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Association of Carotid Plaque Calcification Attenuation With Intraplaque Hemorrhage Volume: 3D-Segmentation Analysis 颈动脉斑块钙化衰减与斑块内出血量的关系:3d分割分析
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-07-14 DOI: 10.1111/jon.70071
Jeremy Rubin, Quy Cao, Yu Sakai, Nathan Arnett, Huy Q. Phi, Andrew C. Hu, Brett L. Cucchiara, Daniel Bos, Luca Saba, Elias Johannson, Jarcy Zee, Jae W. Song

Background and Purpose

Despite the high prevalence of plaque calcifications in carotid atherosclerosis, the association between morphologic and attenuation features of calcifications and intraplaque hemorrhage (IPH) remains unclear.

Methods

Calcific carotid plaques were identified on neck computed tomography angiographies (CTAs) from patients meeting criteria for embolic stroke of undetermined source. Plaque calcifications were manually segmented using 3D-Slicer to quantify features, including volume and attenuation (Hounsfield Units [HU]). IPH volume (IPHvol) was quantified using a semi-automated software. A linear mixed regression model evaluated associations between calcification features and IPHvol, adjusting for sex, age, and cardiovascular risk factors. An interaction term between calcification volume and attenuation was included after dichotomizing attenuation (>924HU) and volume (>30 millimeter [mm]3) as high versus low on the basis of median values.

Results

From 70 patients (median age 68 years, 50% female), 116 calcific plaques containing 269 plaque calcifications were analyzed. Adjusting for age, cardiovascular risk factors, and plaque calcification features, being female showed lower IPHvols compared to males (mean ratio 0.34, p = 0.002). A significant interaction between calcification volume and attenuation emerged (p = 0.042). Among plaques with low plaque calcification volumes, plaques with low-attenuation (<924HU) calcifications showed 5.53 times higher IPHvols than plaques with high-attenuation calcifications (p = 0.003). Among plaques with high-attenuation calcifications, plaques with high volumes of these calcifications showed 4.40 times higher IPHvols compared to low-volumes of high-attenuation calcifications (p = 0.011).

Conclusions

Plaque calcification attenuation characteristics are associated with IPHvols. Understanding calcification patterns that correlate with IPH could enable clinicians to infer plaque instability from readily visible calcifications on CTA.

背景和目的尽管颈动脉粥样硬化中斑块钙化的发生率很高,但钙化的形态学和衰减特征与斑块内出血(IPH)之间的关系尚不清楚。方法对符合来源不明的栓塞性卒中标准的患者进行颈动脉钙化斑块的ct血管造影检查。使用3d切片机对斑块钙化进行手动分割,量化特征,包括体积和衰减(Hounsfield单位[HU])。使用半自动软件定量IPH体积(IPHvol)。线性混合回归模型评估钙化特征与IPHvol之间的关系,调整性别、年龄和心血管危险因素。在对衰减(>924HU)和体积(>;30毫米[mm]3)进行二分类后,在中位数的基础上纳入了钙化体积与衰减之间的相互作用项。结果70例患者(中位年龄68岁,女性50%),116个钙化斑块,其中269个斑块钙化。调整年龄、心血管危险因素和斑块钙化特征后,女性的iphol比男性低(平均比值0.34,p = 0.002)。钙化体积和衰减之间存在显著的相互作用(p = 0.042)。在低斑块钙化体积斑块中,低衰减(<924HU)钙化斑块的IPHvols是高衰减钙化斑块的5.53倍(p = 0.003)。在高衰减钙化斑块中,高体积钙化斑块的IPHvols是低体积高衰减钙化斑块的4.40倍(p = 0.011)。结论斑块钙化衰减特征与ivos有关。了解与IPH相关的钙化模式可以使临床医生从CTA上容易看到的钙化推断斑块的不稳定性。
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引用次数: 0
Blood-Brain Barrier Dysfunction in Adults With Heart Failure 成人心力衰竭的血脑屏障功能障碍
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-07-04 DOI: 10.1111/jon.70068
Bhaswati Roy, Xingfeng Shao, Kamlesh J. Jobanputra, Gregg C. Fonarow, Danny J. J. Wang, Mary Woo, Rajesh Kumar

