Andrew C. McClelland, Colin A. Ellis, Emory Kuo, Kenny Q. Ye, Ramani Balu, Suyash Mohan
Background and Purpose
Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state with characteristic imaging findings. While classic PRES typically involves parieto-occipital edema, atypical cases present with variable involvement of deep gray nuclei, brainstem, cerebellum, and corpus callosum, which may complicate diagnosis. This study aims to characterize the neuroimaging features of “atypical” PRES in a large cohort and evaluate relationships with clinical variables and outcomes.
Methods
We retrospectively analyzed neuroimaging data from patients diagnosed with PRES, identifying cases with atypical edema patterns. Relationships between MRI findings, clinical variables, and outcomes were assessed with univariable and multivariable regression analyses.
Results
A total of 184 PRES cases were analyzed. 71.7% had “atypical” imaging findings. Atypical edema was associated with older age (odds ratio [OR] 2.96 ≥52 years, p = 0.002) and negatively associated with pregnancy (OR 0.20, p<0.001). These associations were seen in a subset of atypical locations, particularly those supplied by the posterior circulation. Additionally, certain atypical edema patterns were correlated with prolonged hospital stays and reduced clinical reversibility, suggesting a potential impact on patient outcomes.
Conclusion
In this large series of PRES cases, atypical imaging findings were common. Atypical edema, including a posterior circulation pattern, was seen more commonly in older patients, less commonly in pregnancy, and may represent a more severe form of this syndrome with worse outcomes. Recognizing these atypical imaging patterns is crucial for timely intervention and improved patient outcomes.
背景与目的后路可逆性脑病综合征（PRES）是一种具有特征性影像学表现的神经毒性状态。典型的PRES通常包括顶枕水肿，非典型病例表现为不同程度的深灰色核、脑干、小脑和胼胝体受累，这可能使诊断复杂化。本研究旨在在一个大队列中描述“非典型”PRES的神经影像学特征，并评估其与临床变量和结果的关系。方法回顾性分析PRES患者的神经影像学资料，确定非典型水肿的病例。通过单变量和多变量回归分析评估MRI表现、临床变量和结果之间的关系。结果共分析了184例PRES病例。71.7%有“非典型”影像学表现。非典型水肿与年龄较大相关（比值比[OR] 2.96≥52岁，p = 0.002），与妊娠负相关（比值比[OR] 0.20, p = 0.001）。这些关联见于非典型部位的一个子集，特别是由后循环供应的部位。此外，某些非典型水肿模式与住院时间延长和临床可逆性降低相关，表明对患者预后有潜在影响。结论在这一系列的PRES病例中，不典型的影像学表现是常见的。非典型水肿，包括后循环模式，在老年患者中更常见，在妊娠患者中较少见，并且可能代表该综合征的更严重形式，预后更差。认识到这些非典型影像模式对于及时干预和改善患者预后至关重要。
{"title":"Atypical Edema in Posterior Reversible Encephalopathy Syndrome: Clinical Associations and Outcome","authors":"Andrew C. McClelland, Colin A. Ellis, Emory Kuo, Kenny Q. Ye, Ramani Balu, Suyash Mohan","doi":"10.1111/jon.70078","DOIUrl":"https://doi.org/10.1111/jon.70078","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state with characteristic imaging findings. While classic PRES typically involves parieto-occipital edema, atypical cases present with variable involvement of deep gray nuclei, brainstem, cerebellum, and corpus callosum, which may complicate diagnosis. This study aims to characterize the neuroimaging features of “atypical” PRES in a large cohort and evaluate relationships with clinical variables and outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed neuroimaging data from patients diagnosed with PRES, identifying cases with atypical edema patterns. Relationships between MRI findings, clinical variables, and outcomes were assessed with univariable and multivariable regression analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 184 PRES cases were analyzed. 71.7% had “atypical” imaging findings. Atypical edema was associated with older age (odds ratio [OR] 2.96 ≥52 years, <i>p</i> = 0.002) and negatively associated with pregnancy (OR 0.20, <i>p</i><0.001). These associations were seen in a subset of atypical locations, particularly those supplied by the posterior circulation. Additionally, certain atypical edema patterns were correlated with prolonged hospital stays and reduced clinical reversibility, suggesting a potential impact on patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this large series of PRES cases, atypical imaging findings were common. Atypical edema, including a posterior circulation pattern, was seen more commonly in older patients, less commonly in pregnancy, and may represent a more severe form of this syndrome with worse outcomes. Recognizing these atypical imaging patterns is crucial for timely intervention and improved patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144861910","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}
Cerebral collateral circulation is a critical determinant of infarct evolution, therapeutic response, and clinical outcomes in patients with acute ischemic stroke. While the concept of “time is brain” has traditionally guided reperfusion therapy, recent evidence—particularly from trials like DAWN and DEFUSE 3—suggests that collateral status more accurately determines the rate of infarct progression and the extent of salvageable tissue. This comprehensive review synthesizes advances in neuroimaging modalities for evaluating cerebral collaterals, emphasizing their role in refining stroke diagnosis, guiding patient selection, and informing personalized treatment strategies. Structural approaches such as multiphase and dynamic CT angiography, alongside perfusion-based parameters (e.g., cerebral blood volume, hypoperfusion intensity ratio, and Tmax delay maps), are examined. Cortical venous outflow, assessed via the cortical vein opacification score, emerges as an independent predictor of outcome, complementing arterial grading. Susceptibility-weighted imaging, arterial spin labeling, and metabolic and molecular techniques (e.g., PET imaging of inflammation and vascular remodeling) offer functional insights beyond traditional angiography. Biomarkers such as matrix metalloproteinase-9, integrin αvβ3, and translocator protein–targeted PET ligands are discussed in relation to collateral vessel dynamics. Finally, we explore the integration of genetically informed brain atlases, spatial transcriptomics, and imaging–genomic platforms for high-resolution collateral phenotyping. Although promising, these modalities face challenges related to heterogeneity, limited validation, and the lack of standardization. A biologically informed, multimodal, and automated imaging paradigm may herald a new era of precision stroke medicine.
