Neuroradiology最新文献

Purpose: To assess the diagnostic performance of tumor blood volume (TBV) derived from T1 dynamic contrast-enhanced (DCE) MRI and compare it with ADC and SUV_max in distinguishing recurrence from post-treatment changes.

Methods: This retrospective study included 73 patients with 75 focal contrast-enhancing lesions identified on surveillance MRI. Normalized TBV (nTBV_mean) was calculated from high temporal resolution DCE-MRI using the spinal cord as a reference. The 3D ROI analysis of ADC_mean and SUV_max values were obtained from DWI and ¹⁸F-FDG-PET/CT, respectively. Diagnostic performances were evaluated using multivariate logistic regression analyses, with area under the receiver operating characteristic curve (AUROC) comparisons.

Results: Among the 75 lesions, 38 were recurrence and 37 were post-treatment changes. ADC_mean and SUV_max were significantly different between groups (p < 0.001), while nTBV_mean was higher in recurrence without statistical significance (p = 0.11). The AUROC of ADC_mean, SUV_max, and nTBV_mean were 0.94, 0.88, and 0.60 respectively. The combination of ADC_mean and SUV_max yielded the highest AUROC (0.99), with ADC_mean remaining the most robust predictor. TBV offered complementary value when ADC maps were degraded by susceptibility artifacts.

Conclusions: ADC_mean and SUV_max showed excellent performance in differentiating recurrence from post-treatment changes. TBV maps may offer complementary diagnostic value in cases with compromised ADC quality due to artifacts.

Purpose: Hypoxic-ischemic encephalopathy (HIE) remains a major cause of pediatric morbidity, with deep gray matter injury reflecting a severe pattern. The glymphatic system, a brain-wide perivascular network facilitating cerebrospinal and interstitial fluid exchange, may be vulnerable to disruption after HIE. We assessed glymphatic function in children with HIE-induced deep gray matter injury using diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) and examined age-related patterns in glymphatic function.

Methods: DTI-ALPS analysis was retrospectively studied in 38 normative controls (mean ± SD, 26.94 ± 34.03 months) and 25 patients with HIE and deep gray matter injury (20.55 ± 32.49 months). Bilateral ALPS indices were calculated and correlated with age and pediatric cerebral performance category scale (PCPC) scores. Due to non-normal distributions, Spearman correlations and generalized linear models (Gamma distribution, log link) adjusted for age were used for group comparisons. Age-adjusted associations were evaluated using residual-based analyses.

Results: ALPS indices were significantly reduced in HIE patients compared to controls after age adjustment (Left: adjusted difference = 0.248, p < 0.001; Right: adjusted difference = 0.228, p < 0.001). In controls, ALPS indices positively correlated with age (Left: ρ = 0.730, p < 0.001; Right: ρ = 0.615, p < 0.001). After controlling for age using residual-based analyses, ALPS indices in patients negatively correlated with PCPC scores (Left: ρ = -0.468, p = 0.018; Right: ρ = -0.458, p = 0.021).

Conclusion: HIE disrupts normal age-related glymphatic patterns, and glymphatic dysfunction is associated with adverse functional outcomes.

Introduction: Blood pressure (BP) variability, particularly arterial hypotension during mechanical thrombectomy (MT) for acute ischemic stroke (AIS), has been associated with unfavorable outcomes. This variability in BP is notably present during induction in general anesthesia (GA). This study seeks to assess the effectiveness of a personalized BP management protocol during MT under general GA in mitigating hypotension and its impact on functional outcomes at 90 days.

Methods: We conducted a monocentric before-after study involving two retrospective cohorts of patients who underwent MT for AIS under GA, before and after implementing the protocol. The protocol aimed to maintain the mean arterial pressure (MAP) within 10% of the baseline MAP prior to induction. The main outcome measured was the modified Rankin Scale (mRS) at 90 days.

Results: Our analysis included 179 patients: 121 before and 58 after protocol implementation. The "after" group showed a reduced proportion of MAP drops, especially severe hypotension (32.8% vs. 48.8% below 30% from baseline, and 51.7% vs. 66.1% below 20%). However, these differences lacked statistical significance. At 90 days, a poor outcome (mRS > 2) was observed in 56.9% of patients in the 'after' group vs. 46.3% in the 'before' group, not statistically significant. This association remained statistically insignificant in both univariate and multivariate analyses.

Conclusion: The personalized BP management during MT resulted in a decrease in BP drops without reaching significance. Furthermore, this study did not indicate any improvement in neurological outcomes at 90 days.

Brain amyloidoma is an exceedingly rare localized deposition of amyloid that often radiologically mimics neoplastic or inflammatory disease. We report the case of a previously healthy 53-year-old woman who developed subacute right-hand tremor, pain, and weakness, followed by gait instability. Magnetic resonance imaging (MRI) showed a 35-45 mm hypervascular, infiltrative lesion in the right cerebellar hemisphere, extending into the vermis and middle cerebellar peduncle, with ill-defined margins suggesting of posterior fossa tumor. Subtotal resection was performed. Histopathology confirmed amorphous Congo-red positive amyloid material with perivascular and parenchymal distribution, accompanied by lymphoplasmacytic infiltrates lacking light-chain restriction and therefore without evidence of monoclonality, consistent with amyloidoma. According to the literature, fewer than 100 cases of intra-axial brain amyloidoma have been reported, with infratentorial presentations being extremely uncommon and none previously have been described as an isolated intra-axial cerebellar lesion. This case expands the recognized anatomical spectrum of cerebral amyloidoma, highlights its diagnostic pitfalls, and underscores the essential role of histopathology in establishing the diagnosis.

