Journal of Neuroimaging最新文献_第6页

Detection of pathological contrast enhancement with synthetic brain imaging from quantitative multiparametric MRI 利用定量多参数磁共振成像的合成脑成像检测病理对比度增强

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-04-08 DOI: 10.1111/jon.13201

Graziella Donatelli, Gianmichele Migaleddu, Matteo Cencini, Paolo Cecchi, Claudio D'Amelio, Luca Peretti, Guido Buonincontri, Michela Tosetti, Mauro Costagli, Mirco Cosottini

Background and Purpose

We aimed to test whether synthetic T1-weighted imaging derived from a post-contrast Quantitative Transient-state Imaging (QTI) acquisition enabled revealing pathological contrast enhancement in intracranial lesions.

Methods

The analysis included 141 patients who underwent a 3 Tesla-MRI brain exam with intravenous contrast media administration, with the post-contrast acquisition protocol comprising a three-dimensional fast spoiled gradient echo (FSPGR) sequence and a QTI acquisition. Synthetic T1-weighted images were generated from QTI-derived quantitative maps of relaxation times and proton density. Two neuroradiologists assessed synthetic and conventional post-contrast T1-weighted images for the presence and pattern of pathological contrast enhancement in intracranial lesions. Enhancement volumes were quantitatively compared.

Results

Using conventional imaging as a reference, synthetic T1-weighted imaging was 93% sensitive in revealing the presence of contrast enhancing lesions. The agreement for the presence/absence of contrast enhancement was almost perfect both between readers (k = 1 for both conventional and synthetic imaging) and between sequences (k = 0.98 for both readers). In 91% of lesions, synthetic T1-weighted imaging showed the same pattern of contrast enhancement visible in conventional imaging. Differences in enhancement pattern in the remaining lesions can be due to the lower spatial resolution and the longer acquisition delay from contrast media administration of QTI compared to FSPGR. Overall, enhancement volumes appeared larger in synthetic imaging.

Conclusions

QTI-derived post-contrast synthetic T1-weighted imaging captures pathological contrast enhancement in most intracranial enhancing lesions. Further comparative studies employing quantitative imaging with higher spatial resolution is needed to support our data and explore possible future applications in clinical trials.

背景和目的我们的目的是检验对比后定量瞬态成像（QTI）采集得到的合成 T1 加权成像是否能揭示颅内病变的病理对比增强。方法分析包括 141 名接受 3 Tesla-MRI 脑部检查并静脉注射对比剂的患者，对比后采集方案包括三维快速破坏梯度回波（FSPGR）序列和 QTI 采集。合成 T1 加权图像由 QTI 导出的弛豫时间和质子密度定量图生成。两位神经放射学专家对合成和常规对比后 T1 加权图像进行评估，以确定颅内病变是否存在病理对比度增强以及增强的模式。结果以常规成像为参考，合成 T1 加权成像在显示造影剂增强病变方面的敏感度为 93%。读者之间（传统成像和合成成像的 k = 1）和序列之间（两个读者的 k = 0.98）对是否存在造影剂增强几乎完全一致。在 91% 的病变中，合成 T1 加权成像显示出与常规成像相同的对比度增强模式。与 FSPGR 相比，QTI 的空间分辨率较低，造影剂用药后的采集延迟时间较长，因此其余病灶的增强模式可能存在差异。结论QTI衍生的对比后合成T1加权成像可捕捉到大多数颅内增强病变的病理性对比增强。为了支持我们的数据并探索未来在临床试验中的可能应用，还需要采用空间分辨率更高的定量成像技术进行进一步的比较研究。

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引用次数: 0

Transcranial Doppler cerebrovascular reactivity: Thresholds for clinical significance in cerebrovascular disease 经颅多普勒脑血管反应性：脑血管疾病临床意义的阈值。

IF 2.4 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-03-30 DOI: 10.1111/jon.13197

Robert W. Regenhardt, Neal M. Nolan, Alvin S. Das, Rahul Mahajan, Andrew D. Monk, Sarah L. LaRose, Ibrahim Migdady, Yimin Chen, Faheem Sheriff, Xuesong Bai, Adam A. Dmytriw, Aman B. Patel, Samuel B. Snider, Henrikas Vaitkevicius

Background and Purpose

Thresholds for abnormal transcranial Doppler cerebrovascular reactivity (CVR) studies are poorly understood, especially for patients with cerebrovascular disease. Using a real-world cohort with cerebral arterial stenosis, we sought to describe a clinically significant threshold for carbon dioxide reactivity (CO2R) and vasomotor range (VMR).