{"title":"Advances in Collateral Neuroimaging for Acute Ischemic Stroke: Redefining Time and Tissue Windows in the Reperfusion Era","authors":"Ritwick Mondal, Shramana Deb, Nirmalya Ray, Ananya Sengupta, Vramanti Sarkar, Subhadeep Banerjee, Avik Mukherjee, Jayanta Roy, Julián Benito-León","doi":"10.1111/jon.70079","DOIUrl":"https://doi.org/10.1111/jon.70079","url":null,"abstract":"<p>Cerebral collateral circulation is a critical determinant of infarct evolution, therapeutic response, and clinical outcomes in patients with acute ischemic stroke. While the concept of “time is brain” has traditionally guided reperfusion therapy, recent evidence—particularly from trials like DAWN and DEFUSE 3—suggests that collateral status more accurately determines the rate of infarct progression and the extent of salvageable tissue. This comprehensive review synthesizes advances in neuroimaging modalities for evaluating cerebral collaterals, emphasizing their role in refining stroke diagnosis, guiding patient selection, and informing personalized treatment strategies. Structural approaches such as multiphase and dynamic CT angiography, alongside perfusion-based parameters (e.g., cerebral blood volume, hypoperfusion intensity ratio, and Tmax delay maps), are examined. Cortical venous outflow, assessed via the cortical vein opacification score, emerges as an independent predictor of outcome, complementing arterial grading. Susceptibility-weighted imaging, arterial spin labeling, and metabolic and molecular techniques (e.g., PET imaging of inflammation and vascular remodeling) offer functional insights beyond traditional angiography. Biomarkers such as matrix metalloproteinase-9, integrin αvβ3, and translocator protein–targeted PET ligands are discussed in relation to collateral vessel dynamics. Finally, we explore the integration of genetically informed brain atlases, spatial transcriptomics, and imaging–genomic platforms for high-resolution collateral phenotyping. Although promising, these modalities face challenges related to heterogeneity, limited validation, and the lack of standardization. A biologically informed, multimodal, and automated imaging paradigm may herald a new era of precision stroke medicine.</p>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.70079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144861911","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}
Jakob Pansell, Tina Thomsson, Emelie Eng, Andreas Wallin, Mohammad Hirzallah
Background and purpose
Optic nerve sheath diameter (ONSD) measured by point-of-care ultrasound (POCUS) is a commonly used non-invasive estimate of intracranial pressure (ICP). However, methodological variations limit standardization of this promising technique. Different imaging axes are identified as one such source of ONSD POCUS methodological variation. This study aimed to evaluate the agreement and diagnostic accuracy for elevated ICP between transverse and sagittal ONSD measurements.
Methods
We conducted a post-hoc analysis of 213 intensive care patients from three prior studies. ONSD was measured in both transverse and sagittal planes, externally (ONSDext) and internally (ONSDint) of the dura mater. Agreement was assessed using Lin's concordance correlation coefficient (CCC). Diagnostic accuracy for detecting ICP ≥20 mmHg was evaluated using area under the receiver operator characteristics curve (AUROC) analyses in a subset of 139 patients.
Results
Sagittal ONSD was significantly larger than transverse ONSD (median difference 0.2 mm, p<0.001). Agreement between transverse and sagittal ONSD was poor (CCC: 0.65 and 0.70 for right and left side ONSDext, and 0.43 and 0.51 for right and left side ONSDint). No significant differences in AUROC were found between transverse, sagittal, or averaged measurements.
Conclusions
Transverse and sagittal ONSD measurements are not interchangeable due to significant differences and poor agreement. Diagnostic accuracy was similar across methods. These findings support continued use of transverse measurement as the standard approach for ONSD POCUS in clinical practice.
