Neuroradiology最新文献

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.

Introduction: Parenchymal haematoma (PH) is a potentially serious complication post endovascular treatment (EVT) and is associated with poor functional outcomes. It is unknown if modifiable factors can improve the outcomes of patients with PH. This study aimed to determine whether successful reperfusion is associated with favourable outcome in patients with ischemic stroke despite this complication.

Methods: In an international multi-centre study, favourable outcomes (mRS0-2) of patients achieving successful reperfusion (TICI 2b/3) were compared with outcomes of those with unsuccessful reperfusion.

Results: 346 patients were included in the final analysis. 36 patients had unsuccessful reperfusion (10.4%) while 310 had successful reperfusion (89.6%). Amongst patients with PH post-EVT, successful reperfusion conferred better 3-month favourable outcomes (20.32% vs 5.56%; p=0.032) and lower mortality rates (40.32% vs 72.22%; p <0.001) compared with patients who had unsuccessful reperfusion.

Conclusion: Successful reperfusion remains a strong predictor of favourable outcome and reduced mortality in ischemic stroke patients with parenchymal haematoma post endovascular treatment.

Objectives: Deep learning (DL)-based image reconstruction (DLBIR) techniques promise accelerated MRI acquisitions with enhanced image quality. Herein, we compare the image quality of a DLBIR-based 3D FLAIR (3D-FLAIR_DL) with conventional 3D FLAIR (3D-FLAIR_SOC) in a cohort of multiple sclerosis (MS) patients.

Materials and methods: Our prospective, reader-blinded study, included 26 MS patients who underwent both sequences on a 3T scanner during the same study session over three months. Two neuroradiologists assessed noise, artifacts, sharpness, overall image quality, and diagnostic confidence using 4-point Likert-like scales. Lesion conspicuity was graded for lesions < 3 mm and ≥ 3 mm. Quantitative metrics included lesion count, apparent signal-to-noise ratio (aSNR), and contrast-to-noise ratio (aCNR). A composite gold standard was used to calculate sensitivity and precision.

Results: 3D-FLAIR_DL showed significantly better qualitative scores (p < 0.001) with high inter-reader agreement. Lesion conspicuity and diagnostic confidence improved, especially for < 3 mm lesions. DLBIR images detected 29 additional lesions (10 ≥ 3 mm-sized lesions and 19 < 3 mm lesions), yielding higher sensitivity (99.5% vs. 88.8% for < 3 mm; 100% vs. 97.9% for ≥ 3 mm) without false positives. aSNR and aCNR were significantly higher for DLBIR images (p < 0.001). Acquisition time was reduced by 32% (3:54 vs. 5:44 min).

Conclusion: DLBIR 3D FLAIR significantly improves lesion detection and image quality in MS, supporting its potential integration into standard imaging protocols. As DLBIR algorithms evolve, further validation in larger, diverse cohorts will be essential.

Background and purpose: Mechanical thrombectomy (MT) is an effective treatment for patients with acute ischaemic stroke secondary to internal carotid artery (ICA) occlusion. Intravenous thrombolysis (IVT) prior to MT is also commonly administered in suitable patients. This study aimed to compare the outcomes of patients with acute ICA stroke who were treated with direct MT versus combined IVT plus MT. Additionally, analysis was performed in different subgroups of patients such as those with large artery stenosis (LAA) to evaluate which subgroup of patients would benefit most from bridging IVT.

Methods: This multicenter retrospective cohort study included patients who were treated for acute ICA stroke from three comprehensive stroke centers between January 2015 and December 2019. Patients received direct MT or combined bridging IVT plus MT. Primary outcome was favorable functional outcome defined as modified Rankin Scale (mRS) 0-2 measured at 90 days after discharge. Secondary outcome measures included mRS on discharge, inpatient mortality and complications such as symptomatic intracranial hemorrhage (sICH), subarachnoid haemorrhage (SAH) and embolism of thrombus to new territories.

Results: Among 352 patients, 178 (50.6%) patients underwent bridging IVT followed by MT and 174 (49.4%) underwent direct MT. The mean ± standard deviation age was 69.8 ± 14.6 years, 50.9% were male and median National Institutes of Health Stroke Scale was 16. At 90-days after discharge, patients who underwent bridging IVT had similar functional outcomes as those who underwent direct MT (OR = 1.53; 95% CI 0.68-3.42; p = 0.303). Bridging IVT was also not associated with improvement in discharge mRS score, decreased inpatient mortality, or difference in rate of complications compared to direct MT. In subgroup analyses, patients with underlying atherosclerosis treated with bridging IVT compared to direct MT had a higher rate of favorable functional outcome at 90 days (33.9% vs. 14.0%, p = 0.022).

Conclusions: Bridging IVT is not associated with better functional outcomes compared to direct MT in ICA stroke. However, in the subgroup of patients with underlying large-artery atherosclerosis stroke mechanism, bridging IVT appears to potentially confer beneficial outcomes. This should be validated in larger studies.

Purpose: In emergency diagnostics, head CT and CT angiography (CTA) of craniocervical vasculature are indispensable for children, despite their increased radiation sensitivity. This study assesses the radiation dose metrics of head CT and CTA in pediatric patients managed in the trauma resuscitation unit (TRU).

Methods: All patients aged 0-<15 years who underwent head CT and CTA in the TRU between April 2020 and August 2023 were included. CT dose index volume (CTDIvol) and dose-length product (DLP) were extracted from the Radimetrics Enterprise Platform, which also provided organ doses estimated via Monte Carlo simulations and effective doses (ED) derived from these estimates. Dose metrics were compared with national diagnostic reference levels (DRLs), defined for three pediatric age groups: I (0-<5 years), II (5-<10 years), and III (10-<15 years).

Results: Of 212 pediatric TRU patients, 62.7% (133/212) underwent CT and 72.2% (96/133) received combined CT and CTA. Median CTDIvol and DLP increased with age, whereas ED decreased. For head CT, CTDIvol ranged from 18.9 mGy to 29.4 mGy, DLP from 282 to 460 mGycm, and ED from 1.6 to 1.3 mSv. For CTA, CTDIvol ranged from 1.4 to 2.2 mGy, DLP from 40 to 83 mGycm, and ED from 1.0 to 0.8 mSv. All doses remained below national DRLs.

Conclusion: Head CT and CTA in pediatric trauma can be performed with radiation doses well below national DRLs. Careful dose management is important to reduce potential long-term cancer risks and deterministic effects such as lens cataract formation.