Neuroradiology最新文献

Background and purpose: Degenerative and/or herniated discs are a global cause of chronic lower back and neck pain. While multiple treatments exist, the research for long-term effective interventions with minimal side effects continues. The radioplaque gelified ethanol (RGE) (DiscoGel^®, Hérouville-Saint-Clair, France), is an addition to the armamentarium of potential treatments. This study aimed to evaluate the long-term efficacy of this device in treating lumbar disc herniation through a 10-year follow-up period.

Methods: In this bi-centric observational study, patients treated with RGE in the lumbar spine between 2009 and 2011 were evaluated based on specific inclusion and exclusion criteria. Collected data encompassed preoperative imaging, VAS pain scores, ODI functional scores, were recorded through 10-year follow-up.

Results: Fifty-two participants (26 males and 26 females) with an average age of 51.7 years were enrolled in the study. Ten years after treatment, there was a statistically significant improvement in VAS pain scores and ODI percentages (p < 0.01). Additionally, significant changes in anterior, medial, and posterior disc dimensions were observed, suggesting structural adaptations due to RGE treatment. A statistically significant difference in the anterior dimension of the treated disc was found 10 years postoperatively compared to preoperative measurements (p = 0.0011).

Conclusion: RGE is a promising therapeutic choice for lumbar symptomatic herniation resistant to conservative treatments, offering both immediate relief and enduring benefits. Although our findings are promising, additional randomized controlled trials are essential to compare DiscoGel^® with established treatments and substantiate its efficacy.

Objective: Postoperative peri-lead edema (PLE) is an increasingly recognized complication of deep brain stimulation (DBS), a therapeutic intervention commonly used for neurological conditions such as Parkinson's disease (PD), essential tremor (ET), intractable focal epilepsy, and dystonia. In this study, we conducted a retrospective chart review to evaluate the incidence of PLE and explore potential clinical and demographic risk factors.

Methods: A single physician performed DBS electrode placements. To check for complications, postoperative computed tomography (CT) scans were conducted on the day of surgery and approximately 12-15 days afterward. Data on age, gender, complications, edema size, electrode laterality, lead target, lead brand, indication, and use of robotic assistance versus Starfix were collected and analyzed statistically.

Results: 133 leads were implanted in 63 patients, with peri-lead edema (PLE) observed in 65 electrodes (48.87%). Minor postoperative complications, such as subarachnoid hemorrhage (SAH) and subdural hematoma (SDH), were noted in some patients. A few cases of severe PLE were recorded, with the most significant volume of edema reaching 85.11 cm³. No statistically significant differences were found between PLE-positive and PLE-negative patients based on age, sex, lead target, indication, or robotic assistance versus Starfix. However, the use of Boston Scientific electrodes was significantly associated with PLE, with a p-value of 0.047. A logistic regression model (p = 0.013, R² = 0.219) correctly classified 63.2% of cases, with no significant predictors of PLE, but imaging complications (p = 0.057) and electrode brand (p = 0.086) approached significance, with Boston Scientific electrodes linked to higher PLE risk compared to Abbott electrodes (p = 0.027, OR = 3.729).

Conclusions: PLE appears more prevalent than previously reported and generally presents with delayed onset post-surgery. This retrospective analysis identified the use of Boston Scientific electrodes as a potential risk factor for PLE. Further research, particularly more extensive studies, is necessary to clarify the underlying mechanisms of PLE, improve prevention strategies, and enhance our understanding of this complication.

Purpose: To investigate damage to fiber bundles and brain networks in children with marginal intelligence (MI) or intellectual disability (ID) by using Diffusion Tensor Imaging (DTI) sequences.

Methods: Thirty healthy children, 25 with MI, 35 with ID, and 32 with both ID and attention deficit hyperactivity disorder (ADHD) underwent 3.0 T MRI scans, including DTI sequences. Analysis of the DTI data yielded correlation tractography, network measures, and graph visualizations.

Results: Children with MI, ID or both ID and ADHD have damage in the bilateral arcuate fasciculi, bilateral superior longitudinal fasciculi and thalamic radiations, corpus callosum's body, and right corticostriatal tracts. Furthermore, both the MI and ID-ADHD groups were affected in the right parietal aslant tract, bilateral corticospinal tracts, and bilateral medial lemnisci, which were not affected in patients with ID alone. The MI, ID and ID-ADHD groups exhibited a significantly lower density, global efficiency, and rich club coefficient than the controls. Patients with MI, ID, or both ID and ADHD had no nodes in the bilateral middle and inferior frontal gyri. Moreover, individuals with ID, alone or combined with ADHD, also lacked nodes in the bilateral temporal lobes.

