Josep Puig, Sebastià Remollo, Isabel Rodríguez-Caamaño, Carlos Castaño, Marc Comas-Cufí, Mariano Werner, Guillem Dolz, Jordi Blasco, Luis SanRoman, Juan Manuel Sanchis, Fernando Aparici-Robles, Eva González, Jon Fondevila, Pedro Vega, Eduardo Murias, Elvira Jiménez, Rafael Oteros, Alfonso López-Frias, Manuel Moreu, Saima Bashir, Yolanda Silva, Enric Ripoll, Javier Martínez-Fernández, Yeray Aguilar, José Méndez, Fernando Sánchez, Gonzalo de Paco, Alan Flores, Juan Carlos Llibre, Waleed Brinjikji, ROSSETTI Group
Background and Purpose
Large-bore aspiration catheters (LBACs) are used for thrombectomy in large vessel occlusion (LVO), either as a standalone direct aspiration first-pass technique or combined with a stent retriever (ASR). LBAC design may influence ASR thrombectomy efficacy. We compared the safety and performance of the novel MIVI Q segmental catheter with the well-established SOFIA aspiration device in ASR thrombectomy.
Methods
We analyzed data from the Registry cOmbined vS SinglE Thrombectomy TechnIques registry of consecutive patients with anterior circulation LVO and compared the outcomes of those treated with first-line ASR thrombectomy using Q (Q5 or Q6) or SOFIA (5F or 6F Plus) catheters. Demographic, clinical, angiographic, and clinical outcome data (24-h National Institute of Health Stroke Scale [NIHSS] and modified Rankin Scale score at 3 months) were compared.
Results
Of the 853 patients, 155 (18.2%) were treated with MIVI Q and 698 (81.8%) with SOFIA catheters. After adjusting for age, sex, NIHSS score at baseline, tPA use, site occlusion, anesthesia type, and diameter and length of SR, the MIVI Q group was comparable to the SOFIA group in terms of first-pass effect or successful final recanalization and safety. However, the MIVI Q group had a shorter mechanical thrombectomy time (20 [10–45] min vs. 33 [20–51] min; odds ratio [OR] = 7.4, 95% confidence interval [CI]: 1.1–14; p = 0.021) and a lower rate of symptomatic intracerebral hemorrhage (3.3% vs. 8.8%; OR = 3.59, 95% CI: 1.45–10.9; p = 0.011).
Conclusions
In ASR neurothrombectomy, SOFIA aspiration catheters were not superior to MIVI Q in achieving successful and complete first-passage recanalization; however, MIVI Q had shorter procedural times and a lower rate of symptomatic intracranial hemorrhage.
{"title":"Aspiration Catheter Design Impacts Combined Approach Mechanical Thrombectomy in Anterior Circulation Large Vessel Stroke","authors":"Josep Puig, Sebastià Remollo, Isabel Rodríguez-Caamaño, Carlos Castaño, Marc Comas-Cufí, Mariano Werner, Guillem Dolz, Jordi Blasco, Luis SanRoman, Juan Manuel Sanchis, Fernando Aparici-Robles, Eva González, Jon Fondevila, Pedro Vega, Eduardo Murias, Elvira Jiménez, Rafael Oteros, Alfonso López-Frias, Manuel Moreu, Saima Bashir, Yolanda Silva, Enric Ripoll, Javier Martínez-Fernández, Yeray Aguilar, José Méndez, Fernando Sánchez, Gonzalo de Paco, Alan Flores, Juan Carlos Llibre, Waleed Brinjikji, ROSSETTI Group","doi":"10.1111/jon.70046","DOIUrl":"https://doi.org/10.1111/jon.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Large-bore aspiration catheters (LBACs) are used for thrombectomy in large vessel occlusion (LVO), either as a standalone direct aspiration first-pass technique or combined with a stent retriever (ASR). LBAC design may influence ASR thrombectomy efficacy. We compared the safety and performance of the novel MIVI Q segmental catheter with the well-established SOFIA aspiration device in ASR thrombectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from the Registry cOmbined vS SinglE Thrombectomy TechnIques registry of consecutive patients with anterior circulation LVO and compared the outcomes of those treated with first-line ASR thrombectomy using Q (Q5 or Q6) or SOFIA (5F or 6F Plus) catheters. Demographic, clinical, angiographic, and clinical outcome data (24-h National Institute of Health Stroke Scale [NIHSS] and modified Rankin Scale score at 3 months) were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 853 patients, 155 (18.2%) were treated with MIVI Q and 698 (81.8%) with SOFIA catheters. After adjusting for age, sex, NIHSS score at baseline, tPA use, site occlusion, anesthesia type, and diameter and length of SR, the MIVI Q group was comparable to the SOFIA group in terms of first-pass effect or successful final recanalization and safety. However, the MIVI Q group had a shorter mechanical thrombectomy time (20 [10–45] min vs. 33 [20–51] min; odds ratio [OR] = 7.4, 95% confidence interval [CI]: 1.1–14; <i>p</i> = 0.021) and a lower rate of symptomatic intracerebral hemorrhage (3.3% vs. 8.8%; OR = 3.59, 95% CI: 1.45–10.9; <i>p</i> = 0.011).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In ASR neurothrombectomy, SOFIA aspiration catheters were not superior to MIVI Q in achieving successful and complete first-passage recanalization; however, MIVI Q had shorter procedural times and a lower rate of symptomatic intracranial hemorrhage.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897003","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}
Juan Ignacio García-García, Josep Puig, Óscar Chirife, Andrés Paipa, Sònia Aixut, Jordi Blasco, Mariano Werner, Marc Comas-Cufí, Pedro Vega, Eduardo Murias, Fernando Aparici-Robles, Lluís Morales-Caba, Eva González, Ion Labayen, Veredas Romero, Isabel Bravo, Manuel Moreu, Alfonso López-Frías, Sebastià Remollo, Isabel Rodríguez-Caamaño, Mikel Terceño, Juan Álvarez-Cienfuegos, Javier Martínez-Fernández, Yeray Aguilar, José Carlos Méndez, Fernando Sánchez, Joaquín Zamarro, Víctor Cuba, Miguel Castaño, Antonio López-Rueda, ROSSETTI Group
Background and Purpose
The superiority of achieving modified Treatment in Cerebral Ischemia (mTICI) from multiple passes versus mTICI 2b from a single pass remains uncertain. We aimed to assess whether additional passes in M1 occlusion patients with a first-pass mTICI 2b score improved clinical and functional outcomes.
