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Tandem Cervical Internal Carotid Artery Hyperdensity Implies Stent Reocclusion on Post Thrombectomy Computed Tomography. 串联式颈内动脉高密度提示取栓后计算机断层扫描支架再闭塞。
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-07-01 DOI: 10.1111/jon.70077
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.

背景和目的:作为血管内卒中治疗的一部分,支架置入术后急性串联颈内动脉(ICA)再闭塞被认为是少数患者的并发症,这可能与神经功能恶化和更差的功能结果相关。在这种情况下,非对比CT (NCCT)是初始随访成像的基础。我们的目的是评估上颈ICA内不对称高密度(HD-CICA)在颅NCCT上进行串联ICA再闭塞的敏感性和特异性。方法:这是对前瞻性获得的数据库(包括2022年1月至2024年12月进行的病例)的回顾性研究。将HD-CICA在NCCT 12-24小时的频率与未闭和再闭塞的ICAs患者的同期血管成像(CT血管造影或颈动脉多普勒超声)进行比较。结果:148例患者行取栓联合ICA支架治疗串联闭塞。支架闭塞与早期神经系统改善和再灌注率较低以及神经系统恶化率较高相关。共有99例患者进行了支架通畅的急性调查,92例患者的HD-CICA可评估。支架闭塞组HD-CICA发生率为18/19(94.7%),未通畅组为0/73(0%)。(p)结论:急性随访颅内NCCT的HD-CICA是颈动脉串联再闭塞的可靠急性标志物。
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引用次数: 0
Brain Microstructure Interrogation by Diffusion Tensor and Kurtosis Imaging in Progressive Supranuclear Palsy Subtypes 扩散张量和峰度成像对进行性核上性麻痹亚型脑微观结构的研究
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-06-24 DOI: 10.1111/jon.70062
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.

背景与目的弥散张量成像(DTI)通常用于评估进行性核上性麻痹(PSP)的灰质和白质(WM)结构的完整性。除了DTI,非传统的弥散技术,如弥散峰度成像(DKI)已被证明可以进一步表征脑组织。在这项工作中,我们的目的是确定DKI在帕金森病(PD)和对照的PSP- richardson综合征(PSP- rs)和PSP伴显性帕金森病(PSP- p)的鉴别诊断中的应用。方法对22例PSP-RS患者、23例PSP-P患者、19例PD患者和19例对照患者在Siemens系统上进行3特斯拉时的多壳弥散加权序列测定。计算了9个深灰质区域和6个不同WM束的分数各向异性、平均扩散率、峰度分数各向异性(KFA)和平均峰度(Kmean)。结果DKI识别出对照组和PSP组在外白球、丘底区和壳核的差异(DTI未发现),而壳核中的Kmean能够区分PSP- rs和PD。胼胝体和齿状丘脑束的DKI WM测量将PSP-RS与PD区分开来,皮质纹状体束将PSP-P与PD区分开来。胼胝体体的KFA鉴定PSP-RS的显微结构异常比PSP-P更严重。DKI指标与眼运动障碍的严重程度和帕金森评分相关。结论DKI测量可以区分PSP- rs、PSP- p和PD,因此可能是研究PSP结构神经病理改变的一种有前景的成像工具。
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引用次数: 0
Mediation of Multiphase Collateral Status on Functional Outcome by ASPECTS-Based Net Water Uptake in Acute Stroke 多相侧支状态对急性脑卒中患者净摄水量的影响
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-06-18 DOI: 10.1111/jon.70045
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.