背景与目的视神经鞘直径（ONSD）是一种常用的无创颅内压（ICP）测量方法。然而，方法上的差异限制了这项有前途的技术的标准化。不同的成像轴被认为是ONSD POCUS方法差异的一个来源。本研究旨在评估横向和矢状面ONSD测量之间ICP升高的一致性和诊断准确性。方法：我们对之前三项研究中的213例重症监护患者进行了事后分析。在横切面和矢状面，硬脑膜外部（ONSDext）和内部（ONSDint）测量ONSD。采用Lin’s一致性相关系数（CCC）评价一致性。对139例患者进行受试者操作特征曲线下面积（AUROC）分析，评估检测ICP≥20 mmHg的诊断准确性。结果矢状面ONSD明显大于横面ONSD（中位数差0.2 mm, p<0.001）。横向和矢状面ONSD的一致性较差（左右两侧ONSDext的CCC分别为0.65和0.70，左右两侧ONSDint的CCC分别为0.43和0.51）。横切面、矢状面或平均测量的AUROC无显著差异。结论横切面和矢状面ONSD测量结果差异显著且一致性差，不能互换。不同方法的诊断准确性相似。这些发现支持在临床实践中继续使用横向测量作为ONSD POCUS的标准方法。
{"title":"Optic Nerve Sheath Diameter: Which Axis Should Be Measured?","authors":"Jakob Pansell, Tina Thomsson, Emelie Eng, Andreas Wallin, Mohammad Hirzallah","doi":"10.1111/jon.70076","DOIUrl":"https://doi.org/10.1111/jon.70076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and purpose</h3>\u0000 \u0000 <p>Optic nerve sheath diameter (ONSD) measured by point-of-care ultrasound (POCUS) is a commonly used non-invasive estimate of intracranial pressure (ICP). However, methodological variations limit standardization of this promising technique. Different imaging axes are identified as one such source of ONSD POCUS methodological variation. This study aimed to evaluate the agreement and diagnostic accuracy for elevated ICP between transverse and sagittal ONSD measurements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a post-hoc analysis of 213 intensive care patients from three prior studies. ONSD was measured in both transverse and sagittal planes, externally (ONSDext) and internally (ONSDint) of the dura mater. Agreement was assessed using Lin's concordance correlation coefficient (CCC). Diagnostic accuracy for detecting ICP ≥20 mmHg was evaluated using area under the receiver operator characteristics curve (AUROC) analyses in a subset of 139 patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sagittal ONSD was significantly larger than transverse ONSD (median difference 0.2 mm, p<0.001). Agreement between transverse and sagittal ONSD was poor (CCC: 0.65 and 0.70 for right and left side ONSDext, and 0.43 and 0.51 for right and left side ONSDint). No significant differences in AUROC were found between transverse, sagittal, or averaged measurements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Transverse and sagittal ONSD measurements are not interchangeable due to significant differences and poor agreement. Diagnostic accuracy was similar across methods. These findings support continued use of transverse measurement as the standard approach for ONSD POCUS in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.70076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767780","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}
Byungseok Kim, Ik-Dong Yoo, Hyeonseok S. Jeong, Yong-An Chung, In-Uk Song
Background and Purpose
Isolated cervical dystonia is characterized by sustained or intermittent neck movements caused by involuntary muscle contractions, resulting in abnormal movements or postures of cervical areas. We measured altered regional cerebral blood flow (rCBF) in patients with idiopathic cervical dystonia compared to healthy controls and explored the correlation between dystonia severity and rCBF patterns.
Methods
A total of 38 patients with isolated cervical dystonia and 29 healthy controls were recruited. All subjects underwent Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and Tc-99m HMPAO SPECT; TWSTRS was used to assess the severity of dystonia. rCBF was compared between groups using voxel-wise statistical analyses. Associations between rCBF in significant clusters and TWSTRS scores were examined using linear regression.
Results
Compared with controls, patients with cervical dystonia exhibited reduced rCBF in brain regions implicated in sensory processing, motor control, and higher cognitive functions, including the left middle temporal gyrus, right postcentral gyrus, right lingual gyrus, left precuneus, right temporal pole, right middle cingulate gyrus, and right anterior cingulate gyrus. Although reduced rCBF was observed in seven regions, only the right temporal pole showed a significant correlation with TWSTRS motor scores. Reduced rCBF in the right temporal pole negatively correlated with higher TWSTRS scores in dystonia patients.
Conclusion
The negative correlation between reduced rCBF in the right temporal pole and increased TWSTRS scores highlights a potential association between altered cerebral perfusion and dystonic symptom severity. Understanding these alterations could offer insights into the neurobiological basis of cervical dystonia, aiding targeted therapeutic interventions.
{"title":"SPECT Cerebral Perfusion Patterns in Isolated Cervical Dystonia","authors":"Byungseok Kim, Ik-Dong Yoo, Hyeonseok S. Jeong, Yong-An Chung, In-Uk Song","doi":"10.1111/jon.70073","DOIUrl":"https://doi.org/10.1111/jon.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Isolated cervical dystonia is characterized by sustained or intermittent neck movements caused by involuntary muscle contractions, resulting in abnormal movements or postures of cervical areas. We measured altered regional cerebral blood flow (rCBF) in patients with idiopathic cervical dystonia compared to healthy controls and explored the correlation between dystonia severity and rCBF patterns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 38 patients with isolated cervical dystonia and 29 healthy controls were recruited. All subjects underwent Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and Tc-99m HMPAO SPECT; TWSTRS was used to assess the severity of dystonia. rCBF was compared between groups using voxel-wise statistical analyses. Associations between rCBF in significant clusters and TWSTRS scores were examined using linear regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared with controls, patients with cervical dystonia exhibited reduced rCBF in brain regions implicated in sensory processing, motor control, and higher cognitive functions, including the left middle temporal gyrus, right postcentral gyrus, right lingual gyrus, left precuneus, right temporal pole, right middle cingulate gyrus, and right anterior cingulate gyrus. Although reduced rCBF was observed in seven regions, only the right temporal pole showed a significant correlation with TWSTRS motor scores. Reduced rCBF in the right temporal pole negatively correlated with higher TWSTRS scores in dystonia patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The negative correlation between reduced rCBF in the right temporal pole and increased TWSTRS scores highlights a potential association between altered cerebral perfusion and dystonic symptom severity. Understanding these alterations could offer insights into the neurobiological basis of cervical dystonia, aiding targeted therapeutic interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767392","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}
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder prevalent among adolescents and exhibits notable sex dimorphism. Despite an increasing body of research, the impact of sex on ADHD remains underexplored. This study aimed to examine sex differences in white matter organization in children with ADHD using magnetic resonance (MR) diffusion data analyzed with fixel-based analysis (FBA), a novel technique that enables detailed assessment of both microstructural and macrostructural properties of white matter.
