Josep Puig, Guillem Dolz, Mariano Werner, Pepus Daunis-i-Estadella, Marc Comas-Cufí, Alejandro Tomasello, Eva González, Xabier Manso del Caño, Pedro Vega, Eduardo Murias, Isabel Bravo, Elvira Jiménez, Fernando Aparici-Robles, Juan Manuel Sanchís, Sebastià Remollo, Carlos Castaño, Manuel Moreu, Alfonso López-Frías, Mikel Terceño, Yolanda Silva, Óscar Chirife, Antonio López-Rueda, Javier Martínez-Fernández, José Carlos Méndez, Antonio Sagredo, José Díaz-Pérez, Víctor Cuba, José Carlos Llibre, Yeray Aguilar, Luis SanRoman, Jordi Blasco, ROSSETTI Group
Background and Purpose
Guidelines recommend stent retrievers (SRs) for treating large vessel occlusion (LVO) stroke. We assessed noninferiority of the iNtercept (iVascular) SR with a self-expanding basket on a pusher wire versus contemporary SRs (CSRs) using propensity score (PS) matching analysis.
Methods
We analyzed data from the ROSSETTI multicenter registry of patients with anterior circulation LVO to compare procedural (recanalization rates according to the modified Thrombolysis In Cerebral Infarction (mTICI) score and procedural complications), clinical (modified Rankin Scale at 90 days), and safety (symptomatic intracranial hemorrhage, mortality at 90 days) outcomes of patients treated with iNtercept or CSRs (Solitaire, Trevo, and EmboTrap) as a first-line strategy, with or without balloon-guide catheter (BGC + SR, BCG − SR) after PS matching. Non-inferiority of iNtercept was established if the prespecified lower bound of the 95% confidence interval was over −10%.
Results
A total of 164 and 132 patients treated first-line by iNtercept were matched to 656 and 132 patients treated first-line by CSR + BGC and CSR − BGC, respectively. After matching, successful reperfusion (mTICI2b/3) after first-line strategy was achieved in 53.7% and 54.8% in the iNtercept versus CSR + BGC groups, respectively (absolute difference, −0.1%), and 53.8% and 51.3% in the iNtercept versus CSR − BGC, respectively (2.6%). Final reperfusion rates and favorable 90-day outcomes were similar. iNtercept had fewer sICH, procedural complications, and emboli in a new territory than CSR + BGC, and fewer procedural complications than CSR − BGC.
Conclusions
This multicenter registry with PS matching demonstrated the non-inferiority of iNtercept to approved CSRs for successful reperfusion in LVO acute ischemic stroke.
{"title":"New Stent Retriever Technology Versus Standard Devices for Anterior Large Vessel Thrombectomy: A Multicenter Study","authors":"Josep Puig, Guillem Dolz, Mariano Werner, Pepus Daunis-i-Estadella, Marc Comas-Cufí, Alejandro Tomasello, Eva González, Xabier Manso del Caño, Pedro Vega, Eduardo Murias, Isabel Bravo, Elvira Jiménez, Fernando Aparici-Robles, Juan Manuel Sanchís, Sebastià Remollo, Carlos Castaño, Manuel Moreu, Alfonso López-Frías, Mikel Terceño, Yolanda Silva, Óscar Chirife, Antonio López-Rueda, Javier Martínez-Fernández, José Carlos Méndez, Antonio Sagredo, José Díaz-Pérez, Víctor Cuba, José Carlos Llibre, Yeray Aguilar, Luis SanRoman, Jordi Blasco, ROSSETTI Group","doi":"10.1111/jon.70111","DOIUrl":"https://doi.org/10.1111/jon.70111","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Guidelines recommend stent retrievers (SRs) for treating large vessel occlusion (LVO) stroke. We assessed noninferiority of the iNtercept (iVascular) SR with a self-expanding basket on a pusher wire versus contemporary SRs (CSRs) using propensity score (PS) matching analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from the ROSSETTI multicenter registry of patients with anterior circulation LVO to compare procedural (recanalization rates according to the modified Thrombolysis In Cerebral Infarction (mTICI) score and procedural complications), clinical (modified Rankin Scale at 90 days), and safety (symptomatic intracranial hemorrhage, mortality at 90 days) outcomes of patients treated with iNtercept or CSRs (Solitaire, Trevo, and EmboTrap) as a first-line strategy, with or without balloon-guide catheter (BGC + SR, BCG − SR) after PS matching. Non-inferiority of iNtercept was established if the prespecified lower bound of the 95% confidence interval was over −10%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 164 and 132 patients treated first-line by iNtercept were matched to 656 and 132 patients treated first-line by CSR + BGC and CSR − BGC, respectively. After matching, successful reperfusion (mTICI2b/3) after first-line strategy was achieved in 53.7% and 54.8% in the iNtercept versus CSR + BGC groups, respectively (absolute difference, −0.1%), and 53.8% and 51.3% in the iNtercept versus CSR − BGC, respectively (2.6%). Final reperfusion rates and favorable 90-day outcomes were similar. iNtercept had fewer sICH, procedural complications, and emboli in a new territory than CSR + BGC, and fewer procedural complications than CSR − BGC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This multicenter registry with PS matching demonstrated the non-inferiority of iNtercept to approved CSRs for successful reperfusion in LVO acute ischemic stroke.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 6","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.70111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626233","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}