Methods
We analyzed Registry Combined vs. Single Thrombectomy Techniques registry data of consecutive M1-occlusion patients, comparing outcomes of those with mTICI 2b-stopped after the first pass versus continued mechanical thrombectomy (MT) to improve angiographic results (mTICI 2b or mTICI 2c/3). We compared demographic, clinical, angiographic, and clinical outcome data (National Institute of Health Stroke Scale [NIHSS] at 24 h and modified Rankin Scale at 3 months).
Results
Patients with first-pass mTICI 2b had lower NIHSS scores at admission, fewer left-side occlusions, and longer last-seen-well times. Endovascular techniques and time from groin puncture to revascularization were similar across groups. Patients with final mTICI 2c/3 had the highest distal embolism rates in a new territory (0% for mTICI2b-stopped vs. 3% for final mTICI2b-continued; 7.7% for final mTICI2c/3; p = 0.02). The groups had similar rates of death, symptomatic intracranial hemorrhage, same-area distal embolism, other MT-related complications, NIHSS at 24 h, NIHSS change from admission to 24 h, and same-territory distal embolism.
Conclusion
Achieving mTICI 2b after the first pass in M1-occlusion patients proved relevant. These patients had comparable clinical and functional outcomes and a lower risk of new territory distal embolisms compared to those with final mTICI 2c/3 scores.
{"title":"Modified Treatment in Brain Ischemia 2b Stopped or Continued After First-Pass Mechanical Thrombectomy for M1 Occlusions","authors":"Juan Ignacio García-García, Josep Puig, Óscar Chirife, Andrés Paipa, Sònia Aixut, Jordi Blasco, Mariano Werner, Marc Comas-Cufí, Pedro Vega, Eduardo Murias, Fernando Aparici-Robles, Lluís Morales-Caba, Eva González, Ion Labayen, Veredas Romero, Isabel Bravo, Manuel Moreu, Alfonso López-Frías, Sebastià Remollo, Isabel Rodríguez-Caamaño, Mikel Terceño, Juan Álvarez-Cienfuegos, Javier Martínez-Fernández, Yeray Aguilar, José Carlos Méndez, Fernando Sánchez, Joaquín Zamarro, Víctor Cuba, Miguel Castaño, Antonio López-Rueda, ROSSETTI Group","doi":"10.1111/jon.70047","DOIUrl":"https://doi.org/10.1111/jon.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>The superiority of achieving modified Treatment in Cerebral Ischemia (mTICI) from multiple passes versus mTICI 2b from a single pass remains uncertain. We aimed to assess whether additional passes in M1 occlusion patients with a first-pass mTICI 2b score improved clinical and functional outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed Registry Combined vs. Single Thrombectomy Techniques registry data of consecutive M1-occlusion patients, comparing outcomes of those with mTICI 2b-stopped after the first pass versus continued mechanical thrombectomy (MT) to improve angiographic results (mTICI 2b or mTICI 2c/3). We compared demographic, clinical, angiographic, and clinical outcome data (National Institute of Health Stroke Scale [NIHSS] at 24 h and modified Rankin Scale at 3 months).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients with first-pass mTICI 2b had lower NIHSS scores at admission, fewer left-side occlusions, and longer last-seen-well times. Endovascular techniques and time from groin puncture to revascularization were similar across groups. Patients with final mTICI 2c/3 had the highest distal embolism rates in a new territory (0% for mTICI2b-stopped vs. 3% for final mTICI2b-continued; 7.7% for final mTICI2c/3; p = 0.02). The groups had similar rates of death, symptomatic intracranial hemorrhage, same-area distal embolism, other MT-related complications, NIHSS at 24 h, NIHSS change from admission to 24 h, and same-territory distal embolism.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Achieving mTICI 2b after the first pass in M1-occlusion patients proved relevant. These patients had comparable clinical and functional outcomes and a lower risk of new territory distal embolisms compared to those with final mTICI 2c/3 scores.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875587","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}
Maria Martucci, Mohamad Ezzeldin, Kaho Adachi, Adam Delora, Rime Ezzeldin, Ameer E. Hassan, Farhan Siddiq, Faheem G. Sheriff, Peter Kan, Nazli Janjua, Kaiz S. Asif, Ramesh Grandhi, Ali Alaraj, Muhammad Niazi, Ossama Mansour, Saif Bushnaq, Omar Tanweer, Samantha Miller, Navpreet K. Bains, Gabriela Colina, Mohammad AlMajali, Gautam Edhayan, Musaab Froukh, Walid K. Salah, Elsa Nico, Shehab Ashraf, Yazan Radaideh, Darko Quispe-Orozco, Osama Zaidat, M. Shazam Hussain
Background and Purpose
Carotid artery stenting is a well-established method for treating carotid artery stenosis; however, there are conflicting data on prestenting versus post-stenting balloon angioplasty. Our study aims to understand the risk and safety of pre-stent balloon angioplasty (Pre-SB) and post-stent balloon angioplasty (Post-SB), or both techniques.
