Journal of Neuroimaging最新文献_第2页

Perfusion Territory Shifts in Cerebrovascular Diseases Measured by Super-Selective Arterial Spin Labeling 超选择性动脉自旋标记测量脑血管疾病灌注区域转移。

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2025-11-12 DOI: 10.1111/jon.70101

Gabriel Hoffmann, Miriam Reichert, Jens Göttler, Michael Helle, Lena Schmitzer, Moritz Hernandez Petzsche, Claus Zimmer, Christine Preibisch, Michael Kallmayer, Kornelia Kreiser, Nico Sollmann, Hans Liebl, Stephan Kaczmarz

Background and Purpose

Individualized diagnostic approaches are crucial in cerebrovascular diseases, such as internal carotid artery stenosis (ICAS). To evaluate individual collateral blood supply, vessel-selective imaging has gained high relevance. However, clinically established digital subtraction angiography (DSA) exposes patients to intervention risks and radiation. Two noninvasive MRI-based alternatives are super-selective pseudo-continuous arterial spin labeling (ss-pCASL, a technique for selective labeling of arterial blood-water) for perfusion territory mapping and four-dimensional vessel-selective angiography (4D-sPACK). We hypothesized that asymptomatic atherosclerosis-induced ICAS and Moyamoya disease result in chronic malperfusion. Therefore, we aimed towards quantitative assessment of collateral blood flow by ss-pCASL.

Methods

In this prospective monocentric study, we acquired data in three subgroups (n = 23): patients with asymptomatic unilateral atherosclerosis-induced ICAS, Moyamoya disease, and age-matched healthy controls (HCs). On the basis of vascular territories from ss-pCASL, we introduced four parameters: volume, territorial shift, overlap with an atlas, and cerebral blood flow (CBF). For patients with atherosclerosis-induced ICAS, ipsi- and contralateral hemispheres were compared (paired t-test), and hemispheric lateralization Δ was calculated subjectwise and compared between patients and HCs (unpaired t-test) (p < 0.05).

Results

We included data from 20 subjects (8 ICAS, 3 Moyamoya, 9 HC). Group-level results showed ICAS-induced shifts with significant lateralization compared to HCs (Δ_Volume,ICAS = 18% ± 10%, p < 0.001; Δ_Shift,ICAS = 4.9% ± 5.8%, p = 0.027; Δ_Overlap,ICAS = 0.2 ± 0.3, p = 0.033, Δ_CBF,ICAS = 3 ± 3 mL/100 g/min, p = 0.045). Furthermore, collateral blood supply in Moyamoya disease was assessed by 4D-sPACK and showed comparable diagnostic value as DSA.

Conclusion

Perfusion territory mapping by ss-pCASL revealed chronic malperfusion in asymptomatic ICAS that can be objectively quantified, and 4D-sPACK added diagnostic value similar to DSA.

背景与目的：个体化诊断方法对颈内动脉狭窄（ICAS）等脑血管疾病至关重要。为了评估个体侧支血供，血管选择性成像具有很高的相关性。然而，临床上建立的数字减影血管造影（DSA）使患者暴露于干预风险和辐射。两种基于mri的非侵入性替代方法是用于灌注区域测绘的超选择性伪连续动脉自旋标记（ss-pCASL，一种动脉血流选择性标记技术）和四维血管选择性血管造影术（4D-sPACK）。我们假设无症状动脉粥样硬化诱导的ICAS和烟雾病导致慢性灌注不良。因此，我们旨在通过ss-pCASL定量评估侧支血流量。方法：在这项前瞻性单中心研究中，我们获得了三个亚组（n = 23）的数据：无症状单侧动脉粥样硬化诱导的ICAS患者、烟雾病患者和年龄匹配的健康对照（hc）。在ss-pCASL血管区域的基础上，我们引入了四个参数：体积、区域移位、与图谱的重叠和脑血流量（CBF）。对于动脉粥样硬化诱导的ICAS患者，比较左半球和对侧半球（配对t检验），计算受试者半球偏侧Δ，并比较患者和HC之间（未配对t检验）(p)结果：我们纳入了来自20名受试者（8名ICAS， 3名Moyamoya， 9名HC）的数据。组水平结果显示，与hcc相比，ICAS诱导的移位明显偏侧（ΔVolume,ICAS = 18%±10%，p移位，ICAS = 4.9%±5.8%,p = 0.027； ΔOverlap,ICAS = 0.2±0.3,p = 0.033， ΔCBF,ICAS = 3±3ml / 100g /min, p = 0.045）。此外，通过4D-sPACK评估烟雾病的侧支血供，其诊断价值与DSA相当。结论：ss-pCASL灌注区域定位显示无症状ICAS慢性灌注不良，可客观量化，4D-sPACK具有与DSA相似的诊断价值。

