Neuroradiology Journal最新文献

Background and purpose: The World Health Organization (WHO) subdivided medulloblastoma into genetic and histopathological groups, each with a specific therapeutic intervention and different clinical outcomes. These subtypes may present with distinct imaging features. Therefore, the current study aimed to identify magnetic resonance imaging (MRI) biomarkers to predict the precise pathological characteristics of medulloblastoma. Methods: This study included 28 patients with a first diagnosis of medulloblastoma who underwent preoperative brain MRI with subsequent surgical resection and histopathological confirmation at our hospital between 2010 and 2022. Conventional MRI parameters, including apparent diffusion coefficient (ADC) mean values, were correlated with molecular subtypes to identify distinct MRI biomarkers. Results: Out of 28 tumors, two (7.1%) tumors exhibited wingless (WNT) activation, thirteen (46.4%) exhibited sonic hedgehog (SHH) activation, and thirteen (46.4%) exhibited non-WNT/non-SHH activation (Group 3 or 4). Statistical analysis revealed a significant association of SHH-activated tumors with paramidline/cerebellar location and the presence of peritumoral edema (p value = <0.0001). No significant correlations were found between the genetic subtypes and the other MRI parameters. A distinctive distribution of the ADC-mean values among the various genetic subtypes with recognizable tendencies was identified. However, it was statistically insignificant. Conclusion: Conventional MRI features of the paramidline/hemispheric location and the presence of peritumoral edema were significantly correlated with the SHH activated pathway and hence can be used to facilitate the preoperative implementation of SHH-targeted therapeutic intervention. Although the ADC-mean measurements were not statistically significant, a recognizable distribution of values among the various genetic subtypes was identified.

Objective: To analyze the hemodynamic changes caused by arteriovenous malformation (AVM) and AVM embolization through a meta-analysis of the existing literature. Method: Search for relevant studies on PubMed/Medline until November 7, 2023, and further screen the bibliographies of relevant studies to ensure comprehensive search. According to the PRISMA guidelines, manuscripts were selected to provide local hemodynamic information on AVM arterial feeders and drainage veins. Result: A total of 13 studies were included in the final analysis. The diameter of the supplying artery (y = 0.002x + 2.24, R² = 0.99) and flow velocity (y = 0.09x + 54.55, R² = 0.92) had a positive linear relationship with cerebral blood flow. The pressure difference through the small AVM nidus was higher than that in the large AVM, with values of (y = -12.23x + 101.39, R² = 0.96). There was a negative linear correlation between the sessions of AVM embolization and blood flow (1 session: y = -150.7x + 564.97, R² = 0.98 and 4 sessions: y = -118.81x + 750.07, R² = 0.99). There was a positive linear relationship between the increase in arterial pressure, peri-AVM parenchymal perfusion, and the percentage of occlusion in the medium-sized AVMs. However, this correlation was a nonlinear relationship between elevated arterial pressure, peri-AVM parenchymal perfusion, and the percentage of large AVM occlusion. Conclusion: The hemodynamic changes of AVM (in the feeding arteries, compartments of AVM, and draining veins) follow a linear relationship. The impact of embolization on hemodynamics in medium and small AVMs follows a linear relationship. The impact of embolization of large AVMs on hemodynamics follows a nonlinear relationship.

Norrie disease (ND) is a rare x-linked disease with retinal and cochlear vascular abnormalities. Clinically, it is characterized by congenital blindness and progressive sensorineural hearing loss during adolescence. We present images of a 3 year old child with ND and normal hearing demonstrating bilateral cochlear enhancement on brain MRI, a finding which has not been previously reported. ND mouse models show progressive degeneration of the endolymph-producing stria vascularis (SV); we hypothesize that these changes allow gadolinium leakage into the endolymph. Our images indicate that cochlear enhancement precedes changes in hearing and suggest that temporal bone/internal auditory canal MR imaging should be considered in the evaluation of ND. Future studies are needed to characterize the temporal evolution of this cochlear enhancement and how it corresponds with hearing loss. Mouse models suggest that it may be a transient phenomenon and diminish as the SV degenerates further. As ND gene therapy trials approach clinical use, cochlear enhancement could aid candidate selection and provide insight into treatment effect.

Introduction: Traumatic brain injury (TBI) is a leading cause of disability and mortality worldwide, with epidural hematoma (EDH) being a severe consequence. This study focuses on identifying factors predicting EDH volume changes in TBI patients and developing a machine learning (ML) model to predict EDH expansion.

Methods: The study includes patients with traumatic EDH between 2019 and 2021. Data were gathered from CT scans performed at the time of admission and 6 hours later, and subsequently analyzed. The data was divided into three cohorts: all cases, adults, and pediatrics. To predict EDH volume changes, we used Logistic Regression (LR), Random Forest (RF), XGBoost, and K-Nearest Neighbors (KNN) models. Data was divided into an 80% training set and a 20% test set. Through a rigorous process of parameter optimization and K-fold cross-validation, focusing on the area under the receiving operating curve (AUROC), we identified the best models in all cohorts. The best models were evaluated on the test sets, reporting AUROC, recall, precision, and accuracy using the youden index threshold.

