Neuroradiology最新文献

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.

Purpose: This study presents a long-term single-centre experience with CS-DAVFs and discusses the historical progression, current state, and future directions of endovascular treatment.

Methods: We retrospectively reviewed all patients with CS-DAVFs endovascularly treated at our institution between 2006 and 2024. We evaluated clinical presentation, imaging findings, endovascular treatment techniques, and clinical improvement.

Results: 63 patients underwent 68 endovascular procedures. 49 patients (72%) underwent transvenous procedures through the inferior petrosal sinus or ophthalmic veins. 39 fistulas (57%) were occluded using liquid embolic agents (LEAs) alone or in combination with coils. Eight patients (12%) required the injection of LEAs in the superior pharyngeal branch of the APA to reach the complete occlusion of the fistula. In 4 cases, the vascular anatomy of the fistula required the direct puncture of the draining vein. In 46 cases (68%), the fistula was successfully occluded using coils. Complete occlusion was achieved in 52 of the cases (77%), but two cases (3%) had fistula recurrence after the first treatment. We found one complication of the endovascular procedure in the study population. The median imaging follow-up time was 12 months (range 2-135); the median clinical follow-up was 32 months (range 1.5-194). 60 Patients (95%) showed persistent clinical improvement.

Conclusions: Endovascular occlusion is the gold standard for CS-DAVFs, with high rates of occlusion and few complications. Continued advancements in techniques and devices are essential to improve outcomes and reduce complications.

Purpose: Currently, the different types of ependymal neoplasm (EPN) are defined by anatomical localization and genetics. This retrospective multicenter study aimed to analyze the imaging patterns of both local and distant recurrences in supratentorial (ST) and posterior fossa (PF) EPN.

Methods: We exclusively evaluated patients with recurrent EPN. To form the basis for follow-up evaluations the imaging characteristics for ST-EPN and PF-EPN were assessed and compared to each other. Follow-up assessments included the idenTIFFication of local recurrent tumors, leptomeningeal dissemination, secondary intraparenchymal lesions, and extraneural metastases. MR-signal characteristics of local recurrent tumors were compared to the primary tumor.

Results: The imaging series included 73 patients (median age at diagnosis 4.6 years; 56 PF-EPN). Recurrences were observed at up to five time points, with a total of 145 recurrence events documented. At first recurrence most PF-EPN recurred locally (29/56), while ST-EPN relapsed by intracranial dissemination (9/17). Local recurrent tumor grew fast and differed in up to one-fifth from the primary (13.2% lower T2-signal, 14.6% brighter T1-signal, 19% less contrast-enhancement). Leptomeningeal dissemination in ST-EPN is mainly restricted to intracranial (90.5%) while PF-EPN more frequently present with spinal spread (45.7%). Transient post-radiogenic lesions (n = 2) and secondary malignancies (n = 2) were rare. Extraneural metastases (n = 3) were found mainly near the surgical access.

Conclusion: Recurrences can occur multiple times in EPN patients, and the recurrence patterns differ between ST-EPN and PF-EPN. Imaging characteristics of local recurrences can differ from the primary tumor which is crucial for accurate diagnosis and treatment planning.

Purpose: This study aims to investigate the potential effect of compromised structural integrity on cerebral aging and cognitive function in cerebral small vessel disease (CSVD).

Methods: Fifty-five CSVD patients and 42 controls underwent three-dimensional T1-weighted imaging and diffusion tensor imaging. Relative brain age (RBA) was computed to assess cerebral aging. Variables of structural integrity included cortical thickness, cortical volume, white matter hyperintensity (WMH) volume, peak width of skeletonized mean diffusivity (PSMD), ventricular volume, and choroid plexus volume. Mini-Mental State Examination (MMSE) was conducted to assess general cognition. Trail Making Test (TMT) and Auditory Verbal Learning Test were administered to evaluate executive function and episodic memory, respectively. Mediation analysis and multivariate linear regression with interaction terms were performed to explore the differential impacts of RBA on cognitive function and structural integrity between CSVD patients and controls.