Methods
Fifty-five children with ADHD and 37 age-matched typically developing controls underwent MR diffusion. FBA was used to assess white matter structure. Group comparisons examined sex differences within and between groups, and correlation analyses were conducted between white matter features and clinical symptoms in the ADHD group.
Results
The results demonstrated that no significant sex differences were identified among healthy controls. However, within the ADHD group, the fiber cross-section (FC) metric revealed significant white matter alterations in several tracts, including the arcuate fasciculus, corpus callosum (CC), cingulum (CG), superior longitudinal fascicle, striato-fronto-orbital (ST_FO), and striato-precentral. In addition, the fiber density and cross-section metrics showed comparable abnormalities in the CC, CG, and ST_FO. Females with ADHD showed stronger correlations between FC metrics in bundles of white matter and clinical symptoms.
Conclusions
This study is the first to demonstrate sex differences in ADHD white matter bundles using FBA, contributing to a deeper understanding of the pathological mechanisms of ADHD and offering new insights for its diagnosis and treatment.
{"title":"Sex Differences in White Matter Structure in Attention Deficit Hyperactivity Disorder: MR Diffusion Fixel-Based Analysis","authors":"Yan Yu, Jiancheng Fu, Meihao Wang, Ronghui Zhou, Chenhao Shan, Xinye Sun, Yuanjing Feng","doi":"10.1111/jon.70072","DOIUrl":"https://doi.org/10.1111/jon.70072","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder prevalent among adolescents and exhibits notable sex dimorphism. Despite an increasing body of research, the impact of sex on ADHD remains underexplored. This study aimed to examine sex differences in white matter organization in children with ADHD using magnetic resonance (MR) diffusion data analyzed with fixel-based analysis (FBA), a novel technique that enables detailed assessment of both microstructural and macrostructural properties of white matter.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fifty-five children with ADHD and 37 age-matched typically developing controls underwent MR diffusion. FBA was used to assess white matter structure. Group comparisons examined sex differences within and between groups, and correlation analyses were conducted between white matter features and clinical symptoms in the ADHD group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The results demonstrated that no significant sex differences were identified among healthy controls. However, within the ADHD group, the fiber cross-section (FC) metric revealed significant white matter alterations in several tracts, including the arcuate fasciculus, corpus callosum (CC), cingulum (CG), superior longitudinal fascicle, striato-fronto-orbital (ST_FO), and striato-precentral. In addition, the fiber density and cross-section metrics showed comparable abnormalities in the CC, CG, and ST_FO. Females with ADHD showed stronger correlations between FC metrics in bundles of white matter and clinical symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study is the first to demonstrate sex differences in ADHD white matter bundles using FBA, contributing to a deeper understanding of the pathological mechanisms of ADHD and offering new insights for its diagnosis and treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144751291","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}
Rami Fakih, Ibrahim A. Bhatti, Rehan Ahmed, Xiaoyu Ma, Syed A. Gillani, Farhan Siddiq, Camilo R. Gomez, Adnan I. Qureshi
Background and Purpose
The impact of endovascular therapy (EVT) on outcomes in World Federation of Neurological Societies (WFNS) grade ≥ 4 aneurysmal subarachnoid hemorrhage (aSAH) remains unclear.
Methods
We conducted a retrospective cohort study of 80 patients with WFNS grade ≥ 4 aSAH and secondary vasospasm treated between 2010 and 2023. EVT included intra-arterial vasodilators and/or balloon angioplasty. The primary outcome was favorable functional status at 90 days (modified Rankin Scale 0–3). Multivariable logistic regression was used to assess associations between EVT and outcomes, adjusting for age, sex, and time-to-aneurysm securement.
Results
EVT was performed in 77.5% of patients (n = 62). Favorable outcomes occurred in occurred in 42.5% of all patients (n = 34), and were significantly more frequent in the EVT group (48.4% versus 22.2%; p = 0.038). EVT was independently associated with greater odds of favorable outcome (adjusted odds ratio [aOR] 3.15, 95% confidence interval [CI] 1.12–8.85; p = 0.030) and reduced mortality (aOR 0.24, 95% CI 0.07–0.82; p = 0.023). Early aneurysm treatment (≤ 12 h) also independently predicted favorable outcomes (aOR 2.38, p = 0.044) and lower mortality (aOR 0.42, p = 0.045).
Conclusions
Among patients with poor-grade aSAH and vasospasm, EVT was independently associated with improved functional outcomes and survival. These findings challenge historical nihilism and support timely, aggressive endovascular intervention as a critical component of care in this high-risk population.