Methods

CVR studies were performed during conditions of breathing room air normally, breathing 8% carbon dioxide air mixture, and hyperventilation. The mean and standard deviation (SD) of CO2R and VMR were calculated for the unaffected side in patients with unilateral stenosis; a deviation of 2 SDs below the mean was chosen as the threshold for abnormal. Receiver operating characteristic (ROC) curves for both sides for patients with unilateral and bilateral stenosis were evaluated for sensitivity (Sn) and specificity (Sp).

Results

A total of 133 consecutive CVR studies were performed on 62 patients with stenosis with mean±SD age 55±16 years. Comorbidities included hypertension (60%), diabetes (15%), stroke (40%), and smoking (35%). In patients with unilateral stenosis, mean±SD CO2R for the unaffected side was 1.86±0.53%, defining abnormal CO2R as <0.80%. Mean±SD CO2R for the affected side was 1.27±0.90%. The CO2R threshold predicted abnormal acetazolamide single-photon emission computed tomography (SPECT) (Sn = .73, Sp = .79), CT/MRI perfusion abnormality (Sn = .42, Sp = .77), infarction on MRI (Sn = .45, Sp = .76), and pressure-dependent exam (Sn = .50, Sp = .76). For the unaffected side, mean±SD VMR was 39.5±15.8%, defining abnormal VMR as <7.9%. For the affected side, mean±SD VMR was 26.5±17.8%. The VMR threshold predicted abnormal acetazolamide SPECT (Sn = .46, Sp = .94), infarction on MRI (Sn = .27, Sp = .94), and pressure-dependent exam (Sn = .31, Sp = .90).

Conclusions

In patients with multiple vascular risk factors, a reasonable threshold for clinically significant abnormal CO2R is <0.80% and VMR is <7.9%. Noninvasive CVR may aid in diagnosing and risk stratifying patients with stenosis.

背景和目的：人们对经颅多普勒脑血管反应性（CVR）研究异常的阈值知之甚少，尤其是对脑血管疾病患者而言。我们利用现实世界中患有脑动脉狭窄的人群，试图描述具有临床意义的二氧化碳反应性（CO2R）和血管运动范围（VMR）阈值：在正常呼吸室内空气、呼吸 8% 二氧化碳空气混合物和过度换气的条件下进行了 CVR 研究。计算单侧血管狭窄患者未受影响一侧的 CO2R 和 VMR 的平均值和标准差（SD）；选择低于平均值 2 SD 的偏差作为异常阈值。对单侧和双侧血管狭窄患者两侧的接收者操作特征（ROC）曲线进行敏感性（Sn）和特异性（Sp）评估：共对 62 名血管狭窄患者进行了 133 次连续 CVR 检查，患者平均（±SD）年龄为 55±16 岁。合并症包括高血压（60%）、糖尿病（15%）、中风（40%）和吸烟（35%）。在单侧血管狭窄患者中，未受影响一侧的 CO2R 平均值（±SD）为 1.86±0.53%，将 CO2R 异常定义为结论：在有多种血管风险因素的患者中，具有临床意义的 CO2R 异常的合理阈值是

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引用次数: 0

A patient-specific circle of Willis blood flow model in predicting outcomes of balloon test occlusion 预测球囊闭塞试验结果的患者特异性威利斯圈血流模型。

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-03-22 DOI: 10.1111/jon.13198

Jianmin Li, Daniel Li, Ali Alaraj, Xinjian Du, Kezhou Wang, Fady T. Charbel

Background and Purpose

Balloon test occlusion (BTO) evaluates cerebral ischemic tolerance before internal carotid artery (ICA) sacrifice but carries risks like dissection and thrombosis. This study introduces a new approach using a patient-specific circle of Willis (COW) blood flow model, based on non-invasive quantitative MR angiography (qMRA) measurements, to predict the outcomes of BTO.

Methods

We developed individualized COW blood flow models for 43 patients undergoing BTO. These models simulated blood flow and pressure under normal conditions and with the ICA occlusion. We then compared the model's predictions of blood flow changes due to the simulated ICA occlusion to actual qMRA measurements before the BTO.

