Doudou Cao, Litong Ni, Qi Qi, Lan Zhou, Wei Zhang, Yi Wang, Li Zhu, Guolin Ma, Fan Zhang, Shijun Li
Background and Purpose
The middle longitudinal fascicle (MdLF), a recently characterized white matter tract within the ventral language network, remains understudied in autism spectrum disorder (ASD). We hypothesized that altered microstructural development of the MdLF contributes to language impairment in children with ASD.
Methods
Free water corrected diffusion magnetic resonance imaging (MRI) tractography was employed to reconstruct the MdLF in 57 children with ASD (5.79±0.99 years) and 37 matched typically developing (TD) controls (5.99±1.38 years), aged 4–9 years. Language impairment was assessed using the Autism Behavior Checklist language subscale. General linear models and partial correlations (covarying age) were applied to investigate age-related differences of diffusion metrics and the correlation of diffusion metrics with language impairment in ASD.
Results
Significant age-by-group interactions emerged for bilateral MdLF fractional anisotropy tissue (FAt) (TD: left/right β = 0.614/0.511, p < 0.01; ASD: p > 0.05) and axial diffusivity tissue (ADt) (ASD: left/right β = −0.458/−0.348, p < 0.05; TD: p > 0.05). In ASD, FAt (r = −0.441, p < 0.001) and ADt (r = −0.28, p = 0.037) were negatively correlated with language impairment, while radial diffusivity tissue showed a positive correlation (r = 0.355, p = 0.007) in the right MdLF. There were no significant between-group differences found in diffusion metrics.
Conclusions
The MdLF exhibits aberrant developmental trajectories in preschool children with ASD, and its microstructural integrity is linked to language impairment. These findings underscore the MdLF's role in ASD-related language deficits and highlight the importance of early neurodevelopmental assessment.
背景与目的中纵束（MdLF）是最近在腹侧语言网络中发现的一个白质束，在自闭症谱系障碍（ASD）中的研究尚不充分。我们假设MdLF的微观结构发育改变有助于ASD儿童的语言障碍。方法对57例（5.79±0.99岁）和37例（5.99±1.38岁）4 ~ 9岁的正常发育（TD）儿童（5.99±1.38岁）采用游离水校正弥散性磁共振（MRI）束道成像重建MdLF。使用自闭症行为检查表语言子量表评估语言障碍。采用一般线性模型和部分相关模型（共变年龄）研究ASD中扩散指标的年龄相关差异以及扩散指标与语言障碍的相关性。结果双侧MdLF分数各向异性组织（FAt）出现显著的年龄组相互作用(TD：左/右β = 0.614/0.511, p <；0.01;ASD: p >；0.05)和轴向扩散性组织（ADt） (ASD：左/右β =−0.458/−0.348,p <；0.05;TD: p >；0.05)。在ASD中，FAt (r = - 0.441, p <；0.001)和ADt （r = - 0.28, p = 0.037）与语言障碍呈负相关，而右侧MdLF的径向扩散率组织呈正相关（r = 0.355, p = 0.007）。扩散指标组间无显著差异。结论学龄前ASD患儿的MdLF表现出异常的发育轨迹，其微观结构完整性与语言障碍有关。这些发现强调了MdLF在自闭症相关语言缺陷中的作用，并强调了早期神经发育评估的重要性。
{"title":"Middle Longitudinal Fascicle Maldevelopment on Free Water Corrected MR Diffusion Underlies Language Impairment in Autism","authors":"Doudou Cao, Litong Ni, Qi Qi, Lan Zhou, Wei Zhang, Yi Wang, Li Zhu, Guolin Ma, Fan Zhang, Shijun Li","doi":"10.1111/jon.70067","DOIUrl":"https://doi.org/10.1111/jon.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>The middle longitudinal fascicle (MdLF), a recently characterized white matter tract within the ventral language network, remains understudied in autism spectrum disorder (ASD). We hypothesized that altered microstructural development of the MdLF contributes to language impairment in children with ASD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Free water corrected diffusion magnetic resonance imaging (MRI) tractography was employed to reconstruct the MdLF in 57 children with ASD (5.79±0.99 years) and 37 matched typically developing (TD) controls (5.99±1.38 years), aged 4–9 years. Language impairment was assessed using the Autism Behavior Checklist language subscale. General linear models and partial correlations (covarying age) were applied to investigate age-related differences of diffusion metrics and the correlation of diffusion metrics with language impairment in ASD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significant age-by-group interactions emerged for bilateral MdLF fractional anisotropy tissue (FA<sub>t</sub>) (TD: left/right β = 0.614/0.511, <i>p</i> < 0.01; ASD: <i>p</i> > 0.05) and axial diffusivity tissue (AD<sub>t</sub>) (ASD: left/right β = −0.458/−0.348, <i>p</i> < 0.05; TD: <i>p</i> > 0.05). In ASD, FA<sub>t</sub> (<i>r</i> = −0.441, <i>p</i> < 0.001) and AD<sub>t</sub> (<i>r</i> = −0.28, <i>p</i> = 0.037) were negatively correlated with language impairment, while radial diffusivity tissue showed a positive correlation (<i>r</i> = 0.355, <i>p</i> = 0.007) in the right MdLF. There were no significant between-group differences found in diffusion metrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The MdLF exhibits aberrant developmental trajectories in preschool children with ASD, and its microstructural integrity is linked to language impairment. These findings underscore the MdLF's role in ASD-related language deficits and highlight the importance of early neurodevelopmental assessment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551010","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}
Pedro Navia, Andres Fernandez-Prieto, Alberto Alvarez-Muelas, Ángel Calleja, Joaquin Ortega, Carlos Domínguez, Antonio Sagredo, Amado Rodríguez-Benítez, Juan García-Villanego, Alberto Martínez-Calvo, Daniel Cubillo-Prieto, Carmen de la Rosa, Antonio Mosqueira, Rebeca Bermejo-Garcés, Juan Chaviano, Isabel Bermúdez-Coronel, Carlos Pérez-García, Carlos Manuel Rodriguez-Paz, Carlos Hidalgo-Barranco, Javier Maynar, Jose Luis Caniego, Juan David Molina-Nuevo, Víctor Maestro, Juan Manuel Sanchís-García, Oscar Balboa, Mario Martínez-Galdamez, Eñaut Garmendia, Marc Comas-Cufí, Josep Puig, Joaquín Zamarro
Background and Purpose
The effectiveness of a large-bore aspiration catheter for contact aspiration (CA) thrombectomy is compared to the combined use of an aspiration catheter and a stent retriever (CA+SR) for large vessel occlusion (LVO). We assessed the efficacy and safety of CA alone versus CA+SR as first-line treatment for middle cerebral artery (MCA) LVO in daily practice.
