Clinical Neuroradiology最新文献

Purpose: Idiopathic intracranial hypertension (IIH) is a complex neurological disease characterized by symptoms of raised intracranial pressure of unclear etiology. Although optic nerve sheath dilation is a common MR neuroimaging feature of IIH, how and why it occurs remains poorly understood. The purpose of the presented analysis was to investigate if optic nerve sheath dilation might be associated with neuroimaging correlates of cerebrospinal and interstitial fluid homeostasis.

Methods: IIH patients were retrospectively identified from 2016-2023 from our tertiary healthcare system. Brain MRIs were computationally segmented using FreeSurfer. Additionally, diffusion tensor imaging along the perivascular space (DTI-ALPS) was employed to assess cerebral glymphatic flow. The mean perioptic subarachnoid space (PSAS) to optic nerve sheath diameter (ONSD) ratio from both eyes was correlated with neuroimaging markers of CSF and interstitial fluid homeostasis (choroid plexus, ventricle, and gray and white matter volume) and glymphatic flow. All volumes of interest were normalized to total intracranial volume. Multiple linear regression was used to evaluate for associations between continuous variables accounting for covariates of patient age, sex, and body mass index.

Results: In total, 55 IIH patients (89% female; mean age: 30.3 years [SD: 7.6]) were included. Increasing PSAS/ONSD was found to be significantly associated with increasing normalized total choroid plexus volume (p = 0.001, R = 0.48) and total ventricle volume (P = 0.014, R = 0.39). Additionally, increasing PSAS/ONSD was associated with declining/worsening cerebral glymphatic clearance based on DTI-APLS (p = 0.043, R = 0.34). Additionally, there was a significant association between increasing PSAS/ONSD and increasing normalized total gray matter volume (p = 0.025, R = 0.36) and declining normalized total white matter volume (p = 0.012, R = 0.40).

Conclusion: These findings suggest that MR optic nerve sheath dilation in IIH might be associated with CSF dyshomeostasis with possible choroid plexus hyperplasia and impaired cerebral glymphatic flow based on DTI-ALPS. These findings encourage future research into the ocular glymphatic system in IIH patients.

Purpose: To compare the diagnostic accuracy of CT angiography (CTA), MR angiography (MRA), and their combined use for detecting unruptured intracranial aneurysms (UIAs).

Methods: Between September 2019 and August 2023, 235 patients suspected of having UIA underwent CTA, MRA, and digital subtraction angiography (DSA)/3-dimensional rotational angiography (3DRA). Two neuroradiologists retrospectively reviewed these images for UIA presence. The value of combining modalities was assessed using confidence rating scores for each. The sensitivity, specificity, and accuracy of these modalities were calculated on a per-aneurysm basis and compared using DSA/3DRA as the reference standard. Subgroup analyses were performed based on aneurysm size (≤ 3 or > 3 mm).

Results: DSA/3DRA detected 252 UIAs in 182 patients, no aneurysms detected in 53 (mean age: 61.9 years ±11.6, 83 men). The overall sensitivity/specificity/accuracy of the combined analysis of CTA and MRA were 91.3%/88.7%/90.7%, respectively, which were significantly higher than those of CTA alone (86.9%/71.8%/83.6%) (P = 0.006/0.003/<0.001) and MRA alone (86.9%/80.3%/85.5%) (P =0.003/0.041/<0.001). No significant differences were found in sensitivity, specificity, or accuracy between the use of CTA and MRA (P = 1/0.26/0.45). CTA and MRA sensitivity and accuracy for aneurysms ≤3 mm were significantly lower than for those aneurysms larger. (P < 0.001, each).

Conclusion: Combining CTA and MRA analysis improves sensitivity, specificity, and accuracy for UIA detection compared to using each modality alone.

Purpose: Accurate detection of cerebral microbleeds (CMBs) is important for detection of multiple conditions. However, CMBs can be challenging to identify on MR images, especially for distinguishing CMBs from the mimic of calcification. We performed a comparative reader study to assess the diagnostic performance of two primary MR sequences for differentiating CMBs from calcification.

Methods: Under IRB approved exempt retrospective protocol, 49 adult patients with identifiable intracranial hemorrhage who underwent multi-echo 3D Gradient Recall Echo (GRE) using 3T MRI were non-sequentially recruited under a retrospective IRB approved protocol. Multi-echo complex total field inversion quantitative susceptibility mapping (QSM) and susceptibility weighted imaging/phase (SWI/P) images were generated for all patients. 53 lesion ROIs were identified and classified on provided images by an expert panel of three neuroradiologists as either: CMB, Blood, Calcification, or Other. Three additional neuroradiologists subsequently reviewed the same SWI/P and QSM images in independent sessions and designated lesions as either blood and/or calcification using a 5-point Likert scale. Statistical analyses, on lesion classification and reader diagnostic accuracy, reader confidence-level, reader agreement-level, and the predictability of mean susceptibility values between SWI/P and QSM were conducted with logistic regression and calculation of Fleiss' κ, Kendall's w, Krippendorff's α.

Results: Across all qualitative assessment and quantitative metrics measured (simple accuracy, confidence as degree of ground truth alignment, and inter-rater agreement) QSM outperformed SWI/P. Additionally, logistic regression of average QSM voxel susceptibility achieved near-perfect separation in differentiating between CMB and calcification in the limited number of CMB/Calcification ROIs, indicating a high predictability.

