Neuroradiology最新文献

Background and purpose: Emissary veins (EVs) are common incidental radiological findings, and enlarged EVs have been associated with the development of pulsatile tinnitus (PT). The purpose of this study is to further investigate the prevalence and characteristics of EVs in patients with and without PT.

Materials and methods: We conducted a case-control study of consecutive patients with PT and age- and sex-matched controls who received imaging (primarily CTA, CTV, and MRI) between February 2018 and February 2022. Radiological evaluation was performed by two neuroradiologists and EVs measurements were performed at the point of maximal diameter. For statistical analyses, Mann-Whitney U test was used to compare vein diameters, and Fisher's exact test was used to compare vein frequencies.

Results: Condylar and mastoid emissary veins of any diameter were less frequently observed in patients with PT than controls (66% vs. 78%; p < 0.01). The median diameter of mastoid emissary veins (MEVs) was significantly greater in the PT cohort (1 [IQR 1-2] mm vs. 1 [1-1] mm; p < 0.01) but there was no difference in median condylar emissary vein (CEV) diameter (3 [2-4] mm vs. 2 [2-3.5] mm; p = 0.64). Dilated CEVs (≥ 5 mm, 11% vs. 4%; p = 0.02) and MEVs (≥ 2 mm, 30% vs. 13%; p < 0.01) were more common in patients with PT. In both the PT and control cohorts, there was no significant difference in the prevalence of dilated EVs in patients with and without significant internal jugular stenosis (IJVS), transverse sinus stenosis (TSS). Additionally, there was no significant difference in the prevalence of dilated EVs in patients with and without idiopathic intracranial hypertension (IIH) in the PT cohort.

Conclusion: Dilated CEVs and MEVs were more common in patients with PT compared to controls, while the overall prevalence of CEVs/MEVs was lower in the control cohort.There was no association between the prevalence of dilated EVs and the presence of significant IJVS or TSS in patients with PT or controls.

Purpose: Congenital brain malformations are structural anomalies present at birth stemming from underlying genetic mutations or prenatal disruptions. The increased use of advanced genomic sequencing has led to major breakthroughs in pediatric neurogenetics; however, progress in unraveling the genetic basis of many central nervous system (CNS) malformations has lagged. This gap is partly due to the complexity of brain development and challenges like establishing the genetic culprit in somatic mosaicism. This review aims to integrate embryology, genetics, and neuroimaging to provide a practical radiogenomic framework for congenital brain malformations.

Methods: A narrative review of the literature was performed focusing on fundamental embryologic processes of CNS development, genetic concepts relevant to malformations, and key molecular pathways and protein structures implicated in neurodevelopment. Representative malformations of cortical development, midline anomalies, and hindbrain malformations are discussed with emphasis on radiologic-genetic correlations.

Results: Critical developmental pathways and proteins-including mTOR and Ras/MAPK signaling cascades and the tubulin cytoskeleton-are central to the pathogenesis of congenital brain malformations. Genetic principles, such as types of genetic alterations (e.g. somatic vs germline), mosaicism, penetrance, and expressivity explain the imaging and clinical phenotype variability and the diagnostic challenges encountered. Distinct radiogenomic patterns are identified across malformations of cortical development, corpus callosum anomalies, holoprosencephaly and posterior fossa malformations highlighting the diagnostic value of integrating neuroimaging with embryologic and molecular insights.

Conclusion: Radiogenomic correlation of congenital brain malformations is increasingly important in the era of precision medicine. By correlating neuroimaging phenotypes with the relevant embryologic and molecular mechanism, neuroradiologists can improve diagnostic accuracy, guide genetic testing strategies, and contribute to multidisciplinary care and counseling.

Purpose: Diffusion MRI-based indirect indices of neurofluid dynamics, such as diffusion tensor imaging along the perivascular space (DTI-ALPS) and extracellular free water (FW), have been reported to have prognostic implications in glioblastoma. However, their clinical utility, replicability, and the relation between the tumor burden remain insufficiently investigated with inconsistent results hindering its integration into routine imaging.

Methods: Two datasets of isocitrate dehydrogenase-wildtype (IDHwt) glioblastoma were retrieved from The Cancer Imaging Archive (UPENN = 200, UCSF = 125). The automated DTI-ALPS (aDTI-ALPS) and the FW index was used as an indirect indicator of glymphatic function. Prognostic significance was assessed using Kaplan-Meier analysis along with log-rank test, and multivariable Cox regression including aDTI-ALPS and clinical variables such as age, and extent of resection. Associations between MRI indices and tumor characteristics were also evaluated.

Results: A higher aDTI-ALPS index was associated with longer survival (P = 0.024 and 0.018 for both datasets, respectively; log-rank test), indicating its prognostic significance. Multivariable Cox analysis revealed low aDTI-ALPS as an independent factor for poor prognosis (hazard ratio (HR), 1.352; P = 0.050 and hazard ratio, 1.616; P = 0.044, respectively). Low FW index was associated with longer survival in UPENN. Additionally, the aDTI-ALPS index showed no correlation with tumor volume or tumor laterality, and the HR was smaller than molecular markers.

Conclusion: Automated DTI-ALPS and the free water index may serve as reproducible prognostic factors in IDH-wildtype glioblastoma, while showing no significant correlation with tumor burden.

Purpose: To evaluate the associations between computer-aided multi-parametric tortuosity indexes and the occurrence and instability of intracranial aneurysms (IAs), and to explore the independence of these associations.

Methods: A retrospective analysis was conducted on 705 patients (female: 64.1%, age: 58.58 ± 11.69) who underwent intracranial Computed Tomography Angiography, comprising 235 unstable aneurysm patients, 235 stable aneurysm patients, and 235 healthy controls. Computer-aided analysis quantified relative length (RL), triangular index (TI), and mean curvature (κmean) in bilateral internal carotid arteries (ICAs) and middle cerebral arteries (MCAs). Univariate analysis compared tortuosity parameters within/between groups, and multivariate analysis evaluated independence.

Results: Compared with the non-aneurysm side, the ICA aneurysm-bearing side had a higher TI (p = 0.005) at the C6, and a higher RL (p = 0.004), TI (p = 0.003), and κmean (p = 0.009) at the C7. Compared with the healthy arteries from control subjects, the C6 of the ICA aneurysm-bearing arteries had higher κmean (p = 0.002), the C7 had higher TI (p < 0.001) and κmean (p < 0.001), aneurysm-bearing MCAs had higher TI (p < 0.001) and κmean (p = 0.004). Compared with arteries with stable aneurysms, the aneurysm-bearing ICAs in the unstable group had higher TI (p = 0.001) and κmean (p = 0.039), and the aneurysm-bearing MCAs had higher TI (p = 0.044). Multivariate analysis showed that TI (p < 0.001, OR = 4.63) was an independent risk factor for ICA aneurysm instability.

Conclusions: Increased intracranial arterial tortuosity is associated with the occurrence and instability of IAs. TI of the aneurysm-bearing arteries is an independent risk factor for the instability of ICA aneurysms. TI tends to have a higher sensitivity than RL.