Clinical Neuroradiology最新文献

Objectives: Throughout the pandemic, it has become evident that COVID-19 should be recognized as a systemic disease that can affect the coagulation system, potentially resulting in arterial thrombotic events (ATE) with partially bulky free-floating clots. This study aimed to investigate the incidence and imaging characteristics of ATE in hospitalized patients with COVID-19 using clinical and imaging data.

Methods: From January 2020 to May 2021, databases of five German tertiary care centers were retrospectively screened for COVID-19 patients with coincidental ATE. ATE were analyzed for localization, time of occurrence, imaging characteristics, and associations with clinical data and laboratory parameters.

Results: Out of 3267 patients, 110 ATE (102 patients, mean age, 72.01 ± 15.64 years; 63 men) were observed in the presence of COVID-19 (3.1%). ATE included ischemic stroke (40%), myocardial infarction (46.4%, %), peripheral infarction (3.6%), thrombi in precerebral arteries (3.6%), mesenteric ischemia (2.7%), thrombi in the aorta (1.8%), splenic infarction (0.9%), and kidney infarction (0.9%). The median time interval between the onset of typical respiratory COVID-19 symptoms and ATE was four days (range, -5-58, negative values indicate ATE prior to symptom onset). A significant percentage of patients exhibited ATEs with an atypical free-floating appearance (10.0%) and multiple occlusions (21.2%).

Conclusion: COVID-19 is a systemic disease associated with ATE in all vascular regions, with a predilection for the heart and brain. The incidence of ATE might be higher than in comparable viral infections and ATE possibly exhibit distinct imaging features rarely seen, such as bulky free-floating clot masses and multiple occlusions. ATE occur most frequently during the first week around the COVID-19 diagnosis.

Background and purpose: Venous outflow (VO) impairment predicts unfavorable outcomes in patients with acute ischemic stroke caused by large vessel occlusion (AIS-LVO). Prolonged venous transit (PVT), a visual qualitative VO marker on CT perfusion (CTP) time to maximum (Tmax) maps, has been associated with 90-day mortality despite successful reperfusion. This study investigates the association between PVT and modified Rankin Scale (mRS) score at discharge among AIS-LVO patients who have undergone successful reperfusion.

Methods: We performed a retrospective analysis of prospectively collected data from consecutive adult AIS-LVO patients with successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/2c/3). PVT+ was defined as Tmax ≥ 10 s in at least one of the following locations: superior sagittal sinus and/or torcula. The primary outcome was dichotomous mRS scores at discharge (favorable: mRS 0-2; unfavorable: mRS 3-6). Regression analyses were performed to assess the effect of PVT on discharge mRS.

Results: In 119 patients of median (IQR) age 71 (63-81) years, a significantly higher proportion of PVT+ patients exhibited unfavorable mRS scores compared to PVT- patients (88.8% vs. 62.7%, p = 0.004). After adjusting for age, sex, hyperlipidemia, diabetes, history of stroke or transient ischemic attack (TIA), tobacco use, administration of intravenous thrombolysis (IVT), admission National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early CT (ASPECTS) score, and ischemic core volume, the PVT+ remains significantly associated with unfavorable mRS (OR = 0.231, 95%CI 0.054-0.980, p = 0.047).

Conclusions: PVT+ was significantly associated with unfavorable mRS at discharge despite successful reperfusion in AIS-LVO patients, underscoring the importance of VO impairment in short-term functional outcomes. PVT serves as a valuable adjunct imaging biomarker derived from CTP for assessing VO profiles in AIS-LVO.

Purpose: The etiopathogenesis of fibromyalgia (FM), which affects millions of people worldwide, is still debated. Recent research provides significant evidence that there are changes in the functions of the central and peripheral nervous systems and the sense of smell. This study analyzed the clinical assessment results of the sense of smell in individuals with FM and examined the olfactory-related structures in the nervous system.

Methods: Thirty patients with FM and 31 age- and sex-matched asymptomatic controls participated in this cross-sectional study. Participants' sense of smell was assessed with the Connecticut Chemosensory Clinical Research Center (CCCRC) including the Butanol threshold test (BET) and Smell Identification Tests. The total number of fibers, mean fiber length, the ratio of the number of fibers in this pathway to the number of fibers in the whole brain of the same individual, fractional anisotropy (FA), mean diffusion (MD), axial diffusion (AD) and radial diffusion (RD) values were calculated by tractography. Additionally, entorhinal cortex volume calculation was performed in MriStudio and MriCloud software using Diffusion tensor imaging (DTI) data in DICOM format.

