Neuroradiology Journal最新文献

Parkinson's disease (PD) is a chronic progressive neurodegenerative disorder characterized by tremors, rigidity, and bradykinesia. This is primarily attributed to loss of nigrostriatal dopaminergic neurons to varying degrees. Many conditions that present similar classic motor symptoms of PD, known as atypical parkinsonian syndromes (APS), have also been identified. These encompass multiple system atrophy (MSA), progressive supranuclear palsy (PSP), dementia with Lewy bodies (DLB), and corticobasal degeneration (CBD). On the other hand, causes of non-neurodegenerative parkinsonism include vascular parkinsonism, drug-induced parkinsonism, and essential tremors. Neuroimaging plays a significant role in discriminating PD from its mimics which may represent a significant challenge in clinical practice. This article aims to review recent developments in imaging technologies, particularly magnetic resonance imaging (MRI) and nuclear medicine imaging techniques, that have the potential to unravel characteristic morphological and metabolic changes in the brain and would aid in the early diagnosis of PD and its differentiation from its potential mimickers.Learning objectivesTo identify the peculiar structural imaging features of atypical parkinsonian syndromes and recognize the role of the current state-of-the-art neuroimaging modalities (particularly MRI and nuclear medicine techniques) in discriminating Parkinson's disease from its mimics.

The optimal treatment strategy for isolated internal carotid artery occlusion (IICAO) presenting as acute ischemic stroke (AIS) remains uncertain because these patients were largely excluded from pivotal thrombectomy trials. We compared endovascular treatment (EVT) with best medical treatment (BMT) for IICAO, assessing functional independence, mortality, and safety, and explored outcomes by occlusion site (cervical vs intracranial). Following PRISMA guidelines (PROSPERO CRD420251004624), PubMed, Embase, and Cochrane Library were searched through September 2025. Eligible studies enrolled adults with IICAO treated with EVT or BMT and reported ≥1 predefined outcome: modified Rankin Scale (mRS) 0-2 at 90 days, 90-day mortality, or symptomatic intracranial hemorrhage (sICH). Data were pooled using Mantel-Haenszel random-effects models, reporting odds ratios (ORs) with 95% confidence intervals (CIs). Risk of bias was assessed with ROBINS-I. Five studies including 1531 patients (878 EVT; 653 BMT) met inclusion criteria. EVT patients were younger and had more severe strokes. Pooled analysis showed no significant difference in 90-day functional independence between EVT and BMT (OR 1.78; 95% CI 0.99-3.21; I² = 71%), and adjusted analyses attenuated the effect (OR 1.22; 95% CI 0.82-1.82). No significant differences were found for 90-day mortality (OR 0.84; 95% CI 0.64-1.09; I² = 0%) or sICH (OR 1.48; 95% CI 0.72-3.07; I² = 0%). Subgroup analyses by occlusion site yielded similar neutral results. Current evidence does not demonstrate superiority of EVT over BMT for IICAO, though a possible benefit for intracranial occlusions cannot be excluded. These findings remain hypothesis-generating and emphasize the need for dedicated randomized trials.

PurposeSpine-related pain disorders commonly require interventions such as spinal injections, which are often image-guided and increase in demand as populations age. This study investigates the impact of lifestyle changes following retirement on the incidence of these procedures, hypothesizing that retirement significantly influences the requirement for such treatments.MethodsA review of medical records from XXX County between 2000 and 2023 was conducted, focusing on patients who received spinal injections, including epidural steroid, facet, and sacroiliac joint injections. Data were stratified by age, employment status pre- and post-procedure, and type of injection. Statistical analysis, including segmental linear regression and t-tests, was used to assess changes in incidence rates over time and across demographic subsets.ResultsOut of 134,318 patients analyzed, a total of 359,224 spinal injections were performed. There was a significant (p-value <.01) increase in the frequency of procedures among individuals around the age of 60, which coincides with the typical retirement age in the United States. The study also highlighted a subsequent decline in the incidence of these procedures between the ages of 70 and 74, suggesting potential adaptation to chronic conditions or the effectiveness of earlier treatments.ConclusionThe findings of this study confirm the hypothesis that retirement significantly impacts the demand for spinal injections, as evidenced by the marked increase in procedures at typical retirement ages. This underscores the importance of integrating preventive care and personalized medical guidance into healthcare strategies for individuals nearing retirement to effectively manage spine-related pain disorders and reduce the necessity for invasive treatments.