背景与目的血管内治疗（EVT）对世界神经学会联合会（WFNS）分级≥4级动脉瘤性蛛网膜下腔出血（aSAH）预后的影响尚不清楚。方法对2010年至2023年间80例WFNS分级≥4级aSAH伴继发性血管痉挛患者进行回顾性队列研究。EVT包括动脉内血管扩张和/或球囊血管成形术。主要终点为90天的良好功能状态（修正Rankin量表0-3）。采用多变量逻辑回归评估EVT与预后之间的关系，调整年龄、性别和动脉瘤固定时间。结果62例（77.5%）患者行EVT。42.5%的患者（n = 34）出现了良好结果，EVT组出现良好结果的频率更高(48.4% vs 22.2%；P = 0.038)。EVT与更大的有利结局几率独立相关(调整优势比[aOR] 3.15, 95%可信区间[CI] 1.12-8.85；p = 0.030)和降低死亡率(aOR 0.24, 95% CI 0.07-0.82；P = 0.023)。动脉瘤早期治疗（≤12 h）也独立预测了良好的预后（aOR 2.38, p = 0.044）和较低的死亡率（aOR 0.42, p = 0.045）。结论：在低度aSAH和血管痉挛患者中，EVT与改善功能结局和生存率独立相关。这些发现挑战了历史虚无主义，并支持及时、积极的血管内干预作为高危人群护理的关键组成部分。
{"title":"Endovascular Therapy Outcomes for Cerebral Vasospasm in Poor-Grade Aneurysmal Subarachnoid Hemorrhage","authors":"Rami Fakih, Ibrahim A. Bhatti, Rehan Ahmed, Xiaoyu Ma, Syed A. Gillani, Farhan Siddiq, Camilo R. Gomez, Adnan I. Qureshi","doi":"10.1111/jon.70066","DOIUrl":"https://doi.org/10.1111/jon.70066","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>The impact of endovascular therapy (EVT) on outcomes in World Federation of Neurological Societies (WFNS) grade ≥ 4 aneurysmal subarachnoid hemorrhage (aSAH) remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of 80 patients with WFNS grade ≥ 4 aSAH and secondary vasospasm treated between 2010 and 2023. EVT included intra-arterial vasodilators and/or balloon angioplasty. The primary outcome was favorable functional status at 90 days (modified Rankin Scale 0–3). Multivariable logistic regression was used to assess associations between EVT and outcomes, adjusting for age, sex, and time-to-aneurysm securement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>EVT was performed in 77.5% of patients (n = 62). Favorable outcomes occurred in occurred in 42.5% of all patients (n = 34), and were significantly more frequent in the EVT group (48.4% versus 22.2%; p = 0.038). EVT was independently associated with greater odds of favorable outcome (adjusted odds ratio [aOR] 3.15, 95% confidence interval [CI] 1.12–8.85; p = 0.030) and reduced mortality (aOR 0.24, 95% CI 0.07–0.82; p = 0.023). Early aneurysm treatment (≤ 12 h) also independently predicted favorable outcomes (aOR 2.38, p = 0.044) and lower mortality (aOR 0.42, p = 0.045).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among patients with poor-grade aSAH and vasospasm, EVT was independently associated with improved functional outcomes and survival. These findings challenge historical nihilism and support timely, aggressive endovascular intervention as a critical component of care in this high-risk population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740537","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}
Syeda Maria Muzammil, Yasaman Pirahanchi, Ammar Tarabichi, Joseph C. Masdeu
Neurologists have a unique ability to interpret neuroimaging in conjunction with clinical context and disease pathology, making their role vital in accurate interpretation. Neuroimaging education is essential for enhancing these skills, typically provided through neurology residency programs and specialized neuroimaging fellowships. Neuroimaging training experience in neurology residency programs can be quite variable. Neurology residents typically gain substantial exposure to neuroimaging techniques through the sheer volume of cases they encounter during training, often under direct guidance of subspeciality neurologists. However, curriculum implementation and proper documentation of training often lacks consistency, and opportunities for advanced neuroimaging training are limited. The number of fellowship-trained neuroimaging specialists is insufficient to meet the growing demand for neuroimaging expertise. Credentialing and certification issues related to neuroimaging training for neurologists hinder the integration of qualified neurologists into the neuroimaging field. The need for additional years of specialized training, financial burden associated with maintaining certification, opposition by radiological societies, complexities of reimbursement which vary by insurer, region, and hospital policies are some of the challenges. This article explores these issues and suggests that solutions may include the establishment of more accredited neuroimaging fellowship programs or an increase in the neuroimaging component of subspecialty training, as well as addressing credentialing and hospital privileging issues.