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引用次数: 0

Differentiating Brain Metastasis and High-Grade Glioma Using Multi-b Value Diffusion MRI and Tumor Volumetry 多b值扩散MRI和肿瘤体积测量鉴别脑转移和高级别胶质瘤。

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2025-11-12 DOI: 10.1111/jon.70103

Tereza Kopřivová, Marek Dostál, Tomáš Jůza, Václav Vybíhal, Petra Ovesná, Michal Kozubek, Miloš Keřkovský

Background and Purpose

To evaluate feasibility of multi-b value diffusion magnetic resonance imaging (MRI) and volumetry in differentiating between brain metastases and high-grade gliomas (HGGs) while producing a differentiation tool.

Methods

Preoperative brain MRI consisting of both morphological and multi-b value diffusion sequences of patients with HGGs and brain metastases was prospectively performed. Three-dimensional masks of enhancing and non-enhancing tumor and surrounding edema were semiautomatically segmented. Multiple diffusion parameters were subsequently derived together with volumes of the particular tissues. Histogram analysis of the diffusion parameters was performed, and the parameters’ diagnostic power to differentiate between the subgroups was evaluated by receiver operating characteristic analysis and least absolute shrinkage and selection operator (LASSO) regression method.

Results

A training dataset included 97 consecutive patients (67 HGGs, 30 metastases), whereas 17 patients (9 HGGs and 8 metastases) comprised a validation group. Overall, 66 histogram diffusion parameters and tissue volumes were found to differ significantly between metastasis and HGG subgroups. LASSO regression identified 17 of these as best predictors. A decision tree using four parameters achieved sensitivity of 90% and 87.5% and specificity of 97% and 77.8% for the training and validation subgroups, respectively.

Conclusion

Multi-b diffusion MRI and tumor volumetry may be valuable diagnostic tools for differentiating HGG from brain metastasis.

背景与目的：探讨多值扩散磁共振成像（MRI）和体积法鉴别脑转移瘤和高级别胶质瘤（HGGs）的可行性，同时提供一种鉴别工具。方法：对HGGs合并脑转移患者进行术前脑MRI，包括形态学和多b值弥散序列。对增强和非增强肿瘤及周围水肿的三维掩膜进行半自动分割。随后导出了多个扩散参数以及特定组织的体积。对扩散参数进行直方图分析，并通过受试者操作特征分析和最小绝对收缩和选择算子（LASSO）回归法评估参数对亚组的诊断能力。结果：训练数据集包括97例连续患者（67例HGGs， 30例转移），而17例患者（9例HGGs， 8例转移）组成验证组。总的来说，66个直方图扩散参数和组织体积在转移和HGG亚组之间存在显著差异。LASSO回归确定了其中17个为最佳预测因子。对于训练亚组和验证亚组，使用四个参数的决策树的灵敏度分别为90%和87.5%，特异性分别为97%和77.8%。结论：MRI和肿瘤体积测量可作为鉴别HGG与脑转移的重要诊断手段。

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引用次数: 0

Diffusion Tensor Imaging Reveals Altered Centrality of Pain-Related Regions in SCN9A-Associated Small Fiber Neuropathy 弥散张量成像显示scn9a相关小纤维神经病疼痛相关区域中心性改变。

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2025-11-11 DOI: 10.1111/jon.70105

Gerhard S. Drenthen, Dennis Kool, Amir Far, Jaymin Upadhyay, David E. J. Linden, Raquel van Gool, Celine P. Goijen, Ingemar S. J. Merkies, Walter H. Backes, Catharina G. Faber, Jacobus F. A. Jansen, Janneke G. J. Hoeijmakers

Background and Purpose

Small fiber neuropathy (SFN) is a neuropathic disorder that is associated with chronic pain. While most SFN cases are idiopathic, SFN can also have hereditary causes. For example, rare SCN9A gene mutations can impair the Na_V1.7 sodium channel, which leads to dorsal root ganglion neuron hyperexcitability, causing SFN. Although chronic pain may induce cerebral changes, the specific structural brain alterations in SCN9A-associated SFN (SFN-SCN9A) remain insufficiently characterized. Therefore, potential alterations in the structural brain network of idiopathic SFN and SFN-SCN9A were explored.