Results: RBA was significantly increased in CSVD patients compared to controls (p < 0.001). White matter injuries as assessed with PSMD (mediation magnitude: 41.1%) and WMH volume (mediation magnitude: 56.9%) significantly mediated the relationship between CSVD pathologies and RBA (p < 0.001). Higher RBA was significantly correlated with poorer scores of MMSE, TMT-A, and TMT-B in CSVD patients (p < 0.01). Additionally, PSMD (mediation magnitude: 57.8% in MMSE, 48.3% in TMT-A, and 28.8% in TMT-B) and WMH volume (mediation magnitude: 55.1% in MMSE) significantly mediated the relationship between RBA and cognitive function (p < 0.05).

Conclusion: White matter injuries play a critical role in the cerebral aging and cognitive decline in CSVD patients.

Purpose: Early identification of the underlying cause of intracerebral hemorrhage (ICH) is important for treatment and prognosis. This study aims to investigate the association of hematoma volume and other clinical parameters on the distribution of cerebral amyloid angiopathy (CAA) probability according to the simplified Edinburgh CT criteria in a large, unselected intracerebral hemorrhage (ICH) population.

Method: Patients with spontaneous ICH residing in Skane county registered with clinical data in the Swedish Stroke Register 2016-2020 were included. Radiological parameters were evaluated using baseline non-contrast CT (NCCT) for categorization according to the simplified Edinburgh CT criteria by the presence of subarachnoid hemorrhage (SAH) and fingerlike-projections (FLP). Multivariable logistic regression analysis was used to determine factors associated with an increased (intermediate/high) CAA probability.

Results: Of 666 patients with lobar ICH, 190 (29%) had high, 92 (14%) had intermediate, and 384 (58%) had low CAA probability. Patients with increased CAA probability presented more often with decreased level of consciousness, larger hematoma volumes, and higher 90-day mortality. Baseline hematoma volume [10-30 ml (OR = 4.03;95%CI: 2.26-7.19); 30-80 ml (OR = 12.00;95%CI:7.26-22.53); >80 ml (OR = 30.00;95%CI:15.94-59.09)], female sex (OR = 1.58;95%CI:1.08-2.32) and age (OR = 1.04;95%CI:1.02-1.06) were associated with an increased odds of having an increased CAA probability.

Conclusion: We identified a strong association between baseline hematoma volume and an increased probability of CAA in lobar ICH patients on NCCT, indicating that large hematoma volumes alone may contribute to the occurrence of FLP and SAH, and act as a confounder for the simplified Edinburgh CT criteria. Validation against MRI is warranted.

Purpose: To investigate the concurrent brain structural and functional alterations related to cognition in patients with cerebral small vessel disease (CSVD).

Methods: Thirty normal controls and 65 CSVD patients, including 33 patients with mild cognitive impairment and 32 patients with no cognitive impairment were included. Structural and resting-state functional MRI measures, including gray matter volume (GMV) and white matter volume (WMV) using voxel-based morphometry (VBM) analysis and amplitude of low-frequency fluctuation (ALFF), were obtained and compared among the three groups. Associations between cognitive scores and ALFF/VBM coupling in the co-altered regions were investigated in CSVD groups.

Results: Multiple brain regions showed significant differences in GMV and WMV among the three groups (P < 0.01). Abnormal ALFF among the three groups was identified in the left putamen, Rolandic operculum, fusiform gyrus, caudate, parahippocampal gyrus, insula, middle cingulum, bilateral lingual gyrus, and right frontal lobe (P < 0.01). Importantly, a decrease in VBM and increase in ALFF in the left parahippocampal gyrus, caudate and Rolandic operculum, a reduction of the WMV and ALFF in the right superior frontal lobe, and a united rise of GMV and ALFF in the left caudate were detected in CSVD groups. In addition, abnormal ALFF/VBM coupling was significantly related to multiple cognitive assessments.

Conclusion: The study indicated a reversed pattern of the brain structural deficits and functional activation in the left parahippocampal gyrus, caudate, and Rolandic operculum, suggesting structure-function decoupling in CSVD groups. These might help further understand the pathophysiological mechanism of CSVD.

Background: Sleep disturbance is a common comorbidity in tinnitus patients, which may be attributed to changes in brain structure and function. The aim of this study was to explore the potential role of the glymphatic system (GS), a recently discovered pathway for brain waste clearance, in tinnitus and the associated sleep disturbance.

Methods: The DTI-ALPS index of 22 tinnitus patients and 22 healthy controls (18-60 years old) were compared after controlling for age, sex, and handedness. Partial correlation and mediation analyses were performed to explore the association between the above parameters and clinical data.