Background: Silent corticotroph adenoma (SCA) exhibits high invasiveness and recurrence; thus, accurate prediction of postoperative recurrence is crucial.

Objective: To predict recurrence-free survival (RFS) in SCA using habitat analysis (subregion radiomics) and to develop a comprehensive nomogram integrating habitat scores, clinical, radiological, and pathological features.

Methods: This retrospective study included 325 SCA patients, randomly assigned to training and testing cohorts in a 7:3 ratio. Radiomics features were extracted from tumor subregions clustered via K-means based on CE-T1WI and T2WI. Feature selection involved t-tests, Pearson / Spearman correlation, and the least absolute shrinkage and selection operator (LASSO) regression, and the habitat score was calculated based on the selected subregional radiomics features and their corresponding coefficients. Kaplan-Meier and Cox regression analyses were used to identify prognostic factors. A nomogram incorporating independent predictors was constructed and validated for RFS prediction. Predictive performance was evaluated through the Harrell C-index, calibration curves, and decision curve analysis (DCA).

Results: Habitat scores significantly stratified patients by RFS (p < 0.001). Multivariate Cox analysis identified habitat score, Ki-67 index, surgical method, and postoperative gamma knife radiotherapy as independent predictors. Calibration and DCA curves confirmed good agreement and clinical utility.

Conclusion: Habitat scores derived from subregional radiomics provide good prognostic value for RFS prediction in SCA. The proposed nomogram enables individualized recurrence risk assessment, supporting postoperative decision-making.

Purpose: To evaluate whether preoperative MRI features can accurately predict WHO grade 2/3 meningiomas using routinely available imaging parameters.

Materials and methods: This retrospective single-centre study included 282 patients (mean age 58.4 ± 13.4 years; 176 women) who underwent surgery for histologically confirmed meningiomas between 2010 and 2024. Preoperative MRI was assessed for tumour volume, peritumoral oedema, heterogeneous enhancement, cystic components, midline shift, and normalized apparent diffusion coefficient (NADC). Univariable and multivariable logistic regression analyses identified independent predictors of high-grade meningiomas (WHO grade 2/3). Model performance was evaluated with ROC curve analysis.

Results: Among 282 meningiomas, 78% were WHO grade 1 and 22% were grade 2 or 3. High-grade tumours were significantly associated with tumour volume ≥ 45 cc (p= 0.016), presence of cystic components (p = 0.005), midline shift > 3 mm (p = 0.024), and NADC < 1.07 (p = 0.028). These features remained independently associated with higher grade in the multivariable model. The resulting model achieved an AUC of 0.768 (95% CI: 0.689-0.847), with 75.5% sensitivity and 62.8% specificity at the optimal threshold.

Conclusion: We obtained a multivariable MRI-based model combining morphologic and diffusion features that potentially enables preoperative risk stratification of meningiomas and supports surgical decision-making. Further validation in prospective, multicentre cohorts is warranted.

Flow diverters have been in current practice for almost 2 decades, and since then, endovascular treatment of intracranial aneurysms has evolved considerably. Among relatively common complications, stent migration remains an infrequent but clinically significant event. This single patient observational technical note presents a successful endovascular rescue treatment of a proximally migrated flow diverter stent using balloon-assisted remodeling, detected at the eight month follow-up angiography. This strategy allowed the migrated stent to be recatheterized and the treatment to be completed with a second flow diverter stent.

A 43-year-old male patient presented with monoparesis in his left leg, which had persisted for one year, then progressed to spastic dysarthria, tetraparesis, wide-based gait, muscle atrophy, weakness, fasciculations, and signs of pyramidal signs in all limbs. Brain MRI findings revealed hyperintensities on T2/FLAIR and diffusion-weighted imaging (DWI) along the corticospinal tracts, extending from the corona radiata and internal capsules to the brainstem, the "bright tongue sign" and the "wine glass sign,". This case highlights the classic findings in amyotrophic lateral sclerosis, which was confirmed by electroneuromyography.

Purpose: Accurate preoperative assessment of internal carotid artery (ICA) invasion is crucial in managing glomus jugulare tumors. This study evaluated the efficacy of contrast-enhanced 3D BRAin VOlume (BRAVO) imaging compared to enhanced fast spin-echo (FSE) T1-weighted imaging and enhanced computed tomography (CT).

Methods: Retrospective analysis was performed on imaging data from surgically confirmed glomus jugulare tumors, including temporal bone enhanced BRAVO, enhanced T1-weighted FSE, and temporal bone enhanced CT sequences. ICA encasement and stenosis by tumor were graded and compared based on intraoperative assessment. According to Fisch criteria, the preoperative image C-type based on BRAVO, FSE and CT were separately and compared with surgical C-type (gold standard).

Results: Among 21 patients, For image Fisch C-type, BRAVO showed excellent agreement with surgical C-type (κ = 1.000, P < 0.001), outperforming enhanced FSE (κ = 0.561) and CT (κ = 0.702). For ICA encasement, BRAVO had moderate agreement (κ = 0.513), slightly better than enhanced FSE (κ = 0.431) but inferior to enhanced CT (κ = 0.648). For ICA stenosis, BRAVO (κ = 0.588) surpassed enhanced FSE (κ = 0.339) but was less accurate than enhanced CT (κ = 0.716).

Conclusion: Enhanced BRAVO and temporal bone enhanced CT are complementary for assessing ICA involvement in glomus jugulare tumors, offering superior accuracy over conventional FSE imaging.