Background and PurposeCone-beam CT (CBCT) and high-resolution multislice CT (HR-MSCT) are the mainstay postoperative imaging modalities following cochlear implant (CI) surgery, with CBCT often preferred due to lower susceptibility to metallic artifacts. However, CBCT is more prone to motion artifacts due to longer acquisition times. Recent advancements in accelerated flat panel CT (Acc-FPCT) available with latest generation angiography systems addressed traditional limitations of CBCT by significantly decreasing scan time. This study evaluates the diagnostic performance and radiation dose of Acc-FPCT compared to HR-MSCT in postoperative CI evaluation.MethodsFive cadaveric whole-head specimens (ten temporal bones) were operated on by an ENT surgeon. Ten CIs were inserted via cochleostomy. Post-operatively, specimens were scanned using six Acc-FPCT protocols and HR-MSCT. Three neuroradiologists assessed the image quality of FPCT protocols in comparison to HR-MSCT using a 5-point Likert scale. Seven electrode characteristics including scalar position and discernibility of individual contacts were evaluated. Radiation dose parameters (CTDIvol and DLP) were compared among protocols.ResultsTwo high-resolution Acc-FPCT (HR-FPCT) protocols were rated superior to HR-MSCT (p < .01). There were no significant differences between these two protocols (p = .25). The remaining Acc-FPCT protocols were rated inferior to HR-MSCT (p < .05). Inter-rater reliability was excellent (ICC (2,k) = 0.908; CI [0.85-0.94]). DLP was significantly lower in all Acc-FPCT protocols compared to HR-MSCT.ConclusionsThe results of this study underscore the utility of Acc-FPCT protocols as a feasible alternative to HR-MSCT in postoperative CI evaluation, allowing for better visualization of electrode array while significantly reducing scan duration and radiation exposure.

The objective of this study was to assess the performance of an artificial intelligence (AI) algorithm in detecting intracranial haemorrhages (ICHs) on non-contrast CT scans (NCCT). Another objective was to gauge the department's acceptance of said algorithm. Surveys conducted at three and nine months post-implementation revealed an increase in radiologists' acceptance of the AI tool with an increasing performance. However, a significant portion still preferred an additional physician given comparable cost. Our findings emphasize the importance of careful software implementation into a robust IT architecture.

Background: Recent studies highlight the benefits of endovascular thrombectomy (EVT) combined with standard medical treatment (SMT) for acute ischemic stroke (AIS) patients with large infarcts compared to SMT alone. Objective: This study evaluates the efficacy, bleeding risk, and mortality of EVT versus SMT in AIS patients with Alberta Stroke Program Early CT Score (ASPECTS) ≤5. Methods: A systematic review of MEDLINE, Embase, and Cochrane databases was conducted on June 6, 2024, to identify randomized controlled trials (RCTs) comparing EVT plus SMT with SMT alone in AIS patients with ASPECTS ≤5. Primary outcomes included successful reperfusion, modified Rankin scale (mRS) scores of 0-2 and 0-3, and neurological improvement. Secondary outcomes assessed all-cause mortality, intracranial hemorrhage (ICH), and EQ-5D-5L Utility Index. Statistical analyses applied the Mantel-Haenszel method with 95% confidence intervals (CIs), with heterogeneity evaluated via I² statistics. Results: Six RCTs involving 1887 patients (944 receiving EVT) were included. EVT significantly increased the incidence of mRS 0-2 (RR 2.50; 95% CI 1.89 to 3.30; p < .001; I² = 8%) and mRS 0-3 (RR 1.92; 95% CI 1.50 to 2.46; p < .001; I² = 62%). However, EVT was associated with a higher risk of ICH (RR 1.73; 95% CI 1.11 to 2.69; p = .016; I² = 0%) and did not reduce mortality compared to SMT (RR 0.86; 95% CI 0.72 to 1.02; p = .082; I² = 47%). Conclusion: EVT improves functional outcomes in AIS patients with moderate-to-low ASPECTS but increases the risk of ICH without reducing mortality.

