Neuroradiology Journal最新文献

BackgroundThe amygdala is a key structure involved in memory, emotional processing, and sensory integration. While the cortical connectivity of the amygdala with the frontal and temporal lobes has been extensively studied, its direct connections with the parieto-occipital cortices remain underexplored. This study aims to delineate the direct connectivity between the amygdala and the parietal and occipital cortices via the parahippocampal segment of the cingulum bundle.MethodsHigh-resolution diffusion-weighted imaging (DWI) tractography was performed on 30 healthy adult brains. Fiber tracking was conducted using three regions of interest (ROIs) placed in the parietal, occipital, and medial temporal lobes. A fractional anisotropy (FA) threshold of 0.25 and an angle threshold of 70° were applied to reconstruct the fiber pathways.ResultsA consistent bilateral trajectory of the parahippocampal segment of the cingulum bundle was identified, originating in the posterior parietal and lateral occipital cortices and terminating in the amygdala. This pathway was distinct from adjacent fiber tracts such as the amygdalofugal pathway and fornix.ConclusionThis study confirms the existence of a direct parieto-occipital connection to the amygdala via the parahippocampal cingulum bundle which is an important part of the ventral and dorsal Kamali limbic circuitry. These findings contribute to our understanding of posterior limbic connectivity and may have implications for visuosensory-emotional processing in both health and disease.

Background: Little is known about the association between intraplaque hemorrhage (IPH) and other features of high-risk carotid atherosclerotic plaques, such as the presence of plaque ulceration, plaque enhancement, and lipid-rich necrotic core (LRNC). This study set out to assess the relationship between IPH and other vulnerable plaque features. Materials and Methods: A retrospective review was done of 102 patients with IPH in one or both of the internal carotid arteries (ICA) on neck MRA between 1/1/2016 and 3/31/2021. IPH was defined as a ≥200% signal intensity of the adjacent sternocleidomastoid muscle on MPRAGE images. All ICA plaques were assessed for the presence or absence of IPH, plaque ulceration, plaque enhancement, and LRNC, as well as IPH volume. IPH volume was measured manually by outlining the region of interest. Results: A total of 102 patients were included, with 88 (86.3%) being male. The average age was 73.5 years (SD = 9.0). Both IPH and LRNC were more commonly seen in the left carotid artery (p = .018 and p = .047, respectively). For right-sided ICAs, there was a significant association between IPH and LRNC (p < .0001). Lesions without IPH were more likely to have plaque enhancement than lesions with IPH (p = .04). For left-sided ICAs, there was also a significant association between the presence of IPH and LRNC (p < .0001). Conclusions: There is a significant association between the presence of IPH and LRNC. An inverse relationship was found between the presence of IPH and plaque enhancement for right-sided plaques. No associations were found between IPH and plaque ulceration.

BackgroundThe pretreatment rCBV <42% lesion volume on CT Perfusion (CTP) has recently been shown to predict 90-day functional outcomes in stroke patients. However, its association with length of stay (LOS) has not yet been explored. This study aims to assess the relationship between rCBV <42% and prolonged LOS, defined as 7 days or longer.MethodsIn this retrospective evaluation of our prospectively collected database, we analyzed patients with confirmed anterior circulation large vessel occlusion on CT angiography who also received CT perfusion between 9/1/2017 and 10/01/2023. We used Student's t-test, Mann-Whitney U test, and Chi-Square test to assess differences. Logistic regression and ROC analyses were employed to evaluate the relationship between rCBV <42% and length of stay (LOS). A p-value of ≤0.05 was considered statistically significant.ResultsA total of 268 patients met our inclusion criteria. Of these, 85 (31.7%) received intravenous thrombolysis (IVT), and 221 (82.5%) underwent mechanical thrombectomy (MT). After adjusting for several variables, logistic regression analysis revealed that an rCBV <42% lesion volume was independently associated with prolonged length of stay (LOS) (aOR = 0.98, p < .001). ROC analysis indicated an area under the curve (AUC) of 0.66 (p < .001) for predicting prolonged LOS.ConclusionrCBV <42% lesion volume is independently associated with prolonged LOS. This parameter may serve as a useful adjunct tool in prognostication of AIS-LVO patients.