Results

For all 31 BTO failures, the ipsilateral hemisphere showed an average flow decrease of 15 ± 10% (mean ± standard deviation), compared to 3 ± 2% in the contralateral hemisphere. In all 12 BTO passes, these figures were 6 ± 3% and 1 ± 0.8%, respectively. Notably, all BTO passes had less than a 10% reduction in the ipsilateral hemisphere. In contrast, 65% of BTO failures and 67% single-photon emission computed tomography (SPECT) failures exhibited a decrease of 10% or more in the same region.

Conclusion

Blood flow reduction exceeding 10% in the ipsilateral hemisphere during BTO is a strong predictor of failure in both BTO and SPECT. Our patient-specific COW blood flow models, incorporating detailed flow and arterial geometry data, offered valuable insights for predicting BTO outcomes. These models are especially beneficial for situations where conducting BTO or SPECT is clinically impractical.

背景和目的：球囊试验闭塞（BTO）可在牺牲颈内动脉（ICA）前评估脑缺血耐受性，但存在夹层和血栓形成等风险。本研究根据无创定量磁共振血管造影（qMRA）测量结果，采用患者特异性威利斯圈（COW）血流模型，提出了一种预测 BTO 结果的新方法：我们为 43 名接受 BTO 的患者建立了个性化的威利斯环血流模型。这些模型模拟了正常情况下和 ICA 闭塞时的血流和血压。然后，我们将模型对模拟 ICA 闭塞导致的血流变化的预测与 BTO 前的实际 qMRA 测量结果进行了比较：在所有 31 次 BTO 失败中，同侧半球的血流平均减少了 15 ± 10%（平均 ± 标准偏差），而对侧半球则减少了 3 ± 2%。在所有 12 次 BTO 通过中，这两个数字分别为 6 ± 3% 和 1 ± 0.8%。值得注意的是，同侧半球的所有 BTO 通过率均下降不到 10%。相比之下，65% 的 BTO 失败者和 67% 的单光子发射计算机断层扫描（SPECT）失败者在同一区域的血流量减少了 10%或更多：结论：在 BTO 过程中，同侧半球血流减少超过 10% 是 BTO 和 SPECT 失败的有力预测因素。我们的患者特异性 COW 血流模型结合了详细的血流和动脉几何数据，为预测 BTO 结果提供了有价值的见解。这些模型尤其适用于临床上无法进行 BTO 或 SPECT 的情况。

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引用次数: 0

A deep learning method to identify and localize large-vessel occlusions from cerebral digital subtraction angiography 从脑数字减影血管造影术中识别和定位大血管闭塞的深度学习方法。

IF 2.4 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-03-20 DOI: 10.1111/jon.13193

Roshan Warman, PranavI. Warman, Anmol Warman, Tulio Bueso, Riichi Ota, Thomas Windisch, Gabriel Neves

Background and purpose

An essential step during endovascular thrombectomy is identifying the occluded arterial vessel on a cerebral digital subtraction angiogram (DSA). We developed an algorithm that can detect and localize the position of occlusions in cerebral DSA.

Methods

We retrospectively collected cerebral DSAs from a single institution between 2018 and 2020 from 188 patients, 86 of whom suffered occlusions of the M1 and proximal M2 segments. We trained an ensemble of deep-learning models on fewer than 60 large-vessel occlusion (LVO)-positive patients. We evaluated the model on an independent test set and evaluated the truth of its predicted localizations using Intersection over Union and expert review.

Results

On an independent test set of 166 cerebral DSA frames with an LVO prevalence of 0.19, the model achieved a specificity of 0.95 (95% confidence interval [CI]: 0.90, 0.99), a precision of 0.7450 (95% CI: 0.64, 0.88), and a sensitivity of 0.76 (95% CI: 0.66, 0.91). The model correctly localized the LVO in at least one frame in 13 of the 14 LVO-positive patients in the test set. The model achieved a precision of 0.67 (95% CI: 0.52, 0.79), recall of 0.69 (95% CI: 0.46, 0.81), and a mean average precision of 0.75 (95% CI: 0.56, 0.91).

Conclusion

This work demonstrates that a deep learning strategy using a limited dataset can generate effective representations used to identify LVOs. Generating an expanded and more complete dataset of LVOs with obstructed LVOs is likely the best way to improve the model's ability to localize LVOs.

