Neuroradiology最新文献

Intrathoracic carotid bifurcation (ITCB) is a rare vascular anomaly often associated with Klippel-Feil syndrome (KFS); however, its coexistence with tetralogy of Fallot (TOF) has not been previously reported. A male patient in his 30s with childhood TOF repair presented with mild right-sided hemiparesis and motor aphasia due to an ischemic infarction. Cerebral angiography revealed ITCB at the T2 level with severe left internal carotid artery stenosis, a right aortic arch, and aberrant left subclavian artery. Percutaneous transluminal angioplasty initially resolved the stenosis, but progressive restenosis required carotid artery stenting, achieving sustained patency. Embryologically, neural crest anomalies and persistence of fetal vascular structures, including the ductus caroticus and the ductus arteriosus, may underpin ITCB associated with TOF. Carotid artery stenting in this setting is technically more challenging, as the guide catheter must be positioned unusually low in the thorax, risking proximal slipping of the guiding system into the aorta.

Background: The Pipeline Vantage Flow Diverter (PVFD) with shield technology is the fourth and latest generation of the Pipeline embolization devices which are flow diverting stents used in the treatment of cerebral aneurysms. In early 2025 the larger PVFD 027s were recalled due to concerns of braid deformities with updated instructions provided for the PVFD 021. This study aimed at evaluating the safety and efficacy of the PVFD for cerebral aneurysm treatment in small parent vessels ≤ 2.5 mm.

Methods: A retrospective review of patients who received a 2.5 mm diameter PVFD for cerebral aneurysm treatment at our institution over 4 years was performed. Baseline patient characteristics, complications, clinical and radiological outcomes were collected for each patient with a mean follow up duration of 1 year and 17 days (median 7 months and 5 days).

Results: There were a total of 14 patients identified with a total of 16 aneurysms treated. At latest follow up complete aneurysm occlusion was achieved in 10 (66.7%) out of 16 treated aneurysms with 1 patient still awaiting follow up imaging. There were 2 (14.3%) of 14 patients who had immediate neurological complications, of which 1 was a transient deficit, and 0 patients with delayed complications. In-stent stenosis was found in 2 (15.4%) of 13 patients and asymptomatic stent occlusion occurred in 1 patient (7.69%).

Conclusions: This case series demonstrated an acceptable safety profile with reasonable aneurysm occlusion rates for the use of PVFD in cerebral vessels ≤ 2.5 mm in treating aneurysms.

Purpose: Surface modifications may improve procedural safety of flow diverter (FD) treatment, but larger studies are rare. This multicenter study aims to evaluate the safety and efficacy of unruptured aneurysm treatment with surface-modified and coated FDs.

Methods: Patients treated with the following FDs at 8 neurovascular centers were retrospectively reviewed: Pipeline Vantage Embolization Device, Pipeline Flex with Shield Technology, FRED X, p48/64 HPC, Derivo Embolization Device (DED), and DED 2heal. Aneurysm characteristics, procedural details, and angiographic results were evaluated in detail.

Results: A total of 511 patients with 545 aneurysms were included (mean aneurysm size: 8.2 ± 5.5 mm, 12% posterior circulation, 14% non-saccular morphology). Multiple FDs were used in 26/515 (5%) procedures and adjunctive coiling in 76 (15%). Thromboembolic events occurred in 40 (7.8%) cases, including 9 (1.7%) major ischemic events, 20 (3.9%) minor ischemic events and 11 (2.1%) asymptomatic/technical events. Non-saccular aneurysm morphology (p = 0.014) and use of multiple FDs (p = 0.025) favored thromboembolic events. Hemorrhagic events occurred in 5 (1.0%) cases, of which 3 were symptomatic. The combined morbidity and mortality rate was 11/515 (2.1%). Complete and adequate occlusion rates were 66% (196/297) and 80% (238/297) at 6 months, respectively, and 70% (64/92) and 85% (78/92) at 12 months, respectively.

Conclusion: The present study demonstrates high safety and efficacy for coated or surface-modified FDs. Whether the surface modifications confer a clinical benefit needs to be addressed in comparative studies.

Background: Identifying cardioembolism (CE) in large artery occlusion acute ischemic stroke (LAO-AIS) is critical for treatment decisions but often requires time-consuming diagnostic workups. Arterial and venous time-density curves (ATDC and VTDC), automatically derived from brain CTP, may reflect cardiac dysfunction and thrombus formation, offering a rapid alternative for CE detection.

