Neuroradiology Journal最新文献

Despite the exponential growth in academic publications and industrial investments in artificial intelligence (AI) in medical imaging, clinical translation remains disproportionately low. Notably, the absence of internationally recognized guidelines for evaluating AI model performance and ethical considerations creates a critical gap in current practices. In this regard, we aim to offer a practical concise perspective exploring performance challenges to implementation while focusing on their mitigation. The dialog continues in subsequent work (part 2) which focuses on ethical issues. In this part, we explore the challenges inherent to the performance evaluation of AI in radiology, focusing on data heterogeneity, the choice of performance metrics and their interpretability, and data access. By shedding light on these issues and discussing potential opportunities, this work contributes to the ongoing dialog surrounding the practical integration of AI in clinical settings. It highlights the imperative need for established guidelines to ensure the safe and efficient deployment of AI technologies in medical imaging, ultimately bridging the gap between theoretical potential and practical implementation.

Diabetic striatopathy (DS), also known as non-ketotic hyperglycemic hemichorea, is a rare condition that arises from uncontrolled hyperglycemia. It is characterized by new onset movement disorders, changes in the striatum on imaging, or both. DS can occur as a complication of long-standing non-ketogenic hyperglycemia or be the first presentation of previously undiagnosed diabetes mellitus (DM). Additionally, uncontrolled or rapidly corrected hyperglycemia can, in rare cases, lead to osmotic demyelination syndrome (ODS). Although ODS typically occurs after the rapid correction of hyponatremia, the same effects and symptoms can manifest in patients with diabetes when hyperglycemia is corrected too quickly. We present a 59-year-old male with a history of uncontrolled diabetes mellitus and cerebrovascular accident who was brought to the emergency department by EMS with a new onset movement disorder. This case demonstrates a rare example of a patient presenting with classic imaging findings of both DS and ODS. Specifically, the patient demonstrated unilateral basal ganglia hyperdensity on CT, indicative of DS, alongside central pontine diffusion restriction and T2/FLAIR hyperintensity, consistent with ODS. This report discusses a rare case of the simultaneous occurrence of diabetic striatopathy and osmotic demyelination syndrome in a patient with uncontrolled diabetes mellitus, highlighting the intricate neurological complications of hyperglycemia. These findings stress the importance of timely recognition and management of hyperglycemia-related conditions, with imaging playing a pivotal role in diagnosis.

BackgroundThe 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).MethodsFour electronic databases, PubMed, Scopus, Embase, and Web of Science, were searched from inception to November 5^th, 2024.ResultsTen 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).ConclusionSVB 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.

ObjectiveTo present and analyze the characteristics of the 100 most cited articles that used cerebral angiography for clinical evaluation and intervention.MethodTwo researchers independently extracted articles from multiple databases and ranked them by citation count to create the "top 100 most-cited" list.ResultsThe 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.ConclusionWithin 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.

BackgroundThe 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 MTMethodsOutcomes 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 analyzedResultsA 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 groupsConclusionIn 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.

BackgroundThis systematic review aims to reflect the current state of the literature on use and efficacy of the Contour Neurovascular System (CNS), an endovascular implant specifically developed for the treatment of intracranial wide-neck aneurysms.MethodsWe included manuscripts from a PubMed search with the terms "contour AND aneurysm." Manuscripts that did not refer to the CNS were excluded via screening.The number of interventions from included studies was calculated and, where possible, occlusion rates of aneurysms, used CNS sizes, and complications were recorded.ResultsWe found a total number of 23 studies with 625 patients and 661 aneurysms treated with CNS (122 ruptured). The number of studies with low bias and sufficient randomization is very small. Only two prospective studies with 43 patients could be identified. The mean aneurysm size was 6.4 mm (height), 5.5 mm (dome size), and 3.9 mm (neck size). Most used CNS sizes were "7" and "9." A complete occlusion result was achieved in 61% of patients in the long-term controls; in 28%, an adequate occlusion with a small neck rest was reported.ConclusionsThe preliminary results of the CNS are promising. However, these findings need to be proven in larger, prospective studies.