背景和目的：血管内血栓切除术的一个重要步骤是在脑数字减影血管造影（DSA）上识别闭塞的动脉血管。我们开发了一种算法，可以检测和定位脑数字减影血管造影（DSA）中闭塞血管的位置：我们回顾性地收集了 2018 年至 2020 年间来自一家机构的 188 名患者的脑 DSA，其中 86 名患者的 M1 和 M2 近段闭塞。我们在不到 60 名大血管闭塞（LVO）阳性患者身上训练了一组深度学习模型。我们在一个独立的测试集上对模型进行了评估，并使用 "交集大于联合"（Intersection over Union）和专家评论对其预测定位的真实性进行了评估：在由 166 个脑 DSA 帧组成的独立测试集中，LVO 发生率为 0.19，该模型的特异性为 0.95（95% 置信区间 [CI]：0.90, 0.99），精确度为 0.7450（95% CI：0.64, 0.88），灵敏度为 0.76（95% CI：0.66, 0.91）。在测试集中的 14 例 LVO 阳性患者中，该模型至少在 13 例患者的一帧中正确定位了 LVO。该模型的精确度为 0.67（95% CI：0.52，0.79），召回率为 0.69（95% CI：0.46，0.81），平均精确度为 0.75（95% CI：0.56，0.91）：这项研究表明，使用有限数据集的深度学习策略可以生成用于识别 LVO 的有效表征。要想提高模型定位 LVO 的能力，最好的方法可能是生成一个包含阻塞性 LVO 的更完整的 LVO 数据集。

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引用次数: 0

Brain connectivity in status epilepticus as a predictor of outcome: A diffusion tensor imaging study 状态性癫痫的脑连接性可预测预后：弥散张量成像研究

IF 2.4 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-03-18 DOI: 10.1111/jon.13196

Dong Ah Lee, Ho-Joon Lee, Kang Min Park

Background and Purpose

We aimed to explore structural connectivity in status epilepticus.

Methods

We enrolled participants who underwent diffusion tensor imaging. We applied graph theory to investigate structural connectivity. We compared the structural connectivity measures between patients and healthy controls and between patients with poor (modified Rankin Scale [mRS] >3) and good (mRS ≤3) admission outcomes.

Results

We enrolled 28 patients and 31 healthy controls (age 65.5 vs.62.0 years, p = .438). Of these patients, 16 and 12 showed poor and good admission outcome (age 65.5 vs.62.0 years, p = .438). The assortative coefficient (−0.113 vs. −0.121, p = .021), mean clustering coefficient (0.007 vs.0.006, p = .009), global efficiency (0.023 vs.0.020, p = .009), transitivity (0.007 vs.0.006, p = .009), and small-worldness index (0.006 vs.0.005, p = .021) were higher in patients with status epilepticus than in healthy controls. The assortative coefficient (−0.108 vs. −0.119, p = .042), mean clustering coefficient (0.007 vs.0.006, p = .042), and transitivity (0.008 vs.0.007, p = .042) were higher in patients with poor admission outcome than in those with good admission outcome. MRS score was positively correlated with structural connectivity measures, including the assortative coefficient (r = 0.615, p = .003), mean clustering coefficient (r = 0.544, p = .005), global efficiency (r = 0.515, p = .007), transitivity (r = 0.547, p = .007), and small-worldness index (r = 0.435, p = .024).

Conclusion

We revealed alterations in structural connectivity, showing increased integration and segregation in status epilepticus, which might be related with neuronal synchronization. This effect was more pronounced in patients with a poor admission outcome, potentially reshaping our understanding for comprehension of status epilepticus mechanisms and the development of more targeted treatments.