Purpose: To evaluate the diagnostic utility of CTP-derived ATDC and VTDC parameters, combined with thrombus attenuation, for identifying CE in LAO-AIS patients.

Materials and methods: This retrospective study analyzed 103 LAO-AIS patients (median age 69 [IQR 63-77] years; 63 men) with anterior circulation occlusions who underwent CTP within 24 h of onset. Patients were classified into CE (n = 56) and non-CE (n = 47) groups per TOAST criteria. ATDC and VTDC parameters (onset, peak, end, width) and thrombus CT attenuation were measured. Diagnostic performance was assessed using univariable and multivariable logistic regression.

Results: Compared to the non-CE group, the CE group exhibited significant delays in onset, peak, and end times, along with wider curve widths of ATDC and VTDC, and higher thrombus attenuation (P_FDR≤0.001). ATDC width demonstrated the highest discriminative power for CE (AUC: 0.83 [95%CI: 0.74-0.89]; sensitivity: 73.2%, specificity: 87.2%; cutoff-value: 27s). Multivariable analysis confirmed ATDC width (OR = 1.214; 95% CI: 1.080-1.365; P = 0.001) and thrombus attenuation (OR = 1.114; 95% CI: 1.006-1.233; P = 0.038) as independent CE predictors, with a combined AUC of 0.93.

Conclusions: Prolonged ATDC and VTDC phases, wider curve widths, and elevated thrombus attenuation on CTP are strongly associated with CE in LAO-AIS, providing a rapid, imaging-based diagnostic tool.

Background: Current diagnostic approaches of leptomeningeal disease (LMD) rely heavily on cerebrospinal fluid (CSF) cytology, which shows significant limitations and the requirement for invasive procedures. We aim to develop an MRI-based grading scores for LMD diagnosis and prognosis that address current diagnostic limitations and provide standardized, reproducible assessment criteria.

Methods: We conducted a retrospective analysis of 32 adult cancer patients evaluated for suspected LMD. Two experienced neuroradiologists independently assessed MRI studies using our novel grading system, which incorporates leptomeningeal enhancement/intensity patterns (grades 1-6), Evans index for hydrocephalus assessment, brain metastases characteristics, and spinal involvement. Confirmation of LMD cases was employed using dual confirmation approach combining CSF cytology and follow-up MRI.

Results: Our MRI grading system demonstrated promising inter-observer performance. Inter-rater reliability between two attending level neuroradiologists was excellent (ICC = 0.953, P-value < 0.001) using a cutoff score of 2 or higher, the system demonstrated comparable performance. Risk stratification analysis revealed clear prognostic value, with mortality rates of 8.6% for low-risk patients (Grade 1-2), 50% for medium-risk patients (Grade 3-4), and 80.0% for high-risk patients (Grade 5 +). The Kaplan-Meier survival curves demonstrate a statistically significant difference in overall survival between patients with varying grades (p-value of 0.00011). Notably, survival probability drops steeply in the Grade 5 + group early on, suggesting that higher LMD burden is associated with rapid clinical deterioration. In contrast, low risk patients appear to have a more indolent course.

Conclusions: Our preliminary findings detail a promising approach in evaluating LMD patients which offers valuable prognostic information for clinical decision making. Furthermore, the high inter-rater reliability across various tumor types further encourages the potential utility of this approach, although further research on a broader population is needed before clinical implementation.

Purpose: Inborn errors of immunity (IEIs) are a heterogeneous group of germline disorders whose recognition is increasing but which remain underdiagnosed and associated with significant pediatric morbidity and mortality. This review aims to systematize the main neuroimaging manifestations of IEIs, addressing how neuroradiologists can identify characteristic patterns to support earlier diagnosis and guide clinical management.

Methods: A narrative review of IEIs with neurological involvement was performed, focusing on reported primary and secondary neuroimaging features across major IEI categories. Imaging findings were correlated with underlying immune defects, typical clinical phenotypes, and their impact on diagnostic workup, risk assessment, and genetic counseling.

Results: IEIs demonstrate a broad neurological spectrum that extends beyond recurrent infections to encompass autoinflammatory, autoimmune, allergic, and malignant phenotypes with central nervous system involvement. Neuroimaging reveals both primary manifestations directly related to immune dysregulation and secondary features, allowing recognition of patterns in IEI subgroups that can provide crucial diagnostic clues in otherwise non-specific clinical scenarios.