Colin P. Galvin, Ben Phan, Leo Zekelman, Mark Vangel, Mary Beth Anketell, Erickson Torio, Alexandra J. Golby, Frederic Racicot
Background and Purpose
Idiopathic normal pressure hydrocephalus (iNPH) is a neurological disorder that primarily affects older adults and is typically characterized clinically by a triad of symptoms: gait disturbance, urinary urgency or incontinence, and cognitive decline. The relationship between clinical presentation and iNPH imaging biomarkers remains unclear, as does the ability of these markers to predict outcomes following cerebrospinal fluid diversion. Additionally, the association between fecal incontinence (FI) and iNPH, as well as the relationship between FI and iNPH imaging biomarkers, is poorly understood.
Methods
A retrospective review was conducted on 125 consecutive iNPH patients treated by a single surgeon at Brigham and Women's Hospital between 2015 and 2023. Patients were treated with the placement of a ventriculoperitoneal (VP) shunt. Patient demographics, symptoms, and clinical improvement were recorded at 3 and 12 months post-shunt placement. Imaging biomarkers, including Evans Index (EI), callosal angle (CA), anteroposterior diameter of the lateral ventricle index (ALVI), and disproportionately enlarged subarachnoid space hydrocephalus score, were measured using preoperative imaging.
Results
Of 125 patients (mean age 74.8 years, 71 males), 124 presented with gait disturbance, 113 with urinary dysfunction, and 111 with cognitive decline. FI was present in 24 patients. Patients with preoperative FI had higher EI and ALVI. Patients with improved FI at 3-month follow-up had larger CA. Patients with improved gait at 12-month follow-up had smaller EI and ALVI scores. Patients with preoperative urinary symptoms had a higher EI.
Conclusions
Imaging biomarkers can have both diagnostic utility and predictive potential for outcomes related to specific symptoms following CSF diversion with VP shunts.
{"title":"Imaging Biomarkers in Idiopathic Normal Pressure Hydrocephalus: Associations With Symptoms and 1-Year Treatment Outcomes","authors":"Colin P. Galvin, Ben Phan, Leo Zekelman, Mark Vangel, Mary Beth Anketell, Erickson Torio, Alexandra J. Golby, Frederic Racicot","doi":"10.1111/jon.70109","DOIUrl":"https://doi.org/10.1111/jon.70109","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Idiopathic normal pressure hydrocephalus (iNPH) is a neurological disorder that primarily affects older adults and is typically characterized clinically by a triad of symptoms: gait disturbance, urinary urgency or incontinence, and cognitive decline. The relationship between clinical presentation and iNPH imaging biomarkers remains unclear, as does the ability of these markers to predict outcomes following cerebrospinal fluid diversion. Additionally, the association between fecal incontinence (FI) and iNPH, as well as the relationship between FI and iNPH imaging biomarkers, is poorly understood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review was conducted on 125 consecutive iNPH patients treated by a single surgeon at Brigham and Women's Hospital between 2015 and 2023. Patients were treated with the placement of a ventriculoperitoneal (VP) shunt. Patient demographics, symptoms, and clinical improvement were recorded at 3 and 12 months post-shunt placement. Imaging biomarkers, including Evans Index (EI), callosal angle (CA), anteroposterior diameter of the lateral ventricle index (ALVI), and disproportionately enlarged subarachnoid space hydrocephalus score, were measured using preoperative imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 125 patients (mean age 74.8 years, 71 males), 124 presented with gait disturbance, 113 with urinary dysfunction, and 111 with cognitive decline. FI was present in 24 patients. Patients with preoperative FI had higher EI and ALVI. Patients with improved FI at 3-month follow-up had larger CA. Patients with improved gait at 12-month follow-up had smaller EI and ALVI scores. Patients with preoperative urinary symptoms had a higher EI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Imaging biomarkers can have both diagnostic utility and predictive potential for outcomes related to specific symptoms following CSF diversion with VP shunts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 6","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lenka Novakova, Igal Rosenstein, Markus Axelsson, Russell Ouellette
Background and Purpose
Synthetic (Sy) MRI is a clinically approved technique providing quantitative MRI measures based on T1-weighted, T2-weighted, and proton density relaxometry. MRI sequences are often acquired after contrast injection with gadolinium (Gd) to assess active lesions in persons with multiple sclerosis (PwMS), affecting relaxation time. We aimed to assess the influence of Gd on the SyMRI-based volumetrics in PwMS.