PurposeNon-contrast cerebral computed tomography (NCCT) is one of the most frequently performed CT examinations. Photon-counting CT (PCCT) offers advantages in terms of noise reduction, higher spatial resolution, and inherent spectral information. PCCT available today allows NCCT to be performed with tube voltage of 120 or 140 kVp. This study evaluates the impact of tube voltage on image quality at an equivalent dose.Methods76 patients with an NCCT with 120 kVp, 76 with 140 kVp, and 56 patients with slightly different effective tube current per group were included. Signal, noise, signal-to-noise ratio, gray-white contrast, and contrast-to-noise ratio were determined using several regions of interest for different virtual monoenergetic image (VMI) levels and compared between dose-equivalent groups. An image quality rating of the clinically used virtual monoenergetic images (VMIs) 65 keV was performed.ResultsThe VMI 65 keV images at 120 kVp exhibited reduced noise, improved gray-white contrast, and improved contrast-to-noise ratio compared to 140 kVp (p < .001). The density differences between cortical gray matter at different distances from calvaria were also lower with 120 kVp (p < .001). The rating of image quality showed no difference between 120 kVp and 140 kVp.ConclusionsCurrently, NCCT with a tube voltage of 120 kVp versus 140 kVp seems to achieve better image quality. However, further studies are required to evaluate possible advantages of 140 kVp, for example artifact reduction in the case of dense foreign materials or enhanced spectral possibilities, and regarding imaging of special intracranial pathologies.

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 and purposeInter-hypothalamic adhesions (IHAs) are parenchymal tissue bridges traversing the third ventricle, previously reported only in the pediatric population. We aim to understand the prevalence of IHA in the adult population, assess their size and location, and ultimately investigate whether IHA volumes correlate with age.Materials and methodsPatients who underwent routine high-resolution 3D T2WI MRI studies of the temporal bone/internal auditory canal at an otolaryngology clinic between 2008 and 2014 were consecutively selected. The presence of IHAs was confirmed when a parenchymal structure could be traced across the third ventricle, connecting bilateral hypothalamus, and was visible in at least two planes. They were classified based on their location within the third ventricle, considering their connection with hypothalamic nuclei. Patient clinical information were collected from electronic charts. The prevalence and volumes of IHAs were calculated. Associations between age and IHA volume, as well as between IHA type, age, volume, and gender, were analyzed.Results779 patients, with a mean age of 54.7 years were included. Among them, 44 IHAs were identified within 41 patients, resulting in a prevalence of 5.26% in our cohort. Type 1 IHA was the most frequently encountered type, comprising 70.5% of all cases. No significant correlation was observed between IHA volumes and age. Additionally, no associations were found between IHA type and age, volume, or gender.ConclusionIHAs are not exclusive to the pediatric population; they are also present in adults, with a prevalence of 5.26% in patients undergoing temporal bone/internal auditory canal MRI.

Background: Vertebrobasilar artery occlusion (VBAO) is a life-threatening condition with often nonspecific symptoms, making early diagnosis challenging. Timely intervention is crucial, especially in cases involving distal vertebral artery stenosis. Case Report: A 65-year-old male presented with acute vertigo, dizziness, and visual disturbances, along with ipsilateral sixth cranial nerve palsy. His medical history included a treated abdominal aortic aneurysm, hypercholesterolemia, and hypertension. CT angiography (CTA) revealed an occlusion in the V4 segment of the right vertebral artery. CT perfusion imaging showed minimal perfusion delay in the right brainstem. The patient received intravenous thrombolysis (IVT) with tenecteplase, followed by mechanical thrombectomy (MT), partial recanalization was achieved. However, digital subtraction angiography (DSA) identified a critical stenosis (>90%) responsible for the occlusion, consistent with arteriosclerotic disease. Following intravenous administration of 500 mg acetylsalicylic acid, a Biotronik Orsiro 2.25 × 9 mm drug-eluting stent was placed, achieving complete recanalization (eTICI 3). Neurologic symptoms resolved completely post-intervention, and the patient received 300 mg clopidogrel. He was discharged with an MRS score of 0 within 3 days. Conclusion: This case highlights the effectiveness of a multimodal approach (IVT, MT, and stenting) in treating distal vertebral artery occlusion (Mori Type C). Early diagnosis and timely endovascular intervention led to rapid symptom resolution and complete neurological recovery. Follow-up ultrasound at 4 months confirmed good bilateral vertebral artery perfusion without restenosis, supporting the potential long-term benefits of this multimodal treatment approach. This case underscores the importance of advanced imaging for early detection and the role of thrombectomy and stenting in optimizing patient outcomes.