Methods
We retrospectively analyzed data from the SARA-3 registry of patients with MCA occlusion (M1 and M2 segments), dividing them into two groups: first-line CA alone and combined CA+SR. Demographic, clinical, angiographic, and clinical outcomes (National Institute of Health Stroke Scale score at 24 h and modified Rankin Scale [mRS] score at 3 months) were compared.
Results
Of 551 patients, 348 (63.8%) received CA alone and 203 (36.8%) received CA+SR. The groin-to-reperfusion time was significantly shorter in the CA-alone group than in the combined CA+SR group (median, 26 vs. 40 min, p < 0.001). The CA group demonstrated higher first-pass modified Thrombolysis In Cerebral Infarction (mTICI) 3 recanalization rates (47% vs. 37%; adjusted odds ratio [OR] 1.5 [confidence interval 1–2.1], p = 0.042), a higher final mTICI 3 rate (65% vs. 56%; OR 1.5 [1–2.2], p = 0.037), and fewer new territory embolisms (0.9% vs. 3.9%; OR 0.2 [0–0.8], p = 0.028) compared to the CA+SR group. The CA-alone group had better functional outcomes at 3 months (mRS ≤ 2, 77% vs. 63%; OR 1.9 [1.3–3], p = 0.003).
Conclusions
CA alone outperformed CA+SR as a first-line treatment for MCA LVO, yielding higher first-pass and final recanalization rates, lower new territory embolism risk, shorter procedure times, and better functional outcomes at 3 months.
背景与目的比较了大口径吸血导管用于接触吸血（CA）取栓的有效性，并将其与大血管闭塞（LVO）联合使用吸血导管和支架回收器（CA+SR）进行了比较。我们在日常实践中评估了单独CA与CA+SR作为大脑中动脉（MCA） LVO一线治疗的有效性和安全性。方法回顾性分析SARA-3登记的MCA闭塞（M1和M2段）患者的资料，将其分为两组：一线CA单独组和CA+SR联合组。比较人口学、临床、血管造影和临床结果（24小时时美国国立卫生研究院卒中量表评分和3个月时改良Rankin量表[mRS]评分）。结果551例患者中，单纯CA治疗348例（63.8%），CA+SR治疗203例（36.8%）。CA单独组腹股沟到再灌注时间明显短于CA+SR联合组(中位数，26 vs 40 min, p <；0.001)。CA组表现出更高的首过改良脑梗死溶栓（mTICI） 3再通率(47% vs 37%；校正优势比[OR] 1.5[置信区间1-2.1],p = 0.042)，最终mTICI 3率较高(65%对56%；OR为1.5 [1-2.2],p = 0.037)，新区域栓塞较少(0.9% vs. 3.9%；OR 0.2 [0-0.8], p = 0.028)，与CA+SR组比较。单独ca组在3个月时功能预后更好(mRS≤2,77% vs. 63%；OR 1.9 [1.3-3], p = 0.003)。结论单独CA优于CA+SR作为MCA LVO的一线治疗，在3个月时具有更高的首次通过率和最终再通率，更低的新区域栓塞风险，更短的手术时间和更好的功能结果。
{"title":"Contact Aspiration Alone or Combined With Stent Retriever Thrombectomy for Middle Cerebral Artery Large Vessel Occlusion","authors":"Pedro Navia, Andres Fernandez-Prieto, Alberto Alvarez-Muelas, Ángel Calleja, Joaquin Ortega, Carlos Domínguez, Antonio Sagredo, Amado Rodríguez-Benítez, Juan García-Villanego, Alberto Martínez-Calvo, Daniel Cubillo-Prieto, Carmen de la Rosa, Antonio Mosqueira, Rebeca Bermejo-Garcés, Juan Chaviano, Isabel Bermúdez-Coronel, Carlos Pérez-García, Carlos Manuel Rodriguez-Paz, Carlos Hidalgo-Barranco, Javier Maynar, Jose Luis Caniego, Juan David Molina-Nuevo, Víctor Maestro, Juan Manuel Sanchís-García, Oscar Balboa, Mario Martínez-Galdamez, Eñaut Garmendia, Marc Comas-Cufí, Josep Puig, Joaquín Zamarro","doi":"10.1111/jon.70065","DOIUrl":"https://doi.org/10.1111/jon.70065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>The effectiveness of a large-bore aspiration catheter for contact aspiration (CA) thrombectomy is compared to the combined use of an aspiration catheter and a stent retriever (CA+SR) for large vessel occlusion (LVO). We assessed the efficacy and safety of CA alone versus CA+SR as first-line treatment for middle cerebral artery (MCA) LVO in daily practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed data from the SARA-3 registry of patients with MCA occlusion (M1 and M2 segments), dividing them into two groups: first-line CA alone and combined CA+SR. Demographic, clinical, angiographic, and clinical outcomes (National Institute of Health Stroke Scale score at 24 h and modified Rankin Scale [mRS] score at 3 months) were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 551 patients, 348 (63.8%) received CA alone and 203 (36.8%) received CA+SR. The groin-to-reperfusion time was significantly shorter in the CA-alone group than in the combined CA+SR group (median, 26 vs. 40 min, <i>p</i> < 0.001). The CA group demonstrated higher first-pass modified Thrombolysis In Cerebral Infarction (mTICI) 3 recanalization rates (47% vs. 37%; adjusted odds ratio [OR] 1.5 [confidence interval 1–2.1], <i>p</i> = 0.042), a higher final mTICI 3 rate (65% vs. 56%; OR 1.5 [1–2.2], <i>p</i> = 0.037), and fewer new territory embolisms (0.9% vs. 3.9%; OR 0.2 [0–0.8], <i>p</i> = 0.028) compared to the CA+SR group. The CA-alone group had better functional outcomes at 3 months (mRS ≤ 2, 77% vs. 63%; OR 1.9 [1.3–3], <i>p</i> = 0.003).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CA alone outperformed CA+SR as a first-line treatment for MCA LVO, yielding higher first-pass and final recanalization rates, lower new territory embolism risk, shorter procedure times, and better functional outcomes at 3 months.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.70065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144536927","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}
