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.
{"title":"Sustained Enlargement in Vagus and Sural Nerve Cross-Sectional Areas in Fibromyalgia: A Longitudinal Study","authors":"Benedetta Bianchi, Edoardo Cipolletta, Sonia Farah, Fausto Salaffi, Marco Di Carlo","doi":"10.1111/jon.70055","DOIUrl":"https://doi.org/10.1111/jon.70055","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.70055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191101","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}
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。
{"title":"Cardiovascular Risk Factors Impact Brain Volume and White Matter Hyperintensities: A Multiethnic Cohort Study","authors":"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","doi":"10.1111/jon.70057","DOIUrl":"https://doi.org/10.1111/jon.70057","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.70057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191102","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}
Zeynep Bendella, Robert Haase, Ralf Clauberg, Stefan Zülow, Christine Kindler, Alexander Radbruch, Daniel Paech, Katerina Deike
Background and Purpose
Intracranial hypotension (IH) results from cerebrospinal fluid (CSF) leakage from the dural sac, occurring spontaneously or iatrogenically (e.g., post-lumbar puncture), and may cause a wide range of symptoms with significant functional impairment. Accurate detection of the epidural CSF lamella is key to diagnosis. This study evaluated the diagnostic value of intravenous contrast-enhanced MRI using heavily T2-weighted FLAIR (HT2-FLAIR) spine imaging compared to nonenhanced MR myelography at 3 Tesla.
Methods
Ten consecutive patients with IH symptoms were prospectively examined using HT2-FLAIR imaging of the spine before and up to 3 h after gadolinium-based contrast agent administration, alongside noncontrast MR myelography. Two readers assessed the conspicuity of the CSF lamella on contrast-enhanced HT2-FLAIR (ceHT2-FLAIR) using a score from −2 to +2 and evaluated additional diagnostic benefit.
Results
A CSF lamella was seen in eight of 10 patients as a strongly enhancing band on ceHT2-FLAIR. In one case, the lamella was visible exclusively on ceHT2-FLAIR (conspicuity score [CS] = 2, n = 1) and was more conspicuous in three cases (CS = 1, n = 3). Six cases showed equal conspicuity (CS = 0, n = 6). In two cases each, ceHT2-FLAIR either enabled diagnosis or provided supporting information. In six cases, it confirmed diagnosis based on noncontrast imaging. Beyond improved conspicuity, ceHT2-FLAIR helped detect low-flow leaks, optimize axial slice positioning, and assess CSF lamella distribution.
Conclusions
Intravenous ceHT2-FLAIR MRI may be considered as an additional tool in CSF leak evaluation, particularly when used for detecting indirect signs of IH.
背景和目的颅内低血压（IH）是由脑脊液（CSF）从硬脑膜囊渗漏引起的，可自发或医源性发生（如腰椎穿刺后），并可引起广泛的症状和显著的功能损害。硬膜外脑脊液片的准确检测是诊断的关键。本研究评估了静脉内对比增强MRI使用重t2加权FLAIR （HT2-FLAIR）脊柱成像与非增强MRI脊髓造影在3特斯拉时的诊断价值。方法对10例连续出现IH症状的患者进行前瞻性检查，在给予钆造影剂前和注射后3小时内使用HT2-FLAIR脊柱成像，同时进行非对比MR脊髓造影。两位读者评估了对比增强HT2-FLAIR （ceHT2-FLAIR）的脑脊液板层的显著性，评分从- 2到+2，并评估了额外的诊断价值。结果10例患者中有8例脑脊液板层为ceHT2-FLAIR强增强带。1例片层仅在ceHT2-FLAIR上可见（显著性评分[CS] = 2, n = 1）， 3例片层更明显（CS = 1, n = 3）。6例显著性相等（CS = 0, n = 6）。在两种情况下，ceHT2-FLAIR要么启用诊断，要么提供支持信息。在6例病例中，它根据非对比成像证实了诊断。除了提高可视性外，ceHT2-FLAIR还有助于检测低流量泄漏，优化轴向切片定位，评估脑脊液板层分布。结论静脉注射ceHT2-FLAIR MRI可作为脑脊液泄漏评估的附加工具，特别是用于检测IH的间接征象时。
{"title":"Intravenous Contrast-Enhanced MR Myelography in CSF Leakage for the Detection of Spinal CSF Lamellae","authors":"Zeynep Bendella, Robert Haase, Ralf Clauberg, Stefan Zülow, Christine Kindler, Alexander Radbruch, Daniel Paech, Katerina Deike","doi":"10.1111/jon.70056","DOIUrl":"https://doi.org/10.1111/jon.70056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Intracranial hypotension (IH) results from cerebrospinal fluid (CSF) leakage from the dural sac, occurring spontaneously or iatrogenically (e.g., post-lumbar puncture), and may cause a wide range of symptoms with significant functional impairment. Accurate detection of the epidural CSF lamella is key to diagnosis. This study evaluated the diagnostic value of intravenous contrast-enhanced MRI using heavily T2-weighted FLAIR (HT2-FLAIR) spine imaging compared to nonenhanced MR myelography at 3 Tesla.