背景和目的：我们旨在探索癫痫状态的结构连接性：我们招募了接受弥散张量成像的参与者。我们应用图论研究结构连通性。我们比较了患者与健康对照组之间以及入院预后较差（改良Rankin量表[mRS] >3）和较好（mRS ≤3）的患者之间的结构连通性测量结果：我们共招募了 28 名患者和 31 名健康对照者（年龄分别为 65.5 岁和 62.0 岁，P = .438）。在这些患者中，分别有 16 人和 12 人的入院预后较差和较好（年龄为 65.5 岁对 62.0 岁，P = .438）。同类系数（-0.113 vs. -0.121，p = .021）、平均聚类系数（0.007 vs. 0.006，p = .009）、全局效率（0.023 vs. 0.020，p = .0090.020, p = .009）、传递性（0.007 vs. 0.006, p = .009）和小世界指数（0.006 vs. 0.005, p = .021）在癫痫状态患者中均高于健康对照组。入院预后差的患者的同类系数（-0.108 vs. -0.119，p = .042）、平均聚类系数（0.007 vs. 0.006，p = .042）和转运性（0.008 vs. 0.007，p = .042）均高于入院预后好的患者。MRS评分与结构连通性指标呈正相关，包括同类系数（r = 0.615，p = .003）、平均聚类系数（r = 0.544，p = .005）、全局效率（r = 0.515，p = .007）、转运性（r = 0.547，p = .007）和小世界指数（r = 0.435，p = .024）：我们发现了结构连接的改变，显示癫痫状态患者的整合和分离增加，这可能与神经元同步化有关。这种效应在入院结果不佳的患者中更为明显，有可能重塑我们对癫痫状态机制的理解，并开发出更有针对性的治疗方法。

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引用次数: 0

Utilizing imaging parameters for functional outcome prediction in acute ischemic stroke: A machine learning study 利用成像参数预测急性缺血性脑卒中的功能预后：机器学习研究

IF 2.4 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-03-02 DOI: 10.1111/jon.13194

Burak B. Ozkara, Mert Karabacak, Meisam Hoseinyazdi, Samir A. Dagher, Richard Wang, Sadik Y. Karadon, F. Eymen Ucisik, Konstantinos Margetis, Max Wintermark, Vivek S. Yedavalli

Background and Purpose

We aimed to predict the functional outcome of acute ischemic stroke patients with anterior circulation large vessel occlusions (LVOs), irrespective of how they were treated or the severity of the stroke at admission, by only using imaging parameters in machine learning models.

Methods

Consecutive adult patients with anterior circulation LVOs who were scanned with CT angiography (CTA) and CT perfusion were queried in this single-center, retrospective study. The favorable outcome was defined as a modified Rankin score (mRS) of 0-2 at 90 days. Predictor variables included only imaging parameters. CatBoost, XGBoost, and Random Forest were employed. Algorithms were evaluated using the area under the receiver operating characteristic curve (AUROC), the area under the precision-recall curve (AUPRC), accuracy, Brier score, recall, and precision. SHapley Additive exPlanations were implemented.

Results

A total of 180 patients (102 female) were included, with a median age of 69.5. Ninety-two patients had an mRS between 0 and 2. The best algorithm in terms of AUROC was XGBoost (0.91). Furthermore, the XGBoost model exhibited a precision of 0.72, a recall of 0.81, an AUPRC of 0.83, an accuracy of 0.78, and a Brier score of 0.17. Multiphase CTA collateral score was the most significant feature in predicting the outcome.

Conclusions

Using only imaging parameters, our model had an AUROC of 0.91 which was superior to most previous studies, indicating that imaging parameters may be as accurate as conventional predictors. The multiphase CTA collateral score was the most predictive variable, highlighting the importance of collaterals.

背景和目的：我们的目的是通过机器学习模型中的成像参数，预测急性缺血性卒中患者前循环大血管闭塞（LVO）的功能预后，无论他们入院时如何治疗或卒中的严重程度如何：在这项单中心回顾性研究中，对连续接受 CT 血管造影 (CTA) 和 CT 灌注扫描的前循环 LVOs 成年患者进行了查询。良好预后的定义是 90 天后修改后的 Rankin 评分（mRS）为 0-2。预测变量仅包括成像参数。研究采用了 CatBoost、XGBoost 和随机森林算法。使用接收者操作特征曲线下面积（AUROC）、精确度-召回曲线下面积（AUPRC）、准确度、布赖尔评分、召回率和精确度对算法进行评估。结果：共纳入 180 名患者（102 名女性），中位年龄为 69.5 岁。92名患者的mRS介于0和2之间。就 AUROC 而言，最佳算法是 XGBoost（0.91）。此外，XGBoost 模型的精确度为 0.72，召回率为 0.81，AUPRC 为 0.83，准确度为 0.78，Brier 得分为 0.17。多相 CTAateral 评分是预测结果的最重要特征：结论：仅使用成像参数，我们的模型的AUROC为0.91，优于之前的大多数研究，表明成像参数可能与传统预测指标一样准确。多相 CTA 侧支评分是最具预测性的变量，凸显了侧支的重要性。