背景和目的阿尔伯塔卒中项目早期CT评分为基础的净摄水量(ASPECTS-NWU)是一种定量成像生物标志物,用于评估急性缺血性卒中患者的早期缺血性变化。ASPECTS-NWU在确定卒中发作时间、测量缺血性组织水肿和预测功能预后方面进行了研究。然而,ASPECTS-NWU的介导作用及其与络、梗死面积和功能结局的关系仍需探索。因此,我们假设ASPECTS-NWU是侧支循环和梗死体积之间的中介,并研究了它们与预后的关系。方法201例患者,其中131例行机械取栓术。使用多相Menon评分对抵押品进行评分。观察ASPECTS-NWU在络部与梗死体积之间的中介作用。通过单变量和多变量logistic回归分析评估梗死面积、侧枝、再通状态和功能结局之间的关系。结果侧络良好的患者在入院时表现出较高的ASPECTS,较低的ASPECTS- nwu,较低的美国国立卫生研究院卒中量表评分(nihss入院),较小的梗死体积、缺血组织体积和半暗区体积。ASPECTS-NWU是络部与梗死面积之间的中介,贡献率为27.9%。在多变量logistic回归分析中,梗死面积和再通状态与功能预后相关。结论spect - nwu在络支与梗死体积之间起部分中介作用。梗死面积和再通状态是功能预后的有力预测指标。ASPECTS-NWU和侧枝通过调节梗死体积间接影响功能结局。
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引用次数: 0
Diffusion Tensor Imaging in Progressive Supranuclear Palsy Versus Other Neurodegenerative Diseases: A Review 进展性核上性麻痹与其他神经退行性疾病的弥散张量成像研究进展
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-06-16 DOI: 10.1111/jon.70063
Alexandros Giannakis, Spiridon Konitsiotis, Georgia Xiromerisiou

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.

进行性核上性麻痹(PSP)是一种复杂的神经退行性疾病,经常被误诊,很大程度上是因为它与其他神经退行性疾病如帕金森病和多系统萎缩有重叠的临床特征。准确和早期诊断仍然是一个重大的临床挑战。在这种情况下,扩散张量成像(DTI),一种专门的磁共振成像技术,测量神经组织中水分子的定向运动,已经成为一种有前途的生物标志物。本文综述了DTI在PSP与其他神经退行性疾病鉴别中的应用。多项研究报道了DTI参数的显著变化,特别是分数各向异性和平均弥漫性,在关键的大脑区域,包括小脑上脚、丘脑、皮质脊髓束、胼胝体前部和前额皮质。虽然经典的放射学征象,如蜂鸟和米老鼠征象,对经典理查森综合征(PSP- rs)仍然具有高度的特异性,优于本回顾研究中强调的任何结果,但在与其他PSP亚型相关的区域,如额叶皮层,DTI的诊断准确率很高,这一点可以在未来的研究中得到更多的探索。然而,样本量小、异质性研究设计以及主要关注PSP-RS亚型等局限性限制了更广泛的推广。大规模、多中心的研究是必要的,以验证这些发现,跨越不同的PSP表现,并建立DTI作为一个强大的诊断工具。
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引用次数: 0
Unified Framework for Oculomotor Nerve Reconstruction: Tractography-Based Anatomical Assessment 动眼神经重建的统一框架:基于神经束造影的解剖评估
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-06-13 DOI: 10.1111/jon.70052
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.