Methods
We enrolled 106 PwMS and 15 controls who performed pre-/post-contrast brain SyMRI on a 3T scanner. We evaluated mean change in brain parenchymal fraction (BPF), white matter (WM), grey matter (GM), myelin (Myl), non-aqueous component (NAC), excess parenchymal water (EPW), and T1 enhancement (T1E) using paired sample t-test for pre-/post-Gd volumes and independent sample t-test for comparison between groups.
Results
The mean age was 40.9 and 39.9 years with 69% and 87% females in MS and controls, respectively. Compared to native volumetrics, Gd caused a significant observed volume increase (p < 0.001) in BPF 1.05 ± 0.3%, WM 2.8 ± 0.99%, Myl 1.42 ± 0.39%, NAC 1.04 ± 0.23%, and EPW 0.6 ± 0.4% and decrease in GM −3.05 ± 1.34% in MS. Similar change was seen in controls: BPF 0.99 ± 0.21%, WM 2.94 ± 0.93%, Myl 1.35 ± 0.37%, NAC 0.99 ± 0.22%, EPW 0.47 ± 0.29%, and GM −2.89 ± 1.18%. The change in T1E was 0.05 ± 0.12% in MS (p < 0.001) and 0.02 ± 0.25% (p = 0.76) in controls. The number of contrast-enhancing lesions correlated with T1E (r = 0.348, p < 0.003).
Conclusion
There was a consistent pattern of volume changes in PwMS and controls, except for T1E, where the contrast could have affected the results in PwMS. Therefore, combining pre- and post-contrast metrics in longitudinal studies should be interpreted with caution.
{"title":"The Effect of Gadolinium on Synthetic Magnetic Resonance Quantitative Imaging","authors":"Lenka Novakova, Igal Rosenstein, Markus Axelsson, Russell Ouellette","doi":"10.1111/jon.70104","DOIUrl":"10.1111/jon.70104","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Synthetic (Sy) MRI is a clinically approved technique providing quantitative MRI measures based on T<sub>1</sub>-weighted, T<sub>2</sub>-weighted, and proton density relaxometry. MRI sequences are often acquired after contrast injection with gadolinium (Gd) to assess active lesions in persons with multiple sclerosis (PwMS), affecting relaxation time. We aimed to assess the influence of Gd on the SyMRI-based volumetrics in PwMS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We enrolled 106 PwMS and 15 controls who performed pre-/post-contrast brain SyMRI on a 3T scanner. We evaluated mean change in brain parenchymal fraction (BPF), white matter (WM), grey matter (GM), myelin (Myl), non-aqueous component (NAC), excess parenchymal water (EPW), and T<sub>1</sub> enhancement (T<sub>1</sub>E) using paired sample <i>t</i>-test for pre-/post-Gd volumes and independent sample <i>t</i>-test for comparison between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age was 40.9 and 39.9 years with 69% and 87% females in MS and controls, respectively. Compared to native volumetrics, Gd caused a significant observed volume increase (<i>p</i> < 0.001) in BPF 1.05 ± 0.3%, WM 2.8 ± 0.99%, Myl 1.42 ± 0.39%, NAC 1.04 ± 0.23%, and EPW 0.6 ± 0.4% and decrease in GM −3.05 ± 1.34% in MS. Similar change was seen in controls: BPF 0.99 ± 0.21%, WM 2.94 ± 0.93%, Myl 1.35 ± 0.37%, NAC 0.99 ± 0.22%, EPW 0.47 ± 0.29%, and GM −2.89 ± 1.18%. The change in T<sub>1</sub>E was 0.05 ± 0.12% in MS (<i>p</i> < 0.001) and 0.02 ± 0.25% (<i>p</i> = 0.76) in controls. The number of contrast-enhancing lesions correlated with T<sub>1</sub>E (<i>r</i> = 0.348, <i>p</i> < 0.003).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There was a consistent pattern of volume changes in PwMS and controls, except for T<sub>1</sub>E, where the contrast could have affected the results in PwMS. Therefore, combining pre- and post-contrast metrics in longitudinal studies should be interpreted with caution.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 6","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12623708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145541006","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}
Brandon Ojogho, Aidin Abedi, Darrin J. Lee, Xingfeng Shao, Jonathan Russin, Kay Jann, Charles Y. Liu, Danny J. J. Wang
Background and Purpose
Cranioplasty reconstruction after hemicraniectomy restores skull integrity and has been associated with neurological improvement, but the physiological mechanisms underlying recovery remain incompletely understood. This study investigated cerebral blood flow (CBF), arterial transit time (ATT), and blood–brain barrier (BBB) water exchange rate (Kw) as imaging metrics of hemodynamic recovery following cranioplasty.