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ten consecutive patients with IH symptoms were prospectively examined using HT2-FLAIR imaging of the spine before and up to 3 h after gadolinium-based contrast agent administration, alongside noncontrast MR myelography. Two readers assessed the conspicuity of the CSF lamella on contrast-enhanced HT2-FLAIR (ceHT2-FLAIR) using a score from −2 to +2 and evaluated additional diagnostic benefit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A CSF lamella was seen in eight of 10 patients as a strongly enhancing band on ceHT2-FLAIR. In one case, the lamella was visible exclusively on ceHT2-FLAIR (conspicuity score [CS] = 2, <i>n</i> = 1) and was more conspicuous in three cases (CS = 1, <i>n</i> = 3). Six cases showed equal conspicuity (CS = 0, <i>n</i> = 6). In two cases each, ceHT2-FLAIR either enabled diagnosis or provided supporting information. In six cases, it confirmed diagnosis based on noncontrast imaging. Beyond improved conspicuity, ceHT2-FLAIR helped detect low-flow leaks, optimize axial slice positioning, and assess CSF lamella distribution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Intravenous ceHT2-FLAIR MRI may be considered as an additional tool in CSF leak evaluation, particularly when used for detecting indirect signs of IH.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.70056","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148625","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}
Resting-state functional MRI has revealed abnormal brain activity in patients with migraine, though findings have been inconsistent. This meta-analysis utilized Seed-based d Mapping to assess variations in amplitude of low-frequency fluctuations (ALFF) and fractional amplitude of low-frequency fluctuations (fALFF). The aim was to identify common brain regions with altered spontaneous brain activity in migraine patients.
Methods
A systematic search was conducted in PubMed, Web of Science, and Embase for studies published up to August 2023, comparing spontaneous low-frequency brain activity between migraine patients and healthy controls (HCs). Jackknife sensitivity, heterogeneity, publication bias, and meta-regression analyses were performed to ensure the robustness and reliability of our findings.
Results
Nine studies, including 708 migraine patients and HCs, were included in the analysis. Applying a highly conservative family-wise error rate correction, no significant findings were observed. However, when a less conservative threshold was used, migraine patients exhibited increased ALFF/fALFF in the left anterior thalamus and the corticospinal tract but showed decreased values in the right middle frontal gyrus. Jackknife sensitivity analysis confirmed the reproducibility of these results, while heterogeneity analysis revealed significant variability across studies, likely due to differences in study design and patient populations.
Conclusions
This meta-analysis provides a comprehensive synthesis of neuroimaging evidence, linking migraine to abnormal spontaneous brain activity in regions associated with pain processing and nociceptive emotional modulation. These findings enhance our understanding of migraine pathophysiology and highlight potential targets for neuromodulation therapies, offering new directions for future research and clinical interventions.
背景和目的静息状态功能MRI显示偏头痛患者的大脑活动异常，尽管结果不一致。本荟萃分析利用基于种子的d映射来评估低频波动幅度（ALFF）和低频波动幅度分数（fALFF）的变化。目的是确定偏头痛患者大脑自发活动改变的共同大脑区域。方法系统检索PubMed、Web of Science和Embase截至2023年8月发表的研究，比较偏头痛患者和健康对照（hc）的自发低频脑活动。为了确保研究结果的稳健性和可靠性，我们进行了刀切敏感性、异质性、发表偏倚和meta回归分析。结果纳入9项研究，包括708例偏头痛患者和hc患者。应用高度保守的家庭误差率校正，没有观察到显著的发现。然而，当使用较低的保守阈值时，偏头痛患者表现出左前丘脑和皮质脊髓束的ALFF/fALFF增加，但右侧额叶中回的ALFF/fALFF值下降。Jackknife敏感性分析证实了这些结果的可重复性，而异质性分析显示了研究之间的显著差异，可能是由于研究设计和患者群体的差异。结论：本荟萃分析提供了综合的神经影像学证据，将偏头痛与疼痛加工和伤害性情绪调节相关区域的异常自发脑活动联系起来。这些发现增强了我们对偏头痛病理生理学的认识，突出了神经调节治疗的潜在靶点，为未来的研究和临床干预提供了新的方向。
