred in 8.3% of females and 7.7% of males (P = 0.67).

Conclusions: After adjustment for age, baseline disability, and vascular risk factors, biological sex was not independently associated with functional or safety outcomes following mechanical thrombectomy for DMVO stroke.

Background: Mechanical thrombectomy (MT) is the standard treatment for acute posterior circulation artery occlusion (PCAO), but predicting outcomes remains challenging. Existing prognostic models combine clinical, imaging, and procedural variables but show inconsistent performance. Our objective is to evaluate the diagnostic accuracy of Machine Learning (ML) models in predicting favorable functional outcomes of thrombectomy for acute PCAO.

Methods: We conducted a systematic review and bivariate diagnostic meta-analysis of PubMed, Embase, and Web of Science. Eligible studies evaluated ML predicting favorable outcomes (Modified Rankin Scale of 0 to 3 at hospital discharge or at 90 days) after MT for PCAO. Pooled sensitivity, specificity, and area under the summary receiver operating characteristic curve (AUC) were calculated with a bivariate random-effects model.

Results: Five studies including 1739 patients met inclusion criteria. Pooled sensitivity was 78% (95% CI: 59-89%; I² = 89.29%) and specificity was 80% (95% CI: 74-85%; I² = 46.06%) for a favorable outcome. The Summary Receiver Operating Characteristic (SROC) curve yielded an AUC of 83% (95% CI: 80-86%). Subgroup analyses revealed that studies including patients with successful reperfusion (mTICI ≥ 2b) had significantly lower sensitivity and specificity. Random forest-based models achieved greater specificity, and multicenter studies demonstrated inferior specificity compared to single-center designs.

Conclusions: ML models demonstrate good diagnostic accuracy in predicting functional outcomes after thrombectomy for acute PCAO. Integration of these models into clinical practice may support individualized decision-making and resource allocation, although prospective validation and improved reporting are needed before routine implementation.

Purpose: This study aimed to assess the utility of dual-energy computed tomography (DECT) for evaluating carotid plaque vulnerability.

Methods: This prospective observational study included consecutive patients who underwent DECT for preoperative evaluation of carotid plaques before elective carotid artery stenting between June 2023 and May 2025. DECT parameters-including effective atomic number (Z), electron density (Rho), virtual non-contrast CT value (VNC), fat fraction (FF), and iodine concentration (IC)-were measured. Relative signal intensity (rSI) was calculated on T1-weighted magnetic resonance images as the ratio of plaque to adjacent sternocleidomastoid muscle signal.

Results: A total of 46 carotid plaques, asymptomatic (n = 27) and symptomatic (n = 19), were analyzed. Both Rho and VNC were significantly lower in symptomatic compared to asymptomatic lesions (Rho, 29.6 [IQR, 26.5-33.6] vs 37.4 [IQR, 30.4-42.7], p < 0.05; VNC, 25.0 [IQR, 19.5-30.9] vs 31.2 [IQR, 21.9-41.4], p < 0.05), and FF was significantly higher in symptomatic compared to asymptomatic ones (21.5 [IQR, 17.4-23.3] vs 15.1 [IQR, 11.6-20.1], p < 0.05). No significant correlation was observed between the rSI and any of the DECT parameters. Multivariate logistic regression analysis showed that FF was significantly associated with symptomatic lesions in a model including rSI and VNC (OR, 1.39 [95% CI, 1.03-1.99], p < 0.05). Receiver operating characteristic analysis showed that adding FF to rSI improved discrimination of symptomatic plaques compared with rSI alone (AUC, 0.792 vs 0.560, p < 0.05).

Conclusion: In this exploratory study, DECT-derived FF was associated with symptomatic carotid plaques and may provide complementary information beyond MRI-based plaque assessment in patients with moderate-to-severe carotid artery stenosis.

Purpose: Emergent intracranial stenting (EICS) has demonstrated efficacy in managing intracranial stenosis in patients undergoing mechanical thrombectomy (MT) for acute ischemic stroke. However, an optimal pharmacological regimen balancing thrombosis prevention and hemorrhagic risk following stent deployment remains undefined. This study aimed to assess the safety and efficacy of prophylactic low-dose intra-arterial Eptifibatide following EICS.

Methods: This single-center retrospective study included 57 consecutive patients who underwent EICS following MT due to an underlying intracranial stenosis. Patients received intravenous heparin and Aspirin pre-stenting, followed by prophylactic low-dose intra-arterial Eptifibatide post-stenting. Univariate and multivariable logistic regression analyses were conducted to identify factors associated with 90-day functional outcomes, categorized as favorable (modified Rankin Scale [mRS] 0-2) and non-favorable (mRS 3-6).

Results: Among 57 patients who underwent EICS, 93.0% (n = 53) received a balloon-mounted coronary stent. Successful recanalization (TICI 2b/3) was achieved in 93.0% of cases. Intracranial hemorrhage was detected in 8.8% within 24 h post-procedure. The median mRS score at 90 days was 3.5 (IQR 1-6), with 40.4% of patients achieving favorable functional outcomes (mRS 0-2). Advanced age was independently associated with a non-favorable functional prognosis (OR = 1.06, 95% CI: 1.00-1.11, P = 0.034).