Intravascular lymphoma (IVL) is a rare and aggressive lymphoma subtype that poses diagnostic challenges due to its nonspecific clinical presentation. This study aimed to evaluate the imaging findings of this disease in the CNS and to assess the diagnostic potential of advanced imaging techniques, including dynamic susceptibility contrast (DSC) perfusion, magnetic resonance spectroscopy (MRS), and fluorine-18 fluorodeoxyglucose (FDG) PET.
Methods
Twenty-one pathologically confirmed cases of IVL with CNS involvement were evaluated. Two cases underwent DSC perfusion, three underwent MRS, and three underwent FDG PET.
Results
Ninety percent of patients had intracranial imaging findings. The most common imaging pattern on brain MRI was infarct-like lesions (68%), followed by mass-like enhancement and nonspecific white matter changes (11% each). The remaining findings included enhancing lesions without mass effect and a central pontine T2/fluid-attenuated inversion recovery hyperintensity, each observed in one patient. T2* imaging abnormalities were found in 60% of cases. Vascular irregularity on noninvasive angiographic imaging was observed in 30% of cases. Spinal intradural involvement was found in four cases (19%), including three cases with nerve root enhancement and one case with spinal cord infarction. MRS showed variable choline/creatine ratios elevation in two out of three cases. No cases showed apparent cerebral blood volume elevation on DSC perfusion or increased uptake on FDG PET.
Conclusion
Several imaging findings can be observed in CNS IVL, with infarct-like lesions being the most common. Awareness of these imaging features is crucial for the accurate diagnosis of this challenging entity.
{"title":"Conventional and Advanced Imaging Features of CNS Intravascular Lymphoma","authors":"Sunpob Cheewadhanaraks, Otto Rapalino","doi":"10.1111/jon.70061","DOIUrl":"https://doi.org/10.1111/jon.70061","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Intravascular lymphoma (IVL) is a rare and aggressive lymphoma subtype that poses diagnostic challenges due to its nonspecific clinical presentation. This study aimed to evaluate the imaging findings of this disease in the CNS and to assess the diagnostic potential of advanced imaging techniques, including dynamic susceptibility contrast (DSC) perfusion, magnetic resonance spectroscopy (MRS), and fluorine-18 fluorodeoxyglucose (FDG) PET.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-one pathologically confirmed cases of IVL with CNS involvement were evaluated. Two cases underwent DSC perfusion, three underwent MRS, and three underwent FDG PET.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety percent of patients had intracranial imaging findings. The most common imaging pattern on brain MRI was infarct-like lesions (68%), followed by mass-like enhancement and nonspecific white matter changes (11% each). The remaining findings included enhancing lesions without mass effect and a central pontine T2/fluid-attenuated inversion recovery hyperintensity, each observed in one patient. T2* imaging abnormalities were found in 60% of cases. Vascular irregularity on noninvasive angiographic imaging was observed in 30% of cases. Spinal intradural involvement was found in four cases (19%), including three cases with nerve root enhancement and one case with spinal cord infarction. MRS showed variable choline/creatine ratios elevation in two out of three cases. No cases showed apparent cerebral blood volume elevation on DSC perfusion or increased uptake on FDG PET.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Several imaging findings can be observed in CNS IVL, with infarct-like lesions being the most common. Awareness of these imaging features is crucial for the accurate diagnosis of this challenging entity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144536925","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}
Alex Mortimer, Wedad Mohamed, Richard Flood, Sandeep Buddha
Background and purpose: Acute tandem internal carotid artery (ICA) reocclusion after stenting as part of endovascular stroke treatment is recognized as a complication in a significant minority of patients, and this can be associated with neurological deterioration and worse functional outcomes. Non-contrast CT (NCCT) forms the basis of initial follow-up imaging in this setting. We aimed to assess the sensitivity and specificity of asymmetrical hyperdensity within the superior cervical ICA (HD-CICA) on cranial NCCT for tandem ICA reocclusion.
Methods: This was a retrospective review of a prospectively acquired database (of cases performed January 2022-December 2024 inclusive) at a regional thrombectomy center. The frequency of HD-CICA on 12-24 h NCCT was compared to contemporaneous vascular imaging (CT angiography or carotid Doppler ultrasound) in patients with patent and reoccluded ICAs.