Methods

Ten SFN-SCN9A patients, 20 idiopathic SFN patients, and 20 controls were included. All participants underwent 3-Tesla diffusion MRI (66 gradient directions, b-value = 1200 s/mm²), and the brain network was quantified using nodal importance, which describes the influence of a group of regions on the whole network.

Results

The nodal importance of pain-associated regions (postcentral gyrus, insular cortex, anterior cingulate cortex, and thalamus) was increased in SFN-SCN9A patients compared to controls (β = 0.43, p = 0.02) and idiopathic SFN patients (β = 0.43, p = 0.02). Moreover, higher self-reported pain was associated with higher nodal importance of pain-associated regions in the SFN-SCN9A group (r = 0.67, p = 0.03), while this effect was not observed in the idiopathic SFN patients (r = −0.22, p = 0.34). As self-reported pain did not differ between the SFN groups, it is likely specific to the SCN9A-mutation and not to differences in pain intensity.

Conclusion

Combined, these results suggest the potential involvement of a distinct structural pathway related to pain processing in SFN-SCN9A.

背景和目的：小纤维神经病（SFN）是一种与慢性疼痛相关的神经性疾病。虽然大多数SFN病例是特发性的，但SFN也可能有遗传原因。如罕见的SCN9A基因突变可损害NaV1.7钠通道，导致背根神经节神经元高兴奋性，引起SFN。尽管慢性疼痛可能会引起大脑的变化，但scn9a相关的SFN （SFN- scn9a）的特异性脑结构改变仍然没有充分的特征。因此，我们探索特发性SFN和SFN- scn9a的脑结构网络的潜在改变。方法：选取SFN- scn9a患者10例，特发性SFN患者20例，对照组20例。所有参与者都进行了3-Tesla扩散MRI(66个梯度方向，b值= 1200 s/mm2)，并使用节点重要性来量化脑网络，节点重要性描述了一组区域对整个网络的影响。结果：与对照组（β = 0.43, p = 0.02）和特发性SFN患者（β = 0.43, p = 0.02）相比，SFN- scn9a患者疼痛相关区域（中央后回、岛叶皮质、前扣带皮层和丘脑）的结重要性增加。此外，在SFN- scn9a组中，较高的自我报告疼痛与较高的疼痛相关区域的淋巴结重要性相关（r = 0.67, p = 0.03），而在特发性SFN患者中没有观察到这种影响（r = -0.22, p = 0.34）。由于自我报告的疼痛在SFN组之间没有差异，这可能是scn9a突变所特有的，而不是疼痛强度的差异。结论：综上所述，这些结果提示SFN-SCN9A可能参与了一个与疼痛加工相关的独特结构通路。

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引用次数: 0

Distinguishing Myo-Inositol From Glycine in Brain MRS at 3T: A Pitfall Using Intermediate Echo Times 在3T脑mr中区分肌醇和甘氨酸：利用中间回声时间的一个缺陷。

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2025-11-11 DOI: 10.1111/jon.70107

Seyma Alcicek, Georg Oeltzschner, Doris D. M. Lin, Peter B. Barker

Background and Purpose

In in vivo magnetic resonance spectroscopy (MRS) of the brain, glycine (Gly) is traditionally separated from the overlapping signal of myo-inositol (mI) through the use of intermediate (e.g., 130–140 ms) or long (270–280 ms) echo times (TE). However, no quantitative comparisons have been performed to date comparing the performance of clinically available MRS sequences to differentiate mI and Gly as a function of TE.

Methods

In vivo spectra recorded with two clinically available MRS pulse sequences (single voxel PRESS and semi-LASER 2D-MRSI) with short (35 ms), intermediate (135 ms), and long (280 ms) echo times in a neonate with clinically suspected nonketotic hyperglycinemia were compared to those recorded from phantoms, and spectral simulations.

Results

In vivo spectra recorded at short and intermediate TE spectra showed signals at 3.5 ppm that could arise from either mI or Gly; however, long TE spectra showed an absence of signal in this spectral region, which was consistent with the final clinical diagnosis of hypoxic-ischemic encephalopathy. Phantom data and spectral simulations demonstrated that at intermediate TE, mI has a “pseudo-singlet” appearance that is very similar to that of Gly.

Conclusions

Long echo times are used to best discriminate Gly from mI if specialized sequences and analysis methods are not available. Quantitative spectral analysis methods may also assist in correctly assigning Gly and mI.

