Neuroradiology最新文献

Purpose: The aim of this study was to leverage fluorodeoxyglucose-positron emission tomography (FDG-PET) and blood oxygen level dependent-functional magnetic resonance imaging (BOLD-fMRI) to perform a comprehensive multi-modal analysis of metabolic alteration and individualized functional connectivity in Alzheimer's Disease (AD) and mild cognitive impairment (MCI) and characterize the relationship of these alterations with neurocognitive scores.

Methods: We analyzed data from 71 subjects, including those with AD, MCI and Health Control (HC), using FDG-PET and BOLD-fMRI acquired from Alzheimer's Disease Neuroimaging Initiative (ADNI). We examined network functional connectivities (FC) base on Independent Component Analysis (ICA), analyzed regional standardized uptake value ratios (SUVR) and their relationships with neurocognitive scores.

Results: Both AD and MCI showed metabolic and functional connectivity abnormalities in Default Mode Network (DMN) region. We also found abnormalities in the somatomotor system in AD, which may be an early predictive indicator of AD. In MCI, both metabolic and functional connectivity abnormalities appear in precuneus, and these two modes were closely related, indicating that the precuneus may be a core region in the transition of healthy individuals to MCI.

Conclusion: This study demonstrated that the individual brain network technology based on ICA, combined with the metabolic characteristics of FDG-PET, facilitates the development of personalized early diagnosis for AD/MCI, enhances our understanding of the underlying neuropathological mechanisms, and also promotes the development of interdisciplinary technologies.

Purpose: This study aimed to optimize three-dimensional real inversion recovery (3D-real IR) with T2 preparation (T2Prep) protocols to improve perilymphatic enhancement (PE) and endolymphatic hydrops (EH) detection.

Methods: Fifty-three consecutive participants with unilateral Ménière's disease were prospectively recruited. All participants underwent 3D-zoomed imaging technique with parallel transmission real IR (z-3D real IR), z-3D real IR with T2Prep (tz-3D real IR), and optimized tz-3D real IR (otz-3D real IR). Overall image quality, the separation of endolymph and perilymph and EH were scored/graded and compared among three 3D real IRs respectively. The signal intensity ratio (SIR), contrast to noise ratio (CNR), and signal to noise (SNR) were quantitatively calculated and compared among three 3D real IRs respectively.

Results: Tz-3D real IR was superior to z-3D real IR in overall image quality, SIR, SNR, and CNR (P < 0.017 for all), moreover, the vestibular EH detection of tz-3D real IR sequence were inferior to z-3D real IR (P = 0.005). On otz-3D real IR images, overall image quality, endolymph visualization, and the SIR and CNR significantly increased compared to those of the tz-3D real IR sequence and z-3D real IR sequence (P < 0.017 for all). Moreover, the cochlear and vestibular EH detection of otz-3D real IR sequence were significant superior to tz-3D real IR (P = 0.008 for both).

Conclusion: The optimized otz-3D real IR sequence, incorporating T2Prep, significantly improves PE and EH detection. These enhancements highlight its potential utility in clinical settings for accurate and timely diagnosis of EH.

Purpose: The Woven EndoBridge (WEB) device is an intrasaccular flow disruptor designed for the treatment of wide-neck intracranial bifurcation aneurysms. The purpose of this study was to evaluate various factors associated with clinical and angiographic outcomes following WEB treatment.

Methods: This multicenter, retrospective study analyzed 405 patients with 412 aneurysms treated with the WEB device across 22 neurovascular centers. Clinical and radiologic data were reviewed to identify factors influencing patients' clinical outcome and target aneurysmal occlusion at short-term (within 6 months) and long-term (beyond 1 year) follow-up. Occlusion status of target aneurysms was analyzed in relation to the various clinical and morphological factors. Outcomes were also compared based on institutional treatment volume.

Results: Centers with higher WEB treatment volumes (more than 30 cases) demonstrated lower thromboembolic events with sequelae (0.8% vs. 5.9%, p = 0.003). The rate of aneurysmal adequate occlusion, defined by Raymond-Roy occlusion class 1 and 2, increased from 70.2% at short-term (mean, 133 ± 42 days) to 83.2% at long-term (mean, 499 ± 134 days) follow-up (p = 0.003). Aneurysm diameter was inversely correlated with complete occlusion, with a 6-mm cutoff identified. Wide-neck aneurysms exhibited lower occlusion rates at short-term period, but this effect was not observed at later periods. Aneurysms at the basilar apex and internal carotid artery terminus demonstrated higher rates of complete occlusion (p = 0.046). Smoking acted as an inhibitor of long-term occlusion of target aneurysms.

Conclusion: Institutional experience appeared to play a role in reducing procedure-related thromboembolic complications. Aneurysmal diameter, neck width, location and patients' smoking status influenced angiographic outcomes.

