Neuroradiology最新文献

Purpose: This study aimed to investigate thalamic microstructural alterations in cerebral small vessel disease (CSVD) patients with mild cognitive impairment (MCI) using diffusion kurtosis imaging (DKI), and to examine the associations between DKI parameters and cognitive performance.

Methods: The study included 80 CSVD patients and 40 healthy controls (HC). Based on Montreal Cognitive Assessment (MoCA) scores, CSVD patients were divided into MCI (n = 40) and non-MCI (n = 40) groups. DKI parameters of the thalamus and its subregions were compared among the three groups and correlated with cognitive performance.

Results: CSVD-MCI patients exhibited significant alterations in DKI parameters, predominantly in the left thalamus. Compared to HC, CSVD-MCI patients showed reduced FA and decreased kurtosis parameters (KFA, MK, AK), along with increased diffusivity metrics (MD, AD, RD). Subregional analysis revealed the most pronounced changes in the left posterior, medial, and ventral groups. The lateral geniculate nucleus showed particularly significant reductions in FA and KFA. Cognitive assessments revealed significant correlations between DKI parameters and cognitive performance, with BNT and VFT scores showing strong correlations with DKI parameters in the left thalamus, particularly in the posterior nucleus and pulvinar.

Conclusion: Thalamic microstructural alterations may play a crucial role in cognitive decline among CSVD patients. Diffusion kurtosis imaging parameters may provide novel perspectives for investigating the mechanisms of cognitive deterioration in CSVD patients.

Purpose: This study compared two image post-processing toolboxes primarily designed for focal cortical dysplasia (FCD): Multi-Centre Epilepsy Lesion Detection (MELD) and Morphometric Analysis Program (MAP18), in identifying temporal lobe epilepsy (TLE) structural lesions on MRI.

Methods: This retrospective study examined 79 adults, 58 patients with confirmed TLE, and 21 healthy controls. All participants underwent an elective brain MRI between June 2007 - May 2023 at Hospital Clinic, Barcelona, Spain. All the 3D T1-weighted images were processed using MELD and MAP18 to detect potential epileptogenic lesions. The location (lateral or mesial) and laterality of the reference TLE structural lesion (refTLE) were determined through histopathology or multidisciplinary consensus based on clinical data. Toolboxes' performance was evaluated using descriptive statistics, specificity, and diagnostic accuracy. Additionally, a second-look MRI was conducted for cases where abnormalities detected by MELD and MAP18 did not match the refTLE.

Results: MELD and MAP18 demonstrated variability in specificity and diagnostic accuracy. Specificity ranged from 48% to 86%, with ProbMAP (MAP18) achieving the highest values. Global diagnostic accuracy ranged from 7% to 42%, with MELD showing the highest performance. In four patients with visible epileptogenic lesions on MRI, MELD and MAP18 identified additional abnormalities that were previously overlooked. Moreover, MELD detected one TLE lesion in one patient initially classified as MRI-negative (nonlesional).

Conclusion: Incorporating tools like MELD and MAP18 into the diagnostic workflow can enhance the detection of TLE-related abnormalities on MRI, potentially improving patient outcomes and aiding in clinical decision-making.

Background and purpose: Cerebral small vessel disease (cSVD) is a common condition with complex pathophysiology, resulting in poor clinical outcomes. This study uses four-dimensional flow (4D flow) imaging to examine how carotid artery hemodynamics and geometry impact cSVD development.

Methods: Combining ultrasound, 4D flow, and three-dimensional time-of-flight magnetic resonance angiography (3D-TOF MRA), we analyzed and measured internal carotid artery (ICA) hemodynamics and geometric parameters. Based on cranial magnetic resonance imaging (MRI) findings, the characteristics, counts, and scores of small vessel diseases were assessed. Single-factor analyses affecting cSVD were conducted, followed by multivariable logistic regression to pinpoint independent risk factors. A P-value of < 0.05 was considered statistically significant. ROC curves were used to evaluate the model's performance and explanatory power.

Results: Multivariable analysis revealed differences in white matter hyperintensities (WMH) related to maximum pressure gradient (PG_max), with an OR_Zscore of 1.602. Maximum velocity(velocity_max) negatively correlated with enlarged perivascular space (PVS) count (P = 0.025). ICA-C5/ICA initial segment diameter ratio, velocity_max, and PG_max were independent risk factors for lacune (Lac) (P < 0.01). Circumferential wall shear stress (WSS_mean) and PG_max were positively correlated with cerebral microbleed (CMB) count (P = 0.019 and P = 0.002), while the ICA-C5/ICA ratio was negatively correlated (P = 0.003). The MCA/ICA-C5 diameter ratio was positively associated with SVD score (P = 0.021). ROC curves demonstrated strong model performance for WMH and Lac.