Conclusion: Children with MI, ID, or comorbid ID and ADHD exhibited significant morphological abnormalities in fiber tracts, substantial reductions in fiber bundle volumes, and disrupted neural network connectivity. Furthermore, graph visualizations of the connectome reveal a progressive increase in the defect of hub nodes, worsening from MI to ID, whether alone or in conjunction with ADHD, when compared to normal controls.

Purpose: The pipeline embolization device (PED) has been established as an effective treatment option for aneurysms within its designated indications. Recently, its off-label applications, including treating middle cerebral artery (MCA) aneurysms, have increased. This study augmented the current literature by examining the outcomes of PED utilization for MCA aneurysms.

Methods: We collected data from consecutive patients with MCA aneurysms treated with PED between June 2016 and December 2021. Particularly, we collected data on patient demographics, aneurysm characteristics, procedural details, perioperative complications, and clinical and angiographic follow-up results.

Results: A total of 69 patients (mean age 47.4 years; 42.0% female) with MCA aneurysms who underwent PED treatment were included in this study. Among these, 5 aneurysms had ruptured previously, and 10 patients had previously undergone open surgery or received endovascular treatment. In the last angiographic follow-up, conducted at a mean of 19.0 ± 13.5 months, 44 of 56 (78.6%) aneurysms achieved complete occlusion. Ten (17.9%) and three (5.4%) patients exhibited in-stent stenosis and MCA occlusion, respectively. During a mean clinical follow-up period of 35.1 months, 10 of 63 patients (15.8%) experienced major procedure-related complications, including 2 hemorrhagic (3.2%) and 8 ischemic (12.7%) events.

Conclusion: PED is a viable treatment for MCA aneurysms, particularly those with fusiform and wide-necked characteristics that pose challenges for traditional open surgery. PED shows favorable clinical outcomes and occlusion rates and presents a notable risk of complications and in-stent restenosis. Therefore, careful patient selection is crucial when using PEDs to treat MCA aneurysms.

Purpose: To evaluate the clinimetric reliability of automated vestibular schwannoma (VS) segmentations by a comparison with human inter-observer variability on T1-weighted contrast-enhanced MRI scans.

Methods: This retrospective study employed MR images, including follow-up, from 1,015 patients (median age: 59, 511 men), resulting in 1,856 unique scans. Two nnU-Net models were trained using fivefold cross-validation to create a single-center segmentation model, along with a multi-center model using additional publicly available data. Geometric-based segmentation metrics (e.g. the Dice score) were used to evaluate model performance. To quantitatively assess the clinimetric reliability of the models, automated tumor volumes from a separate test set were compared to human inter-observer variability using the limits of agreement with the mean (LOAM) procedure. Additionally, new agreement limits that include automated annotations are calculated.

Results: Both models performed comparable to current state-of-the-art VS segmentation models, with median Dice scores of 91.6% and 91.9% for the single and multi-center models, respectively. There is a stark difference in clinimetric performance between both models: automated tumor volumes of the multi-center model fell within human agreement limits in 73% of the cases, compared to 44% for the single-center model. Newly calculated agreement limits including the single-center model, resulted in very high and wide limits. For the multi-center model, the new agreement limits were comparable to human inter-observer variability.

Conclusion: Models with excellent geometric-based metrics do not necessarily imply high clinimetric reliability, demonstrating the need to clinimetrically evaluate models as part of the clinical implementation process. The multi-center model displayed high reliability, warranting its possible future use in clinical practice. However, caution should be exercised when employing the model for small tumors, as the reliability was found to be volume-dependent.

Purpose: Magnetic resonance imaging (MRI) is an essential technique for diagnosing pituitary adenomas; however, it is also challenging for neurosurgeons to use it to precisely identify some types of microadenomas. A novel neural network model was developed using preoperative MRI to assist clinicians in diagnosing pituitary microadenomas.

Method: Sixty patients with pathologically diagnosed pituitary microadenomas, including hyperprolactinemia (n = 19), growth hormone microadenomas (n = 17), and adrenocorticotropin microadenomas (n = 24), were enrolled. An image edge-supervised same receptive field semantic segmentation network was developed based on T1-weighted, T2-weighted, and contrast-enhanced T1-weighted images.

Results: The mean Intersection over Unions of our neural network model were 0.7013 ± 0.3400, 0.7295 ± 0.321, and 0.8053 ± 0.3052 for the test sets of T1-weighted, T2-weighted, and contrast-enhanced T1-weighted sequences, respectively, while the Dice Similarity Coefficient values were 0.8075 ± 0.3895, 0.8192 ± 0.3733, and 0.8860 ± 0.3443 for the corresponding sequences. The performance on contrast-enhanced T1-weighted images was better than that of the other two MR sequences.

Conclusions: The image edge-supervised same receptive field segmentation network can potentially be used to precisely identify pituitary microadenomas automatically with preoperative MRI. The developed model exhibited good performance with contrast-enhanced T1-weighted images and could help neurosurgeons accurately determine the locations of pituitary microadenomas.