Methods
Multicenter retrospective data on angioplasty balloons, stents, complications, and modified Rankin score (mRS) before and after the procedure were collected. Statistical analysis was performed to correlate with complication risks and clinical outcomes.
Results
1,355 patients were enrolled. Post-SB predicted fewer complications (p = 0.035) than Pre-SB or combined Pre-SB and Post-SB. Female sex was a predictor of complications (p = 0.041), while utilization of an embolic protection device predicted fewer complications (p < 0.001). Increasing age (p < 0.001) and smoking (p = 0.027) predicted increased length of stay. Using open-cell stents versus closed-cell stents did not predict follow-up modified rankin score (mRS) or complications, but using open-cell stents did predict a shorter length of stay. Conversely, open-cell stents were more likely to undergo Post-SB (p < 0.001), while closed-cell stents were more likely to undergo Pre-SB (p = 0.002).
Conclusions
Unlike previous literature, our results showed that Post-SB alone was associated with fewer complications compared to either Pre-SB alone or the combination of Pre-SB and Post-SB. Open-cell stents required a higher rate of Post-SB.
{"title":"Clinical Outcomes and Complications of Carotid Artery Stenting With or Without Pre-Stent and Post-Stent Balloon Angioplasty","authors":"Maria Martucci, Mohamad Ezzeldin, Kaho Adachi, Adam Delora, Rime Ezzeldin, Ameer E. Hassan, Farhan Siddiq, Faheem G. Sheriff, Peter Kan, Nazli Janjua, Kaiz S. Asif, Ramesh Grandhi, Ali Alaraj, Muhammad Niazi, Ossama Mansour, Saif Bushnaq, Omar Tanweer, Samantha Miller, Navpreet K. Bains, Gabriela Colina, Mohammad AlMajali, Gautam Edhayan, Musaab Froukh, Walid K. Salah, Elsa Nico, Shehab Ashraf, Yazan Radaideh, Darko Quispe-Orozco, Osama Zaidat, M. Shazam Hussain","doi":"10.1111/jon.70041","DOIUrl":"https://doi.org/10.1111/jon.70041","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Carotid artery stenting is a well-established method for treating carotid artery stenosis; however, there are conflicting data on prestenting versus post-stenting balloon angioplasty. Our study aims to understand the risk and safety of pre-stent balloon angioplasty (Pre-SB) and post-stent balloon angioplasty (Post-SB), or both techniques.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Multicenter retrospective data on angioplasty balloons, stents, complications, and modified Rankin score (mRS) before and after the procedure were collected. Statistical analysis was performed to correlate with complication risks and clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>1,355 patients were enrolled. Post-SB predicted fewer complications (<i>p</i> = 0.035) than Pre-SB or combined Pre-SB and Post-SB. Female sex was a predictor of complications (<i>p</i> = 0.041), while utilization of an embolic protection device predicted fewer complications (<i>p</i> < 0.001). Increasing age (<i>p</i> < 0.001) and smoking (<i>p</i> = 0.027) predicted increased length of stay. Using open-cell stents versus closed-cell stents did not predict follow-up modified rankin score (mRS) or complications, but using open-cell stents did predict a shorter length of stay. Conversely, open-cell stents were more likely to undergo Post-SB (<i>p</i> < 0.001), while closed-cell stents were more likely to undergo Pre-SB (<i>p</i> = 0.002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Unlike previous literature, our results showed that Post-SB alone was associated with fewer complications compared to either Pre-SB alone or the combination of Pre-SB and Post-SB. Open-cell stents required a higher rate of Post-SB.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143861693","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}
Aniruddha R. Upadhye, Eleana Cintron, Jichu Zhang, Jennifer Coleman, Chaitanya Kolluru, Michael W. Jenkins, David Wilson, Nicole A. Pelot, Andrew J. Shoffstall
Background and Purpose
Peripheral nerve stimulation is approved by the US Food and Drug Administration for treating various disorders, but it is often limited by side effects, highlighting the need for a clear understanding of fascicular and fiber organization to design selective therapies. Micro-CT imaging of contrast-stained nerves enables the visualization of tissue microstructures, such as the fascicular perineurium and vasculature. In this work, we evaluated phosphotungstic acid (PTA) as a contrast agent and assessed its compatibility with downstream histology.
Methods
Human vagus nerve samples were collected from three embalmed cadavers and subjected to three different staining methods, followed by micro-CT imaging: Lugol's iodine, osmium tetroxide, and PTA. Contrast ratios of adjacent tissue microstructures (perineurium, interfascicular epineurium, and fascicle) were quantified for each stain and compared. We further developed a pipeline to optimize micro-CT scan acquisition parameters based on objective metrics for sharpness, noise, and pixel saturation. The PTA-stained samples underwent subsequent histological processing and staining with hematoxylin and eosin, Masson's trichrome, and immunohistochemistry and were assessed for tissue degradation.
Results
PTA enhanced the visualization of perineurium, providing high contrast ratios compared to iodine and osmium tetroxide. Optimized scanning parameters for PTA-stained nerves (55 kV and 109 µA) effectively balanced noise and sharpness. While we found that PTA is generally nondestructive for downstream histology, higher concentrations and longer exposure could alter the optical density of nuclei and affect stain differentiation in special stains.
Conclusion
PTA serves as a valuable micro-CT contrast agent for nerve imaging, effective in visualizing the perineurium with minimal impact on histological integrity.
