Neuroradiology最新文献

Purpose: Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline and impaired daily functioning. The glymphatic system removes neurotoxic waste, including amyloid-beta (Aβ), an important factor in AD pathogenesis. This study used the Diffusion Tensor Imaging Analysis Along the Perivascular Space (DTI-ALPS) index, which reflects glymphatic function, to explore its relationship with cognitive decline in patients with probable AD.

Methods: We conducted a longitudinal study of 16 participants aged 60-79 years with probable AD who were evaluated using the Clinical Dementia Rating (CDR) and Mini-Mental State Examination (MMSE). Glymphatic function was assessed using the DTI-ALPS index; plasma Aβ 42/40 ratios were measured to account for amyloid pathology. The relationship between the DTI-ALPS index and baseline cognitive function was analyzed using multiple regression models adjusted for age, sex, and plasma Aβ 42/40 ratios. Associations between the DTI-ALPS index and cognitive decline over 1 year were assessed by a model using the percentage change in the MMSE z-score as the outcome variable.

Results: Higher DTI-ALPS index was significantly associated with better baseline cognitive function as assessed by MMSE (standardized beta = 1.17, p < 0.001) and lower clinical severity as assessed by CDR (standardized beta = - 1.00, p = 0.006). Over the 1-year follow-up, greater baseline DTI-ALPS index values were associated with less cognitive decline (standardized beta = - 0.85, p = 0.018).

Conclusion: Our findings suggest that DTI-ALPS index is associated with cognitive performance and is a biomarker for predicting cognitive decline in AD. Future studies should consider larger sample sizes and longer follow-up periods to validate these findings.

Background: Crossing Y-stent-assisted coiling (CYSAC) is a feasible yet technically challenging technique for the treatment of wide-neck bifurcation aneurysms (WNBAs).

Objective: To present mid-term results of Y-stent-assisted coiling (YSAC) using the LVIS EVO stent and to describe our "drill turn" technique for stent crossing.

Methods: This retrospective, observational study included 37 consecutive patients treated with YSAC using LVIS EVO stents at five centres between September 2020 and March 2023.

Results: Immediately after treatment, 31 of the 37 patients (83.8%) achieved Raymond-Roy occlusion classification (RROC) Class I occlusion, while 5 patients (13.5%) had Class II and 1 patient (2.7%) had Class III occlusion. The mean follow-up period was 32.8 months (range: 11-41 months), and all patients underwent follow-up imaging after ≥ 6 months. On follow-up imaging, 34 patients (92%), including all those with immediate RROC Class I occlusion, 2 with Class II, and 1 with Class III, showed Class I occlusion. One patient with RROC Class II occlusion demonstrated a gradual decrease in residual filling, while one large partially thrombosed middle cerebral artery aneurysm and one large basilar tip aneurysm (8%) with residual neck filling remained unchanged on the 6-month digital subtraction angiograph.

Conclusion: Utilizing the described drill turn technique, CYSAC with LVIS EVO stents was found to be feasible and safe for WNBA treatment, with high and stable occlusion rates observed during mid-term follow-up.

Purpose: Although neuropathological comorbidities, including Alzheimer's disease neuropathological change (AD-NC) and limbic-predominant age-related TAR DNA-binding protein 43encephalopathy neuropathological change (LATE-NC), are associated with medial temporal atrophy in patients with Lewy body disease (LBD), the diagnostic performance of magnetic resonance imaging (MRI)-derived indices remains unclear. This study aimed to investigate the diagnostic performance of MRI-derived indices representing medial temporal atrophy in differentiating between LBD with AD-NC and/or LATE-NC (mixed LBD [mLBD]) and without these comorbidities (pure LBD [pLBD]).

Methods: This study included 24 and 16 patients with pathologically confirmed mLBD and pLBD, respectively. In addition to the well-known medial temporal atrophy and entorhinal cortex atrophy (ERICA) scores, the cross-sectional areas of the bilateral entorhinal cortices/parahippocampal gyri (ABEP) were segmented manually.

Results: Even incorporating various covariates such as age at MRI examination, sex, argyrophilic grain, the MRI-derived indices, especially ABEP, significantly correlated with the severity of AD-NC, and showed a trend of correlation with LATE-NC. For the differentiation between all mLBD and pLBD, the ERICA score and ABEP demonstrated higher diagnostic performance (area under the receiver-operating-characteristic curve [AUC] of 0.80 and 0.87, respectively). Additionally, the highest diagnostic performance for ABEP (AUC, 0.94; sensitivity, 100%; specificity, 88.9%; accuracy, 96%) was observed in differentiating between pLBD and mLBD with two comorbidities (AD-NC and LATE-NC).

Conclusion: In patients with pathologically confirmed LBD, medial temporal atrophy was significantly correlated with AD-NC, and showed a trend of correlation with LATE-NC. Moreover, MRI-derived indices indicative of medial temporal atrophy were useful in diagnosing these comorbidities.