Purpose: Traumatic brain injury (TBI) often leads to blood-brain barrier (BBB) disruption, contributing to secondary brain damage. Perfusion computed tomography (PCT) may assess BBB permeability through the transfer constant (K^trans), while serum S100 calcium-binding protein B (S100B) serves as a biomarker of BBB integrity. However, the relationship between PCT derived K^trans and serum S100B concentrations in TBI has not been fully explored.

Methods: This observational study included 26 adult patients with moderate or severe TBI. PCT was performed 12-24 h after admission to measure K^trans values in the pericontusional edema region. Serum S100B levels were measured at regular intervals during the first 36 h. Correlations between K^trans and S100B were analyzed using Spearman's rank correlation, and the predictive capacity of mean K^trans for serum S100B rise was evaluated using receiver operating characteristic (ROC) analysis.

Results: A significant positive correlation was found between both initial and peak serum S100B concentrations and mean K^trans (r_s = 0.52, p = 0.018 and r_s = 0.47, p = 0.029, respectively) and maximum K^trans values (r_s = 0.47, p = 0.029 and r_s = 0.56, p = 0.011, respectively). ROC analysis showed that mean K^trans values predicted serum S100B rise with AUC of 0,74 (CI 95%: 0.55, 0.91).

Conclusions: Our findings demonstrated a significant correlation between pericontusional K^trans values and serum S100B concentrations, with mean K^trans values showing potential as an early predictor for serum S100B rise. These findings suggest that combining PCT and serum biomarkers could improve assessment of BBB integrity and aid in the management of TBI.

Purpose: This study aims to investigate microstructural changes in the corpus callosum (CC) of multiple sclerosis (MS) patients using texture analysis (TA), even in the absence of visible lesions on conventional MRI, and to assess its diagnostic value in distinguishing patients from healthy controls.

Methods: A retrospective analysis was conducted on midsagittal T2-weighted MRI scans of 54 MS patients without CC lesions and 50 healthy controls. Histogram-based texture analysis was performed using MATLAB software, and statistical evaluations were conducted with SPSS version 25. Texture parameters were compared between groups, and a logistic regression model was developed to predict MS diagnosis. Given that our study involves a retrospective radiology analysis, obtaining consent forms is not necessary.

Results: Statistically significant differences were found between MS patients and controls in most histogram-derived texture features, including mean, median, standard deviation, and multiple percentiles (p < 0.001). The logistic regression model incorporating selected parameters achieved a diagnostic accuracy of 94.23%, successfully identifying patients with MS despite the absence of radiologically visible lesions.

Conclusion: Texture analysis of the CC can detect subtle tissue changes in MS patients, offering a promising, non-invasive method for early diagnosis. These findings highlight the potential of TA as a complementary imaging tool in MS diagnostics and warrant further research in larger populations.

Purpose: This study aimed to identify predictive factors for incomplete occlusion in posterior communicating artery (PCoA) aneurysms after endovascular treatment (EVT) and investigate the role of fetal-type posterior cerebral artery (fPCA) in occlusion outcomes using quantitative digital subtraction angiography (QDSA).

Methods: We analyzed 287 patients with 292 PCoA aneurysms treated with EVT between 2016 and 2022. Aneurysms were categorized into incomplete (n = 49) and complete (n = 243) occlusion groups based on follow-up DSA. Clinical, morphological, and hemodynamic parameters from QDSA were compared, and independent risk factors were identified via multivariate logistic regression. Predictive performance was evaluated using area under the curve (AUC) and subgroup analysis with Benjamini-Hochberg correction for fPCA effects.

Results: Independent risk factors for incomplete occlusion included size (p < 0.001, OR = 1.127), neck cerebral blood flow (CBF) (p = 0.001, OR = 4.024), simple coiling (p < 0.001, OR = 4.635), ruptured status (p = 0.002, OR = 3.281), and fPCA (p = 0.030, OR = 2.218). AUCs for the combined model, size, neck CBF, simple coiling, ruptured status, and fPCA were 0.822, 0.721, 0.708, 0.656, and 0.603, respectively. In the fPCA subgroup, ruptured status, neck CBF, neck cerebral blood volume (CBV), PCoA CBF, and PCoA CBV showed significance, while in the non-fPCA subgroup, only simple coiling and size remained significant.

Conclusion: Size, neck CBF, simple coiling, ruptured status, and fPCA are independent risk factors for incomplete occlusion in PCoA aneurysms treated with EVT. fPCA likely influences incomplete occlusion through hemodynamic changes.

Objective: Determining the best-performing corticospinal tract (CST) tractography pipelines based on the experts score for patients with four types of edema degree and tumor locations.