背景与目的动眼神经(OCN)支配眼部肌肉,可受到炎症、压迫和病理状况的影响。扩散MRI (dMRI)示踪显示了描述OCN轨迹的潜在能力。然而,由于颅底复杂的组织环境,海绵窦OCN的重建仍然具有挑战性。方法在本研究中,我们整合解剖学知识,使用来自22-36岁的人类连接组计划受试者的45个dMRI数据集和4个41-53岁的视觉行为障碍神经外科患者的数据,提出了一个统一的OCN神经束造影框架。我们首先采用自动标记的直接和间接解剖标志作为个体化牵引造影的参考位置。接下来,我们比较了五种广泛使用的颅神经重建算法,以评估最适合OCN重建的方法。最后,我们在肿瘤患者中测试了统一框架和优化的肛管造影方法的结合。结果我们发现unscented Kalman filter (UKF)-2T和probability tractgraphy在OCN纤维tractgraphy中表现优于其他方法,因为它们分别具有“一步一步”的纤维方向计算和多向考虑。在神经外科患者中,UKF-2T可有效重建病变周围的OCN纤维。结论本研究为研究人员和临床医生在ocn相关疾病的诊断和治疗以及神经外科手术提供了有价值的见解。
{"title":"Unified Framework for Oculomotor Nerve Reconstruction: Tractography-Based Anatomical Assessment","authors":"Jiahao Huang,&nbsp;Qingrun Zeng,&nbsp;Ye Wu,&nbsp;Jiawei Zhang,&nbsp;Mengjun Li,&nbsp;Lei Xie,&nbsp;Mingchu Li,&nbsp;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}
引用次数: 0
Hyperattenuating Collateral Arteries and Accompanying Cortical Veins as Auxiliary Signs of M2 Occlusion on Dual-Phase CTA 双期CTA显示侧支及伴随皮质静脉高衰减为M2闭塞的辅助征象
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-06-07 DOI: 10.1111/jon.70060
Alex Mortimer, Richard Flood, Sophie Dunkerton

Background and Purpose

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。
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引用次数: 0
Observer Variability in CT Angiography Carotid Segmentation: Assessing Variability to Set Minimum Clinical Performance CT血管造影颈动脉分割中的观察者可变性:评估可变性以设定最低临床表现
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-06-04 DOI: 10.1111/jon.70058
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,&nbsp;Timothy J. Kleinig,&nbsp;Joseph Dawson,&nbsp;Sandy Patel,&nbsp;Wolfgang Mayer,&nbsp;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}
引用次数: 0
Functional Brain Abnormalities in Patients With Accommodative Asthenopia: A Resting-State fMRI Study 适应性弱视患者脑功能异常:静息状态fMRI研究
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-06-02 DOI: 10.1111/jon.70059
Xiaoli Lv, Wenli Tan, Ying Yu, Yu Shao, Jinhua Tao, Wanhong Miao, Pingping Yu, Yilei Chen

Background and Purpose

Excessive electronic device use has intensified visual workload, resulting in accommodative asthenopia (AA). Our previous functional MRI (fMRI) studies linked abnormal brain function to AA, prompting this resting-state fMRI study to explore local and global brain activity changes.

Methods

We recruited 33 healthy controls and 44 patients with AA, analyzing regional brain function via coherent regional homogeneity (Cohe-ReHo) and amplitude of low-frequency fluctuation (ALFF)/fractional ALFF (fALFF). Group independent component analysis (gICA) extracted independent components (ICs) for spatial comparison, and static/dynamic functional network connectivity (sFNC/dFNC) assessed subnetwork interactions.

Results

Patients with AA had increased ALFF in regions of the right cerebellum 9, superior lobe of the right cerebellum, left cerebellum 8, left cerebellum 9, and left brainstem; there were negative regions in the frontal lobe (also the same area found in fALFF values) and the right postcentral gyrus. Cohe-ReHo was elevated in the inferior lobes of the bilateral cerebellum and left caudate nucleus but reduced in the left median cingulate, paracingulate gyri, and right precentral gyrus. Correlation analysis among Cohe-ReHo, ALFF/fALFF values, and asthenopia survey scores showed that the correlation had no statistical significance. The gICA revealed that the spatial distribution of ICs showed no difference. The results of sFNC and dFNC analysis showed that there was no difference.

Conclusions

Patients with AA had regional brain dysfunction. In the analysis of brain subnetworks, there was no difference between the groups in terms of the spatial organization of subnetworks or the static and dynamic connectivity between subnetworks.

