Neuroradiology Journal最新文献

Background: The Silk Vista Baby (SVB) flow diverter (FD) is a stent designed for small vessels ranging from 1.5 to 3.5 mm. It is the only FD deliverable through a 0.017-inch microcatheter. This systematic review and meta-analysis aimed to assess the SVB utilization in intracranial aneurysms (IAs).

Methods: Four electronic databases, PubMed, Scopus, Embase, and Web of Science, were searched from inception to November 5^th, 2024.

Results: Ten studies with 359 patients with 373 IAs were included. Our results revealed a pooled complete occlusion rate of 65% (95%CI: 43%-83%), a favorable outcome rate of 94% (95%CI: 83%-100%), and a morbidity rate of 4% (95%CI: 0%-11%). Our meta-analysis revealed a pooled in-stent thrombosis rate of 2% (95%CI: 1%-5%), side branch occlusion rate of 2% (95%CI: 0%-3%), intracerebral hemorrhage (ICH) rate of 2% (95%CI: 1%-4%), and device shortening rate of 4% (95%CI: 3%-6%). The subgroup analysis showed that the complete occlusion rate (≤6: 84% [95%CI: 49%-100%] vs >6: 58% [95%CI: 41%-73%], p < .001) was higher in studies with 6-month or lower follow-up duration, and the favorable outcome rate was higher in those with greater than 6-month duration (≤6: 84% [95%CI: 73%-93%] vs >6: 97% [95%CI: 82%-100%], p < .001).

Conclusion: SVB is an efficient and safe therapeutic option for managing IAs. We demonstrated that it is associated with promising clinical and radiological outcomes and low rates of complications.

Background: Paediatric neuro-interventional (PNI) procedures are markedly different to adult procedures and are more likely to be complicated by vasospasm. Traversing the complex tortuous anatomy in these fragile vessels requires both torque control and distal tip softness of the microwire. The Aristotle wires (Scientia Vascular Inc) are a new family of wires with design features offering both torque control and distal tip softness. We sought to assess the ability of these wires to achieve successful target vessel cannulation in paediatric patients.

Methods: The study design was a single-centre case-control study. We compared a case cohort of PNI procedures performed using the Aristotle wires (2023-24) with a control cohort using other wires (2022-23). The primary study outcome was successful cannulation of the target vessel (Yes/No) with a microcatheter.

Results: The Aristotle wires cohort consisted of 44 targeted vessels across 40 procedures in 20 patients (F = 8; mean age 6.9, SD 6.53 years). The other wires cohort consisted of 41 targeted vessels across 41 procedures in 19 patients (F = 6; mean age 4.3, SD 4.98 years). Successful cannulation of the target vessel was achieved in 43 of 44 target vessels (97.7%) in the Aristotle wires cohort and 34 of 41 target vessels (82.9%) in the other wires cohort (p = .020). The rate of wire-related complications was significantly lower in the Aristotle wires cohort (0 of 44 vs 6 of 41 target vessels, p = .008).

Conclusion: Aristotle wires were associated with significantly better target vessel cannulation and lower wire-related complications than other wires in PNI procedures.

Objective: To present and analyze the characteristics of the 100 most cited articles that used cerebral angiography for clinical evaluation and intervention.

Method: Two researchers independently extracted articles from multiple databases and ranked them by citation count to create the "top 100 most-cited" list.

Results: The top 100 articles received a total of 115,243 citations. Twenty-one of the top 100 articles were published between 2006 and 2010. Most studied disorder was ischemic stroke (n = 35), and cerebral angiography was used most frequently for diagnosis (n = 88).The United States was affiliated with the highest number of articles (n = 62), with Stroke publishing most articles (n = 22). Public sources funded 39 articles, private sources funded 35, and 38 articles reported conflicts of interest. Thirty-six studies were randomized controlled trials, and male authors held the majority of both first (n = 90) and senior (n = 88) authorship positions.

Conclusion: Within the scope of this study, the following features may define a typical highly cited article-a randomized controlled clinical trial conducted in the United States that studied ischemic stroke, used cerebral angiography for diagnosis, and was published relatively recently in a high-impact journal by male first and senior authors.

Purpose: Synthetic MRI has potential to significantly reduce MR scan time by reconstructing multiple contrast images from a single acquisition. The aim of this study was to compare the image quality of both pre- and post-contrast synthetic MRI in subjects with ring-enhancing brain lesions with conventional images.

