Neuroradiology最新文献

Purpose: This study evaluated the peak width of skeletonized mean diffusivity (PSMD) as a quantitative imaging marker in patients with magnetic resonance imaging-negative (MRI-negative) temporal lobe epilepsy (TLE), accounting for age and sex effects.

Methods: This retrospective study included 34 MRI-negative TLE patients and 40 age- and sex-matched healthy controls (HCs). PSMD was calculated using tract-based spatial statistics and histogram analysis. Hierarchical regression identified PSMD determinants. Receiver operating characteristic analysis compared uncorrected and age- and sex-corrected PSMD, with the latter validated by 10-fold cross-validation.

Results: PSMD was significantly elevated in patients versus HCs (2.545 × 10^-⁴ mm²/s vs. 2.340 × 10^-⁴ mm²/s, p = 0.004) and independently associated with TLE (OR = 2.39, p = 0.011). Sensitivity analysis confirmed robustness (OR = 2.22, p = 0.013). In addition, males showed higher PSMD than females in both patients (p = 0.022) and HCs (p < 0.001). Furthermore, age (β = 0.453, p = 0.005) and male sex (β = 0.539, p = 0.014) were associated with higher PSMD. Age/sex correction improved specificity (82.5% vs. 67.5%) but reduced sensitivity (64.7% vs. 52.9%), with an area under the curve (AUC) of 0.696. AUC improvement was non-significant (p = 0.676); cross-validated AUC was 0.628.

Conclusion: PSMD is a quantitative marker of diffuse white matter pathology in MRI-negative TLE, modulated by demographic factors. Consistent sex effects across groups indicate biological rather than disease-specific variation. Demographic adjustment improves specificity but not overall accuracy, supporting PSMD for group-level cross-sectional studies. Sex effects must be controlled for in white-matter diffusion MRI.

Purpose: Adjunctive techniques are frequently required in endovascular treatment (EVT) for ruptured intracranial aneurysms (RIAs) with complex morphology. However, comprehensive nationwide data on technique selection and its relationship with outcomes remain limited. We aimed to clarify anatomical and clinical factors associated with technique selection and to evaluate short-term outcomes using a large nationwide registry.

Methods: The Japanese Registry of Neuroendovascular Therapy (JR-NET) 4 included over 4,000 RIAs treated between 2015 and 2019. After exclusions, 3,600 patients treated with balloon-assisted coil embolization (BAC), double-microcatheter coil embolization (DMC), or stent-assisted coil embolization (SAC) were analyzed. Multinomial logistic regression identified factors associated with treatment selection, and multivariable logistic regression evaluated predictors of favorable outcome (modified Rankin Scale; mRS 0-2) and mortality at 30 days.

Results: Wide-neck and large RIAs were associated with DMC and SAC, while bifurcation RIAs were more often treated with DMC. BAC remained the most frequently used technique. Thirty-day outcomes were primarily determined by World Federation of Neurosurgical Societies (WFNS) grade and aneurysm morphology, rather than treatment type. WFNS grade IV-V was linked to a markedly lower chance of favorable outcome (OR 0.10, 95% CI 0.07-0.14), whereas neither DMC nor SAC showed an independent effect compared with BAC.

Conclusions: In this nationwide registry, technique selection was chiefly determined by aneurysm morphology and location, while outcomes were influenced by patient severity and aneurysm complexity. These findings, from the largest nationwide registry of EVT for RIAs, provide real-world evidence to guide treatment planning.