背景和目的：在大脑的体内磁共振波谱（MRS）中，甘氨酸（Gly）通常通过使用中间（例如130-140 ms）或长（270-280 ms）回声时间（TE）从肌醇（mI）的重叠信号中分离出来。然而，迄今为止还没有进行定量比较，比较临床可用的MRS序列区分mI和Gly作为TE的功能的性能。方法：用两种临床可用的MRS脉冲序列（单体素PRESS和半激光2D-MRSI）记录的体内光谱，分别为短（35 ms）、中（135 ms）和长（280 ms）的回声时间，对临床怀疑为非酮症性高血糖症的新生儿进行对比。结果：体内短光谱和中间光谱显示3.5 ppm的信号，可能是由mI或Gly引起的；然而，长TE谱显示该谱区无信号，这与临床最终诊断为缺氧缺血性脑病一致。幻影数据和光谱模拟表明，在中间TE， mI具有与Gly非常相似的“伪单线态”外观。结论：如果没有专门的序列和分析方法，长回声时间可以最好地区分Gly和mI。定量光谱分析方法也有助于正确分配Gly和mI。

{"title":"Distinguishing Myo-Inositol From Glycine in Brain MRS at 3T: A Pitfall Using Intermediate Echo Times","authors":"Seyma Alcicek, Georg Oeltzschner, Doris D. M. Lin, Peter B. Barker","doi":"10.1111/jon.70107","DOIUrl":"10.1111/jon.70107","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>In in vivo magnetic resonance spectroscopy (MRS) of the brain, glycine (Gly) is traditionally separated from the overlapping signal of <i>myo</i>-inositol (mI) through the use of intermediate (e.g., 130–140 ms) or long (270–280 ms) echo times (TE). However, no quantitative comparisons have been performed to date comparing the performance of clinically available MRS sequences to differentiate mI and Gly as a function of TE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In vivo spectra recorded with two clinically available MRS pulse sequences (single voxel PRESS and semi-LASER 2D-MRSI) with short (35 ms), intermediate (135 ms), and long (280 ms) echo times in a neonate with clinically suspected nonketotic hyperglycinemia were compared to those recorded from phantoms, and spectral simulations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In vivo spectra recorded at short and intermediate TE spectra showed signals at 3.5 ppm that could arise from either mI or Gly; however, long TE spectra showed an absence of signal in this spectral region, which was consistent with the final clinical diagnosis of hypoxic-ischemic encephalopathy. Phantom data and spectral simulations demonstrated that at intermediate TE, mI has a “pseudo-singlet” appearance that is very similar to that of Gly.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Long echo times are used to best discriminate Gly from mI if specialized sequences and analysis methods are not available. Quantitative spectral analysis methods may also assist in correctly assigning Gly and mI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 6","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12604077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145489032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Assessing a Stimulator Modification for Simultaneous Noninvasive Auricular Vagus Nerve Stimulation and MRI 评估无创耳迷走神经同时刺激和MRI的刺激器改良。

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2025-11-06 DOI: 10.1111/jon.70098

Vanessa Teckentrup, Mareike Ludwig, Janis Seibt, Renée Hartig, Hubert Preissl, Mark Schuppert, Nikolai I. Avdievich, Klaus Scheffler, Nikos Priovoulos, Maik Ehses, Benedikt A. Poser, Christopher J. Wiggins, Peter Trautner, Walter Honerbach, Heidi I. L. Jacobs, Oliver Speck, Dorothea Hämmerer, Nils B. Kroemer

Background and Purpose

The vagus nerve can be stimulated noninvasively at the ear using transcutaneous auricular vagus nerve stimulation (taVNS). Concurrent functional MRI (fMRI) permits study of taVNS-induced changes in brain dynamics, a key requisite for precision neurostimulation. However, there is no standardized protocol for how to safely apply taVNS during MRI. One major risk is temperature increase exceeding innocuous thresholds due to coupling of the emitted radio frequency (RF) pulse during imaging. Thus, we developed and tested a stimulator cable configuration with floating ground cable traps and filter plate connectors.

Methods

We measured temperature, resonance of the stimulation electrodes, and current interference using unmodified and modified stimulation cables. Measurements were conducted across three sites using different 3T MRI scanner models, stimulators, and stimulation strengths with phantoms and human participants.

Results

The modified compared to the unmodified cable considerably reduced RF heating as the relative temperature increase stayed well below the 2 K threshold specified by the ASTM F2182 standard. Additionally, in accordance with ASTM 2119, we can rule out potential distortion and signal loss around the electrodes due to current flow from the stimulator and demonstrate that impaired image quality in brainstem and midbrain regions is recovered using the modified cable.