Purpose: Takayasu arteritis (TA) is a rare, chronic, inflammatory large-vessel vasculitis that affects the aorta and its main branches, including the cerebrovascular system. This review analyzes current knowledge and patient outcomes concerning the cerebrovascular implications of TA.

Methods: A literature search, with publications from 1994 to 2024, identified pertinent studies through PubMed. An illustrative case report details a 19-year-old female with Type 1 TA, illustrating the complex decision required in the absence of surgical or endovascular options.

Results: Our results offer a demographic analysis of 1,698 TA patients, highlighting a female predominance of 89.99% and a mean symptom onset at 33 years. The clinical spectrum of cerebrovascular involvement presented varied symptoms, most notably dizziness, with significant incidences of ischemic events and bilateral stenosis primarily affecting the carotid and subclavian arteries. The most common type of TA was Type V, affecting 40% of patients studied. Endovascular treatment had a 95% initial success rate, with a 67% restenosis rate. Surgical treatment was successful in 84% of cases, but 21% had notable post-operative complications. Similar to the endovascular population, those treated with stand-alone conservative therapy saw a 93% initial remission rate with 52% having relapsed.

Conclusion: Assessing the disease activity of TA is crucial when planning vascular intervention due to its significant impact on treatment outcomes. Despite its greater initial invasiveness, surgical interventions showed lower restenosis rates compared to either endovascular interventions or standalone conservative management. We emphasize advancements in TA management and the pressing need for continued research into diagnostic and treatment protocols for improved patient outcomes.

Purpose: Objective information about the central auditory pathways in vestibular schwannoma can guide strategies for hearing rehabilitation and prognostication. This study aims to generate this information using diffusion tensor imaging (DTI).

Methods: This is a prospective observational single center study including 35 patients with vestibular schwannoma and 40 controls. Subjects underwent 64 direction multi-shell DTI which was processed to yield scalar parameters [Fractional Anisotropy (FA) and Apparent Diffusion Coefficient (ADC)] and probabilistic fiber tracking parameters.

Results: FA values were found to be significantly reduced at bilateral medial geniculate bodies and contralateral inferior colliculus (P < 0.001). In contrast, FA values were significantly increased at bilateral Heschl's gyrus (P < 0.001). This was further validated by a progressive increase in FA values at bilateral Heschl's gyri with increasing tumor size. Contralateral inferior colliculus showed a marginal increase in FA value (P = 0.006) and a marginal decrease in ADC value (P = 0.045) in patients with nonfunctional hearing as compared to patients with functional hearing. Rest of the DTI parameters were comparable across patient groups based on duration of hearing loss, hearing function, tumor location and tumor size. FA values along the tracts and the tract volumes were reduced significantly on both the sides (P < 0.001).

Conclusion: Vestibular schwannoma induces degenerative changes in subcortical auditory pathways bilaterally; bilateral medial geniculate bodies and contralateral inferior colliculi being the epicenters of these changes. Primary auditory cortex attempts to reorganize and adjust to the loss of these subcortical inputs.

Background and purpose: Synthetic MRI utilizes the quantitative relaxometry parameters to generate multiple contrast images through a single acquisition. We tried to explore the utility of synthetic MRI derived relaxometry parameters in evaluation of ring enhancing lesions of brain.

Materials and methods: This was a prospective study. 40 subjects with ring enhancing lesions in brain underwent pre and post contrast synthetic MRI using MDME sequence. Pre and post contrast R1, R2 and PD values were recorded from the core, wall and perilesional edema of lesions and sub group analysis was done among infective, primary neoplastic and secondary neoplastic (metastatic) lesion groups.

Results: Pre and post contrast R1, R2 values from core were higher in the infective group compared to the others. Pre and post contrast R1, R2 values were lower in the wall where as it was significantly higher in the perilesional edema of primary neoplastic group. Post-pre the values increased significantly in the perilesional edema of primary neoplasms. R1 value of ≥ 0.689 and R2 value of ≥ 7.481 in the perilesional edema predicts a primary neoplasm over infection with 70.6% sensitivity and 85.7% specificity and over secondary neoplasm with 64.7% sensitivity and 100% specificity.

Conclusion: Synthetic MRI derived relaxometry parameters in ring enhancing lesions were found to be significantly different across sub groups and can be used to differentiate between primary neoplastic, secondary neoplastic and infective group with parameters from perilesional edema being the most useful.

Various space occupying lesions can arise in the orbit, ranging from developmental anomalies to malignancies, and many of the diseases occurring in children are different from the pathologies in the adult population. As the clinical presentation is frequently nonspecific, radiologic evaluation is essential for lesion detection and characterization as well as patient management. While orbital masses may in some cases involve multiple compartments, a simple compartmental approach is the key for the diagnosis on imaging studies, and MRI is the modality of choice. This pictorial review presents the most common and characteristic non-emergent pediatric orbital lesions, stressing their MRI and CT appearances, including specific differentiating features. The lesions are subdivided into 4 compartments: intraocular, intraconal, extraconal, and orbital walls. Retinoblastoma, Coats disease and persistent fetal vasculature; optic pathway glioma and lymphovascular malformations; rhabdomyosarcoma, infantile hemangioma, neurofibroma and lymphoma; neuroblastoma, leukemia/myeloid sarcoma, Langerhans cell histiocytosis and dermoid are reviewed in their respective compartments.

