Neuroradiology Journal最新文献

Background: Multiple sclerosis (MS) is a long-term autoimmune inflammatory disorder that affects the central nervous system leading to neurodegeneration, and can involve a variety of symptoms. These symptoms can include fatigue, anxiety, depression, and cognitive decline, which may be silent. The objective of this study was to explore changes in brain iron deposition in people with relapsing-remitting MS (pw-RRMS) compared to healthy controls (HCs), with a particular focus on regions of fear circuit. Additionally, the study aimed to evaluate relationship between iron deposition in these areas and clinical measurements. Methods: Pw-RRMS and HCs participants underwent brain MRI scans using quantitative susceptibility mapping (QSM) to assess iron deposition in the fear circuit between the two groups. The study analyzed correlations between brain susceptibility changes and clinical measurements. Results: We recruited 35 pw-RRMS (mean age = 46.7 ± 11 years; median EDSS = 2.5) and 18 HCs (mean age = 40.6 ± 17.8 years). Our research revealed significant increases in QSM signals relating to iron deposition in pw-RRMS compared to HCs, whole fear circuit (β = 5.82, p < 0.001), caudate (β = 21.48, p < 0.001), and putamen (β = 17.53, p = 0.03), showing the greatest difference. The whole fear circuit and particularly the caudate are strongly associated with fatigue in pw-RRMS. QSM values in the anterior cingulate cortex significantly differed between pw-RRMS with normal and abnormal depression scores (p = 0.007). Conclusions: These results strengthen the relationship between increased iron deposition in fear circuit regions and specific silent symptoms in pw-RRMS. However, further studies are required to confirm these findings and clarify the implications of iron accumulation in MS pathophysiology.

PurposeEpidemiological studies on idiopathic normal pressure hydrocephalus (iNPH) imaging markers and their normal values are scarce. This population-based study aimed to analyze several morphologic and volumetric iNPH-related imaging markers in a large sample, determining their distribution, diagnostic accuracy, suggested cut-offs, and associations with iNPH symptoms.MethodsThis cross-sectional study included 791 70 year olds, 40 with radiologically probable iNPH (iNPH_Radiol) and 751 without iNPH features (reference). MRI measures included Evans index (EI), z-EI, brain per ventricle ratio at anterior (BVR_AC) and posterior commissures (BVR_PC), sulcal compression, Sylvian fissure enlargement, callosal angle, diameter of temporal horns, 3^rd and 4^th ventricles, midbrain, and pons. Volumes of ventricles, corpus callosum, and brainstem were computed using automated segmentation. ROC analysis determined imaging markers' cut-offs. Symptoms were evaluated clinically and through self-report.ResultsIn the reference group, median values (95% CI) for imaging markers were as follows: EI: 0.27 (0.26-0.27), z-EI: 0.28 (0.26-0.31), BVR_AC: 1.69 (1.48-1.90), and BVR_PC: 2.66 (2.24-3.27). Most imaging markers differed significantly between iNPH_Radiol and the reference. Lateral ventricle volumes correlated better with z-EI and BVR than EI (Rs > 0.81 vs 0.68). Optimal cut-off values for z-EI, and BVR_AC and BVR_PC for distinguishing iNPH_Radiol were 0.32, 1.36, and 1.83, respectively. Clinical symptoms correlated moderately with imaging markers (Rs < 0.49 for iNPH_Radiol, p < .01).ConclusionsWe report population-based reference values and propose cut-offs for iNPH-related imaging markers and volumetric measurements. Z-EI and BVR are likely superior markers for assessing ventricular enlargement in iNPH. Imaging markers of iNPH correlate moderately with iNPH symptoms.

Acute occlusion of vertebrobasilar artery mostly presents with severe neurologic impairment. Bilateral sensorineural hearing loss (SNHL) as the first clinical symptom on onset is a rare phenomenon. Clinical benefit of mechanical thrombectomy (MT) in terms of hearing loss in these cases is poorly understood. We describe a case of a patient with vertebrobasilar occlusion who presented with only sudden bilateral SNHL and recovered poorly in terms of hearing loss after full recanalization with MT. We describe a 52-year-old right-handed male patient with an unremarkable medical history. On admission, he was hypertensive to 200/102 mm Hg; neurological examination was significant for mild right facial palsy and bilateral SNHL, later confirmed by an audiogram. diffusion-weighted imaging (DWI) showed infarction of bilateral anterior cerebellum, cerebellar peduncles, and pons with negative flair. Computed tomography angiography showed occlusion in the level of the vertebrobasilar junction. Patients' neurological status deteriorated within hours into a comatose status with anarthria and quadriplegia. He was treated with MT and stenting and full recanalization was achieved. All neurological examination findings have completely resolved, except for the bilateral SNHL. Acute onset of sudden bilateral deafness in isolation or accompanied by vestibular, cerebellar, and/or brainstem signs may indicate large vessel occlusion. Although rapid recanalization with MT helps improve the symptoms, the specific impact over SNHL varies between patients.

