Neuroradiology最新文献

Objective: Young migraine patients often present with white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI). This study aimed to analyze whether synthetic (Syn) T2-FLAIR and Syn double inversion recovery (DIR) can reveal WMHs more clearly and sensitively than conventional T2-FLAIR.

Materials and methods: Conventional MRI and Syn MRI data from 50 young migraine patients were analyzed prospectively. WMHs in each anatomical region (periventricular, deep white matter, and juxtacortical) were recorded separately. The differences in the clarity of lesion boundaries and the number of lesions displayed in the three sequences in the same anatomical region were analyzed.

Results: A total of 80 (periventricular area, 15; deep white matter, 31; juxtacortical area, 34), 163 (17, 50, 96), and 134 (18, 42, 74) lesions were observed with conventional T2-FLAIR, Syn T2-FLAIR, and Syn DIR, respectively. Syn T2-FLAIR and Syn DIR can show lesions more clearly than conventional T2-FLAIR (all P < 0.001). There was no significant difference in the number of lesions observed in the periventricular white matter among the three sequences (P = 0.159, 0.083, 0.322). Syn T2-FLAIR and Syn DIR can detect more lesions in the deep white matter than conventional T2-FLAIR (P < 0.001, P = 0.006). Syn T2-FLAIR revealed more lesions in the juxtacortical white matter than Syn DIR and conventional T2-FLAIR imaging (all P < 0.001), and conventional T2-FLAIR revealed the fewest lesions (P < 0.001).

Conclusion: Syn T2-FLAIR and Syn DIR sequences can clearly and sensitively detect WMHs, especially in deep and juxtacortical white matter areas.

Purpose: Various angiographic assessment scales have been used to report the results of endovascular treatment with the WEB device. We aimed to review the use and reliability of these scales.

Methods: We systematically reviewed studies reporting angiographic outcomes of WEB-treated aneurysms from January 2010 to May 2023. We identified the studies that reported the reliability of the various scales. Data from eligible studies were extracted and evaluated by two independent reviewers, with discrepancies resolved by a third reviewer.

Findings: The review identified 138 studies that used 12 different occlusion scales. The non-specific Raymond-Roy occlusion classification (RROC) was most commonly used (94/138 (68%)), followed by the Bicêtre Occlusion Scale Score (BOSS; 21/138 (15%)) and the Web Occlusion Scale (WOS; 16/138 (12%)), both specifically adapted to the WEB. Six reliability studies were identified, which included 16-30 cases evaluated by few (2-7) raters. Studies were too heterogenous to proceed with a meta-analysis. Substantial agreement in reporting angiographic results was shown in one study using the WOS (K = 0.70; 0.64-0.75), and one using the BOSS (K = 0.82; 0.68-0.96), but only when categories were dichotomized as complete versus incomplete occlusion. Most classifications can be translated into the RROC, allowing comparisons with other devices and treatment modalities. The RROC reached substantial agreement, but only between 2 raters in a small 26-patient study (k = 0.69; 0.46-0.93).

Conclusion: More agreement studies are needed to validate the reliability of angiographic outcome scales that can be used to compare WEB with other endovascular or surgical treatments.

Introduction: Mechanical thrombectomy (MT) efficacy in medium vessel occlusion (MeVO) stroke, particularly in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS), remains less explored.

Methods: This retrospective study analyzed data from 443 AIS patients treated with MT for MeVO and low ASPECTS (4-7) at 37 centers across North America, Asia, and Europe, from September 2017 to July 2021. Patients were categorized into ASPECTS of 4-5 and 6-7.

Results: Of 443 patients, 51 (12%) had ASPECTS of 4-5, and 392 (88%) had scores of 6-7. The median age was 65 years (IQR: 46-79), with a balanced sex distribution between the groups. The most common site of initial occlusion was M2 branch in both groups (92% in ASPECTS 4-5 and 85% in ASPECTS 6-7) (p = 0.68). The ASPECTS 4-5 group had lower TICI 2c-3 achievement (31% vs. 55%, p = 0.002) and poorer functional outcomes (mRS 0-1 at 90 days: 12% vs. 29%, p = 0.03) compared to the ASPECTS 6-7 group. Intracranial hemorrhagic complications were higher in the ASPECTS 4-5 group (69% vs. 47%, p = 0.007). Multivariable analysis revealed ASPECTS 6-7 to be associated with higher odds of TICI 2c-3 (OR: 2.5; CI: 1.28 to 4.89, p = 0.007) and lower odds of intracranial hemorrhagic complications (OR: 0.4; CI: 0.19 to 0.81, p = 0.012).