Results: Significant differences were found between the right-side DTI-ALPS index and the DTI-ALPS index of the healthy group. Furthermore, the DTI-ALPS index in tinnitus patients was significantly lower than that of the healthy group (1.288 vs. 1.422, p = 0.009). After adjusting for age and sex, the DTI-ALPS index correlated significantly with the Tinnitus Handicap Inventory (THI) scores (r = -0.587, p < 0.001). The DTI-ALPS index was negatively correlated with Pittsburgh Sleep Quality Index (PSQI) scores (r = -0.457, p = 0.032). The mediation analysis of the ALPS index, PSQI, and THI revealed a significant indirect effect of PSQI on the association between ALPS index and THI (p < 0.0001).

Conclusion: The glymphatic system may influence sleep disturbance in tinnitus patients due to its role in brain waste clearance. We observed a decrease in DTI-ALPS in tinnitus patients, and our analyses suggest that sleep disturbances influence tinnitus through the mediation of DTI-ALPS. Thus, greater emphasis should be placed on averting sleep issues at Tinnitus.

Purpose: To evaluate the efficacy of arterial spin labeling (ASL) MRI in detecting residual arteriovenous (AV) shunting in treated arteriovenous malformations (AVMs) and fistulas (AVFs).

Methods: A retrospective institutional review identified 29 patients with DSA-confirmed AV shunt lesions treated via embolization (n = 17), stereotactic radiosurgery (n = 2), surgical resection (n = 8), or combined embolization and surgical resection (n = 4), with corresponding baseline and post-treatment ASL and DSA studies. Two neuroradiologists independently assessed ASL images for residual AV shunting, with inter-rater agreement calculated. Disagreements were jointly reviewed to reach consensus. Sensitivity and specificity for using ASL to detect residual AV shunting were then determined using DSA as the gold standard reference.

Results: Seventeen patients with Spetzler-Martin grades II-V AVMs were included: 76.5% with supratentorial nidus, and 52.9% with prior hemorrhage. Twelve AVF patients were included, including eight dural, one vein of Galen, two perimedullary, and one cavernous-carotid fistula. Inter-rater agreement for presence of residual AV shunting was strong (93.5%, κ = 0.87). Two disagreements involved AVM patients after surgical resection. Sensitivity and specificity of ASL for detecting residual was 94% and 93%, respectively. Within the AVM group, both metrics reached 100%, while for AVFs, they both decreased to 83%, with one false positive and one false negative.

Conclusion: ASL MRI is highly sensitive and specific for detection of residual AV shunting across a wide spectrum of AV shunt pathologies and treatment modalities. ASL can play an important role as a non-invasive adjunct to DSA, potentially reducing the frequency of DSA during the continuum of post-treatment care.

Purpose: This study aimed to evaluate the predictive value of automatically assessed collateral circulation (CC) and infarct core for functional outcome in acute ischemic stroke (AIS) patients treated with endovascular thrombectomy (EVT).

Methods: We conducted a retrospective cohort study of 208 patients with anterior large vessel occlusion treated with EVT. Two AI-powered software were used to automatically assess CC and infarct core. Comparative analyses included patient demographics, clinical and imaging data, and functional outcome. Univariate and multivariable logistic regression analyses were conducted to predict the 90-day functional outcome. A favorable outcome was defined as a modified Rankin scale (mRS) score ≤ 2.

Results: Among the 208 patients, 114 (54.8%) were women and 94 were men, with a mean age of 71.4 ± 13.3 years. Patients with higher collateral score (CS) exhibited lower infarct core volumes (p < 0.001) and better mRS score at 90 days (p = 0.008). Among patients with a favorable outcome, the mean infarct core volume was lower compared to those with poor outcomes (5 mL vs. 8.6 mL, p = 0.003). In univariate logistic regression, both infarct core (OR 0.94, p = 0.005) and CS (OR 1.84, p = 0.014) were predictors of favorable outcome. However, in multivariable models, only infarct core remained a significant independent predictor [AORs of 0.95 (p = 0.021) and 0.96 (p = 0.039)].

Conclusion: Automatically assessed infarct core is a robust predictor of functional outcome in AIS patients post-EVT, while CS's predictive value diminishes when adjusted for infarct core. These findings support the integration of AI-powered evaluations in clinical settings to improve prognosis and treatment strategies for AIS.