ObjectiveThis study aims to describe our experience and safety considerations associated with the use of the transulnar approach in neurointerventional procedures when radial access is not feasible.MethodsA prospective exploratory analysis was conducted on 35 patients who underwent diagnostic or therapeutic neuroangiography via transulnar approach due to radial access limitations. Technical aspects of the transulnar approach, patient demographics, procedural details, and complications were documented. Statistical analysis was performed using SPSS Statistics software.ResultsAmong the 35 procedures, the transulnar approach demonstrated a high success rate (97.14%), with only one procedural failure. Indications for transulnar access included larger ulnar artery caliber (46%), radial artery spasm (37%), severe tortuosity of the radial artery (17%), and other anatomical considerations. Complications were rare, with only two access-related complications observed: a type I hematoma and ulnar artery vasospasm. No major bleeding episodes occurred, highlighting the safety profile of transulnar access.ConclusionThe transulnar approach represents a feasible alternative for neurointerventional procedures when radial access is not achievable. It offers high success rates and minimal complications, comparable to the radial approach. Anatomical considerations, safety profile, and patient preference support its consideration as a secondary option in neurointerventional practice. Further research and larger studies are warranted to validate its efficacy and safety in a broader patient population.

Arteriovenous malformations (AVMs) are abnormal connections of arteries and veins without intermediate capillary components. As such, AVMs can remain asymptomatic or have a variety of clinical presentations ranging from mild headaches to severe symptoms like seizures, hemorrhage, and subsequent coma. Papilledema and increased intracranial pressure without hydrocephalus or hemorrhage are rare forms of presentations of cerebral AVM. The mechanism of intracranial hypertension accompanying brain AVMs is not entirely understood, and the right treatment strategy is controversial. Here, we present the treatment and outcomes of four patients with unruptured AVMs who presented with intracranial hypertension accompanied by visual symptoms, papilledema, and without evidence of hydrocephalus. In cases of AVMs accompanied by intracranial hypertension, AVM treatment should be considered the main target of management.

Magnetic Resonance Imaging (MRI) is crucial for evaluating the neonatal brain, but high-quality images require a controlled environment. We discuss principles for creating this environment, including effective planning, presence of trained professionals, monitoring, preparedness for adversity, and ensuring optimal immobility. Planning reduces waiting times and anxiety, and a dedicated imaging team including a neonatologist and a radiologist improve image quality. Monitoring vital signs allows early identification of adverse events, while MR-compatible emergency equipment and a readily available hands-on resuscitation team reduces risk of such adverse events. Optimal immobility is critical for high-quality images. A controlled environment facilitates acquisition of optimal quality images in a quick and safe manner, enabling accurate diagnoses and timely interventions for neonates with brain abnormalities.

BackgroundThe SMART coil system is a relatively new generation of embolic coils consisting of a bare platinum coil, a detachment pusher, and a detachment handle. This study investigated the safety and efficiency of the SMART coil system in treating cerebral aneurysms.MethodPubMed/Medline, Embase, Web of Science, and Scopus were searched until October, 1st 2023. Non-English language, non-human studies, and non-original studies were excluded.ResultsA total of 7 studies were included. The results of our study reflected complete aneurysm occlusion (mRRC1) rate of 45% (95% CI, 0.35-0.56), neck remnant aneurysm (mRRC2) rate of 36% (95% CI, 0.30-0.42), and residual aneurysm (mRRC3) rate of 22% (95% CI, 0.12-0.38) during post-procedural assessment. Moreover, considering longest follow-up, our study showed complete aneurysm occlusion (mRRC1) rate of 66% (95% CI, 0.43-0.84), neck remnant aneurysm (mRRC2) rate of 27% (95% CI, 0.13-0.49), and residual aneurysm (mRRC3) rate of 9% (95% CI, 0.04-0.20). In addition, recanalization and retreatment rates were reported 10% (95% CI, 0.06-0.17) and 9% (95% CI, 0.06-0.12), respectively. The rates of adverse and serious adverse events were 9% (95% CI, 0.07-0.10) and 6% (95% CI, 0.01-0.22), respectively. Three studies reported a stroke rate which was 2% (95% CI, 0.00-0.13), and five studies reported a mortality rate which was 6% (95% CI, 0.03-0.11).ConclusionThe findings suggested that the SMART coil can be a safe and efficient treatment in patients with intracranial aneurysms compared to other available treatment methods.