Conclusions: In cases of MT requiring EICS, the administration of low-dose intra-arterial Eptifibatide immediately post-stenting, in addition to post-procedure dual anti-platelet therapy, demonstrated high recanalization rates with a favorable safety profile.

Purpose: Embolic basilar artery occlusion (eBAO) is less common than embolic anterior circulation stroke. The anatomic basis for this discrepancy is not understood. Vertebral artery dominance (VAD) correlates with blood flow to the basilar artery. We hypothesized that left VAD is less common in eBAO, as the right vertebral artery is the more proximal to the heart in typical aortic arch anatomy.

Methods: This retrospective single-center, case-control study identified cases of eBAO. Right, left, and co-dominant (RVAD, LVAD, and CVAD) prevalence was calculated in standardized fashion by CTA. To estimate the VAD prevalence in asymptomatic patients, a systematic review and metanalysis was performed. The pooled estimate of VAD prevalence in the asymptomatic group was compared to the eBAO cohort using χ² test.

Results: In total, 72 eBAO were identified in the institutional cohort, and prevalence of LVAD, RVAD, and CVAD was 23.6%, 33.3%, and 43.1% respectively. Systematic review included eight studies and 1813 asymptomatic patients. Mean VAD prevalence in the asymptomatic population was LVAD 47.0% (39.0-55.1%), RVAD 26.9% (22.7-31.5%), and CVAD 25.9% (18.8-34.7%). VAD proportions differed significantly in the eBAO group (p < 0.001), with lower proportion of LVAD (OR 0.37, CI 0.20-0.67, p < 0.001), higher proportion of CVAD (OR 1.89, CI 1.13-3.13, p = 0.01) but no difference in RVAD (1.39, CI 0.81-2.35, p = 0.22).

Conclusion: LVAD is significantly less common in patients with eBAO compared to asymptomatic patients. Non-LVAD anatomy (RVAD and CVAD) may represent a novel anatomic risk factor for eBAO. This finding could influence techniques for endovascular thrombectomy.

Purpose: Imaging modalities, particularly magnetic resonance imaging (MRI), have become the gold standard for assessing lesion characteristics of traumatic spinal cord injuries (SCI). Diffusion tensor imaging (DTI), an advanced MRI technique, offers insights into microstructural changes in white matter tracts. While previous studies focused on either acute or chronic SCI, few have examined longitudinal changes during the transition from acute to chronic stages of injury. This study addresses this gap by analyzing the evolution of DTI metrics over the first year following cervical SCI.

Methods: This prospective longitudinal study involved 52 patients with traumatic cervical SCI. MRI and neurological examinations using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) were performed 1 month, 3 months, and 1 year post-injury. Linear mixed model analyses assessed DTI measures over time.

Results: Fractional anisotropy (FA) values gradually decreased in the reference area at the cranio-cervical junction (C0-C4; p < 0.001), indicating ongoing tissue degeneration up to one year after injury, independent of initial clinical severity. FA values at the lesion site correlated moderately with the total motor score 1 month post-SCI (R = 0.37, p = 0.033). Mean diffusivity (MD) increased significantly over time (p < 0.001), suggesting progressive microstructural changes. Axial diffusivity (AD) decreased until 3 months after injury (p < 0.001), then returned to its initial values by 1 year, reflecting dynamic pathophysiological events.

Conclusion: This study highlights the potential of DTI for monitoring microstructural changes after SCI. Longitudinal imaging offers insights into evolving pathology, supports prognostic modeling, and may aid treatment monitoring and outcome prediction.

Purpose: When amyotrophic lateral sclerosis (ALS), a TDP-43 proteinopathy, and progressive supranuclear palsy (PSP), a tauopathy, are associated with frontotemporal dementia (ALS-FTD or PSP-FTD), clinical differentiation can be challenging. There are no established imaging biomarkers to differentiate ALS-FTD from PSP-FTD.

Methods: We evaluated the midsagittal midbrain area (MBA) and the midbrain-to-pons-(MB/P)-ratios in T1 MPRAGE MRI of 36 PSP cases (n = 14 PSP-FTD), 77 ALS cases (n = 10 ALS-FTD), and 72 healthy controls (HC).

Results: In ALS, both parameters were indistinguishable from HC. Patients with ALS-FTD had low MBA-values and MB/P-ratios not significantly different from cases of PSP. While ROC-analyses provided an excellent diagnostic accuracy of both parameters for differentiating PSP from HC (AUC_MBA = 0.974) as well as PSP from ALS (AUC_MBA = 0.982), midbrain morphometry provided poor diagnostic accuracy for distinguishing ALS-FTD from PSP-FTD (AUC_MBA = 0,614).

Conclusion: The MBA and the MB/P-ratio are morphometric parameters that have proven reliable in atypical Parkinsonian syndromes. Both can distinguish between PSP and ALS in their typical clinical forms. However, they cannot differentiate between PSP-FTD and ALS-FTD.