Methods
Fourteen patients (mean age: 33.4 ± 8.53 years; 2 females, 12 males) who previously underwent hemicraniectomy for traumatic brain injury, ruptured aneurysm, or hemorrhagic stroke were included. All participants underwent diffusion-prepared pseudo-continuous arterial spin labeling (DP-pCASL) Magnetic Resonance Imaging (MRI) at 3 Tesla before and after cranioplasty. Hemodynamic parameters were quantified globally and regionally, with particular focus on the middle cerebral artery perforator (MCA Perf) territory.
Results
Post-surgical imaging revealed significant increases in CBF within the ipsilateral MCA Perf territory compared to pre-surgical values. BBB Kw asymmetry between MCA Perf territories also improved, indicating enhanced perfusion and BBB function in the impacted hemisphere. ATT changes were region-specific, with significant increases in asymmetry observed in the leptomeningeal anterior cerebral artery and posterior cerebral artery territories, but not in the MCA Perf region.
Conclusions
These findings underscore the mechanobiological role of cranioplasty reconstruction in neurological recovery. Advanced hemodynamic imaging with DP-pCASL MRI provides quantitative insight into cerebral perfusion, BBB function, and regional perfusion timing. This approach may guide future research on post-cranioplasty recovery and inform personalized rehabilitation strategies.
{"title":"Cerebral Perfusion and Blood−Brain Barrier Changes After Cranioplasty: A Diffusion-Prepared Arterial Spin Labeling Study","authors":"Brandon Ojogho, Aidin Abedi, Darrin J. Lee, Xingfeng Shao, Jonathan Russin, Kay Jann, Charles Y. Liu, Danny J. J. Wang","doi":"10.1111/jon.70106","DOIUrl":"https://doi.org/10.1111/jon.70106","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Cranioplasty reconstruction after hemicraniectomy restores skull integrity and has been associated with neurological improvement, but the physiological mechanisms underlying recovery remain incompletely understood. This study investigated cerebral blood flow (CBF), arterial transit time (ATT), and blood–brain barrier (BBB) water exchange rate (Kw) as imaging metrics of hemodynamic recovery following cranioplasty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fourteen patients (mean age: 33.4 ± 8.53 years; 2 females, 12 males) who previously underwent hemicraniectomy for traumatic brain injury, ruptured aneurysm, or hemorrhagic stroke were included. All participants underwent diffusion-prepared pseudo-continuous arterial spin labeling (DP-pCASL) Magnetic Resonance Imaging (MRI) at 3 Tesla before and after cranioplasty. Hemodynamic parameters were quantified globally and regionally, with particular focus on the middle cerebral artery perforator (MCA Perf) territory.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Post-surgical imaging revealed significant increases in CBF within the ipsilateral MCA Perf territory compared to pre-surgical values. BBB Kw asymmetry between MCA Perf territories also improved, indicating enhanced perfusion and BBB function in the impacted hemisphere. ATT changes were region-specific, with significant increases in asymmetry observed in the leptomeningeal anterior cerebral artery and posterior cerebral artery territories, but not in the MCA Perf region.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings underscore the mechanobiological role of cranioplasty reconstruction in neurological recovery. Advanced hemodynamic imaging with DP-pCASL MRI provides quantitative insight into cerebral perfusion, BBB function, and regional perfusion timing. This approach may guide future research on post-cranioplasty recovery and inform personalized rehabilitation strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 6","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.70106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145522050","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}
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 (ΔVolume,ICAS = 18% ± 10%, p < 0.001; ΔShift,ICAS = 4.9% ± 5.8%, p = 0.027; ΔOverlap,ICAS = 0.2 ± 0.3, p = 0.033, ΔCBF,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.