Results: The BET and CCCRC test scores were lower in the FM group (p < 0.05). Similarly, the mean FA values of the olfactory tract were lower on both the right and left sides in the FM group (p < 0.05). However, the entorhinal cortex volumes were similar, and there was no correlation between the right and left FA values of the olfactory tract and the BET scores or CCCRC scores in both groups (p > 0.05).

Conclusion: Our study, which included participants' self-assessments and data obtained from central nervous system (CNS) images, supports the idea that individuals with FM have a decreased olfactory function. Decreased FA values in individuals with FM may be an indicator of impaired myelin structure and axonal adaptation in individuals with FM.

Background: Patients with aneurysmal subarachnoid haemorrhage (aSAH) often receive multiple radiation based diagnostic studies. Cumulative radiation exposure has been associated with long term health consequences from both dose dependent deterministic harm and increased risk of developing adverse events in a non-dose dependant manner i.e. stochastic harm.

Objective: The objective was to calculate cumulative radiation exposure in the acute phase after aSAH.

Design, setting, participants, main outcome measures: Single centre retrospective, observational study of consecutive adult patients admitted to the ICU for management of aSAH over five years. Organ and effective radiation doses were determined using institution specific conversion coefficients based on scanner radiation output metrics for all computed tomography imaging and fluoroscopy examinations. Calculated patient doses for the duration of the hospital admission were determined using National Cancer Institute radiation dosimetry tools.

Results: A total of 276 patients met the inclusion criteria; 180 females (65%), mean (SD) age 56 (13) years. There were 222 (80%) patients who survived to hospital discharge. The median [IQR] effective cumulative radiation dose was 17.7 [9.7-30.5] mSv. Twenty-one patients (8%) received an effective dose > 50 mSV consistent with potentially harmful ionising radiation exposure. In 162 patients (59%), the equivalent radiation dose to the lens of the eye exceeded the 500 mSv threshold for radiation induced damage.

Conclusion: Survivors of aSAH are exposed to high levels of medical radiation. The eyes are particularly at risk with most patients exposed to levels known to induce lens damage. This highlights the importance of strategies to reduce incidental and cumulative medical radiation exposure in this population.

Purpose: Pituitary adenomas are much rarer in children than in adults. We aimed to analyze their imaging characteristics in this age group and to compare them according to the hormonal secretion. We conducted an observational monocentric retrospective study on clinical and imaging data.

Methods: We analyzed imaging features before surgery or drug treatment of pituitary adenomas in children confirmed by histopathology or hormonal secretion. We assessed tumoral signal intensity, volume and aggressiveness, and compared it according to the hormonal secretion.

Results: We included 31 children (13 lactotroph (42%), 8 corticotroph (26%), 5 somatotroph (16%), 5 plurihormonal adenomas (16%) including 1 non-secreting macroadenoma) with a median age of 13 years (range 2-16 years-old), without age or sex difference between secretion types. Lactotroph and somatotroph adenomas were larger than corticotroph adenomas (p = 0.007) and were more aggressive (p = 0.01). They also had higher signal intensity on T2-weighted images (p = 0.04). T1 signal intensity was similar between the groups on pre and post-contrast images (lower enhancement than the normal pituitary). No non-secreting micro-adenoma became clinically significant enough to lead to a pathological confirmation or specific treatment. Genetic research was conducted on 20 children, finding MEN1 mutations in 80% of the patients.

Conclusions: Pituitary adenomas in children are rare but should be considered when facing similar imaging features than in adults. Imaging characteristics may allow to suspect the hormonal secretion.

Background: Medium vessel occlusions (MeVO) can be either isolated events (primary), or secondary to thrombus migration from a large vessel occlusion to a medium-sized vessel. Outcomes following endovascular thrombectomy (EVT) in the middle cerebral artery (MCA) may differ between primary and secondary MeVOs. This study aimed to assess the association between primary/secondary MeVOs and clinical outcomes following EVT in a nationwide patient cohort.