Materials and methods: Twenty-three patients were stratified into four groups based on tumor location and edema degree: tumors near the precentral cortex without edema, tumors near the precentral cortex with edema, tumors located deep without edema, and tumors located deep with edema. The dataset included 13 males and 10 females, with an average age of 51.04 ± 14.50 years. Diffusion MRI data (b = 1,000 s/mm², 15 directions) were used. Five tractography pipelines were compared: SD-Stream, iFOD2, DSIstudio, TractSeg, and UKF-2T. Three clinical experts evaluate the quality of tractograms based on anatomical expert judgment. Then, quantitative anatomical measures CST gray matter coverage, volume, false-positive streamlines, and reconstruction rate are calculated to provide additional support for expert judgment.

Results: TractSeg performed best for tumors without edema, achieving the highest expert score. UKF-2T and DSIstudio obtained the highest expert score when tumors with edema near the precentral cortex, and tumors located in deep brain, respectively. Quantitative results showed minimal interhemispheric differences in gray matter coverage for DSIstudio and UKF-2T, with slightly higher values on the healthy side. UKF-2T exhibited the highest CST volume. TractSeg generated the lowest false-positive streamlines.

Conclusions: Different tumor locations and edema degrees require specific tractography pipelines. TractSeg is optimal for tumors without edema, while UKF-2T and DSIstudio are superior for tumors with edema.

Purpose: Recent randomized trials showed neutral results for distal medium vessel occlusion (DMVO) thrombectomy, but real-world effectiveness across diverse healthcare settings remains unknown. We evaluated DMVO thrombectomy outcomes in the Middle East and North Africa (MENA) region.

Methods: The MEMENTO registry retrospectively analyzed consecutive DMVO thrombectomy patients (M2, M3, A2-3, P2-3 segments) across 15 centers (2022-2024). DMVOs were classified as primary, baseline secondary, or iatrogenic secondary. Primary outcome was 90-day functional independence (mRS 0-2). Secondary outcomes included successful recanalization (TICI ≥ 2b), mortality, and symptomatic hemorrhage.

Results: Among 164 patients (median age 72, NIHSS 10), subtypes included primary (25%), baseline secondary (50%), and iatrogenic secondary (25%) DMVOs. Overall successful recanalization was 69%, with primary DMVOs achieving higher rates than baseline secondary (78% vs. 59%, p = 0.046). Good functional outcome occurred in 54% overall, with no significant differences between subtypes (primary 59%, baseline secondary 51%, iatrogenic secondary 54%, p = 0.661). Stent retriever achieved highest recanalization (85%) followed by combination (74%) and aspiration (45%, p = 0.046). Independent predictors of poor outcome included age > 75 (aOR 2.34, 95% CI 1.18-4.64), NIHSS > 15 (aOR 3.12, 95% CI 1.45-6.71), and unsuccessful recanalization (aOR 4.89, 95% CI 2.31-10.35). Cost-effectiveness analysis across MENA income levels yielded ICERs of $26,875-$71,333/QALY, exceeding regional GDP thresholds. The modest numerical difference in outcomes (54% vs. 45% historical controls) does not establish clinical benefit given neutral randomized trial results.

Conclusions: Real-world DMVO thrombectomy outcomes closely mirror recent randomized trial results showing limited clinical benefit compared to medical management across diverse healthcare settings, with prohibitive economic costs that challenge routine implementation. These findings support highly selective application focusing on younger patients with moderate deficits and primary occlusions.

Objective: To compare short (TR = 7000 ms) and long (TR = 10000 ms) repetition time 3D-real inversion recovery (IR) sequences with 3D-FLAIR MRI in terms of image quality and diagnostic performance for evaluating endolymphatic hydrops (EH) after a single intravenous dose of gadobutrol in patients with unilateral Ménière's disease.

Materials and methods: Thirty-seven patients with definite unilateral Ménière's disease underwent inner ear MRI 4 h after administration of gadobutrol (0.1 mmol/kg). Each patient was scanned using 3D-real IR sequences with two different TR values (7000 ms and 10000 ms), as well as a conventional 3D-FLAIR sequence. Quantitative image analysis included contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR), while qualitative scoring and inter-/intra-observer agreement were also assessed.

Results: The short TR (7000 ms) 3D-real IR sequence failed to demonstrate adequate perilymphatic enhancement in most cases. In contrast, both the long TR (10000 ms) 3D-real IR and 3D-FLAIR sequences consistently visualized perilymphatic enhancement and EH. The TR = 10,000 ms sequence provided significantly higher image quality metrics (CNR and SNR, P < 0.001), particularly improving detection in the cochlear apex. It also showed better inter-observer agreement than 3D-FLAIR.

Conclusion: The 3D-real IR sequence with a TR of 10,000 ms offers superior image quality and enhanced diagnostic confidence for EH evaluation compared to both the shorter TR sequence and conventional 3D-FLAIR. These findings support the use of a longer TR protocol for inner ear MRI following single-dose gadolinium administration in clinical settings.