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引用次数: 0

T1 mapping in patients with cervical spinal canal stenosis with and without decompressive surgery: A longitudinal study 接受和未接受减压手术的颈椎管狭窄症患者的 T1 图谱：纵向研究

IF 2.4 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-02-25 DOI: 10.1111/jon.13195

Meyer Stefanie, Geiger Antonia, Volnhals Leah Shyela, Hofer Sabine, Dechent Peter, Frahm Jens, Behme Daniel, von der Brelie Christian, Rohde Veit, Bähr Mathias, Liman Jan, Maier Ilko L

Background and Purpose

Cervical spinal canal stenosis (cSCS) is a common cause of spinal impairment in the elderly. With conventional magnetic resonance imaging (MRI) suffering from various limitations, high-resolution single-shot T1 mapping has been proposed as a novel MRI technique in cSCS diagnosis. In this study, we investigated the effect of conservative and surgical treatment on spinal cord T1 relaxation times in cSCS.

Methods

T1-mapping was performed in 54 patients with cSCS at 3 Tesla MRI at the maximum-, above and below the stenosis. Subsequently, intraindividual T1-differences (ΔT1) intrastenosis were calculated. Twenty-four patients received follow-up scans after 6 months.

Results

Surgically treated patients showed higher ΔT1 at baseline (154.9 ± 81.6 vs. 95.3 ± 60.7), while absolute T1-values within the stenosis were comparable between groups (863.7 ± 89.3 milliseconds vs. 855.1 ± 62.2 milliseconds). In surgically treated patients, ΔT1 decreased inverse to stenosis severity. After 6 months, ΔT1 significantly decreased in the surgical group (154.9 ± 81.6 milliseconds to 85.7 ± 108.9 milliseconds, p = .021) and remained unchanged in conservatively treated patients. Both groups showed clinical improvement at the 6-month follow-up.

Conclusions

Baseline difference of T1 relaxation time (ΔT1) might serve as a supporting marker for treatment decision and change of T1 relaxation time might reflect relief of spinal cord narrowing indicating regenerative processes. Quantitative T1-mapping represents a promising additional imaging method to indicate a surgical treatment plan and to validate treatment success.

颈椎管狭窄症（cSCS）是老年人脊柱受损的常见原因。由于传统的磁共振成像（MRI）存在各种局限性，高分辨率单次 T1 图谱作为一种新型磁共振成像技术已被提出用于 cSCS 的诊断。在这项研究中，我们探讨了保守治疗和手术治疗对 cSCS 脊髓 T1 松弛时间的影响。

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引用次数: 0

Natural course of partially embolized carotid-cavernous fistulas 部分栓塞颈动脉-颈静脉瘘的自然病程。

IF 2.4 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-02-11 DOI: 10.1111/jon.13192

Richard Voldřich, Jan Grygar, František Charvát, David Netuka

Background and Purpose

To present the first study analyzing the clinical and radiological course of carotid-cavernous fistulas (CCFs) following incomplete embolization. The study compares magnetic resonance angiography (MRA) to plain angiography (digital subtraction angiography [DSA]) and investigates the long-term ophthalmological impact of residual fistula.

Methods

Fistulas classified as partially embolized after the last endovascular treatment were prospectively followed with DSA, MRA, and ophthalmological examination. Both direct and indirect CCFs were included.

Results

Twenty-one CCFs were included in the study. Nine (43%) fistulas were direct and 12 (57%) were indirect. A favorable clinical outcome of modified Rankin scale ≤2 was recorded in 19 (90%) patients at the last follow-up. Postinterventional ophthalmologic examinations in 16 patients revealed no negative effects of residual fistulas; five remaining patients refused to undergo further examination. Spontaneous thrombosis and complete occlusion of the CCF were demonstrated in 90% of patients, with a mean time to occlusion of 5.7 ± 4.7 months. Fourteen (66%) patients completed the full imaging follow-up (MRA and DSA). In 21% of these cases, discrepancy between the two imaging modalities was observed—MRA failed to detect persistent fistulas identified by DSA.