Conclusion: Diameter variations in the ICA and MCA may indicate changes in vascular compliance and potential remodeling abnormalities. Hemodynamic anomalies in the ICA's initial segment could suggest distal vascular disease, offering new insights into cSVD pathogenesis.

Purpose: Lumbosacral nerve root anomalies are relatively rare but can be a risk factor for intraoperative nerve injury. However, it is often difficult to evaluate them with preoperative imaging. We developed a software that automatically generates three-dimensional (3D) nerve root images from magnetic resonance (MR) imaging using artificial intelligence (AI). This study aims to evaluate the accuracy and utility of this modality in clinical practice by conducting an epidemiological study of nerve root anomalies.

Methods: The incidence and morphology of nerve root anomalies were evaluated in the 3D images of 1,500 patients. The accuracy of the images was evaluated by comparing the images generated automatically using this AI software with those created manually by conventional methods.

Results: Of 1,500 cases, 53 (3.5%) had nerve root anomalies with total of 58 nerve root anomalies. With respect to the spinal level, 35 nerve root anomalies were found in the L5-S1 level, the most common (60.3%). As for morphology, 47 nerve roots (81.0%) were of the Neidre-MacNab classification Type 1. The images matched in 1,493 out of 1,500 cases (99.5%) between the two methods, and the remaining 7 cases all had nerve root abnormalities, which were detected as abnormal by the AI software.

Conclusion: The MR nerve root 3D imaging provided a 3D visualization and understanding of nerve root morphology, including nerve root anomalies. The AI software enables easy and precise 3D nerve root imaging, which greatly aids in the preoperative evaluation for spinal surgery.

Purpose: To compare the prognostic abilities of multiphase CT angiography (mCTA) and multiphase MR angiography (MRA) collateral map in acute anterior circulation ischemic stroke.

Methods: This secondary analysis of a prospective observational study included data from participants with acute ischemic stroke due to steno-occlusion of the internal carotid artery and/or middle cerebral artery within 8 h of symptom onset between January 1, 2016, and March 31, 2021. The intermethod agreement of the collateral scores (CSs) from mCTA and the collateral perfusion scores (CPSs) from the MRA collateral map was analyzed. Multiple logistic regression analyses were conducted to determine the prognostic value of mCTA and MRA collateral maps.

Results: 169 participants (106 men and 63 women, mean age 69 years ± 13) were included. The agreement between the CSs of mCTA and the CPSs of the MRA collateral map (weighted kappa = 0.44, 95% confidence interval [CI]: 0.37-0.52) of 168 participants was moderate. Younger age (Odds ratio [OR], 0.51; 95% CI, 0.34-0.76; p = 0.001), lower baseline NIHSS scores (OR, 0.89; 95% CI, 0.81-0.99; p = 0.024), CPS 4 (OR, 36.66; 95% CI, 1.79-750.29; p = 0.019) and CPS 5 (OR, 144.10; 95% CI, 1.11-18788.93; p = 0.046) on the MRA collateral map, and successful reperfusion (OR, 9.63; 95% CI, 3.00-30.94; p < 0.001) were independently associated with favorable functional outcomes.

Conclusions: Only the MRA collateral map demonstrated clinical prognostic value in acute anterior circulation ischemic stroke patients, demonstrating the superiority of the MRA collateral map over mCTA in collateral assessment.

Purpose: Frailty is a clinical syndrome characterized by reduced physiological reserve and increased vulnerability to adverse health outcomes, potentially impacting patients undergoing mechanical thrombectomy for acute ischemic stroke due to large vessel occlusion (LVO). This study aimed to evaluate the influence of frailty on in-hospital outcomes in these high-risk patients.

Methods: We conducted a retrospective analysis of the National Inpatient Sample (2016-2021), identifying patients with large vessel occlusion stroke undergoing mechanical thrombectomy. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnoses. Propensity score matching (PSM) was applied to create balanced cohorts for primary analysis.