{"title":"Phosphotungstic Acid Staining to Visualize the Vagus Nerve Perineurium Using Micro-CT","authors":"Aniruddha R. Upadhye, Eleana Cintron, Jichu Zhang, Jennifer Coleman, Chaitanya Kolluru, Michael W. Jenkins, David Wilson, Nicole A. Pelot, Andrew J. Shoffstall","doi":"10.1111/jon.70040","DOIUrl":"https://doi.org/10.1111/jon.70040","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Peripheral nerve stimulation is approved by the US Food and Drug Administration for treating various disorders, but it is often limited by side effects, highlighting the need for a clear understanding of fascicular and fiber organization to design selective therapies. Micro-CT imaging of contrast-stained nerves enables the visualization of tissue microstructures, such as the fascicular perineurium and vasculature. In this work, we evaluated phosphotungstic acid (PTA) as a contrast agent and assessed its compatibility with downstream histology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Human vagus nerve samples were collected from three embalmed cadavers and subjected to three different staining methods, followed by micro-CT imaging: Lugol's iodine, osmium tetroxide, and PTA. Contrast ratios of adjacent tissue microstructures (perineurium, interfascicular epineurium, and fascicle) were quantified for each stain and compared. We further developed a pipeline to optimize micro-CT scan acquisition parameters based on objective metrics for sharpness, noise, and pixel saturation. The PTA-stained samples underwent subsequent histological processing and staining with hematoxylin and eosin, Masson's trichrome, and immunohistochemistry and were assessed for tissue degradation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PTA enhanced the visualization of perineurium, providing high contrast ratios compared to iodine and osmium tetroxide. Optimized scanning parameters for PTA-stained nerves (55 kV and 109 µA) effectively balanced noise and sharpness. While we found that PTA is generally nondestructive for downstream histology, higher concentrations and longer exposure could alter the optical density of nuclei and affect stain differentiation in special stains.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PTA serves as a valuable micro-CT contrast agent for nerve imaging, effective in visualizing the perineurium with minimal impact on histological integrity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.70040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143809776","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}
Sebastian Johannes Müller, Eya Khadhraoui, Olga Kukhlenko, Johannes Schwarzer, Jürgen Voges, I. Erol Sandalcioglu, Daniel Behme, Friedhelm Schmitt, Lars Büntjen
Background and Purpose
Temporal lobe epilepsy is the most common form of focal epilepsy. MR-guided laser interstitial thermal therapy (LITT) of the amygdalohippocampal complex has become an established therapy option in case of drug resistance. Long-term anatomic network effects on the brain due to deafferentiation have not yet been evaluated.
Methods
We analyzed brain volumes of 11 patients with temporal lobe epilepsy before and 1-year after hippocampal LITT with FastSurfer segmenting T1-weighted data. Additionally, we performed visual ratings and measurements.
Results
A total of 11 patients with temporal lobe epilepsy (7 left-sided, 4 right-sided) were included (5 females); the mean age years (±standard deviation) at surgery was 41.5 (±18.4) years. The mean postoperative defect size was 1427 (±517) mm3. Volumetry as well as visual ratings found a progressive volume loss after left-sided surgery in the ipsilateral temporal lobe, the contralateral (right) part of the thalamus, and especially contralateral (right) fusiform cortex. These changes could not be detected for right-sided surgery.
Conclusion
A (partial) ablation of the left (dominant) hippocampus appears to exert long-term effects on the right thalamus and right-sided temporal cortices. However, we could not observe this effect in the reverse direction. Volumetric studies for larger cohorts should be conducted to investigate these findings.
{"title":"Brain Volume Loss After Stereotactic Laser Interstitial Thermal Therapy in Patients With Temporal Lobe Epilepsy","authors":"Sebastian Johannes Müller, Eya Khadhraoui, Olga Kukhlenko, Johannes Schwarzer, Jürgen Voges, I. Erol Sandalcioglu, Daniel Behme, Friedhelm Schmitt, Lars Büntjen","doi":"10.1111/jon.70039","DOIUrl":"https://doi.org/10.1111/jon.70039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Temporal lobe epilepsy is the most common form of focal epilepsy. MR-guided laser interstitial thermal therapy (LITT) of the amygdalohippocampal complex has become an established therapy option in case of drug resistance. Long-term anatomic network effects on the brain due to deafferentiation have not yet been evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed brain volumes of 11 patients with temporal lobe epilepsy before and 1-year after hippocampal LITT with FastSurfer segmenting T1-weighted data. Additionally, we performed visual ratings and measurements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 11 patients with temporal lobe epilepsy (7 left-sided, 4 right-sided) were included (5 females); the mean age years (±standard deviation) at surgery was 41.5 (±18.4) years. The mean postoperative defect size was 1427 (±517) mm<sup>3</sup>. Volumetry as well as visual ratings found a progressive volume loss after left-sided surgery in the ipsilateral temporal lobe, the contralateral (right) part of the thalamus, and especially contralateral (right) fusiform cortex. These changes could not be detected for right-sided surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A (partial) ablation of the left (dominant) hippocampus appears to exert long-term effects on the right thalamus and right-sided temporal cortices. However, we could not observe this effect in the reverse direction. Volumetric studies for larger cohorts should be conducted to investigate these findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143793332","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}
Robert W. Regenhardt, Penina P. Krieger, Anna K. Bonkhoff, Markus D. Schirmer, Christopher G. Favilla, Vincent M. Tutino, Alvin S. Das, Adam A. Dmytriw, Raj Gupta, James D. Rabinov, Christopher J. Stapleton, Thabele M. Leslie-Mazwi, Aman B. Patel, Eng H. Lo, Natalia S. Rost
Background and Purpose
Parenchymal hematomas (PHs) represent an important complication in ischemic stroke after endovascular thrombectomy (EVT), but the risk factors are incompletely understood. Neuroimaging data preintervention, such as infarct topography, may help elucidate predisposing factors and inform more nuanced patient care intra- and postprocedurally.