背景与目的过度使用电子设备会加重视觉负荷,导致适应性弱视。我们之前的功能MRI (fMRI)研究将异常的脑功能与AA联系起来,促使这项静息状态fMRI研究探索局部和全局脑活动变化。方法采用相干区域均匀性(Cohe-ReHo)和低频波动幅度(ALFF)/分数ALFF (fALFF)分析脑区域功能。群独立分量分析(gICA)提取独立分量(ic)进行空间比较,静态/动态功能网络连通性(sFNC/dFNC)评估子网相互作用。结果AA患者在右小脑9、右小脑上叶、左小脑8、左小脑9、左脑干等区域ALFF增高;额叶(与fALFF值相同的区域)和右侧中央后回有负性区域。双侧小脑下叶和左侧尾状核的Cohe-ReHo升高,而左侧扣带正中回、扣带副回和右侧中央前回的Cohe-ReHo降低。Cohe-ReHo值、ALFF/fALFF值与视疲劳调查评分的相关分析显示相关性无统计学意义。gICA分析结果显示,各地区ic的空间分布无明显差异。sFNC和dFNC分析结果显示无差异。结论AA患者存在区域性脑功能障碍。在大脑子网的分析中,在子网的空间组织和子网之间的静态和动态连通性方面,各组之间没有差异。
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引用次数: 0
Sustained Enlargement in Vagus and Sural Nerve Cross-Sectional Areas in Fibromyalgia: A Longitudinal Study 纤维肌痛患者迷走神经和腓肠神经横截面积持续增大:一项纵向研究
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-06-01 DOI: 10.1111/jon.70055
Benedetta Bianchi, Edoardo Cipolletta, Sonia Farah, Fausto Salaffi, Marco Di Carlo

Background and Purpose

Fibromyalgia (FM) is a complex condition with unclear pathophysiology. While central sensitization is commonly accepted as the predominant cause of pain symptoms, numerous evidences suggest a role for the peripheral nervous system, particularly small fiber neuropathy. Previous studies have documented that patients with FM show an increased cross-sectional area (CSA) of some nerves, including the vagus and sural nerves, detectable via ultrasound (US). The purpose of this study is to assess whether the CSA increase persists over time and to investigate potential correlations between nerve dimensions and clinical variables.

Methods

This study involved 32 female patients with FM and 20 healthy controls, both evaluated at baseline and after 24 months. Participants completed clinimetric questionnaires addressing disease severity, neuropathic pain features, and autonomic dysfunction, while US measurements of the vagus and sural nerves' CSA were taken. Differences in CSA variation were assessed with student's t-test and chi-square, and the Pearson's correlation coefficient tested relationships between nerve dimensions and clinimetric scores.

Results

CSA values were higher in FM patients compared to controls at both baseline and after 24 months, although no significant differences in CSA changes were found over time. Pearson's correlation revealed some associations between nerve dimensions and clinimetric scores, suggesting potential relationships that require further investigation.

Conclusions

FM patients exhibit persistent increases in the vagus and sural nerves CSAs. Further studies are needed to better understand the clinical significance of these findings and the role of US assessment as a tool for detecting nerve alterations in FM.

背景与目的纤维肌痛(FM)是一种病理生理不明确的复杂疾病。虽然中枢致敏通常被认为是疼痛症状的主要原因,但许多证据表明周围神经系统,特别是小纤维神经病变也起作用。先前的研究表明,FM患者表现出一些神经的横截面积(CSA)增加,包括迷走神经和腓肠神经,通过超声(US)检测。本研究的目的是评估CSA是否随时间持续增加,并研究神经尺寸与临床变量之间的潜在相关性。方法本研究纳入32名女性FM患者和20名健康对照者,分别在基线和24个月后进行评估。参与者完成了关于疾病严重程度、神经性疼痛特征和自主神经功能障碍的临床调查问卷,同时进行了迷走神经和腓肠神经CSA的美国测量。采用学生t检验和卡方检验评估CSA变异的差异,Pearson相关系数检验神经尺寸与临床评分之间的关系。结果在基线和24个月后,FM患者的CSA值均高于对照组,尽管随着时间的推移,CSA变化没有显著差异。Pearson的相关性揭示了神经尺寸和临床评分之间的一些关联,这表明潜在的关系需要进一步的研究。结论FM患者迷走神经和腓肠神经csa持续增高。需要进一步的研究来更好地了解这些发现的临床意义以及US评估作为检测FM神经改变的工具的作用。
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引用次数: 0
Cardiovascular Risk Factors Impact Brain Volume and White Matter Hyperintensities: A Multiethnic Cohort Study 心血管危险因素影响脑容量和白质高信号:一项多种族队列研究
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-06-01 DOI: 10.1111/jon.70057
Esther M. C. Vriend, Alexandra de Sitter, Thomas A. Bouwmeester, Oscar H. Franco, Henrike Galenkamp, Eric P. Moll van Charante, Didier Collard, Aart J. Nederveen, Bert-Jan H. van den Born