Methods: 50 patients with radiologically confirmed ring-enhancing brain lesions underwent TSE_MDME sequence before and after gadolinium administration along with conventional MRI sequences. Image quality was compared between synthetic and conventional sequences on a 4-point scale across 5 parameters, that is, grey white matter differentiation, demarcation of caudate nucleus, lentiform nucleus, demarcation of sulci, and SNR. Also, the artefacts, lesion conspicuity, and ability to diagnose on synthetic images were studied.

Results: Image quality of synthetic MRI was relatively similar across all sequences except for FLAIR. The image quality comparison between synthetic and conventional images showed an agreement in 70.7% of the cases (Weighted Kappa = 0.043, p = <0.001). Artefacts were maximum in synthetic FLAIR sequence (52%). 50% cases showed a discordant enhancement pattern in post contrast synthetic images. Despite a higher occurrence of artefacts in synthetic post contrast images, diagnostic ability was comparable across pre- and post-contrast synthetic and conventional images.

Conclusion: Synthetic MRI provides comparable diagnostic quality of images with acceptable rate of artefacts in both pre and post contrast sequences. However, needs a careful interpretation especially when diagnosis is heavily relied on the enhancement pattern of lesions.

Introduction: Brain tumors pose significant diagnostic and therapeutic challenges due to their diverse treatment responses and complex imaging characteristics. Traditional MRI techniques often struggle to differentiate between tumor recurrence and post-treatment changes such as pseudoprogression and necrosis, highlighting the need for more accurate diagnostic tools.

Material and methods: This retrospective study conducted at a single tertiary care center and evaluated the diagnostic efficacy of Treatment Response Assessment Maps (TRAMs), also known as Contrast Clearance Analysis (CCA), in distinguishing between tumor recurrence and post-treatment changes in patients who underwent initial treatment for brain tumors. Data from 27 patients were analyzed, including 10 who underwent surgical resection (Group 1) and 17 who had serial images and TRAMs/CCA assessment (Group 2).

Result: In Group 1, TRAMs/CCA demonstrated nine positive results, with 8 cases of tumor recurrence confirmed via biopsy. A biopsy also confirmed one negative result after a discussion with the patient. In Group 2, where patients did not undergo biopsy, TRAMs/CCA results varied but correlated with clinical outcomes, underscoring the potential utility of TRAMs/CCA in guiding treatment decisions. These findings suggest that TRAMs/CCA may have superior diagnostic performance compared to traditional MRI in differentiating between tumors.

Conclusion: TRAMs/CCA represents a promising advancement in the imaging assessment of brain tumor treatment response, offering higher sensitivity than conventional MRI methods. While implementing TRAMs/CCA could potentially improve diagnostic accuracy and optimize therapeutic strategies for patients with brain tumors, the final decision remains highly dependent on patient-centered discussions.

Dural arteriovenous fistulas (dAVFs) are a type of vascular malformation that form within the dura mater. Though historically considered rare, their detection is expected to increase with the broader use of advanced cerebral angiography techniques. We describe two 80-year-old men presented for neurovascular procedures. The first, following an emergency craniotomy for subdural hematoma (SDH) evacuation, underwent middle meningeal artery embolization (MMAE). During the procedure, an incidental, asymptomatic middle meningeal artery and superficial temporal artery to superior sagittal sinus (MMA/STA-SSS) dAVF was identified ipsilateral to the original surgical site. Given the fistula's low-risk nature, a conservative, watchful waiting approach was chosen. The second patient, undergoing digital subtraction angiography (DSA) for subarachnoid hemorrhage (SAH), was found to have an MMA-fed dAVF. Due to the unclear causality of this fistula with the concurrent SAH and subdural hematoma (SDH), MMAE was performed to treat the dAVF. With the increasing use of cerebral angiography techniques such as MMAE and DSA for a broader range of indications, the incidence of incidentally and unexpectedly discovered dAVFs is expected to increase. Clinicians should become well-versed in recognizing this condition, treatment indications, and the various management options available, including endovascular embolization, radiosurgery, microsurgery, and serial monitoring.