Methods
Large vessel occlusion patients with pre-EVT MRI were included from a single quaternary center. Diffusion-weighted imaging (DWI) lesions underwent manual segmentation and registration onto a standard brain space for topographical mapping. The presence of PH postintervention was determined. Associations between infarct topography, clinical characteristics, and PH were evaluated.
Results
A total of 165 patients (median age: 69; 56% female) were identified. Intravenous alteplase was administered to 52%, 70% achieved thrombolysis in cerebral infarction 2b-3 reperfusion, and 8% had PH postintervention. The preintervention DWI lesions were 48% (38%–60%) white matter, 23% (6%–47%) cortex, and 15% (4%–28%) basal ganglia. Basal ganglia infarct volume was independently associated with PH (adjusted odds ratio = 1.342, 95% confidence interval 1.002–1.797, p = 0.049), accounting for white matter and cortex infarct volume, among other key factors. Basal ganglia infarct volume was associated with susceptibility-weighted imaging vessel sign (betaadjusted = 0.233, p = 0.006) and the National Institutes of Health Stroke Scale (betaadjusted = 0.220, p = 0.012), controlling for other factors.
Conclusions
Preintervention basal ganglia infarct volume may provide important insights into the risk of PH after intervention. Improved understanding of the biology of basal ganglia infarction and hemorrhagic transformation has implications for the management of patients undergoing EVT and may represent a future therapeutic target for neuroprotective strategies.
{"title":"Parenchymal Hematoma After Endovascular Thrombectomy Is Associated With Pretreatment Basal Ganglia Infarct Volume","authors":"Robert W. Regenhardt, Penina P. Krieger, Anna K. Bonkhoff, Markus D. Schirmer, Christopher G. Favilla, Vincent M. Tutino, Alvin S. Das, Adam A. Dmytriw, Raj Gupta, James D. Rabinov, Christopher J. Stapleton, Thabele M. Leslie-Mazwi, Aman B. Patel, Eng H. Lo, Natalia S. Rost","doi":"10.1111/jon.70031","DOIUrl":"https://doi.org/10.1111/jon.70031","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Parenchymal hematomas (PHs) represent an important complication in ischemic stroke after endovascular thrombectomy (EVT), but the risk factors are incompletely understood. Neuroimaging data preintervention, such as infarct topography, may help elucidate predisposing factors and inform more nuanced patient care intra- and postprocedurally.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Large vessel occlusion patients with pre-EVT MRI were included from a single quaternary center. Diffusion-weighted imaging (DWI) lesions underwent manual segmentation and registration onto a standard brain space for topographical mapping. The presence of PH postintervention was determined. Associations between infarct topography, clinical characteristics, and PH were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 165 patients (median age: 69; 56% female) were identified. Intravenous alteplase was administered to 52%, 70% achieved thrombolysis in cerebral infarction 2b-3 reperfusion, and 8% had PH postintervention. The preintervention DWI lesions were 48% (38%–60%) white matter, 23% (6%–47%) cortex, and 15% (4%–28%) basal ganglia. Basal ganglia infarct volume was independently associated with PH (adjusted odds ratio = 1.342, 95% confidence interval 1.002–1.797, <i>p</i> = 0.049), accounting for white matter and cortex infarct volume, among other key factors. Basal ganglia infarct volume was associated with susceptibility-weighted imaging vessel sign (beta<sub>adjusted</sub> = 0.233, <i>p</i> = 0.006) and the National Institutes of Health Stroke Scale (beta<sub>adjusted</sub> = 0.220, <i>p</i> = 0.012), controlling for other factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Preintervention basal ganglia infarct volume may provide important insights into the risk of PH after intervention. Improved understanding of the biology of basal ganglia infarction and hemorrhagic transformation has implications for the management of patients undergoing EVT and may represent a future therapeutic target for neuroprotective strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717067","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}
Gary Ka Wai Chan, Tsz Kit Chow, Ryan Wui Hang Ho, William C. Y. Leung, Yan Ho Hui, Wai Yin Ho
Background and Purpose
99mTc-TRODAT-1 SPECT imaging is an imaging technique, more commonly used in Asia, to diagnose Parkinson's disease (PD). This study evaluates the use of automated three-dimensional volume-of-interest (VOI) analysis in diagnosing PD.
Methods
99mTc-TRODAT-1 SPECT images of 76 patients (50 with PD and 26 without PD) were retrospectively analyzed. The specific binding ratio (SBR) was calculated using an automated program. Multiple linear regression and receiver operating characteristic curve analyses were performed to identify the factors that affect SBR value and determine the optimal cutoff values.
Results
Multiple regression analysis revealed disease status as the strongest predictor of SBR values, followed by age and sex. Receiver operating characteristic curve analysis demonstrated good diagnostic performance for the striatum (area under the curve [AUC] = 0.922), putamen (AUC = 0.922), and caudate (AUC = 0.881). Optimal cutoff values were determined for the striatum (0.515; sensitivity 88.5%, specificity 90.0%), putamen (0.445; sensitivity 92.3%, specificity 86.0%), and caudate (0.655; sensitivity 84.6%, specificity 90.0%).
Conclusions
Semiautomatic quantitative analysis of 99mTc-TRODAT-1 SPECT using automated three-dimensional VOI shows excellent diagnostic performance in differentiating PD from non-Parkinson's cases. Age and sex significantly influence SBR values, suggesting the need for demographic-adjusted cutoff values in clinical practice.