PurposeThe utility of CT scans of the sinuses before stem cell transplantation among patients with sickle cell disease (SCD) is unclear, as there have been conflicting results in the literature. This study aimed to assess whether brain MRI screening is sufficient for evaluating the paranasal sinuses (PNS), thus eliminating the need for CT scans of the sinuses prior to hematopoietic stem cell transplantation (HSCT).Materials and methodsThis was a retrospective study in which we included all adult patients with SCD who were scheduled for HSCT and underwent CT scans of the sinuses and brain MRI within one week. The Lund and Mackay staging systems were used to score sinus mucosal thickening on both CT and MRI, each of which was performed separately and blindly. The agreement between the two modalities was assessed by the intraclass correlation coefficient (ICC).ResultsA total of 119 pre-transplant patients were included. There was excellent agreement between MRI and CT, with an ICC of 0.978 (0.967-0.985 at 95% confidence interval; p < .001). There was also substantial agreement between MRI and CT in the evaluation of sinus calcifications or hyperdense material, with a Cohen kappa value of 0.8 (p < .001).ConclusionBrain MRI is probably sufficient for assessing PNS disease in SCD patients before stem cell transplantation. Given its effectiveness in detecting sinus disease and silent infarcts without the added risks of radiation, MRI is the preferred and most resource-efficient imaging approach.

PurposeChronic or shunt-dependent hydrocephalus is a frequent consequence of subarachnoid hemorrhage (SAH) with an unclear pathophysiology, making treatment challenging. Despite favorable outcomes following cerebrospinal fluid (CSF) diversion, high-risk surgical interventions remain necessary in some cases. Accurate prediction of chronic or shunt-dependent hydrocephalus in SAH patients can play an important role in their management. This systematic review and meta-analysis assessed the predictive performance of machine learning (ML) models in forecasting chronic or shunt-dependent hydrocephalus following SAH.MethodsA systematic search of PubMed, Embase, Scopus, and Web of Science was conducted. ML or deep learning (DL)-based models that predicted chronic or shunt-dependent hydrocephalus following SAH were included. To avoid bias, only the data of the best-performance model, which was defined by the highest area under the curve (AUC) of the models, were extracted. The pooled AUC, accuracy (ACC), sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated using the R program.ResultsSix studies with 2096 individuals were included. The AUC, ACC, sensitivity, and specificity ranged from 0.8 to 0.92, 0.72 to 0.9, 0.73 to 0.85, and 0.7 to 0.92. The meta-analysis showed a pooled AUC of 0.83 (95%CI: 0.81-0.84) and ACC of 0.79 (95%CI: 0.66-0.91). The meta-analysis revealed a pooled sensitivity of 0.8 (95%CI: 0.73-0.85), specificity of 0.79 (95%CI: 0.68-0.86), and DOR of 12.13 (95%CI: 8.2-17.96) for predictive performance of these models.ConclusionML-based models showed encouraging predictive performance in forecasting chronic or shunt-dependent hydrocephalus following SAH.

BackgroundISFT and HGM exhibit similar imaging characteristics, but their distinct behaviors and treatments necessitate accurate preoperative imaging for optimal management.PurposeTo evaluate conventional CT and MRI in differentiating ISFT from HGM.MethodsRetrospective analysis of clinical data, CT, and MRI images from 31 ISFT and 50 HGM patients confirmed by pathology. Various imaging features were examined, including tumor size, shape (lobulated or round), base width (narrow or broad), presence of cystic necrosis, calcification, signal intensity on T1- and T2-weighted MRI, intravascular flowing-void signs, peritumoral edema, CT attenuation values on non-enhanced and enhanced scans, and adjacent bone destruction. Chi-square tests, t-tests, ROC curves, and multivariate logistic regression were used to establish predictive models. A nomogram illustrated the final model.ResultsISFT onset age was ≤48.5 years, with a maximum tumor diameter of ≥4.5 cm. Features included lobulated appearance, narrow base, cystic necrosis, absence of calcification, low T1-weighted MRI signal, intravascular flowing-void signs, peritumoral edema, CT value ≤51.7 Hu on non-enhanced and ≥107.6 Hu on enhanced scans, and adjacent bone destruction. Combining tumor diameter, vascular flowing void, enhanced CT value, and absence of calcification yielded 92.0% sensitivity and 90.3% specificity for ISFT diagnosis.ConclusionAge and imaging characteristics effectively differentiate ISFT from HGM, particularly with a tumor diameter ≥4.5 cm, vascular flowing-void signals, absence of calcification, and enhanced CT value ≥107.6 Hu. A nomogram shows good predictive efficacy.