Method: Patients undergoing EVT were included in two Swedish quality registries. Secondary MeVO was defined as distal migration of a solitary thrombus between baseline CT-angiography and EVT, or basal ganglia infarction on postoperative CT in a patient that presented with a single MeVO on baseline CT-angiography. The primary outcome was good 90-day functional outcome (modified Rankin Scale 0-2). Postoperative change in the National Institutes of Health Stroke Scale-score (NIHSS), was a secondary outcome. Successfully revascularized patients (mTICI 2b-3) were compared with non-revascularized patients in exploratory analyzes.

Results: Of the 5662 EVTs performed in Sweden (2018-2022), 1118 (20%) targeted solitary MCA territory MeVOs, with 819 (73%) being primary and 299 (27%) secondary. Functional outcomes did not differ between the primary and secondary MeVO groups (OR 0.86, CI 95% 0.65-1.14). Likewise, there was no significant difference in postoperative NIHSS scores (0.26, CI 95% -0.71 to 1.24), between groups (p = 0.597). Successful revascularization was associated with increased chance of good functional outcome for both primary (OR 3.77, CI95% 2.28-6.24, p < 0.001) and secondary MeVOs (OR 2.49, CI95% 1.21-5.14, p = 0.013).

Conclusions: Patients with a single primary or secondary MCA MeVOs have similar EVT outcomes and both groups seem to benefit from recanalization in exploratory analyses. This indicates that that EVT should not be withheld based on primary/secondary MeVO status.

Purpose: The twig-like middle cerebral artery (TL-MCA) is a vascular anomaly reconstituting the MCA-M1 segment through a plexiform arterial network. Most patients with TL-MCA have a high risk of hemorrhage, but the associated vascular anatomical risk factors are poorly understood. To investigate the angioarchitecture of TL-MCA in detail to distinguish the radiological differences between hemorrhagic and non-hemorrhagic onset.

Methods: 3214 cerebral digital subtraction angiography procedures were performed, and patients with TL-MCA were included and their clinical and anatomical characteristics were retrospectively reviewed.

Results: 12 patients (median age 47 years, and 9 women) with TL-MCA were included (incidence rate, 0.37%). Among them, four had hemorrhagic stroke, five had ischemic stroke, and three had no symptoms. Perforator anastomoses were identified in five patients (41.6%). Among the four patients with intraparenchymal hemorrhage (IPH), three had looping lenticulostriate artery (LSA) anastomoses and one had non-looping LSA anastomosis. One looping LSA anastomosis was discovered fortuitously in a patient explored for headaches. The recurrent artery of Heubner, which is responsible for the plexiform arterial network, was identified in 10 patients (83.3%). Angiographic evolutions (de novo TL-MCA) were observed in three patients, and one patient experienced a clinical evolution of a TL-MCA with non-looping LSA anastomosis, progressing from no symptoms to IPH.

Conclusions: In this small series, looping LSA anastomoses were mainly observed in TL-MCA with IPH. This anatomical disposition could represent a potential risk factor. The TL-MCA always affects the subpallial segment of the MCA-M1, and may be a subpallium-related pathology.

Background: The significance between cerebral small vessel disease (CSVD) markers on MRI and clinical outcome in intracerebral hemorrhage (ICH) patients is unclear. This study aimed to explore the connection between CSVD markers and short-term outcome in ICH patients.

Methods: We retrospectively included 318 ICH patients. Patients were categorized into unfavorable and favorable prognosis groups based on their 90-day modified Rankin Scale (mRS) score (mRS > 3 indicates unfavorable). We conducted an MRI-based assessment of CSVD markers and investigated the predictive power of individual markers and the overall burden on prognosis.

Results: White matter hyperintensities (WMH) with a modified Fazekas score ≥ 2 (95% CI 2.367-17.421, p < 0.001), the presence of cortical superficial siderosis (CSS) (95 % CI 2.582-28.212, p < 0.001 in Model 1; 95 % CI 2.701-27.385, p < 0.001 in Model 2), and total CSVD burden (95 % CI 1.249-2.352, p < 0.05) are independent risk factors for unfavorable outcome of ICH.