Results: A total of 148 patients underwent thrombectomy with ICA stenting for tandem occlusion. Stent occlusion was associated with lower rates of early neurological improvement and reperfusion and higher rates of neurological deterioration. A total of 99 patients were acutely investigated for stent patency, and HD-CICA was assessable in 92. The frequency of HD-CICA with stent occlusion was 18/19 (94.7%) versus 0/73 (0%) in patent stents (p < 0.0001). HD-CICA was both a sensitive (18/19, 94.7%, 95% confidence interval: 74.0%-99.9%) and specific sign (73/73, 100%, 95% confidence interval: 95.1%-100%), with high positive and negative predictive value for stent reocclusion.
Conclusion: HD-CICA on acute follow-up cranial NCCT is a reliable acute marker of tandem carotid reocclusion.
{"title":"Tandem Cervical Internal Carotid Artery Hyperdensity Implies Stent Reocclusion on Post Thrombectomy Computed Tomography.","authors":"Alex Mortimer, Wedad Mohamed, Richard Flood, Sandeep Buddha","doi":"10.1111/jon.70077","DOIUrl":"https://doi.org/10.1111/jon.70077","url":null,"abstract":"<p><strong>Background and purpose: </strong>Acute tandem internal carotid artery (ICA) reocclusion after stenting as part of endovascular stroke treatment is recognized as a complication in a significant minority of patients, and this can be associated with neurological deterioration and worse functional outcomes. Non-contrast CT (NCCT) forms the basis of initial follow-up imaging in this setting. We aimed to assess the sensitivity and specificity of asymmetrical hyperdensity within the superior cervical ICA (HD-CICA) on cranial NCCT for tandem ICA reocclusion.</p><p><strong>Methods: </strong>This was a retrospective review of a prospectively acquired database (of cases performed January 2022-December 2024 inclusive) at a regional thrombectomy center. The frequency of HD-CICA on 12-24 h NCCT was compared to contemporaneous vascular imaging (CT angiography or carotid Doppler ultrasound) in patients with patent and reoccluded ICAs.</p><p><strong>Results: </strong>A total of 148 patients underwent thrombectomy with ICA stenting for tandem occlusion. Stent occlusion was associated with lower rates of early neurological improvement and reperfusion and higher rates of neurological deterioration. A total of 99 patients were acutely investigated for stent patency, and HD-CICA was assessable in 92. The frequency of HD-CICA with stent occlusion was 18/19 (94.7%) versus 0/73 (0%) in patent stents (p < 0.0001). HD-CICA was both a sensitive (18/19, 94.7%, 95% confidence interval: 74.0%-99.9%) and specific sign (73/73, 100%, 95% confidence interval: 95.1%-100%), with high positive and negative predictive value for stent reocclusion.</p><p><strong>Conclusion: </strong>HD-CICA on acute follow-up cranial NCCT is a reliable acute marker of tandem carotid reocclusion.</p>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 4","pages":"e70077"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957646","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}
Rodolfo G. Gatto, Hossam Youssef, Nha Trang Thu Pham, Farwa Ali, Heather M. Clark, Julie Stierwalt, Yehkyoung Stephens, Mary M. Machulda, Keith A. Josephs, Jennifer L. Whitwell
Background and Purpose
Diffusion tensor imaging (DTI) is commonly used to assess the integrity of gray and white matter (WM) structures in progressive supranuclear palsy (PSP). Beyond DTI, nontraditional diffusion techniques such as diffusion kurtosis imaging (DKI) have been shown to characterize brain tissue further. In this work, we aim to determine the utility of DKI in the differential diagnosis of PSP—Richardson syndrome (PSP-RS) and PSP with predominant parkinsonism (PSP-P) from Parkinson's disease (PD) and controls.
Methods
A multishell diffusion-weighted sequence was acquired at 3 Tesla on a Siemens system in 22 patients with PSP-RS, 23 with PSP-P, 19 with PD, and 19 controls. Fractional anisotropy, mean diffusivity, kurtosis fractional anisotropy (KFA), and mean kurtosis (Kmean) were calculated for nine deep gray matter regions and six different WM tracts.
Results
DKI identified differences (not found by DTI) between control and PSP groups in the globus pallidum externus, subthalamic region, and putamen, with Kmean in the putamen able to differentiate PSP-RS and PD. DKI WM measurements in the body of the corpus callosum and dentatorubrothalamic tract differentiated PSP-RS from PD, and the corticostriatal tract differentiated PSP-P from PD. KFA in the body of the corpus callosum identified worse microstructural anomalies in PSP-RS compared to PSP-P. DKI metrics correlated with the severity of ocular motor impairment and parkinsonism scores.
Conclusions
DKI measurements could differentiate PSP-RS, PSP-P, and PD and, hence, may be a promising imaging tool for studying structural neuropathological changes in PSP.