Conclusions

We show that adding floating ground cable traps to the stimulator cable allows the safe use of taVNS with fMRI and may improve image quality in functional imaging. To enable other researchers to modify their hardware in the same way, we provide details of the modifications.

背景与目的：经皮耳迷走神经刺激（taVNS）可以在耳内无创地刺激迷走神经。并发功能MRI （fMRI）允许研究tavns诱导的脑动力学变化，这是精确神经刺激的关键条件。然而，在MRI期间如何安全地应用taVNS尚无标准化的方案。一个主要的风险是由于成像过程中发射的射频（RF）脉冲的耦合导致温度升高超过无害阈值。因此，我们开发并测试了一种带有浮动接地电缆陷阱和过滤板连接器的刺激器电缆配置。方法：采用未修改和修改过的刺激电缆测量温度、刺激电极的共振和电流干扰。使用不同的3T MRI扫描仪模型、刺激器和刺激强度对幻影和人类参与者进行了三个部位的测量。结果：与未修改的电缆相比，修改后的电缆显著降低了射频加热，因为相对温度升高远低于ASTM F2182标准规定的2k阈值。此外，根据ASTM 2119，我们可以排除由于刺激器电流产生的电极周围的潜在失真和信号损失，并证明使用改进的电缆可以恢复脑干和中脑区域受损的图像质量。结论：我们表明，在刺激电缆上添加浮动接地电缆陷阱可以安全使用taVNS与fMRI，并可能提高功能成像的图像质量。为了使其他研究人员能够以同样的方式修改他们的硬件，我们提供了修改的细节。

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引用次数: 0

The Ghost Penumbra Pattern in Acute Ischemic Stroke: Characterization and Prognostic Significance 急性缺血性脑卒中的鬼影半影模式：特征及预后意义

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2025-11-03 DOI: 10.1111/jon.70100

Mercedes de Lera Alfonso, Alicia Sierra-Gómez, Ana I. Calleja, Elisa Cortijo, Gonzalo Valle, Beatriz Gómez-Vicente, Mario Martínez-Galdámez, Jorge Galván, Miguel Schüller, Lorenzo Pérez, Alirio Millán, Ignacio Eiros, Juan F. Arenillas

Background and Purpose

We studied the so-called ghost penumbra pattern (GPP), characterized by an underestimation of ischemic core volume on computed tomography perfusion (CTP) as compared with noncontrast CT (NCCT). We aimed to describe its frequency, to characterize the baseline factors associated with its presence, and to investigate its impact on clinical and radiological outcomes in acute ischemic stroke (AIS) patients treated with endovascular therapy (EVT).

Methods

A consecutive series of AIS patients with proximal anterior circulation large vessel occlusion (LVO) treated with EVT and achieving successful reperfusion were included. All underwent NCCT, multiphase CT angiography (CTA), and CTP, which were analyzed with RAPID software. Ischemic core volumes were compared between CT and CTP. GPP was defined by a CT core/CTP core ratio >1.5. Collateral status and thrombus migration were assessed. Parenchymal hematoma (PH) and hypodensity volume were measured at 24 h. Functional outcome was evaluated at 90 days using the modified Rankin Scale.

Results

From June 2020 to December 2021, a total of 173 AIS patients were included in the study (mean age was 73; 52% women; median National Institutes of Health Stroke Scale [NIHSS] 16). GPP was detected in 100 (58%) patients. Good collateral circulation (OR 2.8 [1.5–5.4]; p = 0.001) and lower NIHSS (OR 0.9 [0.8–0.9]; p = 0.02) were independently associated with GPP. The GPP predicted a lower risk of PH (OR 0.43 [0.19–0.97]; p = 0.04).

Conclusion

GPP was observed in about half of the included AIS patients and was associated with better collateral circulation and thrombus migration. Endovascular reperfusion in this group was safe.