{"title":"Aberrant Spontaneous Low-Frequency Brain Activity in Migraine: A Meta-Analysis of Resting-State fMRI Studies","authors":"Qiuyi Chen, Yuhan Liu, Xin Yang, Bin Li, Lu Liu","doi":"10.1111/jon.70043","DOIUrl":"https://doi.org/10.1111/jon.70043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Resting-state functional MRI has revealed abnormal brain activity in patients with migraine, though findings have been inconsistent. This meta-analysis utilized Seed-based d Mapping to assess variations in amplitude of low-frequency fluctuations (ALFF) and fractional amplitude of low-frequency fluctuations (fALFF). The aim was to identify common brain regions with altered spontaneous brain activity in migraine patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search was conducted in PubMed, Web of Science, and Embase for studies published up to August 2023, comparing spontaneous low-frequency brain activity between migraine patients and healthy controls (HCs). Jackknife sensitivity, heterogeneity, publication bias, and meta-regression analyses were performed to ensure the robustness and reliability of our findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nine studies, including 708 migraine patients and HCs, were included in the analysis. Applying a highly conservative family-wise error rate correction, no significant findings were observed. However, when a less conservative threshold was used, migraine patients exhibited increased ALFF/fALFF in the left anterior thalamus and the corticospinal tract but showed decreased values in the right middle frontal gyrus. Jackknife sensitivity analysis confirmed the reproducibility of these results, while heterogeneity analysis revealed significant variability across studies, likely due to differences in study design and patient populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This meta-analysis provides a comprehensive synthesis of neuroimaging evidence, linking migraine to abnormal spontaneous brain activity in regions associated with pain processing and nociceptive emotional modulation. These findings enhance our understanding of migraine pathophysiology and highlight potential targets for neuromodulation therapies, offering new directions for future research and clinical interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.70043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144140546","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}
Mohammed M. Al-Salihi, Maryam S. Al-Jebur, Ram Saha, Ahmed Abd Elazim, Farhan Siddiq, Adnan I. Qureshi
Background and purpose
Despite significant advances in endovascular thrombectomy (EVT) for acute ischemic stroke (AIS), approximately 30%–40% of patients experience futile recanalization. This meta-analysis aimed to assess the effectiveness and safety of adjunctive intra-arterial thrombolysis (IAT) following EVT in individuals with AIS.
Methods
We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared IAT after EVT with standard care. A literature search was conducted across multiple databases up to March 2025. The primary outcome was excellent functional outcome (modified Rankin Scale [mRS] 0–1) at 90 days, functional independence (mRS 0–2), and mortality rate. Risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous variables were calculated with 95% confidence intervals.
Results
Six RCTs comprising 1971 patients were included. Adjunctive IAT significantly increased excellent functional outcomes at 90 days (RR = 1.24 [1.12–1.39], p < 0.0001), without significant improvement in functional independence (RR = 1.04 [0.96–1.13], p = 0.34). The IAT group exhibited significantly higher EuroQol 5 dimensions scores (MD = 0.08 [0.03–0.13], p = 0.001). Mortality rates were comparable (RR = 1.01 [0.84–1.23], p = 0.89). No significant differences were observed in any intracerebral hemorrhage (RR = 1.15 [1.00–1.33], p = 0.08), symptomatic intracerebral hemorrhage (RR = 1.13 [0.76–1.68], p = 0.53), or systemic bleeding complications.
Conclusions
Adjunctive IAT following EVT significantly enhances excellent functional recovery and health-related quality of life after AIS, without significantly increasing hemorrhagic complications. These findings support the consideration of IAT as a complementary strategy following mechanical thrombectomy in AIS patients who present within 24 h of symptom onset.