{"title":"Brain Microstructure Interrogation by Diffusion Tensor and Kurtosis Imaging in Progressive Supranuclear Palsy Subtypes","authors":"Rodolfo G. Gatto, Hossam Youssef, Nha Trang Thu Pham, Farwa Ali, Heather M. Clark, Julie Stierwalt, Yehkyoung Stephens, Mary M. Machulda, Keith A. Josephs, Jennifer L. Whitwell","doi":"10.1111/jon.70062","DOIUrl":"https://doi.org/10.1111/jon.70062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Diffusion tensor imaging (DTI) is commonly used to assess the integrity of gray and white matter (WM) structures in progressive supranuclear palsy (PSP). Beyond DTI, nontraditional diffusion techniques such as diffusion kurtosis imaging (DKI) have been shown to characterize brain tissue further. In this work, we aim to determine the utility of DKI in the differential diagnosis of PSP—Richardson syndrome (PSP-RS) and PSP with predominant parkinsonism (PSP-P) from Parkinson's disease (PD) and controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A multishell diffusion-weighted sequence was acquired at 3 Tesla on a Siemens system in 22 patients with PSP-RS, 23 with PSP-P, 19 with PD, and 19 controls. Fractional anisotropy, mean diffusivity, kurtosis fractional anisotropy (KFA), and mean kurtosis (Kmean) were calculated for nine deep gray matter regions and six different WM tracts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>DKI identified differences (not found by DTI) between control and PSP groups in the globus pallidum externus, subthalamic region, and putamen, with Kmean in the putamen able to differentiate PSP-RS and PD. DKI WM measurements in the body of the corpus callosum and dentatorubrothalamic tract differentiated PSP-RS from PD, and the corticostriatal tract differentiated PSP-P from PD. KFA in the body of the corpus callosum identified worse microstructural anomalies in PSP-RS compared to PSP-P. DKI metrics correlated with the severity of ocular motor impairment and parkinsonism scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DKI measurements could differentiate PSP-RS, PSP-P, and PD and, hence, may be a promising imaging tool for studying structural neuropathological changes in PSP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473106","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}
Qiuxuan Li, Xuesong Bai, Fan Yu, Yao Lu, Miao Zhang, Jingkai Li, Yuan Li, Qiuyue Tian, Adam A. Dmytriw, Robert W. Regenhardt, Liqun Jiao, Jie Lu
Background and Purposes
The Alberta Stroke Program Early CT Score-based net water uptake (ASPECTS-NWU) is a quantitative imaging biomarker used to assess early ischemic changes in acute ischemic stroke patients. ASPECTS-NWU has been investigated in identifying stroke onset time, measuring ischemic tissue edema, and predicting functional outcomes. However, the mediating effect of ASPECTS-NWU and its association with collaterals, infarct volume, and functional outcome still need to be explored. Therefore, we hypothesized that ASPECTS-NWU is a mediator between collateral circulation and infarct volume and investigated their association with outcome.
Methods
There were 201 patients, and 131 of them underwent mechanical thrombectomy. Collaterals were graded using the multiphase Menon score. The mediating effect of ASPECTS-NWU between collaterals and infarct volume was investigated. The association between infarct volume, collaterals, recanalization status, and functional outcome was assessed by univariable and multivariate logistic regression analysis.
Results
Patients with good collaterals displayed higher ASPECTS, lower ASPECTS-NWU, lower National Institute of Health Stroke Scale score at admission (NIHSSadmission), and smaller infarct volume, ischemic tissue volume, and penumbra volume. ASPECTS-NWU was a mediator between collaterals and infarct volume, and the contribution rate of the mediator was 27.9%. In multivariate logistic regression analysis, infarct volume and recanalization status were associated with functional outcomes.
Conclusions
ASPECTS-NWU was a mediator and played a partial role between collaterals and infarct volume. Infarct volume and recanalization status were strong predictors of functional outcome. ASPECTS-NWU and collaterals indirectly influenced functional outcomes by regulating infarct volume.
{"title":"Mediation of Multiphase Collateral Status on Functional Outcome by ASPECTS-Based Net Water Uptake in Acute Stroke","authors":"Qiuxuan Li, Xuesong Bai, Fan Yu, Yao Lu, Miao Zhang, Jingkai Li, Yuan Li, Qiuyue Tian, Adam A. Dmytriw, Robert W. Regenhardt, Liqun Jiao, Jie Lu","doi":"10.1111/jon.70045","DOIUrl":"https://doi.org/10.1111/jon.70045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purposes</h3>\u0000 \u0000 <p>The Alberta Stroke Program Early CT Score-based net water uptake (ASPECTS-NWU) is a quantitative imaging biomarker used to assess early ischemic changes in acute ischemic stroke patients. ASPECTS-NWU has been investigated in identifying stroke onset time, measuring ischemic tissue edema, and predicting functional outcomes. However, the mediating effect of ASPECTS-NWU and its association with collaterals, infarct volume, and functional outcome still need to be explored. Therefore, we hypothesized that ASPECTS-NWU is a mediator between collateral circulation and infarct volume and investigated their association with outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>There were 201 patients, and 131 of them underwent mechanical thrombectomy. Collaterals were graded using the multiphase Menon score. The mediating effect of ASPECTS-NWU between collaterals and infarct volume was investigated. The association between infarct volume, collaterals, recanalization status, and functional outcome was assessed by univariable and multivariate logistic regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients with good collaterals displayed higher ASPECTS, lower ASPECTS-NWU, lower National Institute of Health Stroke Scale score at admission (NIHSS<sub>admission</sub>), and smaller infarct volume, ischemic tissue volume, and penumbra volume. ASPECTS-NWU was a mediator between collaterals and infarct volume, and the contribution rate of the mediator was 27.9%. In multivariate logistic regression analysis, infarct volume and recanalization status were associated with functional outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ASPECTS-NWU was a mediator and played a partial role between collaterals and infarct volume. Infarct volume and recanalization status were strong predictors of functional outcome. ASPECTS-NWU and collaterals indirectly influenced functional outcomes by regulating infarct volume.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315016","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}
Progressive supranuclear palsy (PSP) is a complex neurodegenerative disorder that is frequently misdiagnosed, largely due to its overlapping clinical features with other neurodegenerative diseases, such as Parkinson's disease and multiple system atrophy. Accurate and early diagnosis remains a significant clinical challenge. In this context, diffusion tensor imaging (DTI), a specialized magnetic resonance imaging technique that measures the directional movement of water molecules in neural tissue, has emerged as a promising biomarker. This narrative review synthesizes current research on the utility of DTI in differentiating PSP from other neurodegenerative diseases. Multiple studies have reported significant alterations in DTI parameters—particularly fractional anisotropy and mean diffusivity—in key brain regions, including the superior cerebellar peduncle, thalamus, corticospinal tract, anterior parts of the corpus callosum, and prefrontal cortex. While classical radiological signs such as the hummingbird and Mickey Mouse signs remain highly specific for the classic Richardson syndrome (PSP-RS), superior to any results highlighted by studies of this review, in areas associated with other PSP subtypes, such as the frontal cortex, DTI has scored high rates of diagnostic accuracy, a point that could be more explored in future research efforts. Nonetheless, limitations including small sample sizes, heterogeneous study designs, and a predominant focus on the PSP-RS subtype restrict broader generalizability. Large-scale, multicenter studies are necessary to validate these findings across the diverse spectrum of PSP presentations and to establish DTI as a robust diagnostic tool.