Conclusions: MRI-based markers of CSVD are valuable in assessing the risk of poor outcome in ICH. WMH with a modified Fazekas score ≥ 2, the presence of CSS, and higher CSVD burden are independently associated with adverse functional outcome.

Purpose: To compare the efficacy and safety of the pEGASUS-HPC and CREDO heal coated stent systems used with the NeuroSpeed percutaneous angioplasty (PTA) balloon catheter, for treating acute symptomatic intracranial artery stenosis (ICAS) with or without acute vessel occlusion (VO).

Methods: This retrospective, multicenter study included patients with ICAS between June-2021 and June-2024 treated with the NeuroSpeed PTA balloon catheter and either stent system. Clinical endpoints included National Institutes of Health Stroke Scale (NIHSS) scores and modified ranking scores (mRS), safety and efficacy endpoints included in-stent thrombosis and in-stent stenosis.

Results: Sixty-nine patients were included (pEGASUS-HPC, n = 34; CREDO heal, n = 35). Both groups showed significant improvement in arterial diameter post-intervention (pEGASUS-HPC: 0.47 mm (SD 0.27 mm) to 1.69 mm (SD 0.55 mm); CREDO heal: 0.57 mm (SD 0.41 mm) to 1.89 mm (SD 0.62 mm)). Revascularization success, defined as residual stenosis < 50%, was achieved in 32/34 (93.9%) patients in the pEGASUS-HPC group and 33/35 (94.3%) in the CREDO heal group. In-stent re-stenosis occurred in 5/34 (14.7%) of patients in the pEGASUS-HPC group and 2/35 (5.7%) in the CREDO heal group and retreatment with PTA was performed in 3/34 (8.8%) and 2/35 (5.7%), respectively. Peri- or postprocedural in-stent thrombosis occurred in 3/34 (8.8%) of patients in the pEGASUS-HPC group and 2/35 (5.7%) in the CREDO heal group. At 3-6 months, the proportion of patients achieving an mRS score of 0-2 was 25/34 (73.5%) in the pEGASUS-HPC group and 28/35 (80.0%) in the CREDO heal group (p = 0.578).

Conclusion: Both stent systems proved effective and safe, showing significant post-intervention arterial dilation, high revascularization rates, and similar functional outcomes (mRS 0-2 at 3-6 months), though they differed in in-stent restenosis rates.

Background: Cardiovascular risk management is beneficial, but stringent glycemic control does not prevent the progression of distal sensorimotor polyneuropathy (DSPN). Persistent hyperglycemia-induced alterations and cardiovascular factors may contribute to diabetes-associated nerve damage. This study aimed to evaluate the correlation between skin auto-fluorescence (sAF), an indicator of dermal advanced glycation end-product (AGE) accumulations, cardiovascular risk, and changes in peripheral nerve integrity.

Methods: Sixty-two individuals with type 2 diabetes (T2D) (20 women and 42 men), including 29 diagnosed with DSPN (7 women and 22 men), and 10 healthy controls (HC) underwent diffusion tensor MR imaging of the sciatic nerve to assess fractional anisotropy (FA), an indicator of nerve structural integrity. sAF measurements were combined with clinical, serological, and electrophysiological evaluations. Arterial stiffness was assessed via pulse wave velocity (PWV).

Results: sAF (HC 2.1 ± 0.25 AU, nDSPN 2.3 ± 0.47, DSPN 2.6 ± 0.43; p = 0.005) was higher in individuals with DSPN compared to HC (p = 0.010) and individuals without DSPN (p = 0.035). Within the group of T2D FA correlated negatively with sAF (r = -0.49, p < 0.001), PWV (r = -0.40, p = 0.009) and high-sensitivity troponin T (hsTNT), a marker of microvascular damage (r = -0.39, p < 0.001). In DSPN, sAF correlated positively with hsTNT (r = 0.58, p = 0.005) and with PWV (r = 0.52, p = 0.007), the sciatic nerve's FA correlated negatively with PWV (r = -0.47, p = 0.010).

Conclusions: This study is the first to show close correlations between reduced peripheral nerve integrity and both intradermal AGE deposition and arterial stiffness in individuals with T2D. These findings highlight a mechanistic link between glycation-related vascular injury and neuronal damage emphasizing the importance of cardiovascular risk management in preventing DSPN.