Background and Purpose

Heart failure (HF) patients show brain tissue injury in sites that mediate autonomic, cognitive, and mood dysfunctions that are linked with increased morbidity and mortality. The pathological mechanisms that may contribute to brain tissue injury in HF are unclear, but may include blood brain barrier (BBB) dysfunction.

Methods

We performed diffusion-weighted pseudo-continuous arterial spin labeling (DW-pCASL) in 27 HF and 59 controls to examine BBB, using a 3.0-Tesla MRI scanner, and assessed anxiety, depressive symptoms, and cognition. Using DW-pCASL data, arterial transit time (ATT, an index of large artery integrity) and water exchange rates across the BBB (Kw, an index of BBB function) maps were generated, normalized, smoothed, and compared between HF and controls, and correlated with cognition and mood.

Results

Significantly increased mood deficits and reduced cognition appeared in HF over controls. Multiple brain areas, which are involved in mediating cognition and mood, showed altered Kw and ATT values in HF over controls. Increased Kw emerged in the insula, hippocampus, and cerebellum. ATT values decreased in the prefrontal cortices, cingulate, and cerebellum, and increased in a few sites in HF patients. Kw values from regions that are involved in mood and cognition functions showed significant associations with anxiety, depression, and cognition.

Conclusions

HF patients show impaired BBB function and altered large artery integrity. BBB alterations may introduce neural damage to autonomic, mood, and cognitive regulatory areas, contributing to abnormal functions found in HF. The findings suggest a need to repair BBB function to rescue brain tissue and functions in this condition.

背景和目的心力衰竭(HF)患者表现为介导自主神经、认知和情绪功能障碍的脑组织损伤,这些损伤与发病率和死亡率增加有关。导致HF患者脑组织损伤的病理机制尚不清楚,但可能包括血脑屏障(BBB)功能障碍。方法对27例HF患者和59例对照患者进行弥散加权伪连续动脉自旋标记(DW-pCASL),使用3.0特斯拉MRI扫描仪检查血脑密度,并评估焦虑、抑郁症状和认知能力。使用DW-pCASL数据,生成动脉传输时间(ATT,大动脉完整性指数)和血脑卒中水交换率(Kw,血脑卒中功能指数)图,将其归一化、平滑,并比较HF和对照组之间的图,并将其与认知和情绪相关联。结果与对照组相比,心衰患者情绪缺陷明显增加,认知能力明显下降。与对照组相比,HF患者涉及调节认知和情绪的多个脑区显示出Kw和ATT值的改变。脑岛、海马体和小脑的Kw增加。心衰患者的ATT值在前额皮质、扣带和小脑降低,在少数部位升高。涉及情绪和认知功能的区域的Kw值与焦虑、抑郁和认知有显著关联。结论HF患者血脑屏障功能受损,大动脉完整性改变。血脑屏障改变可引起自主神经、情绪和认知调节区神经损伤,导致心衰患者功能异常。研究结果表明,在这种情况下,需要修复血脑屏障功能来挽救脑组织和功能。
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引用次数: 0
Middle Longitudinal Fascicle Maldevelopment on Free Water Corrected MR Diffusion Underlies Language Impairment in Autism 自由水校正磁共振扩散的中纵束发育不良是自闭症语言障碍的基础
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-07-04 DOI: 10.1111/jon.70067
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。
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引用次数: 0
Contact Aspiration Alone or Combined With Stent Retriever Thrombectomy for Middle Cerebral Artery Large Vessel Occlusion 单纯接触抽吸或联合支架取栓治疗大脑中动脉大血管闭塞
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-07-03 DOI: 10.1111/jon.70065
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,&nbsp;Andres Fernandez-Prieto,&nbsp;Alberto Alvarez-Muelas,&nbsp;Ángel Calleja,&nbsp;Joaquin Ortega,&nbsp;Carlos Domínguez,&nbsp;Antonio Sagredo,&nbsp;Amado Rodríguez-Benítez,&nbsp;Juan García-Villanego,&nbsp;Alberto Martínez-Calvo,&nbsp;Daniel Cubillo-Prieto,&nbsp;Carmen de la Rosa,&nbsp;Antonio Mosqueira,&nbsp;Rebeca Bermejo-Garcés,&nbsp;Juan Chaviano,&nbsp;Isabel Bermúdez-Coronel,&nbsp;Carlos Pérez-García,&nbsp;Carlos Manuel Rodriguez-Paz,&nbsp;Carlos Hidalgo-Barranco,&nbsp;Javier Maynar,&nbsp;Jose Luis Caniego,&nbsp;Juan David Molina-Nuevo,&nbsp;Víctor Maestro,&nbsp;Juan Manuel Sanchís-García,&nbsp;Oscar Balboa,&nbsp;Mario Martínez-Galdamez,&nbsp;Eñaut Garmendia,&nbsp;Marc Comas-Cufí,&nbsp;Josep Puig,&nbsp;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> &lt; 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}
引用次数: 0
Conventional and Advanced Imaging Features of CNS Intravascular Lymphoma 中枢神经系统血管内淋巴瘤的常规和高级影像学特征
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2025-07-03 DOI: 10.1111/jon.70061
Sunpob Cheewadhanaraks, Otto Rapalino