{"title":"Diffusion Tensor Imaging in Progressive Supranuclear Palsy Versus Other Neurodegenerative Diseases: A Review","authors":"Alexandros Giannakis, Spiridon Konitsiotis, Georgia Xiromerisiou","doi":"10.1111/jon.70063","DOIUrl":"https://doi.org/10.1111/jon.70063","url":null,"abstract":"<div>\u0000 \u0000 <p>Progressive supranuclear palsy (PSP) is a complex neurodegenerative disorder that is frequently misdiagnosed, largely due to its overlapping clinical features with other neurodegenerative diseases, such as Parkinson's disease and multiple system atrophy. Accurate and early diagnosis remains a significant clinical challenge. In this context, diffusion tensor imaging (DTI), a specialized magnetic resonance imaging technique that measures the directional movement of water molecules in neural tissue, has emerged as a promising biomarker. This narrative review synthesizes current research on the utility of DTI in differentiating PSP from other neurodegenerative diseases. Multiple studies have reported significant alterations in DTI parameters—particularly fractional anisotropy and mean diffusivity—in key brain regions, including the superior cerebellar peduncle, thalamus, corticospinal tract, anterior parts of the corpus callosum, and prefrontal cortex. While classical radiological signs such as the hummingbird and Mickey Mouse signs remain highly specific for the classic Richardson syndrome (PSP-RS), superior to any results highlighted by studies of this review, in areas associated with other PSP subtypes, such as the frontal cortex, DTI has scored high rates of diagnostic accuracy, a point that could be more explored in future research efforts. Nonetheless, limitations including small sample sizes, heterogeneous study designs, and a predominant focus on the PSP-RS subtype restrict broader generalizability. Large-scale, multicenter studies are necessary to validate these findings across the diverse spectrum of PSP presentations and to establish DTI as a robust diagnostic tool.</p>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144299869","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}
Jiahao Huang, Qingrun Zeng, Ye Wu, Jiawei Zhang, Mengjun Li, Lei Xie, Mingchu Li, Yuanjing Feng
Background and Purpose
The oculomotor nerve (OCN) innervates the eye muscles and can be affected by inflammatory, compressive, and pathological conditions. Diffusion MRI (dMRI) tractography shows the potential ability to describe the trajectory of the OCN. However, reconstruction of the OCN in the cavernous sinus is still challenging due to the complex tissue environment at the skull base.
Methods
In this study, we integrated anatomical knowledge to propose a unified framework for OCN tractography, using 45 dMRI datasets from the Human Connectome Project subjects aged 22–36 years and data from four neurosurgical patients aged 41–53 years with visual behavior disorders. We first employed automatically labeled direct and indirect anatomical landmarks as reference locations for individualized tractography. Next, we compared five widely used cranial nerve reconstruction algorithms to assess the most suitable method for OCN reconstruction. Finally, we tested the combination of the unified framework and the optimized tractography method in tumor patients.
Results
We found that unscented Kalman filter (UKF)-2T and probabilistic tractography outperformed other methods in OCN fiber tractography, owing to their “step-by-step” fiber direction computation and multidirectional consideration, respectively. In neurosurgical patients, UKF-2T effectively reconstructed OCN fibers around lesions.
Conclusion
Our study provides valuable insights for researchers and clinicians in the diagnosis and treatment of OCN-related diseases and neurosurgeries.
{"title":"Unified Framework for Oculomotor Nerve Reconstruction: Tractography-Based Anatomical Assessment","authors":"Jiahao Huang, Qingrun Zeng, Ye Wu, Jiawei Zhang, Mengjun Li, Lei Xie, Mingchu Li, Yuanjing Feng","doi":"10.1111/jon.70052","DOIUrl":"https://doi.org/10.1111/jon.70052","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>The oculomotor nerve (OCN) innervates the eye muscles and can be affected by inflammatory, compressive, and pathological conditions. Diffusion MRI (dMRI) tractography shows the potential ability to describe the trajectory of the OCN. However, reconstruction of the OCN in the cavernous sinus is still challenging due to the complex tissue environment at the skull base.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this study, we integrated anatomical knowledge to propose a unified framework for OCN tractography, using 45 dMRI datasets from the Human Connectome Project subjects aged 22–36 years and data from four neurosurgical patients aged 41–53 years with visual behavior disorders. We first employed automatically labeled direct and indirect anatomical landmarks as reference locations for individualized tractography. Next, we compared five widely used cranial nerve reconstruction algorithms to assess the most suitable method for OCN reconstruction. Finally, we tested the combination of the unified framework and the optimized tractography method in tumor patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found that unscented Kalman filter (UKF)-2T and probabilistic tractography outperformed other methods in OCN fiber tractography, owing to their “step-by-step” fiber direction computation and multidirectional consideration, respectively. In neurosurgical patients, UKF-2T effectively reconstructed OCN fibers around lesions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study provides valuable insights for researchers and clinicians in the diagnosis and treatment of OCN-related diseases and neurosurgeries.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281481","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}
M2 middle cerebral arterial (MCA) occlusions present a greater radiological challenge when compared to more proximal occlusions and additional signs aiding detection could be helpful. We routinely image patients with a dual-phase CT angiography (CTA) protocol, encompassing a bolus-tracked arterial/early and then delayed-phase (40-s post contrast injection) acquisition. We screened a 12-month period of our local thrombectomy database as a preliminary investigation into additional signs that can be gleaned to aid M2 occlusion diagnosis when imaged using this technique.