背景与目的我们研究了所谓的鬼影半影模式（GPP），其特征是与非对比CT （NCCT）相比，计算机断层扫描（CTP）灌注（CTP）对缺血核心体积的低估。我们的目的是描述其频率，表征与其存在相关的基线因素，并研究其对接受血管内治疗（EVT）的急性缺血性卒中（AIS）患者的临床和放射预后的影响。方法对连续接受EVT治疗的近前循环大血管闭塞（LVO） AIS患者进行再灌注治疗。所有患者均行NCCT、多期CT血管造影（CTA）和CTP，并用RAPID软件进行分析。比较CT与CTP的缺血性核体积。GPP定义为CT芯/CTP芯比>；1.5。评估侧枝状态和血栓迁移。在24 h时测量实质血肿（PH）和低密度体积。在90天时使用改进的Rankin量表评估功能结果。结果2020年6月至2021年12月，共有173例AIS患者纳入研究，平均年龄73岁，女性52%，中位数为美国国立卫生研究院卒中量表[NIHSS] 16)。100例（58%）患者检测到GPP。良好的侧支循环（OR为2.8 [1.5-5.4],p = 0.001）和较低的NIHSS （OR为0.9 [0.8-0.9],p = 0.02）与GPP独立相关。GPP预测PH风险较低（OR 0.43 [0.19-0.97]; p = 0.04）。结论约半数AIS患者存在GPP， GPP与侧支循环改善及血栓迁移有关。本组血管内再灌注是安全的。

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引用次数: 0

Middle Meningeal Artery Lidocaine Infusion for Refractory Migraine: Angiographic Dose Response and 3-Month Outcomes 脑膜中动脉输注利多卡因治疗难治性偏头痛：血管造影剂量反应和3个月预后

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2025-11-03 DOI: 10.1111/jon.70096

Rami Fakih, Nived Jayaraj Ranjini, Syed A. Gillani, Kimberley Pfeiffer, Camilo R. Gomez, Alexander Sirakov, M. Fareed K. Suri, Paul Bhogal, Adnan I. Qureshi

Background and Purpose

Several studies have demonstrated the amelioration of refractory migraines with middle meningeal artery (MMA) intra-arterial lidocaine infusion, but the durability beyond 1 month is not well studied, and the angiographic dose response of lidocaine infusion was not previously evaluated. We aimed to assess the efficacy of middle meningeal artery lidocaine infusion in the treatment of refractory migraines at a 3-month follow-up.

Methods

We quantified the response to intra-arterial lidocaine infusion (maximum dose of 150 mg) in patients with refractory migraine using the Migraine Disability Assessment (MIDAS) evaluated pre- and posttreatment. At 3 months, We determined the MIDAS score changes, the proportion of responders (≥50% MIDAS reduction), the proportion of patients with “no disability” (MIDAS Grade 1), and the cessation of opioid medication for headache management measured at the last known follow-up. An angiographic dose response was quantified.

Results

Eight patients were included in our analysis (mean age of 49.1 ± 13.2 years; 87.5% were women). The cohort comprised equal numbers of unilateral and bilateral MMA lidocaine infusions (4 each), with doses titrated from 50 to 150 mg per procedure. At 3 months posttreatment, the mean MIDAS score improved from 86.3 ± 40.1 to 23.5 ± 26.8 (p = 0.001, paired t-test), and 62.5% of the patients showed 50% MIDAS score reduction. The disability pre-treatment was classified as “severe disability” in all patients, and 50% achieved “no disability” (MIDAS Grade 1) at 3 months posttreatment. No adverse events were reported in any of the procedures. At last known follow-up of a median period of 9.8 months [range 4–21 months], three out of the four patients who were on opioid medication pre-treatment discontinued their opioid medications following MMA lidocaine infusion.

Conclusion

Intra-arterial lidocaine infusion was associated with sustained improvement at 3 months posttreatment in 50% of patients with refractory migraines.

背景与目的已有多项研究表明，脑膜中动脉（MMA）动脉内输注利多卡因可改善顽固性偏头痛，但其1个月以上的持续时间尚未得到很好的研究，且输注利多卡因的血管造影剂量反应尚未得到评价。我们的目的是在3个月的随访中评估脑膜中动脉输注利多卡因治疗难治性偏头痛的疗效。方法采用偏头痛失能评估（MIDAS）对治疗前后难治性偏头痛患者动脉内输注利多卡因（最大剂量为150mg）的反应进行量化。在3个月时，我们确定了MIDAS评分的变化，反应者的比例（MIDAS降低≥50%），“无残疾”患者的比例（MIDAS 1级），以及在最后一次已知随访中测量的阿片类药物治疗头痛的停止。血管造影剂量反应被量化。结果8例患者纳入我们的分析，平均年龄49.1±13.2岁，其中87.5%为女性。该队列包括等量的单侧和双侧MMA利多卡因输注（各4次），每次手术剂量从50到150mg不等。治疗后3个月，平均MIDAS评分从86.3±40.1提高到23.5±26.8 （p = 0.001，配对t检验），62.5%的患者MIDAS评分降低50%。所有患者治疗前的残疾被归类为“严重残疾”，50%的患者在治疗后3个月达到“无残疾”（MIDAS 1级）。所有治疗过程均未发生不良事件。最后已知的中位随访期为9.8个月[范围4-21个月]，在MMA利多卡因输注后，4名接受阿片类药物治疗的患者中有3名停止了阿片类药物治疗。结论50%的难治性偏头痛患者在治疗后3个月，动脉内输注利多卡因可持续改善。