{"title":"Neuroimaging Training Programs, Certification Pathways, and Credentialing Issues","authors":"Syeda Maria Muzammil, Yasaman Pirahanchi, Ammar Tarabichi, Joseph C. Masdeu","doi":"10.1111/jon.70049","DOIUrl":"https://doi.org/10.1111/jon.70049","url":null,"abstract":"<div>\u0000 \u0000 <p>Neurologists have a unique ability to interpret neuroimaging in conjunction with clinical context and disease pathology, making their role vital in accurate interpretation. Neuroimaging education is essential for enhancing these skills, typically provided through neurology residency programs and specialized neuroimaging fellowships. Neuroimaging training experience in neurology residency programs can be quite variable. Neurology residents typically gain substantial exposure to neuroimaging techniques through the sheer volume of cases they encounter during training, often under direct guidance of subspeciality neurologists. However, curriculum implementation and proper documentation of training often lacks consistency, and opportunities for advanced neuroimaging training are limited. The number of fellowship-trained neuroimaging specialists is insufficient to meet the growing demand for neuroimaging expertise. Credentialing and certification issues related to neuroimaging training for neurologists hinder the integration of qualified neurologists into the neuroimaging field. The need for additional years of specialized training, financial burden associated with maintaining certification, opposition by radiological societies, complexities of reimbursement which vary by insurer, region, and hospital policies are some of the challenges. This article explores these issues and suggests that solutions may include the establishment of more accredited neuroimaging fellowship programs or an increase in the neuroimaging component of subspecialty training, as well as addressing credentialing and hospital privileging issues.</p>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740536","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}
Julia Pfirrmann, Anne Adlung, Ingo Hermann, Claudia E. Weber, Anne Ebert, Frank G. Zöllner, Achim Gass, Philipp Eisele
Background and Purpose
Quantitative MRI provides insights into (patho-) physiological processes of the brain macro- and microstructure. In this study, we applied a multimodal MRI approach to determine quantitative values of the brain in healthy young adults.
Methods
3 T MRI including sodium MRI (4.0 mm nominal isotropic resolution), 3D T1-weighted magnetization-prepared rapid acquisition gradient-echo (spatial resolution = 0.9 mm × 0.9 mm × 0.9 mm), T2-fluid attenuated inversion recovery (spatial resolution = 0.4 mm × 0.4 mm × 5.0 mm), diffusion-weighted imaging (spatial resolution = 1.0 mm × 1.0 mm × 4.0 mm), PD/T2 (spatial resolution = 1.0 mm × 1.0 mm × 2.0 mm), and MR fingerprinting including T1 and T2* relaxation times (spatial resolution = 1 mm × 1 mm × 2 mm) was performed on 40 healthy young adults (28 women, mean age: 24.55 years).
Results
Mean values for the gray matter were as follows—apparent diffusion coefficient (ADC): 0.95 ± 0.03 × 10−3 mm2/s, total sodium concentration (TSC): 41.99 ± 2.35 mM, T1: 1338.04 ± 46.29 ms, T2*: 63.39 ± 2.94 ms. For the white matter, mean values were as follows—ADC: 0.79 ± 0.02 × 10−3 mm2/s, TSC: 36.08 ± 5.62 mM, T1: 968.47 ± 48.35 ms, T2*: 53.62 ± 8.06 ms, and for the deep gray matter, mean values were as follows—ADC: 0.85 ± 0.04 × 10−3 mm2/s, TSC: 38.23 ± 2.91 mM, T1: 1087.24 ± 39.77 ms, T2*: 54.53 ± 7.15.
Conclusion
Our multimodal, quantitative MRI atlas of the human brain in healthy young adults provides meaningful in vivo insights into the brain microstructure and can be used for reference in future studies.
背景与目的定量MRI提供了对大脑宏观和微观结构（病理）生理过程的深入了解。在这项研究中，我们应用多模态MRI方法来确定健康年轻人大脑的定量值。方法3 T MRI包括钠核磁共振（4.0 mm名义各向同性分辨率）、三维t1加权磁化制备快速采集梯度回波（空间分辨率= 0.9 mm × 0.9 mm × 0.9 mm）、T2流体衰减反演恢复（空间分辨率= 0.4 mm × 0.4 mm × 5.0 mm）、弥散加权成像（空间分辨率= 1.0 mm × 1.0 mm × 4.0 mm）、PD/T2（空间分辨率= 1.0 mm × 1.0 mm × 2.0 mm）、对40例健康青年（女性28例，平均年龄24.55岁）进行T1和T2*弛豫时间（空间分辨率= 1 mm × 1 mm × 2 mm） MR指纹识别。结果脑灰质表观扩散系数（ADC）平均值：0.95±0.03 × 10−3 mm2/s，总钠浓度（TSC）： 41.99±2.35 mM, T1: 1338.04±46.29 ms, T2*: 63.39±2.94 ms。白质平均值为：adc: 0.79±0.02 × 10−3 mm2/s, TSC: 36.08±5.62 mM, T1: 968.47±48.35 ms, T2*: 53.62±8.06 ms；深灰质平均值为：adc: 0.85±0.04 × 10−3 mm2/s, TSC: 38.23±2.91 mM, T1: 1087.24±39.77 ms, T2*: 54.53±7.15。结论我们的多模态、定量的健康年轻人大脑MRI图谱提供了对大脑微观结构有意义的活体洞察，可为未来的研究提供参考。