Purpose: Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by the narrowing of arteries at the brain's base. While cerebral angiography is the gold standard for diagnosis, high-resolution vessel wall magnetic resonance imaging (VW-MRI) has recently emerged as a non-invasive diagnostic tool. This systematic review aims to provide insights into the role of VW-MRI in enhancing the diagnosis and management of MMD.

Method: A systematic search was conducted in PubMed, Embase, Scopus, and Web of Science for relevant articles on December 5, 2023. Demographic data, the outer diameter of the vessel, vessel wall contrast enhancement (VW-CE) and its pattern, vessel wall thickening and its pattern, remodeling index, and vessel area were extracted. In the analysis proportions were pooled using a random-effects model with logit transformation where applicable. Quality assessment was conducted using the Newcastle-Ottawa scale.

Result: Of the 6035 identified studies in the primary search, 19 met the inclusion criteria. Among the reviewed studies, the most commonly reported variations in patients with MMD using VW-MRI was VW-CE (84.21%) and its pattern (52.63%). The pooled prevalence of enhanced lesions in MMD was 0.55 (95% CI: 0.29-0.79), with ratio of concentric lesions being 0.98 (95% CI: 0.72-1.00, I²: 37%). The remodeling index across three studies showed a pooled estimate of 0.41 (95% CI: 0.11-0.72, I²: 99%).

Discussion: VW-MRI emerges as a promising non-invasive tool for enhancing diagnosis of MMD, potentially aiding in disease differentiation and predicting complications. However, standardization and further research are essential to solidify VW-MRI's role.

Purpose: Patients with contralateral carotid artery occlusion (CCO) represent a subgroup of patients at risk for revascularization procedures. The choice of appropriate revascularization procedure (carotid endarterectomy (CEA) or carotid artery stenting (CAS)) in these patients is controversial. The aim of this study is to share the results of clinical and radiological follow-up after CAS in these patients and to contribute to the literature by evaluating the efficacy and safety of stenting.

Methods: In our study, the clinical and radiological data of 145 patients with CCO and 145 age-gender-matched patients without CCO who underwent elective CAS in the interventional neuroradiology clinic between 2001 and 2023 were retrospectively analyzed. A comparison was made between short- and long-term outcomes between the two groups.

Results: The overall technical success rate of CAS was 99.7% and the 30-day all-cause mortality rate was 1.4%. There was no statistically significant difference between the two groups in terms of early-term (intra-procedural thromboembolic events, post-procedural symptomatic hyperperfusion, intraparenchymal hemorrhage, major and minor ischemic stroke, early-term mortality rate) and long-term (intimal hyperplasia, residual stenosis, major and minor ischemic stroke and long-term all-cause mortality rate) (p > 0.05).

Conclusion: In our experience, it was concluded that CAS performed by an experienced interventional neuroradiology team in patients with CCO does not pose an additional risk. Since CCO poses a risk for CAE, CAS may be a more acceptable treatment modality in these patients due to less perioperative risk. However, further research is required to support our findings.

Purpose: In the 2016 WHO Classification of Lymphoid Tissue Neoplasms, co-expression of MYC and BCL2 is newly designated as double expressor lymphoma. Patients with primary central nervous system lymphoma with double expressor (DE-PCNSL) have been reported to have a higher risk of recurrence and a worse prognosis than those with PCNSL without double expressor (non-DE-PCNSL). The aim of this study was to determine whether DE-PCNSL has characteristic clinical and MR imaging features compared to non-DE-PCNSL.

Methods: This study included 36 immunocompetent patients with PCNSL, including 16 with double expressor and 20 without double expressor. The enhancement pattern and the values of apparent diffusion coefficient (ADC), relative cerebral blood volume (rCBV), leakage-corrected rCBV, and K2 at enhancing lesions were compared between the DE-PCNSL and non-DE-PCNSL groups. The mean and minimum values from the ROI on ADC maps were designated as ADC_mean and ADC_min, respectively. The data of rCBV, leakage-corrected rCBV and K2 were obtained from dynamic susceptibility contrast (DSC) perfusion MRI. The Kaplan-Meier method was used to estimate progression-free survival (PFS) differences.

Results: DE-PCNSL was significantly more common in women (12 of 16 patients, 75%) compared to non-DE-PCNSL (7 of 20 patients, 35%; P =.02). The rCBV ratio and leakage-corrected rCBV ratio were significantly lower in DE-PCNSL compared to non-DE-PCNSL (P =.02 and P =.03, respectively). There was no significant difference in the enhancement pattern and ADC_mean, ADC_min and K2 values between the two groups. DE-PCNSL tended to have a shorter PFS than non-DE-PCNSL, although the difference was not significant.

Conclusion: rCBV and leakage-corrected rCBV may help differentiate double-expressor from non-double-expressor subtypes in PCNSL.