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引用次数: 0

Diagnostic Accuracy of Neuromuscular Ultrasound for Carpal Tunnel Syndrome: A Real-World Study 神经肌肉超声诊断腕管综合征的准确性：一项真实世界的研究

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2025-11-03 DOI: 10.1111/jon.70102

Ujjawal Roy, Michael S. Cartwright, Achal Kumar Srivastava, Abhishek Dixit, Ajay Panwar, Meenakshi Vanchi, Guhan Ramamurthy, M. M. Arun Shivaraman, Saankritya Ayan, Saket Verma, Prabhat Kumar Lal

Background and Purpose

To determine the diagnostic accuracy of median nerve ultrasound in suspected cases of carpal tunnel syndrome (CTS) in a prospective, real-world study.

Methods

This prospective study was carried out over one year at Roy Neuro Care Centre, Ranchi, Jharkhand, India. The clinical, electrophysiologic, and ultrasonographic findings in suspected cases of CTS were collected. A history and physical examination consistent with CTS were considered the gold standard for diagnosis.

Results

A total of 134 patients with symptoms suggestive of CTS were enrolled, and both wrists were examined. The diagnostic accuracy of various ultrasound parameters including maximum cross-sectional area (CSA) of the median nerve in the tunnel, difference between CSA at the level of the pronator quadratus compared to the carpal tunnel, and wrist-to-forearm ratio were evaluated by individual, parallel, and serial testing strategies using optimal cut-off values determined by the Youden Index. Parallel testing provided the highest sensitivity, making it suitable for screening, whereas serial testing produced the highest overall accuracy.

Conclusion

Median nerve ultrasound is an accurate diagnostic tool for CTS in a real-world setting.

背景与目的在一项前瞻性、真实世界的研究中，确定正中神经超声对疑似腕管综合征（CTS）病例的诊断准确性。方法本前瞻性研究在印度贾坎德邦兰契的罗伊神经护理中心进行了一年多的研究。收集疑似CTS病例的临床、电生理及超声检查结果。病史和体格检查符合CTS被认为是诊断的金标准。结果共纳入134例伴有CTS症状的患者，并对其双腕关节进行了检查。各种超声参数的诊断准确性，包括隧道中正中神经的最大横截面积（CSA），旋前方肌水平与腕管水平CSA的差异，腕前臂比，采用约登指数确定的最佳临界值，通过单独、平行和连续测试策略评估。并行测试提供了最高的灵敏度，使其适合筛选，而串行测试产生最高的整体准确性。结论正中神经超声是临床上诊断CTS的准确工具。

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引用次数: 0

Edge-Guided Deep Learning Model to Predict Fetal Brain Age Using MRI 边缘引导深度学习模型用于MRI预测胎儿脑年龄

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2025-11-03 DOI: 10.1111/jon.70099

Haitao Gan, Qingsong Gao, Zhi Yang, Yiyuan Zhou, Ran Zhou, Yu Guo, Wei Xia

Background and Purpose

Deep learning enables fast fetal brain age prediction from MRI. However, most models emphasize global features while ignoring local edge details. To improve accuracy, we propose a novel model incorporating global edge information, achieving performance comparable to that of experienced clinicians.

Methods

A retrospective collection of 1630 fetal brain coronal T2-weighted MR images from 207 singleton pregnancies with brain ages ranging from 22 to 38 weeks from June 2019 to July 2023 was performed. The fetal MRI dataset was divided into two independent subsets: a training dataset for optimizing model parameters and a test dataset for evaluating the model's performance relative to a reference standard. Four-fifths of the dataset were allocated as training data and one-fifth as test data. We trained a neural network that incorporates global edge information and continuously optimized it using performance indicators such as mean absolute error (MAE) and r-square (R²) to achieve the desired results.

Results

In a retrospective study involving 1630 fetal brain MR images from 207 subjects, the edge-guided deep learning model achieved higher accuracy in predicting fetal age compared to existing methods, with an MAE of 0.79 weeks and an R² value of 0.94, and can promote regression models to produce more stable and reliable predictions.