Conclusion: Neurological involvement in IEIs is not uncommon and may be radiologically detectable, making imaging an important ancillary tool in their evaluation. Systematic recognition of primary and secondary neuroimaging features by neuroradiologists can raise suspicion for an underlying IEI, prompting appropriate immunologic and genetic work-up. Earlier diagnosis is crucial to enable timely implementation of preventive or targeted therapies, with the potential to improve long-term outcomes.

Purpose: Steerable guidewires with deflectable tips enable real-time navigation through complex cerebrovascular anatomy without requiring wire removal and tip reshaping. Despite promising early reports, systematic clinical evaluation remains limited.

Methods: We conducted a retrospective analysis of 58 consecutive neurointerventional procedures utilizing steerable guidewires at two centers from September 2024 to August 2025. The cohort comprised 48 cases using the Drivewire 24 (DW24, 0.024-inch diameter) and 10 cases using the Artiria SmartGUIDE (0.014-inch diameter). Primary outcomes included technical success, safety profile, and operator assessment. We also performed a scoping literature review of all published steerable guidewire studies in neurointerventional applications.

Results: Technical success in reaching target vessels was achieved in 100% of cases for both systems with no intraoperative or postoperative complications. Mean fluoroscopy time was 32.7 ± 29.5 min for DW24 and 26.1 ± 16.2 min for Artiria procedures. Treatment indications included aneurysm procedures (53.4%), diagnostic angiographies (20.7%), venous sinus stenting (13.8%), middle meningeal artery embolizations (8.6%), and stroke interventions (3.4%). 8.3% of procedures using DW24 were considered higher-risk by the primary operator without steerable capability, including successful navigation of complex posterior circulation anatomy in giant basilar aneurysms and recurrent superior cerebellar artery aneurysms with prior stent constructs. Our limited experience with the Artiria system (n = 10) revealed operator-noted challenges with shape retention. The scoping review identified only three prior studies encompassing 65 procedures, establishing this as the largest reported experience.

Conclusion: Both steerable guidewire systems achieved perfect technical success with excellent safety profiles. Based on our preliminary experience, the DW24 appeared to offer advantages for procedures requiring navigating larger catheters through tortuous anatomy. These findings support selective clinical use of steerable guidewire technology in challenging neurointerventional procedures.

Objectives: To leverage a combination of cortical high-flow sign on arterial spin labeling (ASL) and cystathionine measurement using ¹H-MR spectroscopy (¹H-MRS) to distinguish oligodendroglioma, IDH-mutant and 1p/19q-codeleted (O_IDHm-codel) from astrocytoma, IDH-mutant (A_IDHm-noncodel).

Materials and methods: We implemented pseudo-continuous ASL technique (post-labeling delay = 2000 ms) using a 3.0-T MRI scanner. Relative perfusion maps were generated by subtracting paired labeled images from control images. ¹H-MRS data were acquired by using the single-voxel point-resolved spectroscopy sequence (PRESS) sequence (TR = 2000 ms, TE = 97 ms, NEX = 128, volume of interest = 20³ mm³). Our study included cases with a Cramér-Rao Lower Bound of cystathionine levels at 2.7 ppm that were below 50%. The presence or absence of cortical high-flow sign and the estimated concentration of cystathionine were compared between A_IDHm-noncodel and O_IDHm-codel. The receiver operating characteristic curves were used to evaluate the diagnostic performance of each parameter, as well as the combination of both.

Results: The cortical high-flow sign was identified more frequent in O_IDHm-codel (7/12, 58.3%) than in A_IDHm-noncodel (3/18, 16.7%; p = 0.018). The cystathionine levels in O_IDHm-codel (1.50 ± 0.63 mM) was significantly higher than in A_IDHm-noncodel (0.85 ± 0.24 mM; p = 0.001). The area under the curve for distinguishing O_IDHm-codel from A_IDHm-noncodel using the presence of cortical high-flow sign, cystathionine levels, and their combination was 0.708 (0.509-0.908), 0.750 (0.553-0.947), and 0.875 (0.737-1.000), respectively.

Conclusion: The presence of cortical high-flow sign on ASL, along with elevated cystathionine levels measured by 1H-MRS, could differentiate O_IDHm-codel from A_IDHm-noncodel.