Conclusion: MT may be associated with improved outcomes in patients with moderate-to-low ASPECTS (6-7), though the lack of a control group limits definitive conclusions about its effectiveness. In patients with very low ASPECTS (4-5), higher rates of hemorrhagic complications and poorer outcomes were observed, but this does not necessarily preclude the use of MT. These findings highlight the need for further research and careful patient selection.

Purpose: The time-intensive nature of acquiring 3D T1-weighted MRI and analyzing brain volumetry limits quantitative evaluation of brain atrophy. We explore the feasibility and reliability of deep learning-based accelerated MRI scans for brain volumetry.

Methods: This retrospective study collected 3D T1-weighted data using 3T from 42 participants for the simulated acceleration dataset and 48 for the validation dataset. The simulated acceleration dataset consists of three sets at different simulated acceleration levels (Simul-Accel) corresponding to level 1 (65% undersampling), 2 (70%), and 3 (75%). These images were then subjected to deep learning-based reconstruction (Simul-Accel-DL). Conventional images (Conv) without acceleration and DL were set as the reference. In the validation dataset, DICOM images were collected from Conv and accelerated scan with DL-based reconstruction (Accel-DL). The image quality of Simul-Accel-DL was evaluated using quantitative error metrics. Volumetric measurements were evaluated using intraclass correlation coefficients (ICCs) and linear regression analysis in both datasets. The volumes were estimated by two software, NeuroQuant and DeepBrain.

Results: Simul-Accel-DL across all acceleration levels revealed comparable or better error metrics than Simul-Accel. In the simulated acceleration dataset, ICCs between Conv and Simul-Accel-DL in all ROIs exceeded 0.90 for volumes and 0.77 for normative percentiles at all acceleration levels. In the validation dataset, ICCs for volumes > 0.96, ICCs for normative percentiles > 0.89, and R² > 0.93 at all ROIs except pallidum demonstrated good agreement in both software.

Conclusion: DL-based reconstruction achieves clinical feasibility of 3D T1 brain volumetric MRI by up to 75% acceleration relative to full-sampled acquisition.

Purpose: Although dopamine transporter (DAT) imaging has been reported to be useful for differentiating idiopathic Normal Pressure Hydrocephalus (iNPH) from its mimics, the radiological findings of DAT imaging in iNPH have not been established. We investigated [¹²³I] N-ω-fluoropropyl-2β-carboxymethoxy-3β-(4-iodophenyl) nortropane (FP-CIT) single photon emission computed tomography (SPECT) images from patients with disproportionately enlarged subarachnoid-space hydrocephalus (DESH)-type iNPH to understand the characteristics of DAT images of iNPH.

Methods: We retrospectively collected 11 DESH-type iNPH patients without comorbidities who underwent FP-CIT SPECT imaging. The patients' FP-CIT SPECT were examined using both visual and quantitative evaluations. Visual assessment used Kahraman et al.'s five-step grading, and quantitative assessment used DaTView and MIM software to calculate specific binding ratios (SBRs) for four volumes of interest (VOIs): the entire striatum, caudate nucleus, anterior putamen, and posterior putamen. Intergroup comparisons were made between the DESH group and a normal control (NC) group adjusted for age and sex.

Results: The visual assessment classified 91% of DESH patients as showing grade 4 'eagle-wing' on FP-CIT SPECT, with a Kappa coefficient of 0.601. The median SBR was lower in the DESH group than in the NC group for all four VOIs, and significantly lower in the anterior and posterior putamen (p < 0.05).

Conclusion: In DESH-type iNPH, FP-CIT SPECT imaging typically shows the 'eagle-wing' finding due to decreased DAT concentration in the putamen. Our results enhance the utility of FP-CIT SPECT in diagnosing iNPH and distinguishing it from mimics.

Purpose: To develop an end-to-end DL model for automated classification of affected territory in DWI of stroke patients.

Materials and methods: In this retrospective multicenter study, brain DWI studies from January 2017 to April 2020 from Center 1, from June 2020 to December 2020 from Center 2, and from November 2019 to April 2020 from Center 3 were included. Four radiologists labeled images into five classes: anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior circulation (PC), and watershed (WS) regions, as well as normal images. Additionally, for Center 1, clinical information was encoded as a domain knowledge vector to incorporate into image embeddings. 3D convolutional neural network (CNN) and attention gate integrated versions for direct 3D encoding, long short-term memory (LSTM-CNN), and time-distributed layer for slice-based encoding were employed. Balanced classification accuracy, macro averaged f1 score, AUC, and interrater Cohen's kappa were calculated.