{"title":"Perfusion Territory Shifts in Cerebrovascular Diseases Measured by Super-Selective Arterial Spin Labeling","authors":"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","doi":"10.1111/jon.70101","DOIUrl":"10.1111/jon.70101","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective monocentric study, we acquired data in three subgroups (<i>n</i> = 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 <i>t</i>-test), and hemispheric lateralization <i>Δ</i> was calculated subjectwise and compared between patients and HCs (unpaired <i>t</i>-test) (<i>p </i>< 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 (<i>Δ</i><sub>Volume,ICAS</sub> = 18% ± 10%, <i>p </i>< 0.001; <i>Δ</i><sub>Shift,ICAS</sub> = 4.9% ± 5.8%, <i>p</i> = 0.027; <i>Δ</i><sub>Overlap,ICAS</sub> = 0.2 ± 0.3, <i>p</i> = 0.033, <i>Δ</i><sub>CBF,ICAS</sub> = 3 ± 3 mL/100 g/min, <i>p</i> = 0.045). Furthermore, collateral blood supply in Moyamoya disease was assessed by 4D-sPACK and showed comparable diagnostic value as DSA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 6","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.70101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145505067","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}
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.
{"title":"Differentiating Brain Metastasis and High-Grade Glioma Using Multi-b Value Diffusion MRI and Tumor Volumetry","authors":"Tereza Kopřivová, Marek Dostál, Tomáš Jůza, Václav Vybíhal, Petra Ovesná, Michal Kozubek, Miloš Keřkovský","doi":"10.1111/jon.70103","DOIUrl":"10.1111/jon.70103","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>To evaluate feasibility of multi-<i>b</i> value diffusion magnetic resonance imaging (MRI) and volumetry in differentiating between brain metastases and high-grade gliomas (HGGs) while producing a differentiation tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Preoperative brain MRI consisting of both morphological and multi-<i>b</i> 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Multi-<i>b</i> diffusion MRI and tumor volumetry may be valuable diagnostic tools for differentiating HGG from brain metastasis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 6","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.70103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145504990","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}
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 NaV1.7 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。
{"title":"Diffusion Tensor Imaging Reveals Altered Centrality of Pain-Related Regions in SCN9A-Associated Small Fiber Neuropathy","authors":"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","doi":"10.1111/jon.70105","DOIUrl":"10.1111/jon.70105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>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<sub>V</sub>1.7 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ten SFN-SCN9A patients, 20 idiopathic SFN patients, and 20 controls were included. All participants underwent 3-Tesla diffusion MRI (66 gradient directions, <i>b</i>-value = 1200 s/mm<sup>2</sup>), and the brain network was quantified using nodal importance, which describes the influence of a group of regions on the whole network.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 (<i>β</i> = 0.43, <i>p</i> = 0.02) and idiopathic SFN patients (<i>β</i> = 0.43, <i>p</i> = 0.02). Moreover, higher self-reported pain was associated with higher nodal importance of pain-associated regions in the SFN-SCN9A group (<i>r</i> = 0.67, <i>p</i> = 0.03), while this effect was not observed in the idiopathic SFN patients (<i>r</i> = −0.22, <i>p</i> = 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Combined, these results suggest the potential involvement of a distinct structural pathway related to pain processing in SFN-SCN9A.</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/PMC12604079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145488985","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}
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.
{"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}
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.
{"title":"Assessing a Stimulator Modification for Simultaneous Noninvasive Auricular Vagus Nerve Stimulation and MRI","authors":"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","doi":"10.1111/jon.70098","DOIUrl":"10.1111/jon.70098","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 6","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.70098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458279","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}
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.
{"title":"The Ghost Penumbra Pattern in Acute Ischemic Stroke: Characterization and Prognostic Significance","authors":"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","doi":"10.1111/jon.70100","DOIUrl":"https://doi.org/10.1111/jon.70100","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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]; <i>p</i> = 0.001) and lower NIHSS (OR 0.9 [0.8–0.9]; <i>p</i> = 0.02) were independently associated with GPP. The GPP predicted a lower risk of PH (OR 0.43 [0.19–0.97]; <i>p</i> = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 6","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145429404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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