BackgroundTransradial arterial access has become widely used as a less invasive approach in neuroendovascular therapy, but the forearm venous approach has rarely been reported.ObjectivesThis study aimed to assess the safety and efficacy of forearm transvenous neurointervention for intracranial lesions. We present our experience with a simultaneous forearm-only transarterial and venous approach (fTAVA) for dural arteriovenous fistulas (dAVFs).MethodsWe retrospectively reviewed a prospective database of consecutive patients who underwent fTAVA for dAVFs between 2021 and 2024. fTAVA was performed using the right radial artery and superficial forearm vein as puncture sites. Arterial closure was achieved using a radial compression device, whereas bandage compression was used for venous closure. Procedural success, angiographic results, procedure-related complications and patient satisfaction were evaluated.ResultsOverall, 13 (8 carotid-cavernous sinus and 5 transverse-sigmoid sinus fistulas) procedures using fTAVA were successfully performed with favorable outcomes. Arterial puncture was performed at the distal radial artery in nine cases. The venous puncture site was the median cubital vein in nine cases and the forearm cephalic vein in four cases. The targeted fistulas were distal to the right jugular vein in four cases and the left jugular vein in nine cases. They were successfully accessed in all cases. The angiographic result was total occlusion in eleven cases and subtotal occlusion in two cases. There was one patient with minor access-site complication in distal radial artery.ConclusionsThe fTAVA is a safe and effective method for the endovascular treatment of dAVFs and is associated with reduced patient discomfort.

BackgroundMiddle meningeal artery (MMA) embolization is an increasingly common procedure involved in the treatment of various vascular and neoplastic diseases. Understanding its anatomical nuances and clinical implications is fundamental in enhancing the safety of preoperative embolization.MethodsA systematic review following PRISMA guidelines was conducted to consolidate literature on the MMA anomalous variations. PubMed, Scopus, and Web of Science were systematically searched using our predefined criteria until 2025. Inclusion encompassed studies focusing on the clinical perspectives of MMA's anomalous anatomy and endovascular implications.ResultsTwelve articles met inclusion criteria, exploring the clinical significance of the MMA's anatomical variations in various clinical situations. We identified 11 case reports, and we also reported the clinical significance of the cases identified among different case series for the treatment of CSDH and other involved pathologies. Anomalous variations of the MMA involving either its origin, branching or connections were detected clinically in about 43 patients in the literature. We identified the basilar artery as an origin of the MMA in 9 case reports. The ophthalmic origin of the MMA was reported in about 12 patients, while an accessory meningeal artery arising from an ophthalmic artery was only reported in two cases.ConclusionProperly identifying the anomalous variants of the MMA is considerably valuable in preoperative planning and decision-making for the endovascular management of various pathologies involving the dura. To choose an appropriate tool and method of endovascular intervention, understanding the anatomical features and variability of the MMA is crucial.

Background and purpose: This study focuses on an objective evaluation of a novel reconstruction algorithm-Deep Learning Image Reconstruction (DLIR)-ability to improve image quality and reduce radiation dose compared to the established standard of Adaptive Statistical Iterative Reconstruction-V (ASIR-V), in unenhanced head computed tomography (CT). Materials and methods: A retrospective analysis of 163 consecutive unenhanced head CTs was conducted. Image quality assessment was computed on the objective parameters of Signal-to-Noise Ratio (SNR) and Contrast-to-Noise Ratio (CNR), derived from 5 regions of interest (ROI). The evaluation of DLIR dose reduction abilities was based on the analysis of the PACS derived parameters of dose length product and computed tomography dose index volume (CTDIvol). Results: Following the application of rigorous criteria, the study comprised 35 patients. Significant image quality improvement was achieved with the implementation of DLIR, as evidenced by up to a 145% and 160% increase in SNR in supra- and infratentorial regions, respectively. CNR measurements further confirmed the superiority of DLIR over ASIR-V, with an increase of 171.5% in the supratentorial region and a 59.3% increase in the infratentorial region. Despite the signal improvement and noise reduction DLIR facilitated radiation dose reduction of up to 44% in CTDIvol. Conclusion: Implementation of DLIR in head CT scans enables significant image quality improvement and dose reduction abilities compared to standard ASIR-V. However, the dose reduction feature was proven insufficient to counteract the lack of gantry angulation in wide-detector scanners.

Although the effectiveness of thrombectomy has become clear, there is no consensus on whether sedation should be performed under general anesthesia or procedural sedation. Midazolam is used to achieve mild sedation during invasive treatments and examinations. This study aimed to investigate the treatment outcomes of thrombectomy under mild sedation using midazolam and report them retrospectively. This study included 100 cases of acute occlusion of the anterior circulation of intracranial vessels with a National Institutes of Health Stroke Scale (NIHSS) score of 10 or more who underwent thrombectomy under sedation using midazolam at our hospital between 2023 and 2024. The average age of the patients was 79.0 ± 12.2 years, and the preoperative NIHSS score was 19.8 ± 6.4. In total, 92 cases (92.0%) with modified Thrombolysis in Cerebral Infarction 2B or higher recovered with an average time from puncture to recanalization of 32 ± 23 min, and 52 cases (52.0%) had a favorable outcome (modified Rankin Scale 0-2) 3 months later. Anesthesia-related complications included postoperative pneumonia in seven cases (7.0%), and procedural complications included symptomatic intracranial hemorrhage due to perforation of intracranial vessels by the microguidewire in one case (1.0%). Nine patients (9.0%) died 3 months after surgery. Thrombectomy under procedural sedation using midazolam achieves favorable outcomes owing to favorable and rapid recanalization. In addition, there are few procedural complications due to body movement and few anesthesia-related complications due to sedation, making this a safe method.

IntroductionAmyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder characterized by progressive upper and lower motor neuron degeneration, leading to muscle weakness, respiratory failure, and mortality. The premotor cortex (PMC), including the frontal eye field (FEF), shows greater resistance, with limb function declining earlier than eye movement. This study utilizes magnetic resonance spectroscopy (MRS) to investigate metabolite ratio changes in these regions for potential early ALS diagnosis.Methods and MaterialsFourteen ALS patients and healthy controls underwent MRS to assess neurometabolite levels, including N-acetyl aspartate (NAA), creatine (Cr), myo-inositol (mIns), and choline (Cho) in the PMC and FEF. ELISA measured superoxide dismutase-1 (SOD1) enzyme levels. Group differences were analyzed statistically using t-tests to evaluate significant variations.ResultIn ALS patients, a significant decrease in NAA/Cr (p = .045) and an increase in mIns/Cr (p < .0001) concentrations were observed in the PMC. No significant differences in Cho/Cr (p = .215) were detected between the FEF and PMC regions in ALS patients. Compared to the control group, NAA/Cr levels in the PMC and FEF regions of ALS patients were significantly lower (p = .004, .001), while mIns/Cr values were significantly higher (p = .001). However, no significant changes were observed in the Cho/Cr ratio in the FEF between ALS patients and controls. Additionally, SOD1 enzyme levels were significantly reduced in ALS patients (p < .0001).ConclusionThe findings suggest that neurometabolites levels in the PMC and FEF may be a promising candidate for clinical and pathological changes in ALS.

BackgroundEdaravone dexborneol has been developed as a novel neuroprotective agent and showed a promising result in treatment of stroke. The current meta-analysis aimed to assess the feasibility and efficacy of the edaravone dexborneol in the treatment of stroke.MethodWe performed a systematic review and meta-analysis of literature in four electronic databases. Binary outcomes were analyzed through the risks ratio (RR) and 95% confidence interval (CI), while the continuous outcomes were analyzed through the standardized mean difference (SMD) and 95% CI. Also, we did a subgroup analysis to show more feasibility and safety dimensions.ResultsFive studies with a total of 2415 patients were included. There were 1119 patients in edaravone dexborneol group and 1216 patients in control group. The 90-mRS 0-1 (RR 1.17 [95% CI 1.09-1.25]; p < 0.0001) and 90-day mRS 0-2 (RR 1.12 [95% CI 1.07-1.18]; p < 0.0001) were statistically significant higher in intervention group compared with control group. There was no significant difference between intervention group and control group concerning 90-day mRS 0-3 (RR 1.03 [95% CI 0.99-1.06]; p = 0.07), 90-day mortality rate (RR 0.71 [95% CI 0.45-1.11]; p = 0.13), serious adverse events (RR 0.91 [95% CI 0.72-1.16]; p = 0.45), and NIHSS score ≤1 at days 14 (RR 0.96; p = 0.69), 30 (RR 1.08; p = 0.18), and 90 (RR 1.06; p = 0.15). No heterogeneity in treatment effect was seen in the analysis, and any potential discrepancies were addressed by sensitivity analysis.ConclusionEdaravone dexborneol can be a favorable treatment option for patients with stroke. However, more randomized controlled trials are required to confirm our findings.

PurposeTo characterize demographic variation in quantitative MR neurography parameters of the peroneal nerve and to assess the methodological impact of epineurium inclusion on signal intensity-based measurements.Materials and MethodsThis retrospective single-center study included 114 screened, presumably healthy subjects undergoing routine 3-T knee MRI. Cross-sectional area (CSA), signal intensity (SI), and nerve-to-muscle SI ratios of the peroneal nerve were measured at three predefined levels, with and without epineurium inclusion. Associations with age, body mass index (BMI), and sex were evaluated using univariable linear regression. Agreement between SI measurements with and without epineurium was assessed using cubic spline regression. Exploratory fuzzy c-means clustering was applied to visualize demographic trends.ResultsSI ratios measured with and without epineurium showed excellent agreement without evidence of a clinically relevant systematic bias. Increasing age was significantly associated with larger CSA (p < .05). In contrast, SI ratios showed no significant age-related association and only weak trends. BMI demonstrated no significant association with either CSA or SI, and no relevant sex-related differences were observed. Fuzzy clustering corroborated regression findings, demonstrating gradual demographic trends with substantial overlap between clusters.ConclusionQuantitative MR neurography parameters of the peroneal nerve exhibit small, gradual variations with age and body mass index, primarily affecting cross-sectional area, while signal-intensity ratios remain largely stable. Measurements with and without epineurium inclusion show strong agreement, indicating that demographic-related variability is modest and should be interpreted as physiological variation rather than pathological change.