Conclusion: Our study demonstrates that QSM offers improved detectability and classification of CMBs compared to the conventionally utilized SWI/P sequence. In addition, QSM simplifies the interpretation workflow by reducing the number of requisite images compared with the conventional counterpart, with improved diagnostic confidence.

Purpose: To evaluate the performance of an artificial intelligence (AI) algorithm for automated quantification of arterial stenosis in head and neck CT angiography (CTA).

Methods: Patients who received head and neck CTA and DSA between January 2019 and December 2021 in two centers were included. The quantitative performance of CerebralDoc per-lesion was evaluated through intraclass correlation coefficients (ICCs) and Bland-Altman analysis, comparing automated stenosis measurements and manual measurements across 0-100%, < 50%, ≥ 50% and ≥ 70% thresholds. Sensitivity analysis included linear and logistic regression, and subgroups analysis was performed to identify influencing factors.

Results: 287 patients with 1765 lesions were analyzed. ICCs between CerebralDoc and DSA for ≥ 50% and ≥ 70% stenosis were excellent (0.955, 0.922, respectively), for 0-100% stenosis was good (0.735), and for < 50% stenosis was poor (0.056). For ≥ 50% and ≥ 70% stenosis of CerebralDoc and CTA manual measurements versus DSA, ICCs were close (0.955 vs 0.994; 0.922 vs 0.986), and differences were small (0.258% vs -0.362%; 0.369% vs -0.199%). The sensitivity analysis revealed that specific locations (V1, V2, V3, V4) and slender vessels have large or remarkable differences ranging from 15.551% to 44.238%.

Conclusion: CerebralDoc exhibited excellent performance in automatically quantifying arterial stenosis of ≥ 50% and ≥ 70% in head and neck CTA. However, further research was needed to improve its performance for < 50% stenosis and to address differences in specific locations and slender vessels.

Background: Tirofiban is administered for the treatment of aneurysms in cases of thromboembolic complications, as well as in cases of acute stenting or flow-diverter implantation required within the scope of aneurysm treatment. We aimed to investigate the efficacy and safety of tirofiban in this group of patients.

Methods: We conducted a retrospective analysis of all patients undergoing aneurysm treatment and receiving peri-interventional tirofiban administration at our institution between 2009 and 2019.

Results: A total of 105 patients were included, with 61% women and 39% men (mean age = 53 years, IQR: 44-60 years). Sixty-seven patients underwent emergency aneurysm treatment, and thirty-eight were treated electively. Hemorrhagic events occurred in 22% (15/67) of the patients treated acutely, with 7.46% (5/67) exhibiting symptoms. Patients undergoing elective aneurysm treatment experienced no hemorrhagic events (p = 0.002). Among the 35 patients who required an external ventricular drain (EVD), 22.86% (8/35) developed EVD-related hemorrhages; however, none were symptomatic (p = 0.007). Of the five patients who required a craniotomy, two experienced significant bleeding, and one experienced non-significant craniotomy-related bleeding (p = 0.20).

Conclusion: Tirofiban may be safe for use during peri-interventional complications or emergency stenting in aneurysm treatment. However, caution is necessary when craniotomy is required. In elective aneurysm treatments, administering Tirofiban in response to periprocedural complications appears to be safe.

Purpose: Myocardial injury, indicated by an elevation of high-sensitive cardiac Troponin (hs-cTnT), is a frequent stroke-related complication. Most studies investigated patients with ischemic stroke, but only little is known about its occurrence in patients with intracerebral hemorrhage (ICH). This study aimed to assess the frequency, predictors, and implications of myocardial injury in ICH patients.

Methods: Our retrospective analysis included 322 ICH patients. We defined myocardial injury as an elevation of hs-cTnT above the 99th percentile (i.e. 14 ng/L). Acute myocardial injury was defined as either a changing pattern of > 50% within 24 h or an excessive elevation of initial hs-cTnT (> 52 ng/L). 3D brain scans were assessed for ICH visually and quantitatively by a deep learning algorithm. Multiple regression models and Voxel-based Lesion-Symptom Mapping (VLSM) were applied.

Results: 63.0% (203/322) of patients presented with myocardial injury, which was associated with more severe strokes and worse outcomes during the in-hospital phase (P < 0.01). Acute myocardial injury occurred in 24.5% (79/322) of patients. The only imaging finding associated with acute myocardial injury was midline shift (69.8% vs. 44.6% for normal or stable hs-cTnT, P < 0.01), which also independently predicted it (odds ratio 3.29, confidence interval 1.38-7.87, P < 0.01). In contrast, VLSM did not identify any specific brain region significantly associated with acute myocardial injury. Acute myocardial injury did not correlate with preexisting cardiac diseases; however, the frequency of adverse cardiac events was higher in the acute myocardial injury group (11.4% vs. 4.1% in patients with normal and/or stable patterns of hs-cTnT, P < 0.05).

Conclusion: Myocardial injury occurs frequently in ICH and is linked to poor outcomes. Acute myocardial injury primarily correlates to space-occupying effects of ICH but is less dependent on premorbid cardiac status. Nonetheless, it is associated with a higher rate of adverse cardiac events.