{"title":"Multimodal Quantitative MRI Atlas of the Human Brain in Healthy Young Adults","authors":"Julia Pfirrmann, Anne Adlung, Ingo Hermann, Claudia E. Weber, Anne Ebert, Frank G. Zöllner, Achim Gass, Philipp Eisele","doi":"10.1111/jon.70074","DOIUrl":"https://doi.org/10.1111/jon.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Quantitative MRI provides insights into (patho-) physiological processes of the brain macro- and microstructure. In this study, we applied a multimodal MRI approach to determine quantitative values of the brain in healthy young adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>3 T MRI including sodium MRI (4.0 mm nominal isotropic resolution), 3D T1-weighted magnetization-prepared rapid acquisition gradient-echo (spatial resolution = 0.9 mm × 0.9 mm × 0.9 mm), T2-fluid attenuated inversion recovery (spatial resolution = 0.4 mm × 0.4 mm × 5.0 mm), diffusion-weighted imaging (spatial resolution = 1.0 mm × 1.0 mm × 4.0 mm), PD/T2 (spatial resolution = 1.0 mm × 1.0 mm × 2.0 mm), and MR fingerprinting including T1 and T2* relaxation times (spatial resolution = 1 mm × 1 mm × 2 mm) was performed on 40 healthy young adults (28 women, mean age: 24.55 years).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean values for the gray matter were as follows—apparent diffusion coefficient (ADC): 0.95 ± 0.03 × 10<sup>−3</sup> mm<sup>2</sup>/s, total sodium concentration (TSC): 41.99 ± 2.35 mM, T1: 1338.04 ± 46.29 ms, T2*: 63.39 ± 2.94 ms. For the white matter, mean values were as follows—ADC: 0.79 ± 0.02 × 10<sup>−3</sup> mm<sup>2</sup>/s, TSC: 36.08 ± 5.62 mM, T1: 968.47 ± 48.35 ms, T2*: 53.62 ± 8.06 ms, and for the deep gray matter, mean values were as follows—ADC: 0.85 ± 0.04 × 10<sup>−3</sup> mm<sup>2</sup>/s, TSC: 38.23 ± 2.91 mM, T1: 1087.24 ± 39.77 ms, T2*: 54.53 ± 7.15.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our multimodal, quantitative MRI atlas of the human brain in healthy young adults provides meaningful in vivo insights into the brain microstructure and can be used for reference in future studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.70074","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144705613","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}
José Carlos Méndez, Pedro Vega, Alfonso Lopez-Frías, Teresa Díaz, Josep Puig, Eduardo Murias, Jordi Blasco, Carlos Pérez-García, Víctor Maestro, Manuel Moreu, Marc Comas-Cufí, Antonio Cruz-Culebras, María Antonia Prieto, Isabel Bermúdez-Coronel, Javier Blázquez, Jaime Masjuán
Background and Purpose
Mechanical thrombectomy (MT) is increasingly performed for distal medium vessel occlusions (DMVOs) of the anterior circulation in acute stroke patients. Although trials have not shown superiority over usual care, selected patients may still benefit from MT. The ideal endovascular technique is debated. We aimed to determine the safety and efficacy of double stent retriever MT (DSR-MT) for DMVOs.
Methods
We retrospective analyzed demographics, procedure characteristics, and clinical data from consecutive patients with acute primary DMVOs treated with DSR-MT at four comprehensive stroke centers. Reperfusion was defined by the extended Thrombolysis In Cerebral Infarction (eTICI) score. Clinical outcomes were measured by the National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores.
Results
We included 32 patients (median age, 78 years, interquartile range [IQR] 71–82; 16 [50%] female), of whom 26 (81.2%) had primary occlusion of the M2 segment of the middle cerebral artery and six (18.8%) had occlusion of M3. Clinical severity was moderate (median, NIHSS 13; IQR 10–15) in 24 patients (75%). First-pass effect (eTICI 2c/3) was achieved in 20 patients (62.5%). Final eTICI 2b/2c/3 was achieved in 30 patients (93.7%) and final eTICI 2c/3 in 25 (78.1%). Symptomatic intracranial hemorrhage developed in one patient (3.1%). Median NIHSS was 6 at 24 h (IQR 3–12) and 4 at discharge (IQR 1–9). At 90 days, 22 (73.3%) patients were functionally independent (mRS 0–2).
Conclusions
This preliminary study found good efficacy and safety of DSR-MT for DMVOs in patients with M2 and M3 occlusions.