Purposeand background: Neuroimaging studies have increasingly found functional connectivity (FC) changes and structural cortical abnormalities in patients with post-traumatic anosmia (PTA). Training and repeated exposure to odorants lead to enhanced olfactory capability. This study is conducted to investigate the correlations between FC and cortical thickness on the olfaction-related regions of the brain in PTA after olfactory training (OT).MethodsTwenty-five PTA patients were randomly divided in three groups: (1) 9 control patients who did not receive any training, (2) 9 patients underwent classical OT by 4 fixed odors, and (3) 7 patients underwent modified OT coming across 4 sets of 4 different odors sequentially. Before and after the training period, all patients performed olfactory function tests, and magnetic resonance imaging (MRI). Sniffin' Sticks test was used to assess olfactory function. MRI data were analyzed using functional connectivity analysis and brain morphometry.ResultsModified OT resulted in heightened activation in the medial orbitofrontal cortex and anterior cingulate cortex and increased FC between the piriform cortex (PIRC) and the caudate cortex. Conversely, classical OT induced increased activation in the insula cortex and greater FC between the PIRC and the pre-central gyrus. Furthermore, after OT, both training groups achieved significantly improved scores in the changes in brain connectivity associated with OT, which were attributable to anatomical measures.ConclusionsThis study demonstrates that intensive olfactory training can enhance functional connectivity, and this improvement correlates with structural changes in the brain's olfactory processing areas.

BackgroundPerianeurysmal edema occurring after endovascular treatment for cerebral aneurysms is uncommon compared to surgical clipping. The clinical aspects and the exact explanation are poorly understood.MethodsWe searched PubMed, Google Scholar, and Web of Science. We used the following keywords: "endovascular management of cerebral aneurysms," "perianeurysmal cerebral edema," "perianeurysmal cerebral edema after endovascular treatment endovascular treatment," "intracranial aneurysms with perianeurysmal edema," and "vessel wall enhancement after endovascular therapy." For each case, demographic, clinicopathological, therapeutic, and follow-up data were gathered and analyzed.ResultsPerianeurysmal edema after endovascular treatment has a clear female predilection, with a male: female ratio of 12:29 (25%; 60.41%). The average time from EVT to the onset of edema ranged from 1 day to about 8 years. The aneurysm dimension ranged from 6.8 to 25 mm as the largest size reported. Most patients were asymptomatic (18 [37.5 %]), and headache was the presenting symptom in 10 patients (20.8%). Aneurysmal wall enhancement was reported in 16 (33.3 %) patients with perianeurysmal edema. About 12 patients (25%) developed post-EVT hydrocephalus. The most common coil used was the platinum type (31 [64.58%]). Most of the patients were treated expectantly with follow-up (17 [35.41 %]), while steroids were used only in 14 (29.16%) patients. Most of the patients have their edema resolved (29 [60.41%]) or stable (9 [37.5%]).ConclusionThere is growing evidence supporting the incidence of post-embolization inflammatory reactions involving the vessel wall and the surrounding parenchyma; however, the exact clinical perspectives and the predisposing factors are not fully uncovered. This analysis highlights the possible presentations and short-term outcome of patients presenting with perianeurysmal edema after endovascular management of cerebral aneurysms.

BackgroundThe pRESET stent retriever is a self-expanding nitinol stent designed for mechanical thrombectomy in cases of large vessel occlusion during acute ischemic stroke. This systematic review and meta-analysis synthesize the available evidence on the safety and efficacy of the pRESET device.MethodsThis is a systematic review and meta-analysis study conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The electronic databases of PubMed, Embase, WoS, and Scopus were systematically reviewed from inception to 8 July 2024.ResultsA total of eight studies involving 1163 patients were included. The pooled mortality rate was 18% with a 95% CI of [12%, 25%]. The rates of any hemorrhagic complication, parenchymal hemorrhage, and subarachnoid hemorrhage were 22% with a 95% CI of [12%, 36%], 7% with a 95% CI of [4%, 13%], and 10% with a 95% CI of [5%, 17%], respectively. The rate of favorable functional outcome (modified Rankin Scale 0-2) at 90 days was 43% with a 95% CI of [34%, 52%]. Successful recanalization rates were 60% with a 95% CI of [52%, 67%] after the first pass and 90% with a 95% CI of [83%, 95%] after the final pass. Rescue devices were used in 13% with a 95% CI of [7%, 24%] of cases.ConclusionsThe pRESET stent retriever demonstrates high recanalization rates and reasonable safety outcomes in patients undergoing mechanical thrombectomy for acute ischemic stroke due to large vessel occlusion. Further randomized trials directly comparing pRESET to other stent retrievers are warranted.