Conclusions

The goal of CCF treatment is safe and complete embolization. However, if adequate flow reduction is achieved, both direct and indirect CCFs tend to spontaneously thrombose. Residual flow does not result in ophthalmological deterioration until the fistula is completely closed. MRA may not be sufficiently sensitive to detect residues of fistulas including cortical venous drainage. Therefore, complete CCF closure should be confirmed through DSA.

背景和目的：首次对颈动脉海绵瘘（CCF）不完全栓塞后的临床和放射学病程进行分析。该研究比较了磁共振血管造影（MRA）和普通血管造影（数字减影血管造影[DSA]），并调查了残留瘘管对眼科的长期影响：对最后一次血管内治疗后被归类为部分栓塞的瘘管进行了前瞻性随访，并进行了数字减影血管造影（DSA）、MRA和眼科检查。结果：21 个 CCF 被纳入研究：研究共纳入 21 个 CCF。结果：研究共纳入 21 例 CCF，其中 9 例（43%）为直接瘘，12 例（57%）为间接瘘。19例（90%）患者在最后一次随访时，改良Rankin量表≤2的临床结果良好。对16名患者进行介入治疗后的眼科检查显示，残留瘘管未造成任何负面影响；其余5名患者拒绝接受进一步检查。90%的患者CCF自发血栓形成并完全闭塞，平均闭塞时间为5.7 ± 4.7个月。14例（66%）患者完成了全部成像随访（MRA和DSA）。在其中21%的病例中，观察到了两种成像方式之间的差异--MRA未能发现DSA发现的持续性瘘管：结论：CCF治疗的目标是安全、彻底地栓塞。结论：CCF 治疗的目标是安全、彻底地栓塞，但如果实现了充分的血流减少，直接和间接 CCF 都有自发血栓形成的趋势。在瘘管完全闭合之前，残留血流不会导致眼科疾病恶化。MRA 的灵敏度可能不足以检测包括皮质静脉引流在内的瘘管残留物。因此，应通过 DSA 确认 CCF 是否完全闭合。

{"title":"Natural course of partially embolized carotid-cavernous fistulas","authors":"Richard Voldřich, Jan Grygar, František Charvát, David Netuka","doi":"10.1111/jon.13192","DOIUrl":"10.1111/jon.13192","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>To present the first study analyzing the clinical and radiological course of carotid-cavernous fistulas (CCFs) following incomplete embolization. The study compares magnetic resonance angiography (MRA) to plain angiography (digital subtraction angiography [DSA]) and investigates the long-term ophthalmological impact of residual fistula.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fistulas classified as partially embolized after the last endovascular treatment were prospectively followed with DSA, MRA, and ophthalmological examination. Both direct and indirect CCFs were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-one CCFs were included in the study. Nine (43%) fistulas were direct and 12 (57%) were indirect. A favorable clinical outcome of modified Rankin scale ≤2 was recorded in 19 (90%) patients at the last follow-up. Postinterventional ophthalmologic examinations in 16 patients revealed no negative effects of residual fistulas; five remaining patients refused to undergo further examination. Spontaneous thrombosis and complete occlusion of the CCF were demonstrated in 90% of patients, with a mean time to occlusion of 5.7 ± 4.7 months. Fourteen (66%) patients completed the full imaging follow-up (MRA and DSA). In 21% of these cases, discrepancy between the two imaging modalities was observed—MRA failed to detect persistent fistulas identified by DSA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The goal of CCF treatment is safe and complete embolization. However, if adequate flow reduction is achieved, both direct and indirect CCFs tend to spontaneously thrombose. Residual flow does not result in ophthalmological deterioration until the fistula is completely closed. MRA may not be sufficiently sensitive to detect residues of fistulas including cortical venous drainage. Therefore, complete CCF closure should be confirmed through DSA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"34 3","pages":"376-385"},"PeriodicalIF":2.4,"publicationDate":"2024-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139723014","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}

引用次数: 0

Clinical and imaging predictors for hemorrhagic transformation of acute ischemic stroke after endovascular thrombectomy 血管内血栓切除术后急性缺血性脑卒中出血转化的临床和影像学预测因素。

IF 2.4 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-01-31 DOI: 10.1111/jon.13191

Yongyao Kuang, Lingtao Zhang, Kunlin Ye, Zijie Jiang, Changzheng Shi, Liangping Luo

Background and Purpose

Hemorrhagic transformation (HT) is a common complication of endovascular thrombectomy (EVT) in patients with acute ischemic stroke (AIS). Our study aims to investigate the clinical and imaging predictors of HT and symptomatic intracranial hemorrhage (sICH) in patients who underwent EVT.