{"title":"Semiautomatic Quantification of 99mTc-TRODAT-1 SPECT Images in Patients With Idiopathic Parkinson's Disease","authors":"Gary Ka Wai Chan, Tsz Kit Chow, Ryan Wui Hang Ho, William C. Y. Leung, Yan Ho Hui, Wai Yin Ho","doi":"10.1111/jon.70038","DOIUrl":"https://doi.org/10.1111/jon.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p><sup>99m</sup>Tc-TRODAT-1 SPECT imaging is an imaging technique, more commonly used in Asia, to diagnose Parkinson's disease (PD). This study evaluates the use of automated three-dimensional volume-of-interest (VOI) analysis in diagnosing PD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p><sup>99m</sup>Tc-TRODAT-1 SPECT images of 76 patients (50 with PD and 26 without PD) were retrospectively analyzed. The specific binding ratio (SBR) was calculated using an automated program. Multiple linear regression and receiver operating characteristic curve analyses were performed to identify the factors that affect SBR value and determine the optimal cutoff values.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Multiple regression analysis revealed disease status as the strongest predictor of SBR values, followed by age and sex. Receiver operating characteristic curve analysis demonstrated good diagnostic performance for the striatum (area under the curve [AUC] = 0.922), putamen (AUC = 0.922), and caudate (AUC = 0.881). Optimal cutoff values were determined for the striatum (0.515; sensitivity 88.5%, specificity 90.0%), putamen (0.445; sensitivity 92.3%, specificity 86.0%), and caudate (0.655; sensitivity 84.6%, specificity 90.0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Semiautomatic quantitative analysis of <sup>99m</sup>Tc-TRODAT-1 SPECT using automated three-dimensional VOI shows excellent diagnostic performance in differentiating PD from non-Parkinson's cases. Age and sex significantly influence SBR values, suggesting the need for demographic-adjusted cutoff values in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143698985","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}
Jonathan Zurawski, Shahamat Tauhid, Brian C. Healy, Renxin Chu, Maria K. Houtchens, Youmna Jalkh, Samar Khalil, Molly Quattrucci, Farrah J. Mateen, Salvatore Napoli, Syed Rizvi, Tarun Singhal, Rohit Bakshi
Background and Purpose
Cladribine, an FDA-approved disease-modifying immunotherapy for multiple sclerosis (MS), penetrates the CSF and mitigates T cells and B cells, and thus may impact the development of cortical gray matter lesions (CLs) and leptomeningeal enhancement (LME). 7T MRI is a highly sensitive tool for monitoring these outcomes in relapsing-remitting (RR) MS.
Methods
MS subjects (n = 19, age [mean ± standard deviation]: 48.8 ± 10.0 years, 63.1% RRMS, 36.9% secondary progressive MS, Expanded Disability Status Scale [EDSS] score 4.1 ± 2.0) underwent 7T MRI with 0.7-mm3 voxels within a mean 1.9 months of oral cladribine initiation and ∼1 year later in this real-world study. CLs and LME were quantified by an expert. Wilcoxon signed rank tests and paired t-tests compared baseline to follow-up data.
Results
A total of 88.2% of subjects had CLs at baseline (mean 14.1 CLs/patient, range 1–77). No subjects accrued new CLs, and CL volume remained stable (0.33 ± 0.48 mL baseline vs. 0.31 ± 0.46 mL follow-up, p = 0.22). LME was found in 88.9% of subjects at baseline. LME foci number was stable in seven (41.2%), increased in five (29.4%), and decreased in five (29.4%) subjects at follow-up, but overall LME burden was stable (3.1 ± 1.8 vs. 3.2 ± 1.6 foci per subject, p = 1.0). No EDSS or timed 25-foot walk change was noted (both p > 0.35). No subjects had clinical relapses or new T2 or gadolinium-enhancing white matter lesions during the study.
Conclusion
These observational data suggest that cladribine therapy stabilizes cortical demyelination in MS over the first year of treatment. Overall, LME burden remained stable over 1 year; however, within-subject resolution and accrual were noted.
背景和目的克拉宾是一种经fda批准的用于多发性硬化症（MS）的疾病修饰性免疫疗法，可穿透脑脊液并减轻T细胞和B细胞，因此可能影响皮质灰质病变（CLs）和脑轻脑膜增强（LME）的发展。7T MRI是一种高度敏感的工具，用于监测复发缓解型（RR） MS患者的这些结果。方法MS受试者（n = 19，年龄[平均±标准差]:48.8±10.0岁，RRMS 63.1%，继发性进展性MS 36.9%，扩展残疾状态量表[EDSS]评分4.1±2.0）在口服cladribine开始的平均1.9个月和1年后接受了0.7 mm3体素的7T MRI。由专家对CLs和LME进行量化。Wilcoxon符号秩检验和配对t检验比较基线和随访数据。结果88.2%的受试者在基线时出现了CLs（平均14.1个CLs/患者，范围1-77）。没有受试者产生新的CL， CL容量保持稳定（基线0.33±0.48 mL vs.随访0.31±0.46 mL, p = 0.22）。88.9%的受试者在基线时发现LME。随访期间，7名受试者LME病灶数稳定（41.2%），5名受试者LME病灶数增加（29.4%），5名受试者LME病灶数减少（29.4%），但总体LME负担稳定（3.1±1.8 vs. 3.2±1.6病灶/名，p = 1.0）。没有EDSS或25英尺步行时间的变化(p >；0.35)。在研究期间，没有受试者出现临床复发或新的T2或钆增强白质病变。结论：这些观察数据表明，在治疗的第一年，克拉宾治疗可以稳定多发性硬化症患者的皮质脱髓鞘。总体而言，LME负担在1年内保持稳定；但是，注意到主题内决议和应计。
{"title":"Cladribine Is Associated With Stable Cortical Gray Matter Lesion Burden in Multiple Sclerosis: A 7T MRI Study","authors":"Jonathan Zurawski, Shahamat Tauhid, Brian C. Healy, Renxin Chu, Maria K. Houtchens, Youmna Jalkh, Samar Khalil, Molly Quattrucci, Farrah J. Mateen, Salvatore Napoli, Syed Rizvi, Tarun Singhal, Rohit Bakshi","doi":"10.1111/jon.70032","DOIUrl":"https://doi.org/10.1111/jon.70032","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Cladribine, an FDA-approved disease-modifying immunotherapy for multiple sclerosis (MS), penetrates the CSF and mitigates T cells and B cells, and thus may impact the development of cortical gray matter lesions (CLs) and leptomeningeal enhancement (LME). 