背景和目的尽管血管内血栓切除术（EVT）治疗急性缺血性卒中（AIS）取得了重大进展，但约30%-40%的患者经历了无效的再通。本荟萃分析旨在评估AIS患者EVT后辅助动脉内溶栓（IAT）的有效性和安全性。方法：我们对比较EVT后IAT与标准治疗的随机对照试验（rct）进行了系统回顾和荟萃分析。截至2025年3月，对多个数据库进行了文献检索。主要转归为90天的良好功能转归（改良Rankin量表[mRS] 0-1）、功能独立性（mRS 0-2）和死亡率。以95%置信区间计算二分类结果的风险比（rr）和连续变量的平均差异（MDs）。结果纳入6项随机对照试验，共纳入1971例患者。辅助IAT显著增加了90天的良好功能预后(RR = 1.24 [1.12-1.39], p <；0.0001)，功能独立性无显著改善（RR = 1.04 [0.96-1.13], p = 0.34）。IAT组EuroQol 5维度得分显著高于对照组（MD = 0.08 [0.03-0.13], p = 0.001）。死亡率具有可比性（RR = 1.01 [0.84-1.23], p = 0.89）。两组脑出血发生率（RR = 1.15 [1.00-1.33], p = 0.08）、症状性脑出血发生率（RR = 1.13 [0.76-1.68], p = 0.53）、全身性出血并发症发生率无统计学差异。结论EVT后辅助IAT可显著提高AIS患者良好的功能恢复和健康相关生活质量，且未显著增加出血性并发症。这些发现支持将IAT作为机械取栓后24小时内出现症状的AIS患者的补充策略。
{"title":"Adjunctive Intra-Arterial Thrombolysis Following Endovascular Thrombectomy in Acute Ischemic Stroke: A Meta-Analysis","authors":"Mohammed M. Al-Salihi, Maryam S. Al-Jebur, Ram Saha, Ahmed Abd Elazim, Farhan Siddiq, Adnan I. Qureshi","doi":"10.1111/jon.70054","DOIUrl":"https://doi.org/10.1111/jon.70054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and purpose</h3>\u0000 \u0000 <p>Despite significant advances in endovascular thrombectomy (EVT) for acute ischemic stroke (AIS), approximately 30%–40% of patients experience futile recanalization. This meta-analysis aimed to assess the effectiveness and safety of adjunctive intra-arterial thrombolysis (IAT) following EVT in individuals with AIS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared IAT after EVT with standard care. A literature search was conducted across multiple databases up to March 2025. The primary outcome was excellent functional outcome (modified Rankin Scale [mRS] 0–1) at 90 days, functional independence (mRS 0–2), and mortality rate. Risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous variables were calculated with 95% confidence intervals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six RCTs comprising 1971 patients were included. Adjunctive IAT significantly increased excellent functional outcomes at 90 days (RR = 1.24 [1.12–1.39], <i>p</i> < 0.0001), without significant improvement in functional independence (RR = 1.04 [0.96–1.13], <i>p</i> = 0.34). The IAT group exhibited significantly higher EuroQol 5 dimensions scores (MD = 0.08 [0.03–0.13], <i>p</i> = 0.001). Mortality rates were comparable (RR = 1.01 [0.84–1.23], <i>p</i> = 0.89). No significant differences were observed in any intracerebral hemorrhage (RR = 1.15 [1.00–1.33], <i>p</i> = 0.08), symptomatic intracerebral hemorrhage (RR = 1.13 [0.76–1.68], <i>p</i> = 0.53), or systemic bleeding complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Adjunctive IAT following EVT significantly enhances excellent functional recovery and health-related quality of life after AIS, without significantly increasing hemorrhagic complications. These findings support the consideration of IAT as a complementary strategy following mechanical thrombectomy in AIS patients who present within 24 h of symptom onset.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144135551","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}
Danielle M. Torp, Ke'La H. Porter, Kyle B. Kosik, Matthew C. Hoch, Kyeongtak Song, Nathan F. Johnson
Background and Purpose
Chronic ankle instability (CAI) disrupts mechanoreceptors at the talocrural joint, which requires reliance on other forms of sensory information to maintain normal physical function. Understanding central nervous system activation patterns in individuals with CAI may lead to the development of interventions aimed at preventing long-term dysfunction. The primary objective of this study was to explore cortical activation patterns between individuals with CAI and uninjured controls during foot tapping and task switching.
Methods
Twenty-six adults (13 CAI) completed a functional MRI protocol. The foot tapping task required participants to tap a response button under their metatarsal heads by plantarflexing their foot in sync with a visual stimulus. The switching task required participants to make a decision about a single stimulus feature (e.g., color or shape) during single and mixed task blocks. Single blocks required attention to either the shape or color of the stimulus, while mixed blocks required participants to switch between features (color and shape). Participants responded to stimuli via a plantarflexion button press. Between and within group voxelwise analyses were then conducted to determine cortical activation patterns.
Results
The CAI group demonstrated greater activation in regions of visual processing and sensorimotor integration during foot tapping when compared to the uninjured controls. During task switching, the uninjured group demonstrated more activation in regions of cognitive flexibility, while CAI participants demonstrated more activation in an area of emotional processing.
Conclusions
Individuals with CAI and uninjured controls demonstrate different activation patterns during foot tapping and task switching.