The purpose of this study was to identify the anatomical variants (AVs) in the intracranial arterial circulation of patients who underwent neuro-interventional procedures (NIPs) and to describe their relationship with intracranial aneurysms (IA). We performed a cross-sectional analysis of angiographic images from patients who underwent NIP at the Interventional Neuroradiology Department of the National Institute of Neurology and Neurosurgery in México between July 1, 2020, and January 1, 2022. After reviewing images from 150 NIPs, we found 144 AVs., yielding a prevalence of 81%. Of these, 49 AVs (34%) were located in the anterior circulation (AC) and 95 (66%) in the posterior circulation (PC); 23 NIPs (16%) showed AVs in both the AC and PC. The most frequent AVs were the fetal pattern of the posterior cerebral artery (19%) and hypoplasia of the A1 segment (12%). AVs were significantly more common in patients with neurovascular disorders than those without (80% vs 49%, p = .003) and in patients with IA compared to those without (68% vs 47%, p = .048). In the studied population, AVs were predominantly located in the PC and are significantly more frequent in patients with neurovascular disorders, particularly those with IA.

Background: The optimal endovascular approach for tandem lesions (extracranial internal carotid artery and intracranial large vessel occlusion) is not clear. Aims: The aim was to evaluate the follow-up results of stroke patients with tandem lesions who underwent emergent stenting of extracranial lesions with antithrombotic therapy combined with intracranial MT.

Methods: Outcomes and predictors of poor prognosis and mortality compared with those of good prognosis at 90 days, 1 year, and 2 years were assessed. A modified Rankin scale (mRS) score was used. Symptomatic intracranial hemorrhage (sICH), National Institutes of Health Stroke Scale (NIHSS) scores at admission and at 24 h, successful recanalization, asymptomatic ICH, embolization, malignant infarction, decompression, in-stent restenosis and extracranial complications were also evaluated. The best age cutoff for predicting mortality was analyzed.

Results: A total of 71 subjects were included. Using patients with a good prognosis as a reference, the independent variables predicting a poor prognosis were a high 24-h NIHSS score and extracranial complications at all timepoints (3-month, 1-year, and 2-year follow-up). The most appropriate age cutoff for predicting 1-year mortality was 67 years [AUC = 0.802 (95% CI = 0.684-0.920); p < .001]. The age cutoff determined for the first year was correlated with the prediction of mortality in the third month and the second year. No significant association was observed between sICH and the groups.

Conclusion: In this study, the 24-h NIHSS score after reperfusion and age were predictors of poor prognosis and mortality in stroke patients with tandem lesions who underwent emergent stenting during thrombectomy.

Changes in ventricular size, related to brain edema and hydrocephalus, as well as the extent of hemorrhage are associated with adverse outcomes in patients with subarachnoid hemorrhage (SAH). Frequently, these are measured manually using consecutive non-contrast computed tomography scans. Here, we developed a rule-based approach which incorporates both intensity and spatial normalization and utilizes user-defined thresholds and anatomical templates to segment both lateral ventricle (LV) and SAH blood volumes automatically from CT images. The algorithmic segmentations were evaluated against two expert neuroradiologists on representative slices from 20 admission scans from aneurysmal SAH patients. Previous methods have been developed to automate this time-consuming task, but they lack user feedback and are hard to implement due to large-scale data and complex design processes. Our results using automatic ventricular segmentation aligned well with expert reviewers with a median Dice coefficient of 0.81, AUC of 0.91, sensitivity of 81%, and precision of 84%. Automatic segmentation of SAH blood was most reliable near the base of the brain with a median Dice coefficient of 0.51, an AUC of 0.75, precision of 68%, and sensitivity of 50%. Ultimately, we developed a rule-based method that is easily adaptable through user feedback, generates spatially normalized segmentations that are comparable regardless of brain morphology or acquisition conditions, and automatically segments LV with good overall reliability and basal SAH blood with good precision. Our approach could benefit longitudinal studies in patients with SAH by streamlining assessment of edema and hydrocephalus progression, as well as blood resorption.

Objective: The objective is to report our experience of transarterial embolization of sinus dural arteriovenous fistula (DAVF) using non-adhesive liquid embolic material.Materials and methods: In 3 cases of Borden type II sinus DAVFs, a Copernic balloon was used to protect sagittal sinus in one patient, palliative Onyx embolization was performed to protect transverse sinus in one patient and EVAL/DMSO/ethanol mixture (EVAL, SUCCESS, Shandong, China) was used in the last patient.Results: Two Borden type II DAVFs were changed into type I DAVF and one was cured. The dural sinus was patent after successful Onyx embolization in 3 cases resulting in well patient recovery. There were no treatment-related events.Conclusion: Transarterial embolization of sinus DAVF using non-adhesive liquid embolic material could be effective and safe with sinus protection techniques.