Methods
We reviewed the CTA and digital subtraction angiographic (DSA) imaging in 10 consecutive patients with M2 MCA occlusions who subsequently underwent thrombectomy.
Results
All patients showed the presence of hyperattenuating M3 and M4 vessels distal to the occlusion on delayed-phase but not early-phase CTA (despite venous opacification evident on the latter). Compared to the contralateral side, attenuation values were significantly elevated in these vessels (202.3 [23.9] vs. 108.5 [16.4] Hounsfield units [HU]; 95% confidence interval [CI] of difference: 69.7–117.9, p < 0.0001). Eight of 10 patients also showed associated ipsilateral hyperattenuating cortical veins; the attenuation difference compared to contralateral cortical veins was 263.5 (58.3) vs. 151 (16.7) HU, 95% CI: 69.0–156.0, p = 0.0005. Collateral appearance and washout were much brisker on DSA suggesting that the signs on delayed-phase CTA represent the retrograde accumulation of contrast material distal to the occlusion after multiple contrast passes with slowed resultant venous flow accounting for an accumulation on the venous side.
Conclusion
An additional phase at 40-s displays hyperattenuating distal arteries and cortical veins that could aid in occlusion detection.
背景和目的与近端闭塞相比，M2脑中动脉（MCA）闭塞具有更大的放射学挑战，其他体征有助于检测。我们常规对患者进行双期CT血管造影（CTA）成像，包括动脉/早期和延迟期（注射造影剂后40秒）采集。我们筛选了12个月的局部取栓数据库，作为使用该技术成像时可以收集到的辅助M2闭塞诊断的其他征象的初步调查。方法回顾10例连续行血栓切除术的M2 MCA闭塞患者的CTA和数字减影血管造影（DSA）成像。结果所有患者在迟发期CTA上均可见闭塞远端高衰减的M3和M4血管，而在早期CTA上未见（尽管早期CTA上可见静脉混浊）。与对侧相比，这些血管的衰减值显著升高(202.3[23.9]比108.5 [16.4]Hounsfield单位[HU]；差异的95%置信区间[CI]: 69.7-117.9, p <；0.0001)。10例患者中有8例还显示相关的同侧皮质静脉过度衰减；与对侧皮质静脉相比，衰减差为263.5（58.3）比151 (16.7)HU, 95% CI: 69.0 ~ 156.0, p = 0.0005。DSA上侧支的外观和冲洗更加明显，提示延迟期CTA上的征象代表了多次造影剂通过后造影剂在闭塞远端逆行堆积，由此导致的静脉血流减慢，导致静脉侧堆积。结论40-s的另一个相位显示远端动脉和皮质静脉的超衰减，有助于闭塞检测。
{"title":"Hyperattenuating Collateral Arteries and Accompanying Cortical Veins as Auxiliary Signs of M2 Occlusion on Dual-Phase CTA","authors":"Alex Mortimer, Richard Flood, Sophie Dunkerton","doi":"10.1111/jon.70060","DOIUrl":"https://doi.org/10.1111/jon.70060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>M2 middle cerebral arterial (MCA) occlusions present a greater radiological challenge when compared to more proximal occlusions and additional signs aiding detection could be helpful. We routinely image patients with a dual-phase CT angiography (CTA) protocol, encompassing a bolus-tracked arterial/early and then delayed-phase (40-s post contrast injection) acquisition. We screened a 12-month period of our local thrombectomy database as a preliminary investigation into additional signs that can be gleaned to aid M2 occlusion diagnosis when imaged using this technique.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We reviewed the CTA and digital subtraction angiographic (DSA) imaging in 10 consecutive patients with M2 MCA occlusions who subsequently underwent thrombectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All patients showed the presence of hyperattenuating M3 and M4 vessels distal to the occlusion on delayed-phase but not early-phase CTA (despite venous opacification evident on the latter). Compared to the contralateral side, attenuation values were significantly elevated in these vessels (202.3 [23.9] vs. 108.5 [16.4] Hounsfield units [HU]; 95% confidence interval [CI] of difference: 69.7–117.9, <i>p</i> < 0.0001). Eight of 10 patients also showed associated ipsilateral hyperattenuating cortical veins; the attenuation difference compared to contralateral cortical veins was 263.5 (58.3) vs. 151 (16.7) HU, 95% CI: 69.0–156.0, <i>p</i> = 0.0005. Collateral appearance and washout were much brisker on DSA suggesting that the signs on delayed-phase CTA represent the retrograde accumulation of contrast material distal to the occlusion after multiple contrast passes with slowed resultant venous flow accounting for an accumulation on the venous side.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>An additional phase at 40-s displays hyperattenuating distal arteries and cortical veins that could aid in occlusion detection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237296","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}
Chris Boyd, Timothy J. Kleinig, Joseph Dawson, Sandy Patel, Wolfgang Mayer, Eva Bezak
Background and Purpose
This work evaluates carotid atherosclerosis quantification from computed tomography angiography (CTA), by novice and expert human contours. Variability sources are critically assessed to establish the minimum performance of future machine learning (ML) tools.