{"title":"Tapping and Task Switching Activation in Individuals With and Without Chronic Ankle Instability: fMRI Pilot Study","authors":"Danielle M. Torp, Ke'La H. Porter, Kyle B. Kosik, Matthew C. Hoch, Kyeongtak Song, Nathan F. Johnson","doi":"10.1111/jon.70053","DOIUrl":"https://doi.org/10.1111/jon.70053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Chronic ankle instability (CAI) disrupts mechanoreceptors at the talocrural joint, which requires reliance on other forms of sensory information to maintain normal physical function. Understanding central nervous system activation patterns in individuals with CAI may lead to the development of interventions aimed at preventing long-term dysfunction. The primary objective of this study was to explore cortical activation patterns between individuals with CAI and uninjured controls during foot tapping and task switching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-six adults (13 CAI) completed a functional MRI protocol. The foot tapping task required participants to tap a response button under their metatarsal heads by plantarflexing their foot in sync with a visual stimulus. The switching task required participants to make a decision about a single stimulus feature (e.g., color or shape) during single and mixed task blocks. Single blocks required attention to either the shape or color of the stimulus, while mixed blocks required participants to switch between features (color and shape). Participants responded to stimuli via a plantarflexion button press. Between and within group voxelwise analyses were then conducted to determine cortical activation patterns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The CAI group demonstrated greater activation in regions of visual processing and sensorimotor integration during foot tapping when compared to the uninjured controls. During task switching, the uninjured group demonstrated more activation in regions of cognitive flexibility, while CAI participants demonstrated more activation in an area of emotional processing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Individuals with CAI and uninjured controls demonstrate different activation patterns during foot tapping and task switching.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126016","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}
Adam Bardoczi, Jonathan Izygon, Randall Wolf, Zsolt Garami
Background and Purpose
Transfemoral radiofrequency ablation (tfRFA) is the most performed procedure to address atrial fibrillation (AF); however, tfRFA produces thousands of microemboli that can reach major cerebral arteries and cause silent ischemic lesions. We measured the microembolization rate during an alternative procedure, the Wolf Procedure (formerly Mini-Maze), to address AF and compared our findings with the literature.
Methods
We used transcranial Doppler monitoring on 10 patients with AF (seven permanent, three paroxysmal) who underwent the Wolf Procedure at Houston Methodist Hospital. Intraoperative emboli, mean flow velocity, and pulsatility index in the middle cerebral artery were monitored and recorded. Standard of care follow-up visits were done at Houston Methodist Hospital. During these visits, the patients’ loop recorder and current heart rhythm were analyzed.
Results
Overall, we saw an average of 4.7 high-intensity transient signals (HITS) in our 10 patients with a median of 3 HITS (interquartile range = 1–5.25), which is markedly less than the thousands of HITS typically reported in the literature for cases that use tfRFA. In two of the 10 Wolf Procedure cases, zero microembolus was detected. At their last follow-up appointments, nine out of 10 patients were in sinus rhythm.
Conclusion
The Wolf Procedure is a safe surgical option for AF treatment with a high success rate even after one procedure. The number of emboli during The Wolf Procedure appears to be markedly lower than that during tfRFA, which reduces patient risk for transient ischemic attack, stroke, and silent ischemic brain lesions.
{"title":"Transcranial Doppler Monitoring of the Wolf Procedure Versus Conventional Ablation to Treat Atrial Fibrillation","authors":"Adam Bardoczi, Jonathan Izygon, Randall Wolf, Zsolt Garami","doi":"10.1111/jon.70042","DOIUrl":"https://doi.org/10.1111/jon.70042","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Transfemoral radiofrequency ablation (tfRFA) is the most performed procedure to address atrial fibrillation (AF); however, tfRFA produces thousands of microemboli that can reach major cerebral arteries and cause silent ischemic lesions. We measured the microembolization rate during an alternative procedure, the Wolf Procedure (formerly Mini-Maze), to address AF and compared our findings with the literature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used transcranial Doppler monitoring on 10 patients with AF (seven permanent, three paroxysmal) who underwent the Wolf Procedure at Houston Methodist Hospital. Intraoperative emboli, mean flow velocity, and pulsatility index in the middle cerebral artery were monitored and recorded. Standard of care follow-up visits were done at Houston Methodist Hospital. During these visits, the patients’ loop recorder and current heart rhythm were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, we saw an average of 4.7 high-intensity transient signals (HITS) in our 10 patients with a median of 3 HITS (interquartile range = 1–5.25), which is markedly less than the thousands of HITS typically reported in the literature for cases that use tfRFA. In two of the 10 Wolf Procedure cases, zero microembolus was detected. At their last follow-up appointments, nine out of 10 patients were in sinus rhythm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The Wolf Procedure is a safe surgical option for AF treatment with a high success rate even after one procedure. The number of emboli during The Wolf Procedure appears to be markedly lower than that during tfRFA, which reduces patient risk for transient ischemic attack, stroke, and silent ischemic brain lesions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118141","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}
Tara Srinivas, Dhairya A. Lakhani, Aneri B. Balar, Risheng Xu, Jee Moon, Caline Azzi, Nathan Hyson, Mona Shahriari, Sijin Wen, Cynthia Greene, Janet Mei, Farzad Maroufi, Jeremy J. Heit, Tobias D. Faizy, Gregory W. Albers, Hamza Salim, Meisam Hoseinyazdi, Vivek S. Yedavalli
Background and Purpose
Collateral status is an important predictor of reperfusion and mortality in patients with large vessel anterior circulation acute ischemic stroke (AIS). We assess the utility of multiphase computed tomography angiography (CTA) derived from CT perfusion (CTP) source imaging (dCTA) in determining collateral status compared to the reference standard American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral score on digital subtraction angiography (DSA).