7T MRI is a highly sensitive tool for monitoring these outcomes in relapsing-remitting (RR) MS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>MS subjects (<i>n</i> = 19, age [mean ± standard deviation]: 48.8 ± 10.0 years, 63.1% RRMS, 36.9% secondary progressive MS, Expanded Disability Status Scale [EDSS] score 4.1 ± 2.0) underwent 7T MRI with 0.7-mm<sup>3</sup> voxels within a mean 1.9 months of oral cladribine initiation and ∼1 year later in this real-world study. CLs and LME were quantified by an expert. Wilcoxon signed rank tests and paired <i>t</i>-tests compared baseline to follow-up data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 88.2% of subjects had CLs at baseline (mean 14.1 CLs/patient, range 1–77). No subjects accrued new CLs, and CL volume remained stable (0.33 ± 0.48 mL baseline vs. 0.31 ± 0.46 mL follow-up, <i>p</i> = 0.22). LME was found in 88.9% of subjects at baseline. LME foci number was stable in seven (41.2%), increased in five (29.4%), and decreased in five (29.4%) subjects at follow-up, but overall LME burden was stable (3.1 ± 1.8 vs. 3.2 ± 1.6 foci per subject, <i>p</i> = 1.0). No EDSS or timed 25-foot walk change was noted (both <i>p</i> > 0.35). No subjects had clinical relapses or new T2 or gadolinium-enhancing white matter lesions during the study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These observational data suggest that cladribine therapy stabilizes cortical demyelination in MS over the first year of treatment. Overall, LME burden remained stable over 1 year; however, within-subject resolution and accrual were noted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143645919","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}
Jianxi Liu, Mingcong Huang, Kang Hu, Nannan Xia, Zeqiang Linli
Background and Purpose
Extensive research has been carried out to investigate changes in various gray matter (GM) regions during the aging process using resting-state functional MRI. However, the impact of aging on the functional connectivity (FC) between white matter (WM) and GM, particularly white matter–gray matter functional connectivity (WM–GM FC), remains largely unknown. This study proposes a novel method for constructing functional networks that integrate both WM and GM.
Methods
By utilizing data from a lifespan cohort of 439 healthy adults, we devised a covariance-based approach to establish a gray matter–white matter–gray matter (GM–WM–GM) mediated network. The FC between GM and WM was quantified using the Johns Hopkins University International Consortium of Brain Mapping-Diffusion Tensor Imaging-81 WM atlas in combination with the Automated Anatomical Labeling atlas. First, the WM–GM FC was calculated via Pearson correlation coefficients between WM and GM regions, followed by the standardization of the resulting matrix. The GM–WM–GM FC was then constructed using the covariance matrix. Furthermore, topological properties were calculated for GM–WM–GM networks. Finally, the age effect of GM–WM–GM and its topology were explored.
Results
Our findings reveal a significant age-related decline in intranetwork connectivity and global network efficiency, while internetwork connectivity followed an inverted U-shaped pattern, suggesting functional dedifferentiation in the aging brain. Despite relatively stable local efficiency, the observed reduction in global efficiency indicates a weakening of long-range neural connections. Additionally, a decrease in network modularity further supports this trend.
Conclusion
These results offer novel insights into the age-associated reorganization of brain networks, enhancing our understanding of the neural mechanisms underlying normal aging.
{"title":"Functional Alterations in Gray Matter Networks Mediated by White Matter During the Aging Process","authors":"Jianxi Liu, Mingcong Huang, Kang Hu, Nannan Xia, Zeqiang Linli","doi":"10.1111/jon.70036","DOIUrl":"https://doi.org/10.1111/jon.70036","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Extensive research has been carried out to investigate changes in various gray matter (GM) regions during the aging process using resting-state functional MRI. However, the impact of aging on the functional connectivity (FC) between white matter (WM) and GM, particularly white matter–gray matter functional connectivity (WM–GM FC), remains largely unknown. This study proposes a novel method for constructing functional networks that integrate both WM and GM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>By utilizing data from a lifespan cohort of 439 healthy adults, we devised a covariance-based approach to establish a gray matter–white matter–gray matter (GM–WM–GM) mediated network. The FC between GM and WM was quantified using the Johns Hopkins University International Consortium of Brain Mapping-Diffusion Tensor Imaging-81 WM atlas in combination with the Automated Anatomical Labeling atlas. First, the WM–GM FC was calculated via Pearson correlation coefficients between WM and GM regions, followed by the standardization of the resulting matrix. The GM–WM–GM FC was then constructed using the covariance matrix. Furthermore, topological properties were calculated for GM–WM–GM networks. Finally, the age effect of GM–WM–GM and its topology were explored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our findings reveal a significant age-related decline in intranetwork connectivity and global network efficiency, while internetwork connectivity followed an inverted U-shaped pattern, suggesting functional dedifferentiation in the aging brain. Despite relatively stable local efficiency, the observed reduction in global efficiency indicates a weakening of long-range neural connections. Additionally, a decrease in network modularity further supports this trend.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These results offer novel insights into the age-associated reorganization of brain networks, enhancing our understanding of the neural mechanisms underlying normal aging.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143645918","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}
Adnan I. Qureshi, Mohammed M. Al-Salihi, Ibrahim A. Bhatti, Maryam S. Al-Jebur, Ahmed Abd Elazim, Sameer A. Ansari, Daniel E. Ford, Daniel F. Hanley, Ameer E. Hassan, Pashmeen Lakhani, David R. Mehr, Thanh N. Nguyen, Alejandro M. Spiotta, William J. Powers, Syed F. Zaidi
Background and Purpose
Intraarterial thrombolysis (IAT) has been sporadically used as an adjunct to mechanical thrombectomy (MT) in acute ischemic stroke patients for nearly two decades to improve distal arterial and microvascular perfusion even in patients with near complete or complete recanalization.