Results: In propensity-matched analysis, frail patients had higher in-hospital mortality (12.06% vs. 9.90%, P = 0.004), seizures (2.35% vs. 1.65%, P = 0.048), major adverse cardiac events (MACE) (15.29% vs. 13.51%, P = 0.044), pulmonary embolism (2.38% vs. 1.62%, P = 0.031), and hospital-acquired pneumonia (6.10% vs. 4.80%, P = 0.023). Sensitivity analysis using multivariable logistic regression confirmed similar trends, with frailty remaining an independent predictor of mortality (aOR 1.24, 95% CI: 1.04-2.23, P = 0.04).

Conclusion: Frailty is associated with significantly worse outcomes, including higher mortality, MACE, and pneumonia in patients undergoing mechanical thrombectomy for LVO. These findings emphasize the need for frailty screening as part of pre-procedural risk stratification and tailored management strategies to improve patient outcomes.

Purpose: To understand the role of enlarged Perivascular Spaces (PVSs) in a population with young middle age stroke and to identify predictors of PVSs enlargment using clinical and imaging data.

Materials/methods: Retrospective revision of demographics, clinical and MRI data, of 163 patients, with MRI confirmed stroke. Ischemic area and WMH were semi-automatically segmented on DWI images and FLAIR images. Severity of PVS was evaluated on T2-weighted images according to the Potter scale. To identify potential predictors of the extent of PVSs, an exploratory backward stepwise ordinal regression model was developed, including all measured variables.

Results: With the extent of PVSs at Basal Ganglia as the dependent variable, the logarithm of WMH demonstrated a significant positive association with the outcome. ESUS exhibited a positive relationship, underscoring its potential role as a predictor of the outcome. In PVSs in Mid Brain, dyslipidemia displayed a significant negative effect, signifying a reduced likelihood of the outcome in its presence. Hypertension emerged as a statistically significant and notably positive predictor of PVSs.

Conclusion: Significant associations between PVSs, WMH volume, and vascular features suggest their potential as vascular health indicators. These findings underscore the potentiality of PVSs as a biomarker for further investigation in stroke research. However, given the cross-sectional nature of our data, the relationship between PVS alterations and stroke requires further longitudinal studies to clarify their role and temporal association and eventually refining diagnostic and therapeutic approaches and mitigating stroke risks for younger stroke populations.

Purpose: Metronidazole is a widely used antimicrobial and is generally well-tolerated, but its adverse effects can rarely manifest as ataxia, dysarthria, and encephalopathy. Rarely it can cause severe neurological toxicity in the form of Metronidazole-Induced Encephalopathy.

Methods: We report a 48-year-old female with acute cerebellar symptoms and altered sensorium following a 12-day course of Metronidazole.

Results: Magnetic Resonance Imaging (MRI) revealed unusual diffuse leukoencephalopathy involving the cerebellar, brainstem, and cerebral white matter with rapid clinical and radiological resolution occurred after discontinuation.

Conclusions: This case highlights the importance of early recognition of symptoms and immediate discontinuation of Metronidazole to prevent irreversible neurological sequelae, even in cases with limited exposure.

Objectives: The impact of artery geometry on intracranial atherosclerosis (ICAS) is unclear. To investigate the association between local artery geometry characteristics and middle cerebral atherosclerotic stenosis.

Methods: This was a case-control study. ICAS patients with more than 50% stenosis in one M1 pre-bifurcation segment but no significant stenosis on the other side were included. The stenosis degree, diameter, length, angle, and morphology (straight-shape, U-shape, and S-shape) of the M1 pre-bifurcation segments were measured by using digital subtraction angiography (DSA) combined with computed tomography angiography (CTA) and 3D reconstruction imaging. The geometry characteristics on both sides were compared. The conditional multivariate Logistics regression was used to investigate the association between stenotic sides and the geometry characteristics.

Result: A total of 133 patients, 266 M1 pre-bifurcation segments, were included. Compared with non-stenotic sides, stenotic sides showed smaller diameters (2.873 ± 0.456 mm vs. 2.993 ± 0.360 mm, P = 0.002) and larger tortuosity index (7.61% vs. 6.45%, P = 0.048). The S-shape M1 pre-bifurcation segment was independently associated with the stenotic sides (OR = 3.509, 95% CI 1.176-10.468, P = 0.024). The stenotic side was worse fitted to Murray's law (mean square error 0.326 vs. 0.313).

Conclusions: The morphology of the M1 pre-bifurcation segment was associated with middle cerebral atherosclerotic stenosis.