Conclusions

Compared to existing methods for predicting fetal brain age, our method demonstrates superior performance and is helpful for accurately assessing the fetal brain development in clinical practice.

背景与目的深度学习可以通过MRI快速预测胎儿脑年龄。然而，大多数模型强调全局特征而忽略局部边缘细节。为了提高准确性，我们提出了一种结合全局边缘信息的新模型，实现了与经验丰富的临床医生相当的性能。方法回顾性收集2019年6月至2023年7月207例脑龄为22 ~ 38周的单胎妊娠的1630张胎儿脑冠状t2加权MR图像。胎儿MRI数据集被分为两个独立的子集：一个用于优化模型参数的训练数据集和一个用于相对于参考标准评估模型性能的测试数据集。数据集的五分之四被分配为训练数据，五分之一被分配为测试数据。我们训练了一个包含全局边缘信息的神经网络，并使用平均绝对误差（MAE）和r平方（R2）等性能指标对其进行持续优化，以达到预期的结果。结果在一项涉及207名受试者的1630张胎儿脑MR图像的回顾性研究中，边缘引导深度学习模型预测胎儿年龄的准确率高于现有方法，MAE为0.79周，R2为0.94，可以促进回归模型产生更稳定可靠的预测。结论与现有的胎儿脑龄预测方法相比，本方法具有较好的预测效果，有助于临床准确评估胎儿脑发育情况。

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引用次数: 0

Dynamic Nature of Arachnoid Granulations During Acute Changes in Intracranial Pressure: A Pilot Study 急性颅内压变化期间蛛网膜颗粒的动态性质：一项初步研究。

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2025-10-26 DOI: 10.1111/jon.70097

Andrew Wai Kei Ko, Dipakkumar Thakor, Nada Aboudahab, Ali Sheikhy, M. Reza Taheri

Background and Purpose

Arachnoid granulations (AGs) are cerebrospinal fluid drainage structures whose number and size may vary with intracranial pressure (ICP). Although changes in AG size following lumbar puncture have been reported, longitudinal changes in patients with and without acute ICP alterations have not been studied. This study evaluated AG number and volume over time in patients with and without acute ICP changes.

Methods

We retrospectively reviewed head and neck computed tomography angiography scans over a 10-year period. Subjects had two consecutive scans with visible AGs. Controls had no acute intracranial pathology, whereas cases had acute hydrocephalus with decompression and ICP monitoring via extraventricular drains. AG volume was measured in both groups; AG number was assessed in controls only. Wilcoxon signed rank tests and paired t-tests were used to assess within-group differences. Welch's t-test and Type III analysis of variance were used for between-group differences and interaction effects.

Results

In 88 controls, AG volumes had a statistically significant change over time (p = 0.010). In four hydrocephalus cases, AG volume decreased by 29.9 mm³ (p = 0.030) after ICP reduction. Between-group analysis showed a significant point estimate difference (p = 0.020) and interaction (p < 0.0001), indicating differing AG responses to acute ICP changes.

Conclusion

AGs are dynamic structures exhibiting measurable changes in number and volume over time. AG volume appears responsive to acute ICP alterations, supporting their function in ICP regulation and suggesting a potential role as an imaging biomarker for ICP dynamics in acute hydrocephalus.

背景与目的：蛛网膜颗粒是脑脊液引流结构，其数量和大小随颅内压（ICP）的变化而变化。虽然有腰椎穿刺后AG大小变化的报道，但有或没有急性ICP改变的患者的纵向变化尚未研究。本研究评估了伴有和不伴有急性ICP改变患者的AG数量和体积随时间的变化。方法：我们回顾性地回顾了10年来的头颈部计算机断层血管造影扫描。受试者连续两次扫描可见AGs。对照组没有急性颅内病理，而病例有急性脑积水，通过室外引流减压和颅内压监测。测定两组的AG体积；仅在对照组中评估AG数。使用Wilcoxon符号秩检验和配对t检验来评估组内差异。组间差异和相互作用效应采用Welch’st检验和III型方差分析。结果：88例对照中，AG体积随时间变化有统计学意义（p = 0.010）。4例脑积水患者颅内压复位后AG体积减少29.9 mm3 （p = 0.030）。组间分析显示点估计差异（p = 0.020）和相互作用(p)显著。结论：AGs是一种动态结构，其数量和体积随时间的变化是可测量的。AG体积似乎对急性颅内压改变有反应，支持其在颅内压调节中的功能，并提示其作为急性脑积水颅内压动态的成像生物标志物的潜在作用。

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引用次数: 0