Results: Results show that age, initial EDH volume, swirl sign, intra-hematoma air bleb, contusion, otorrhagia, subarachnoid hemorrhage, location, and other side extra-axial hematoma have significant effects on changing EDH volume. Based on test AUROC, the best models were RF for adults (82.4%), KNN for pediatrics (90%), and LR for all cases (81.6%).

Discussion: In this study, we identified key features for predicting EDH expansion as well as developing ML models. Using high sensitive models, can assist clinicians in identifying high-risk patients early. This allows for enhanced monitoring and timely intervention, improving patient outcomes by facilitating quicker decisions for follow-up imaging or treatment.

Background: The 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.

Method: PubMed/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.

Results: A 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).

Conclusion: The findings suggested that the SMART coil can be a safe and efficient treatment in patients with intracranial aneurysms compared to other available treatment methods.

Background: Stroke is a major cause of morbidity and mortality worldwide. Despite advances in acute treatments, timely intervention remains crucial. This study assessed stroke knowledge in Malta to identify gaps that could contribute to treatment delays.

Methods: A mixed methods approach was used, starting with qualitative interviews of stroke patients, relatives, and bystanders, followed by a quantitative survey among the general Maltese population and healthcare workers. The online survey included demographics, stroke knowledge, and stroke response questions. Data were analysed using descriptive and inferential statistics to identify knowledge gaps and influencing factors.

Results: The study surveyed 1872 participants, representing the Maltese population. Significant knowledge gaps were found in stroke symptoms, risk factors, and appropriate responses. Younger participants, males, non-Maltese, urban residents, those with higher education, and higher-income individuals showed better stroke knowledge and response. Healthcare workers scored higher than the general public. A strong positive correlation was found between stroke knowledge and appropriate response actions.

Conclusions: The study highlights the need for targeted educational interventions to improve stroke awareness and response, especially among older adults, women, rural residents, and lower-income groups. Recommendations include comprehensive public education campaigns, culturally tailored materials, and ongoing professional development for healthcare workers. Addressing these gaps could enhance stroke prevention and management, reducing stroke-related morbidity and mortality.

Background: Endovascular treatment of dural venous sinus stenosis using auto-expandable stents is progressively becoming a central part in the management of patients with idiopathic intracranial hypertension (IIH) and pulsatile tinnitus. One potential concern during stenting is impairment of venous outflow in the Labbé vein, which usually drains in close proximity to the culprit transverse sinus stenosis. Methods: We propose a technique which can counteract venous outflow impairment, consisting of temporary balloon protection of the Labbé vein during stent deployment. Results: We illustrate the use of this technique in a case of IIH with intrinsic dural sinus stenosis induced by a large arachnoid granulation situated close to the insertion of the Labbé vein. The stent was deployed under temporary balloon inflation in order to deflect the arachnoid granulation away from the vein ostium. Conclusions: In selected cases of intrinsic stenosis, temporary balloon protection can be used to avoid Labbé vein flow impairment during venous sinus stenting.

We herein report the case of a pediatric patient suffering from subarachnoid hemorrhage (SAH) due to a ruptured internal carotid artery (ICA) saccular aneurysm. Considering the unfavorable anatomy and irregular shape of the aneurysm, a flow diverter (FD) stent was positioned in addition to coils in an acute setting. Cangrelor (Kengreal, Chiesi, USA) IV bolus followed by maintenance IV infusion was administered in addition to ASA at the time of intervention. Transitioning from cangrelor to thienopyridine (clopidogrel) was done the day after the procedure without any ischemic or hemorrhagic complications. The patient was discharged symptom-free 24 days later. We discuss technical considerations focusing specifically on antiplatelet therapy 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.

Recanalizing acute ischemic stroke with carotid tandem occlusion (CTO) is technically challenging because distal embolic migration during revascularization can significantly influence outcomes. In this study, we aimed to introduce our coaxial balloon technique using a balloon-guiding catheter (BCG), angioplasty catheter, and aspiration catheter sequentially to prevent thrombus migration to a new vascular territory. We used this technique for six patients with CTO. Technical success with good revascularization of the CTO was achieved in all six patients (100%) without neurological complications, including one and five cases of modified Thrombolysis in Cerebral Infarction 2b and 3, respectively. The median duration of the procedure was 61 (interquartile range, 52-90) min. The mean National Institutes of Health Stroke Scale score at discharge was 3.5 (2-8), with favorable clinical outcomes at 90 days for three of six patients (50%). The coaxial balloon technique for CTO is safe and effective for revascularization in patients with acute ischemic stroke. Thrombectomy before proximal stenting was associated with shorter reperfusion times and better clinical outcomes. Therefore, this approach is recommended for tandem occlusions requiring stent angioplasty.