Background and Purpose

Brain atrophy and white matter hyperintensities (WMHs) are established markers of cerebrovascular disease, yet most evidence comes from older populations of predominantly European descent. We prospectively examined the relationship between cardiovascular risk factors and brain volumes and WMHs in middle-aged participants in a multiethnic cohort and examined ethnic differences in these associations.

Methods

Baseline data (2011–2015) were collected from 562 participants of Moroccan, South-Asian Surinamese, and Dutch descent, with 3 Tesla brain MRIs conducted between 2021 and 2022 (median follow-up 8.4 years). Brain and WMH volumes were assessed using automated segmentation of Magnetization Prepared—RApid Gradient Echo and three-dimensional Fluid-Attenuated Inversion Recovery scans. Linear regression analyses examined associations between cardiovascular risk factors and brain volumes and log-transformed WMH volumes. Interaction terms explored ethnic differences in these associations.

Results

Median age was 53 years, and 45% were female. Higher body mass index (BMI) and diabetes mellitus were associated with lower brain volumes (−7.6 mL per BMI unit, 95% confidence interval [CI] −12.6, −2.7; 103.4 mL for diabetes, 95% CI −167.4, −39.3). Hypertension and a history of cardiovascular disease were associated with 54.7% (95% CI 25.5, 90.7) and 98.3% (95% CI 30.9, 200.4) higher WMH volumes, respectively. Associations of diabetes with brain volume and hypertension with WMH volume were most pronounced among South-Asian Surinamese participants.

Conclusions

Cardiovascular risk factors in midlife were strongly associated with brain volumes and WMHs after 8 years of follow-up. Ethnic differences in the strength of these associations underscore the importance of tailored cerebrovascular risk assessment across diverse populations.

背景和目的脑萎缩和白质高信号(WMHs)是脑血管疾病的确定标志,但大多数证据来自以欧洲血统为主的老年人群。我们在一个多种族队列中前瞻性地研究了心血管危险因素与中年参与者脑容量和WMHs之间的关系,并研究了这些关联的种族差异。方法收集了562名摩洛哥人、南亚苏里南人和荷兰人后裔的基线数据(2011-2015年),并在2021年至2022年期间(中位随访8.4年)进行了3次特斯拉脑mri。使用自动分割磁化准备快速梯度回波和三维流体衰减反演恢复扫描评估脑和WMH体积。线性回归分析检验了心血管危险因素与脑容量和对数转换后的脑mh容量之间的关系。相互作用术语探讨了这些关联中的种族差异。结果中位年龄53岁,女性占45%。较高的身体质量指数(BMI)和糖尿病与较低的脑容量相关(- 7.6 mL / BMI单位,95%可信区间[CI] - 12.6, - 2.7;糖尿病103.4 mL, 95% CI为−167.4,−39.3)。高血压和心血管病史分别与54.7% (95% CI 25.5, 90.7)和98.3% (95% CI 30.9, 200.4)的WMH体积升高相关。糖尿病与脑容量和高血压与WMH容量的关联在南亚苏里南参与者中最为明显。结论经8年随访,中年心血管危险因素与脑容量和WMHs密切相关。这些关联强度的种族差异强调了在不同人群中进行量身定制的脑血管风险评估的重要性。
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引用次数: 0
期刊
Journal of Neuroimaging
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