{"title":"Double Stent Retriever Mechanical Thrombectomy for Distal Medium Vessel Clots in the Middle Cerebral Artery: Initial Experience","authors":"José Carlos Méndez, Pedro Vega, Alfonso Lopez-Frías, Teresa Díaz, Josep Puig, Eduardo Murias, Jordi Blasco, Carlos Pérez-García, Víctor Maestro, Manuel Moreu, Marc Comas-Cufí, Antonio Cruz-Culebras, María Antonia Prieto, Isabel Bermúdez-Coronel, Javier Blázquez, Jaime Masjuán","doi":"10.1111/jon.70064","DOIUrl":"https://doi.org/10.1111/jon.70064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Mechanical thrombectomy (MT) is increasingly performed for distal medium vessel occlusions (DMVOs) of the anterior circulation in acute stroke patients. Although trials have not shown superiority over usual care, selected patients may still benefit from MT. The ideal endovascular technique is debated. We aimed to determine the safety and efficacy of double stent retriever MT (DSR-MT) for DMVOs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospective analyzed demographics, procedure characteristics, and clinical data from consecutive patients with acute primary DMVOs treated with DSR-MT at four comprehensive stroke centers. Reperfusion was defined by the extended Thrombolysis In Cerebral Infarction (eTICI) score. Clinical outcomes were measured by the National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 32 patients (median age, 78 years, interquartile range [IQR] 71–82; 16 [50%] female), of whom 26 (81.2%) had primary occlusion of the M2 segment of the middle cerebral artery and six (18.8%) had occlusion of M3. Clinical severity was moderate (median, NIHSS 13; IQR 10–15) in 24 patients (75%). First-pass effect (eTICI 2c/3) was achieved in 20 patients (62.5%). Final eTICI 2b/2c/3 was achieved in 30 patients (93.7%) and final eTICI 2c/3 in 25 (78.1%). Symptomatic intracranial hemorrhage developed in one patient (3.1%). Median NIHSS was 6 at 24 h (IQR 3–12) and 4 at discharge (IQR 1–9). At 90 days, 22 (73.3%) patients were functionally independent (mRS 0–2).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This preliminary study found good efficacy and safety of DSR-MT for DMVOs in patients with M2 and M3 occlusions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666213","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}
Korhan Buyukturkoglu, Lin Lu, Levi Davis, Renan E. Orellana, Charles C. White, Rongyi Sun, Sinem Ozcelik, Nina M. Isenstein, Kaho B. Onomichi, Rifat Iqbal, Binsheng Zhao, Yaakov Stern, Burcu Zeydan, Orhun H. Kantarci, Claire S. Riley, Philip L. De Jager
Background and Purpose
Radiomics extracts imaging features that may not be detectable through conventional volumetric analyses. Given their role in multiple sclerosis (MS), we applied radiomics to thalamic nuclei and examined their associations with cognitive performance.
Methods
A total of 601 individuals were included (342 people with MS [PwMS] from two cohorts and 259 healthy controls [HC]). Radiomic features (RF) and volumes were extracted from the whole thalamus, five thalamic nuclei, and the putamen segmented on three-dimensional T1-weighted images. Cognitive performance was assessed using the Symbol Digit Modalities Test (SDMT) and Paced Auditory Serial Addition Test (PASAT) in PwMS and the Digit Symbol Substitution Test (DSST) in HC. In the first MS cohort, multivariate linear regression in a discovery set (N = 103) identified thalamus-derived RF associated with SDMT, which were retested in a replication set (N = 63). Their associations with PASAT in a second MS cohort (N = 176) and DSST in HC were also evaluated. We then tested whether the same RFs, when extracted from the putamen, was associated with SDMT. Least Absolute Shrinkage and Selection Operator (LASSO) models assessed the combined predictive value of RF and volumes.
Results
Twenty-eight RF–region of interest (ROI) pairs were associated with SDMT in the replication set (false discovery rate [FDR] < 0.05). Of these, 24 were also associated with PASAT (FDR ≤ 0.03), and 2 with DSST. Only ventral nuclei volume showed replicated associations among volumetrics. Only four putamen-derived pairs were associated with SDMT (FDR = 0.04). LASSO results confirmed RF outperformed volumes.
Conclusion
RF extracted from the thalamus is strongly associated with cognitive performance in PwMS, outperforming volumetric measures and supporting their potential as sensitive imaging biomarkers.
{"title":"A Radiomic Approach to Clinical MRI Refines the Thalamus-Cognition Link in Multiple Sclerosis","authors":"Korhan Buyukturkoglu, Lin Lu, Levi Davis, Renan E. Orellana, Charles C. White, Rongyi Sun, Sinem Ozcelik, Nina M. Isenstein, Kaho B. Onomichi, Rifat Iqbal, Binsheng Zhao, Yaakov Stern, Burcu Zeydan, Orhun H. Kantarci, Claire S. Riley, Philip L. De Jager","doi":"10.1111/jon.70069","DOIUrl":"https://doi.org/10.1111/jon.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Radiomics extracts imaging features that may not be detectable through conventional volumetric analyses. Given their role in multiple sclerosis (MS), we applied radiomics to thalamic nuclei and examined their associations with cognitive performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 601 individuals were included (342 people with MS [PwMS] from two cohorts and 259 healthy controls [HC]). Radiomic features (RF) and volumes were extracted from the whole thalamus, five thalamic nuclei, and the putamen segmented on three-dimensional T1-weighted images. Cognitive performance was assessed using the Symbol Digit Modalities Test (SDMT) and Paced Auditory Serial Addition Test (PASAT) in PwMS and the Digit Symbol Substitution Test (DSST) in HC. In the first MS cohort, multivariate linear regression in a discovery set (<i>N</i> = 103) identified thalamus-derived RF associated with SDMT, which were retested in a replication set (<i>N</i> = 63). Their associations with PASAT in a second MS cohort (<i>N</i> = 176) and DSST in HC were also evaluated. We then tested whether the same RFs, when extracted from the putamen, was associated with SDMT. Least Absolute Shrinkage and Selection Operator (LASSO) models assessed the combined predictive value of RF and volumes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-eight RF–region of interest (ROI) pairs were associated with SDMT in the replication set (false discovery rate [FDR] < 0.05). Of these, 24 were also associated with PASAT (FDR ≤ 0.03), and 2 with DSST. Only ventral nuclei volume showed replicated associations among volumetrics. Only four putamen-derived pairs were associated with SDMT (FDR = 0.04). LASSO results confirmed RF outperformed volumes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>RF extracted from the thalamus is strongly associated with cognitive performance in PwMS, outperforming volumetric measures and supporting their potential as sensitive imaging biomarkers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666214","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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