Methods
We retrospectively analyzed AIS patients treated at our institution from January 9, 2017, to January 10, 2023. Inclusion criteria included CTA-confirmed anterior circulation large vessel occlusion, diagnostic CTP, and mechanical thrombectomy with documented DSA collateral score. The modified treatment in cerebral ischemia score was used to assess reperfusion. Logistic regression analyses evaluated associations between demographic and clinical factors, collateral status, ASITN/SIR, and reperfusion status.
Results
A total of 311 patients (mean age 67.35 ± 16.37, 57.4% female) were included. Univariate analysis showed that proximal M2 (PM2) occlusion site (odds ratio [OR] 4.45, p < 0.001), Alberta Stroke Program Early CT Score (OR 1.24, p = 0.006), dCTA (OR 3.81, p < 0.001), and CTA Tan (OR 6.05, p < 0.001) were associated with an ASITN score of ≥3, indicating collateral flow. Multivariate regression, adjusted for race, occlusion site, radiologic features, National Institutes of Health stroke score, and premorbid modified Rankin score, found PM2 occlusion site (aOR 5.99, p < 0.001), dCTA (adjusted OR [aOR] 2.24, p = 0.04), and CTA Tan (aOR 3.71, p < 0.01) to be significant predictors of ASITN ≥3.
Conclusions
dCTA is associated with favorable DSA collateral scores and may aid clinical decision-making in AIS patients with large vessel occlusions. Further studies can assess its role in outcome prediction.
背景与目的侧支状态是大血管前循环急性缺血性卒中（AIS）患者再灌注和死亡率的重要预测指标。我们评估了由CT灌注（CTP）源成像（dCTA）衍生的多期计算机断层血管造影（CTA）在确定侧支状态方面的效用，并与参考标准美国介入与治疗神经放射学会/介入放射学会（ASITN/SIR）数字减影血管造影（DSA）侧支评分进行了比较。方法回顾性分析2017年1月9日至2023年1月10日在我院治疗的AIS患者。纳入标准包括cta确认的前循环大血管闭塞，诊断性CTP和机械取栓并记录DSA侧支评分。采用改良后的脑缺血评分法评价再灌注。Logistic回归分析评估了人口统计学和临床因素、侧支状态、ASITN/SIR和再灌注状态之间的关系。结果共纳入311例患者，平均年龄67.35±16.37岁，女性占57.4%。单因素分析显示近端M2 （PM2）闭塞部位(优势比[OR] 4.45, p <；0.001)，阿尔伯塔卒中计划早期CT评分（OR 1.24, p = 0.006）， dCTA (OR 3.81, p <；0.001)和CTA Tan (OR 6.05, p <；0.001)与ASITN评分≥3分相关，表明侧支血流。多因素回归，调整种族、闭塞部位、放射学特征、美国国立卫生研究院卒中评分和病前改良Rankin评分，发现PM2闭塞部位(aOR 5.99, p <；0.001)、dCTA（调整后OR [aOR] 2.24, p = 0.04）和CTA Tan (aOR 3.71, p <；0.01)为ASITN≥3的显著预测因子。结论dCTA与良好的DSA侧支评分相关，可能有助于AIS大血管闭塞患者的临床决策。进一步的研究可以评估其在预后预测中的作用。
{"title":"Single- and Multiphase CT Angiography Is Associated With Digital Subtraction Angiography Collateral Score ≥3","authors":"Tara Srinivas, Dhairya A. Lakhani, Aneri B. Balar, Risheng Xu, Jee Moon, Caline Azzi, Nathan Hyson, Mona Shahriari, Sijin Wen, Cynthia Greene, Janet Mei, Farzad Maroufi, Jeremy J. Heit, Tobias D. Faizy, Gregory W. Albers, Hamza Salim, Meisam Hoseinyazdi, Vivek S. Yedavalli","doi":"10.1111/jon.70048","DOIUrl":"https://doi.org/10.1111/jon.70048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Collateral status is an important predictor of reperfusion and mortality in patients with large vessel anterior circulation acute ischemic stroke (AIS). We assess the utility of multiphase computed tomography angiography (CTA) derived from CT perfusion (CTP) source imaging (dCTA) in determining collateral status compared to the reference standard American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral score on digital subtraction angiography (DSA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed AIS patients treated at our institution from January 9, 2017, to January 10, 2023. Inclusion criteria included CTA-confirmed anterior circulation large vessel occlusion, diagnostic CTP, and mechanical thrombectomy with documented DSA collateral score. The modified treatment in cerebral ischemia score was used to assess reperfusion. Logistic regression analyses evaluated associations between demographic and clinical factors, collateral status, ASITN/SIR, and reperfusion status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 311 patients (mean age 67.35 ± 16.37, 57.4% female) were included. Univariate analysis showed that proximal M2 (PM2) occlusion site (odds ratio [OR] 4.45, <i>p</i> < 0.001), Alberta Stroke Program Early CT Score (OR 1.24, <i>p</i> = 0.006), dCTA (OR 3.81, <i>p</i> < 0.001), and CTA Tan (OR 6.05, <i>p</i> < 0.001) were associated with an ASITN score of ≥3, indicating collateral flow. Multivariate regression, adjusted for race, occlusion site, radiologic features, National Institutes of Health stroke score, and premorbid modified Rankin score, found PM2 occlusion site (aOR 5.99, <i>p</i> < 0.001), dCTA (adjusted OR [aOR] 2.24, <i>p</i> = 0.04), and CTA Tan (aOR 3.71, <i>p</i> < 0.01) to be significant predictors of ASITN ≥3.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>dCTA is associated with favorable DSA collateral scores and may aid clinical decision-making in AIS patients with large vessel occlusions. Further studies can assess its role in outcome prediction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950009","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}