Methods

A retrospective analysis of 118 patients undergoing EVT for acute anterior circulation stroke was performed. Potential clinical and imaging predictors of all patients were collected and multivariate logistic regression was performed. The risk prediction system was constructed according to the multivariate logistic regression results.

Results

The incidence of HT and sICH after EVT were 46.6% and 15.3%, respectively. The multivariate logistic regression results showed that Alberta Stroke Program Early CT Score (ASPECTS) (p = .001, odds ratio [OR] = 0.367, 95% [confidence interval] CI, 0.201-0.670), collateral status (p<.001, OR = 0.117, 95% CI, 0.042-0.325), relative cerebral blood flow (CBF) ratio (p = .025, OR = 0.943, 95% CI, 0.895-0.993), and blood glucose on admission (p = .012, OR = 1.258, 95% CI, 1.053-1.504) were associated with HT. While for sICH, collateral circulation (p = .007, OR = 0.148, 95% CI, 0.037-0.589), ASPECTS (p = .033, OR = 0.510, 95% CI, 0.274-0.946), and blood glucose (p = .005, OR = 1.304, 95% CI, 1.082-1.573) were independent factors. The predictive model for HT after EVT was established, and the sensitivity and specificity of it were 90.9% and 79.4%, respectively, with the area under the curve of 90.0% (84.5%-95.4%).

Conclusion

Collateral status, ASPECTS, relative CBF ratio, and blood glucose on admission were predictors for HT in AIS patients, while collateral status, ASPECTS, and blood glucose on admission were also predictors for sICH. In addition, the established predictive model showed good diagnostic value for prediction of HT after EVT.

背景和目的：出血转化（HT）是急性缺血性卒中（AIS）患者血管内血栓切除术（EVT）的常见并发症。我们的研究旨在调查接受 EVT 患者发生 HT 和症状性颅内出血（sICH）的临床和影像学预测因素：方法：我们对118例因急性前循环卒中接受EVT治疗的患者进行了回顾性分析。收集了所有患者的潜在临床和影像学预测因素，并进行了多变量逻辑回归。根据多变量逻辑回归结果构建了风险预测系统：EVT术后HT和sICH的发生率分别为46.6%和15.3%。多变量逻辑回归结果显示，阿尔伯塔省卒中项目早期 CT 评分（ASPECTS）（p = .001，几率比[OR] = 0.367，95% [置信区间] CI，0.201-0.670）、侧支状态（p结论：侧支状态、ASPECTS 评分、多变量逻辑回归结果显示，EVT 后的 HT 和 sICH 发生率分别为 46.6% 和 15.3%：侧支状态、ASPECTS、相对 CBF 比率和入院时的血糖是 AIS 患者发生 HT 的预测因素，而侧支状态、ASPECTS 和入院时的血糖也是发生 sICH 的预测因素。此外，已建立的预测模型对预测 EVT 后的 HT 有很好的诊断价值。

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引用次数: 0

Scattered Media Elastic Fibers from the Aortic Root to the Ascending Aorta in a 30-Year-Old Marfan Syndrome Patient. 一名 30 岁马凡氏综合征患者主动脉根部至升主动脉的散在介质弹性纤维

4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-01-25 Epub Date: 2022-05-19 DOI: 10.5761/atcs.cr.22-00044

Tomohiro Nakajima, Yutaka Iba, Syuichi Naraoka, Tsuyoshi Shibata, Shintaro Sugita, Nobuyoshi Kawaharada

We present a case report of a 30-year-old Marfan syndrome patient who underwent a David procedure for severe aortic valve insufficiency and Valsalva aneurysm. Harvested aortic walls were examined by pathologists. Although the tunica media of the ascending aorta contained aligned elastic fibers, the aortic root media lacked aligned elastic fibers.

我们报告了一例 30 岁马凡氏综合征患者的病例，该患者因严重主动脉瓣关闭不全和 Valsalva 动脉瘤接受了大卫手术。病理学家对采集的主动脉壁进行了检查。虽然升主动脉内膜含有排列整齐的弹性纤维，但主动脉根部内膜却缺乏排列整齐的弹性纤维。

引用次数: 0