Results: Overall, 624 DWI MRIs from 3 centers were utilized (mean age, interval: 66.89 years, 29-95 years; 345 male) with 439 patients in the training, 103 in the validation, and 82 in the test sets. The best model was a slice-based parallel encoding model with 0.88 balanced accuracy, 0.80 macro-f1 score, and an AUC of 0.98. Clinical domain knowledge integration improved the performance with 0.93 best overall accuracy with parallel stream model embeddings and support vector machine classifiers. The mean kappa value for interrater agreement was 0.87.

Conclusion: Developed end-to-end deep learning models performed well in classifying affected regions from stroke in DWI.

Clinical relevance statement: The end-to-end deep learning model with a parallel stream encoding strategy for classifying stroke regions in DWI has performed comparably with radiologists.

Purpose: This study aimed to classify medullary bridging vein-draining dural arteriovenous fistulas (MBV-DAVFs) located around the foramen magnum (FM) according to their location and characterize their angioarchitecture and treatment outcomes.

Methods: Patients with MBV-DAVFs diagnosed between January 2013 and October 2022 were included. MBV-DAVFs were classified into four groups. Jugular vein-bridging vein (JV-BV) DAVF: located in proximity to jugular fossa, Anterior condylar vein (ACV)-BV DAVF: proximity to anterior condylar canal, Marginal sinus (MS)-BV DAVF: lateral surface of FM and Suboccipital cavernous sinus (SCS)-BV DAVF: proximity to dural penetration of vertebral artery.

Results: Twenty patients were included, three JV-BV, four ACV-BV, three MS-BV and ten SCS-BV DAVFs, respectively. All groups showed male predominance. There were significant differences in main feeders between JV (jugular branch of ascending pharyngeal artery) and SCS group (C1 dural branch). Pial feeders from anterior spinal artery (ASA) or lateral spinal artery (LSA) were visualized in four SCS and one MS group. Drainage pattern did not differ between groups. Transarterial embolization (TAE) was performed in three, two, one and two cases and complete obliteration was obtained in 100%, 50%, 100% and 0% in JV, ACS, MS and SCS group, respectively. Successful interventions without major complications were finally obtained in 100%, 75%, 100%, and 40% in JV, ACS, MS and SCS group, respectively.

Conclusion: JV-BV DAVFs were successfully treated using TAE alone. SCS-BV DAVFs were mainly fed by small C1 dural branches of vertebral artery often with pial feeders from ASA or LSA, and difficultly treated by TAE alone.

Radial artery occlusion (RAO) is a relatively common but benign complication following transradial endovascular approaches. Radial artery thrombectomy offers a potential strategy for re-access. Transradial access in the occluded vessel has been described as safe and feasible in recent literature; however, the step-by-step technical details have not been defined. This illustrative case highlights the technique developed at this institution, which has been performed in 7 consecutive patients. A middle-aged woman underwent initial diagnostic cerebral angiogram and balloon-occlusion test for tumor resection planning. Subsequently, the patient returned to for tumor embolization and was found to have RAO. Radial artery mechanical thrombectomy was performed, and this access was safely used for the embolization procedure.This report provides a technical description with illustrations for this approach in the setting of an acute occlusion following prior radial artery catheterizations. Recanalization of an acutely occluded radial artery is feasible and safe in our institutional experience.

Background: The aim of this study was to investigate the dynamics of annual whole brain volume loss (BVL/year) and annual thalamic volume loss (ThalaVL/year) in patients with relapsing-remitting multiple sclerosis (PwRRMS) during the course of the disease.

Methods: A longitudinal database of magnetic resonance imaging (MRI) scans of 195 healthy individuals (age range, 22.8-63.7 years) and longitudinal MRI data of 256 PwRRMS (age range, 20.1-60.8 years) were analyzed and compared. BVL/year and ThalaVL/year were computed for healthy individuals as well as for all patients with MS using a Jacobian integration approach. A linear regression was used to compute the relationship between age and BVL/year and ThalaVL/year for healthy individuals. The linear regression was then used to decompose the BVL/year and ThalaVL/year into a multiple sclerosis (MS)-related and an age-related component for each PwRRMS. PwRRMS were dichotomized into early-phase RRMS (disease duration ≤ 6 years) and later-phase RRMS (disease duration > 6 years), and a t-test was performed to test for differences between these groups.

Results: The 135 early-phase patients (disease duration, ≤ 6 years) had statistically significantly higher MS-related BVL/year than the later-phase patients (n = 121) (- 0.21% vs. - 0.06%, p = 0.007). For MS-related ThalaVL/year, the difference between the groups was even more pronounced (- 0.39% vs. - 0.00%, p < 0.0001).

Conclusions: Our results indicate that in PwRRMS, the MS-related components of BVL/year and ThalaVL/year are accelerated in early phases and slowdown in later phases of the disease. This might explain why early intervention often leads to improved outcomes in patients with MS.