Methods
We provide an overall narrative review that includes a systematic review and meta-analysis of two randomized controlled trials (RCTs), Chemical Optimization of Cerebral Embolectomy and Endovascular Recanalization in Patients with Acute Posterior Circulation Arterial Occlusion, to identify current and future implications. Risk ratios (RRs) were calculated from RCTs using a fixed-effects model. We identified 10 ongoing or planned RCTs after a search on clinicaltrials.gov and other sources, of which eight are in China, one in Europe, and one in Australia.
Results
A previous meta-analysis of 16 (predominantly observational) studies involving 7572 MT-treated patients had identified 14% higher odds of functional independence (modified Rankin scale [mRS] 0–2) at 90 days in patients treated with IAT. In the current analysis of 321 patients who underwent MT in RCTs, 165 were randomized to IAT and 156 were in the control group. The RR of achieving an mRS score of 0–1 at 90 days postrandomization was higher in patients treated with IAT compared with the control group (absolute increase of 12.87%, RR = 1.39, 95% confidence interval [CI] 1.04–1.86). The rate of symptomatic intracerebral hemorrhage (sICH) within 24 h was slightly higher (absolute increase of 1.64%, RR = 0.95, 95% CI 0.07–13.30) in patients treated with IAT. The ongoing RCTs have sample sizes ranging from 80 to 498 that can identify very large minimal clinically important differences (MCIDs) (13%–20% increase) in primary outcomes, but smaller MCIDs (<10%) that can still result in practice changes with interventions associated with low cost and complexity and are easy to implement, such as IAT, will not be identified.
Conclusions
Observational studies and recent RCTs suggest a potential benefit of IAT in improving functional outcomes among patients post-MT, although the potentially increased risk of sICH, inadequate sample sizes, and lack of data from the United States need to be considered. A large, definitive, and generalizable RCT is required to establish the therapeutic value and safety profile of IAT prior to widespread incorporation into routine practice.
{"title":"Intraarterial Thrombolysis as an Adjunct to Thrombectomy in Acute Ischemic Stroke: Current Status and Future Prospects","authors":"Adnan I. Qureshi, Mohammed M. Al-Salihi, Ibrahim A. Bhatti, Maryam S. Al-Jebur, Ahmed Abd Elazim, Sameer A. Ansari, Daniel E. Ford, Daniel F. Hanley, Ameer E. Hassan, Pashmeen Lakhani, David R. Mehr, Thanh N. Nguyen, Alejandro M. Spiotta, William J. Powers, Syed F. Zaidi","doi":"10.1111/jon.70030","DOIUrl":"https://doi.org/10.1111/jon.70030","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Intraarterial thrombolysis (IAT) has been sporadically used as an adjunct to mechanical thrombectomy (MT) in acute ischemic stroke patients for nearly two decades to improve distal arterial and microvascular perfusion even in patients with near complete or complete recanalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We provide an overall narrative review that includes a systematic review and meta-analysis of two randomized controlled trials (RCTs), Chemical Optimization of Cerebral Embolectomy and Endovascular Recanalization in Patients with Acute Posterior Circulation Arterial Occlusion, to identify current and future implications. Risk ratios (RRs) were calculated from RCTs using a fixed-effects model. We identified 10 ongoing or planned RCTs after a search on clinicaltrials.gov and other sources, of which eight are in China, one in Europe, and one in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A previous meta-analysis of 16 (predominantly observational) studies involving 7572 MT-treated patients had identified 14% higher odds of functional independence (modified Rankin scale [mRS] 0–2) at 90 days in patients treated with IAT. In the current analysis of 321 patients who underwent MT in RCTs, 165 were randomized to IAT and 156 were in the control group. The RR of achieving an mRS score of 0–1 at 90 days postrandomization was higher in patients treated with IAT compared with the control group (absolute increase of 12.87%, RR = 1.39, 95% confidence interval [CI] 1.04–1.86). The rate of symptomatic intracerebral hemorrhage (sICH) within 24 h was slightly higher (absolute increase of 1.64%, RR = 0.95, 95% CI 0.07–13.30) in patients treated with IAT. The ongoing RCTs have sample sizes ranging from 80 to 498 that can identify very large minimal clinically important differences (MCIDs) (13%–20% increase) in primary outcomes, but smaller MCIDs (<10%) that can still result in practice changes with interventions associated with low cost and complexity and are easy to implement, such as IAT, will not be identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Observational studies and recent RCTs suggest a potential benefit of IAT in improving functional outcomes among patients post-MT, although the potentially increased risk of sICH, inadequate sample sizes, and lack of data from the United States need to be considered. A large, definitive, and generalizable RCT is required to establish the therapeutic value and safety profile of IAT prior to widespread incorporation into routine practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"35 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633021","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}
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