Madeleine Marshall, Kingkarn Aphiwatthanasumet, Olivier Mougin, Christine Stadelmann, Paul S. Morgan, Rob A. Dineen, Penny Gowland, Nikos Evangelou, Margareta A. Clarke
Background and Purpose
Chronic active multiple sclerosis (MS) lesions represent a particularly destructive subset of lesions on pathology. However, their imaging correlates, including paramagnetic rim lesions (PRLs) detected on susceptibility-weighted imaging, lack sensitivity and are difficult to implement in clinical practice. This exploratory, longitudinal study investigates the prevalence and temporal dynamics of a novel imaging marker, T1-dark rims, and their relationship with PRLs observed on quantitative susceptibility mapping (QSM).
Methods
Four untreated people with MS underwent 7-Tesla MRI scanning six times over a period of 36 weeks. New and pre-existing lesions were analyzed for the presence and temporal evolution of T1-dark and QSM rims. Quantitative T1 values were derived using B1 maps, and the relationship between rim status and lesion size was evaluated.
Results
Of the 159 baseline lesions, 22 (14%) had T1-dark rims, 11 (7%) had QSM rims, and five lesions had both. T1-dark and QSM rims showed temporal changes, with T1-dark rims preceding new QSM rim appearance in three out of four (75%) lesions. Eleven out of 20 (55%) newly formed lesions had T1-dark rims, with a T1-dark rim present in all new lesions over 100 mm3. Small new lesions lacked discernible rims, but their overall T1 values aligned with those of larger lesion T1-dark rims implying shared pathological processes.
Conclusions
T1-dark rims were more common than QSM rims, with greater prevalence in newly formed lesions. We propose they represent edema and inflammation associated with early stages of chronic active lesion formation visible despite, not because of, iron accumulation.
{"title":"T1-Dark Rim as a Marker of New and Chronic Active Multiple Sclerosis Lesions: A Serial Study With Frequent 7T MRI","authors":"Madeleine Marshall, Kingkarn Aphiwatthanasumet, Olivier Mougin, Christine Stadelmann, Paul S. Morgan, Rob A. Dineen, Penny Gowland, Nikos Evangelou, Margareta A. Clarke","doi":"10.1111/jon.70044","DOIUrl":"https://doi.org/10.1111/jon.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Chronic active multiple sclerosis (MS) lesions represent a particularly destructive subset of lesions on pathology. However, their imaging correlates, including paramagnetic rim lesions (PRLs) detected on susceptibility-weighted imaging, lack sensitivity and are difficult to implement in clinical practice. This exploratory, longitudinal study investigates the prevalence and temporal dynamics of a novel imaging marker, T<sub>1</sub>-dark rims, and their relationship with PRLs observed on quantitative susceptibility mapping (QSM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Four untreated people with MS underwent 7-Tesla MRI scanning six times over a period of 36 weeks. New and pre-existing lesions were analyzed for the presence and temporal evolution of T<sub>1</sub>-dark and QSM rims. Quantitative T<sub>1</sub> values were derived using B<sub>1</sub> maps, and the relationship between rim status and lesion size was evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 159 baseline lesions, 22 (14%) had T<sub>1</sub>-dark rims, 11 (7%) had QSM rims, and five lesions had both. T<sub>1</sub>-dark and QSM rims showed temporal changes, with T<sub>1</sub>-dark rims preceding new QSM rim appearance in three out of four (75%) lesions. Eleven out of 20 (55%) newly formed lesions had T<sub>1</sub>-dark rims, with a T<sub>1</sub>-dark rim present in all new lesions over 100 mm<sup>3</sup>. Small new lesions lacked discernible rims, but their overall T<sub>1</sub> values aligned with those of larger lesion T<sub>1</sub>-dark rims implying shared pathological processes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>T<sub>1</sub>-dark rims were more common than QSM rims, with greater prevalence in newly formed lesions. We propose they represent edema and inflammation associated with early stages of chronic active lesion formation visible despite, not because of, iron accumulation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944690","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}
Antonio Lorenzo, Joaquín Gil, Jose Ignacio Gallego, Alfonso González-Cruz, Fernando Aparici-Robles, Antoni Boscà, Antonio Sagredo, Marc Comas-Cufí, Josep Puig
Background and Purpose
Optima coils are a new type of embolic coils with complex and WAVE shape properties and variable degrees of softness. In patients with ruptured intracranial aneurysms, we examined the safety (periprocedural complications) and efficacy (occlusion rate immediately postprocedure) of the Optima coil.