Background and Purpose

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.

背景与目的血管内淋巴瘤(IVL)是一种罕见的侵袭性淋巴瘤亚型,由于其非特异性的临床表现,给诊断带来了挑战。本研究旨在评估该疾病在中枢神经系统的影像学表现,并评估先进成像技术的诊断潜力,包括动态敏感性对比(DSC)灌注、磁共振波谱(MRS)和氟-18氟脱氧葡萄糖(FDG) PET。方法对21例经病理证实的IVL累及中枢神经系统的病例进行分析。2例行DSC灌注,3例行MRS, 3例行FDG PET。结果90%的患者有颅内显像。脑MRI最常见的成像模式是梗死样病变(68%),其次是肿块样增强和非特异性白质改变(各占11%)。其余发现包括无肿块效应的强化病变和桥桥中央T2/液体衰减反转恢复高强度,各在1例患者中观察到。T2*显像异常占60%。30%的病例无创血管造影显示血管不规则。脊髓硬膜内受累4例(19%),其中3例神经根增强,1例脊髓梗死。MRS显示3例中2例胆碱/肌酸比值升高。没有病例显示DSC灌注明显的脑血容量升高或FDG PET摄取增加。结论CNS IVL有多种影像学表现,以梗死样病变最为常见。了解这些影像学特征对于准确诊断这种具有挑战性的实体至关重要。
{"title":"Conventional and Advanced Imaging Features of CNS Intravascular Lymphoma","authors":"Sunpob Cheewadhanaraks,&nbsp;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}
引用次数: 0
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。
{"title":"Mediation of Multiphase Collateral Status on Functional Outcome by ASPECTS-Based Net Water Uptake in Acute Stroke","authors":"Qiuxuan Li,&nbsp;Xuesong Bai,&nbsp;Fan Yu,&nbsp;Yao Lu,&nbsp;Miao Zhang,&nbsp;Jingkai Li,&nbsp;Yuan Li,&nbsp;Qiuyue Tian,&nbsp;Adam A. Dmytriw,&nbsp;Robert W. Regenhardt,&nbsp;Liqun Jiao,&nbsp;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}
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。
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引用次数: 0
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Journal of Neuroimaging
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