Background: Cerebrovascular reactivity (CVR) assesses vascular health in various brain conditions, but CVR measurement requires a challenge to cerebral perfusion such as the administration of acetazolamide(ACZ), thus limiting widespread use. We determined whether generative adversarial networks (GANs) can create CVR images from baseline pre-ACZ arterial spin labeling (ASL) MRI.

Methods: This study included 203 Moyamoya cases with a total of 3248 pre- and post-ACZ ASL Cerebral Blood Flow (CBF) images. Reference CVRs were generated from these CBF slices. From this set, 2640 slices were used to train a Pixel-to-Pixel GAN consisting of a generator and discriminator network, with the remaining 608 slices reserved as a testing set. Following training, the pre-ACZ CBF in the testing set was introduced to the trained model to generate synthesized CVR. The quality of the synthesized CVR was evaluated with structural similarity index(SSI), spatial correlation coefficient(SCC), and the root mean squared error(RMSE), compared with reference CVR. The segmentations of the low CVR regions were compared using the Dice similarity coefficient (DSC). Reference and synthesized CVRs in single-slice and individual-hemisphere settings were reviewed to assess CVR status, with Cohen's Kappa measuring consistency.

Results: The mean SSIs of the CVR of training and testing sets were 0.943 ± 0.019 and 0.943 ± 0.020. The mean SCCs of the CVR of training and testing sets were 0.988 ± 0.009 and 0.987 ± 0.011. The mean RMSEs of the CVR are 0.077 ± 0.015 and 0.079 ± 0.018. Mean DSC of low CVR area of testing sets was 0.593 ± 0.128. Visual interpretation yielded Cohen's Kappa values of 0.896 and 0.813 for the training and testing sets in the single-slice setting, and 0.781 and 0.730 in the individual-hemisphere setting.

Conclusions: Synthesized CVR by GANs from baseline ASL without challenge may be a useful alternative in detecting vascular deficits in clinical applications when ACZ challenge is not feasible.

Recent case reports suggest that endovascular recanalization may be safe and feasible for vertebral artery occlusion (VAO) patients without a stump, however, comprehensive management strategies for endovascular recanalization remain poorly understood. In this technical note, we describe the REVANS technique in patients with VAO lacking a stump. The REVANS technique demonstrates promise as a viable option for managing symptomatic non-acute VAO without a visible stump. This approach leverages cervical collateral vessels to retrogradely access and recanalize occluded vertebral artery segments, offering potential benefits in improving patient outcomes.

Introduction: Endovascular thrombectomy (EVT) patient selection depends on neuroimaging. However, interhospital transfer delays can lead to neuroimaging changes, whether and when repeat imaging is necessary are unclear. Herein, we develop a machine learning model (MLM) to predict vessel recanalization, ischemia progression, and imaging stability for EVT candidates who experience delayed interhospital transfer.

Methods: This retrospective study included EVT candidates with internal carotid or middle cerebral artery occlusion stroke transferred 1.5-6.0 h after initial imaging. Clinical and radiographic data were collected. A gradient-boosted tree-based MLM (XGBoost) was trained and optimized on 66% of the cohort (randomly selected) using 10-fold cross-validation, and the MLM was independently validated on the remaining, untouched 33% of the study cohort. Model performance was assessed using areas under the receiver operating characteristics curve (AUC) for discrimination, F1 scores for precision/recall, and Brier scores for calibration.

Results: Among 317 patients, 69.4% had stable imaging, 14.5% showed ischemia progression (ASPECTS drop ≥ 2), and 16.1% had vessel recanalization. The MLM was developed and optimized in the training cohort (n = 212). NIH stroke scale improvement, onset-to-imaging time, intravenous thrombolysis, initial ASPECTS, and collateral score were important features. In the validation cohort (n = 105), the MLM achieved AUCs of 0.81 (95%CI 0.72-0.90) for imaging stability, 0.82 (95%CI 0.72-0.91) for ischemia progression, and 0.89 (95%CI 0.77-1.00) for vessel recanalization. F1 scores were 0.87 and 0.95 for stability and no recanalization, with Brier scores of 0.17 and 0.08, respectively.

Conclusion: Our MLM accurately predicts imaging changes among EVT candidates who experienced transfer delays.

We present a rare case of endovascular transarterial treatment in a newborn with symptomatic dural arteriovenous fistula (DAVF). Through direct carotid puncture, complete occlusion of the fistula was achieved in a single session. This therapeutic approach demonstrates safety and efficacy in neonatal DAVF treatment. The patient showed significant improvement, with symptoms resolved and complications absent. The successful outcome highlights the importance of early recognition and prompt intervention in pediatric DAVFs.