Methods
We studied 103 consecutive patients with ruptured intracranial aneurysms who were treated exclusively with the Optima coil, without the use of accompanying implanted devices, at five centers in Spain. Endovascular techniques included stand-alone or balloon-assisted coiling. Postprocedural occlusion and periprocedural device-related adverse events were the endpoints. Aneurysm occlusion was graded according to the modified Raymond–Roy Occlusion scale.
Results
Of the 103 enrolled patients (70 female; median age 59 years), 59 (57.3%) presented with an IV Fischer Scale grade, and 61 (59.2%) of the ruptured aneurysms were wide-necked. Thirty-eight (36.9%) aneurysms were located in the anterior communicating artery. Simple-coiling and balloon-assisted coiling were performed in 36 (34.9%) and 65 (63.1%) patients, respectively. Raymond–Roy Class I, II, and III were reached in 64 (60.3%), 29 (28.1%), and ten (9.7%) following the procedure. The periprocedural device-related serious adverse event rate was 12 (13.5%), of which eight (7.7%) were due to coil protrusion. Four (3.8%) patients had intraprocedural aneurysm rupture. No early rebleeding or death was reported.
Conclusion
This analysis suggests that the Optima coil is safe and effective for treating ruptured aneurysms, with satisfactory occlusion rates and low rates of periprocedural device-related serious adverse events.
{"title":"Safety/Efficacy of a Pusher, Thermal Detachment Coil for Ruptured Intracranial Aneurysms: A Multicenter Real-World Study","authors":"Antonio Lorenzo, Joaquín Gil, Jose Ignacio Gallego, Alfonso González-Cruz, Fernando Aparici-Robles, Antoni Boscà, Antonio Sagredo, Marc Comas-Cufí, Josep Puig","doi":"10.1111/jon.70050","DOIUrl":"https://doi.org/10.1111/jon.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Optima coils are a new type of embolic coils with complex and WAVE shape properties and variable degrees of softness. In patients with ruptured intracranial aneurysms, we examined the safety (periprocedural complications) and efficacy (occlusion rate immediately postprocedure) of the Optima coil.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We studied 103 consecutive patients with ruptured intracranial aneurysms who were treated exclusively with the Optima coil, without the use of accompanying implanted devices, at five centers in Spain. Endovascular techniques included stand-alone or balloon-assisted coiling. Postprocedural occlusion and periprocedural device-related adverse events were the endpoints. Aneurysm occlusion was graded according to the modified Raymond–Roy Occlusion scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 103 enrolled patients (70 female; median age 59 years), 59 (57.3%) presented with an IV Fischer Scale grade, and 61 (59.2%) of the ruptured aneurysms were wide-necked. Thirty-eight (36.9%) aneurysms were located in the anterior communicating artery. Simple-coiling and balloon-assisted coiling were performed in 36 (34.9%) and 65 (63.1%) patients, respectively. Raymond–Roy Class I, II, and III were reached in 64 (60.3%), 29 (28.1%), and ten (9.7%) following the procedure. The periprocedural device-related serious adverse event rate was 12 (13.5%), of which eight (7.7%) were due to coil protrusion. Four (3.8%) patients had intraprocedural aneurysm rupture. No early rebleeding or death was reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This analysis suggests that the Optima coil is safe and effective for treating ruptured aneurysms, with satisfactory occlusion rates and low rates of periprocedural device-related serious adverse events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143930411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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