Methods
We analyzed extra cranial carotid lesions, with no, mild, moderate, and severe atherosclerosis (n = 10/group). CTA datasets of 24 patients (n = 6/group) were re-sampled to 2.5 mm axial thicknesses. Lumen, calcific plaque, and soft plaque were manually contoured by three expert experienced clinicians (neuroradiologist, vascular neurologist, and vascular surgeon), a medical physicist (MP), and a radiographer. Contouring was repeated several months later for intra-operator variability and again after development of a protocol. Clinicians blindly ranked each other's contours for descriptive statistical analysis.
Results
Relative to internal carotid origin, plaque began a median of 3.75 mm inferior (Interquartile Range [IQR] 0.8-7 mm), extended 18 mm superior (IQR: 13.0-29.6 mm), with a median total length of 24.4 mm (IQR: 14.7-37.4 mm). Clinicians and non-clinicians contoured lumen and calcific plaque similarly (dice similarity coefficient [DSC]: 0.87/0.62 respectively), but varied greater for soft plaque (DSC: 0.21). Neuroradiologist contours were consistently smaller, from approaching the partial-volume artifact conservatively. Clinicians favored their own contours, most pronouncedly the neuroradiologist (standard deviation: 0.00). Establishing a contouring protocol was not found to improve the agreement between clinicians.
Conclusions
CTA carotid pathology contouring inherently has limited clinician agreement due to small structure size and poor contrast. The reference-contour datasets produced by experienced clinicians are prone to inter-and intra-variability which must be carefully considered to ensure ML models developed from such datasets are not fatally flawed.
背景和目的本研究评估了由新手和专家进行的颈动脉粥样硬化计算机断层血管造影（CTA）量化。对可变性源进行严格评估，以建立未来机器学习（ML）工具的最低性能。方法我们分析颅外颈动脉病变，无、轻度、中度和重度动脉粥样硬化（n = 10/组）。24例患者（n = 6/组）的CTA数据集重新采样至2.5 mm轴向厚度。管腔、钙化斑块和软斑块由三位经验丰富的专家临床医生（神经放射学家、血管神经学家和血管外科医生）、一名医学物理学家（MP）和一名放射技师手工绘制。几个月后重复轮廓，以确定操作者内部的可变性，并在制定协议后再次进行轮廓。临床医生盲目地对彼此的轮廓进行排序，以进行描述性统计分析。结果相对于颈内动脉起源，斑块开始时中位数为3.75 mm（四分位间距[IQR] 0.8-7 mm），延伸至18 mm (IQR: 13.0-29.6 mm)，总中位数为24.4 mm （IQR: 14.7-37.4 mm）。临床医生和非临床医生对管腔和钙化斑块的轮廓相似（骰子相似系数[DSC]分别为0.87/0.62），但软斑块的差异更大（DSC: 0.21）。神经放射学家的轮廓一直较小，因为保守地接近部分体积伪影。临床医生喜欢他们自己的轮廓，最明显的是神经放射学家（标准差：0.00）。建立一个轮廓协议没有发现提高临床医生之间的协议。结论CTA颈动脉病理轮廓由于结构尺寸小，造影剂差，临床一致性有限。由经验丰富的临床医生生成的参考轮廓数据集容易出现内部和内部变异，必须仔细考虑，以确保从这些数据集开发的ML模型不会存在致命缺陷。
{"title":"Observer Variability in CT Angiography Carotid Segmentation: Assessing Variability to Set Minimum Clinical Performance","authors":"Chris Boyd, Timothy J. Kleinig, Joseph Dawson, Sandy Patel, Wolfgang Mayer, Eva Bezak","doi":"10.1111/jon.70058","DOIUrl":"https://doi.org/10.1111/jon.70058","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>This work evaluates carotid atherosclerosis quantification from computed tomography angiography (CTA), by novice and expert human contours. Variability sources are critically assessed to establish the minimum performance of future machine learning (ML) tools.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed extra cranial carotid lesions, with no, mild, moderate, and severe atherosclerosis (<i>n</i> = 10/group). CTA datasets of 24 patients (<i>n</i> = 6/group) were re-sampled to 2.5 mm axial thicknesses. Lumen, calcific plaque, and soft plaque were manually contoured by three expert experienced clinicians (neuroradiologist, vascular neurologist, and vascular surgeon), a medical physicist (MP), and a radiographer. Contouring was repeated several months later for intra-operator variability and again after development of a protocol. Clinicians blindly ranked each other's contours for descriptive statistical analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Relative to internal carotid origin, plaque began a median of 3.75 mm inferior (Interquartile Range [IQR] 0.8-7 mm), extended 18 mm superior (IQR: 13.0-29.6 mm), with a median total length of 24.4 mm (IQR: 14.7-37.4 mm). Clinicians and non-clinicians contoured lumen and calcific plaque similarly (dice similarity coefficient [DSC]: 0.87/0.62 respectively), but varied greater for soft plaque (DSC: 0.21). Neuroradiologist contours were consistently smaller, from approaching the partial-volume artifact conservatively. Clinicians favored their own contours, most pronouncedly the neuroradiologist (standard deviation: 0.00). Establishing a contouring protocol was not found to improve the agreement between clinicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CTA carotid pathology contouring inherently has limited clinician agreement due to small structure size and poor contrast. The reference-contour datasets produced by experienced clinicians are prone to inter-and intra-variability which must be carefully considered to ensure ML models developed from such datasets are not fatally flawed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.70058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214077","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}
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