Neuroradiology Journal最新文献

PurposeSynthetic MRI has potential to significantly reduce MR scan time by reconstructing multiple contrast images from a single acquisition. The aim of this study was to compare the image quality of both pre- and post-contrast synthetic MRI in subjects with ring-enhancing brain lesions with conventional images.Methods50 patients with radiologically confirmed ring-enhancing brain lesions underwent TSE_MDME sequence before and after gadolinium administration along with conventional MRI sequences. Image quality was compared between synthetic and conventional sequences on a 4-point scale across 5 parameters, that is, grey white matter differentiation, demarcation of caudate nucleus, lentiform nucleus, demarcation of sulci, and SNR. Also, the artefacts, lesion conspicuity, and ability to diagnose on synthetic images were studied.ResultsImage quality of synthetic MRI was relatively similar across all sequences except for FLAIR. The image quality comparison between synthetic and conventional images showed an agreement in 70.7% of the cases (Weighted Kappa = 0.043, p = <0.001). Artefacts were maximum in synthetic FLAIR sequence (52%). 50% cases showed a discordant enhancement pattern in post contrast synthetic images. Despite a higher occurrence of artefacts in synthetic post contrast images, diagnostic ability was comparable across pre- and post-contrast synthetic and conventional images.ConclusionSynthetic MRI provides comparable diagnostic quality of images with acceptable rate of artefacts in both pre and post contrast sequences. However, needs a careful interpretation especially when diagnosis is heavily relied on the enhancement pattern of lesions.

BackgroundPaediatric neuro-interventional (PNI) procedures are markedly different to adult procedures and are more likely to be complicated by vasospasm. Traversing the complex tortuous anatomy in these fragile vessels requires both torque control and distal tip softness of the microwire. The Aristotle wires (Scientia Vascular Inc) are a new family of wires with design features offering both torque control and distal tip softness. We sought to assess the ability of these wires to achieve successful target vessel cannulation in paediatric patients.MethodsThe study design was a single-centre case-control study. We compared a case cohort of PNI procedures performed using the Aristotle wires (2023-24) with a control cohort using other wires (2022-23). The primary study outcome was successful cannulation of the target vessel (Yes/No) with a microcatheter.ResultsThe Aristotle wires cohort consisted of 44 targeted vessels across 40 procedures in 20 patients (F = 8; mean age 6.9, SD 6.53 years). The other wires cohort consisted of 41 targeted vessels across 41 procedures in 19 patients (F = 6; mean age 4.3, SD 4.98 years). Successful cannulation of the target vessel was achieved in 43 of 44 target vessels (97.7%) in the Aristotle wires cohort and 34 of 41 target vessels (82.9%) in the other wires cohort (p = .020). The rate of wire-related complications was significantly lower in the Aristotle wires cohort (0 of 44 vs 6 of 41 target vessels, p = .008).ConclusionAristotle wires were associated with significantly better target vessel cannulation and lower wire-related complications than other wires in PNI procedures.

IntroductionBrain tumors pose significant diagnostic and therapeutic challenges due to their diverse treatment responses and complex imaging characteristics. Traditional MRI techniques often struggle to differentiate between tumor recurrence and post-treatment changes such as pseudoprogression and necrosis, highlighting the need for more accurate diagnostic tools.Material and MethodsThis retrospective study conducted at a single tertiary care center and evaluated the diagnostic efficacy of Treatment Response Assessment Maps (TRAMs), also known as Contrast Clearance Analysis (CCA), in distinguishing between tumor recurrence and post-treatment changes in patients who underwent initial treatment for brain tumors. Data from 27 patients were analyzed, including 10 who underwent surgical resection (Group 1) and 17 who had serial images and TRAMs/CCA assessment (Group 2).ResultIn Group 1, TRAMs/CCA demonstrated nine positive results, with 8 cases of tumor recurrence confirmed via biopsy. A biopsy also confirmed one negative result after a discussion with the patient. In Group 2, where patients did not undergo biopsy, TRAMs/CCA results varied but correlated with clinical outcomes, underscoring the potential utility of TRAMs/CCA in guiding treatment decisions. These findings suggest that TRAMs/CCA may have superior diagnostic performance compared to traditional MRI in differentiating between tumors.ConclusionTRAMs/CCA represents a promising advancement in the imaging assessment of brain tumor treatment response, offering higher sensitivity than conventional MRI methods. While implementing TRAMs/CCA could potentially improve diagnostic accuracy and optimize therapeutic strategies for patients with brain tumors, the final decision remains highly dependent on patient-centered discussions.

BackgroundThe Woven EndoBridge 17 (WEB-17) is the latest advancement in the WEB device family. Comprehensive data on its occlusion rates, procedural complications, and mortality is lacking. This meta-analysis aimed to evaluate the efficacy and safety of the WEB-17 device in intracranial aneurysms (IAs).MethodsA systematic literature search was conducted from inception to October 2023 across four databases for studies on IAs treated with WEB 17. Primary outcomes included adequate angiographic occlusion at last follow-up and a composite of intraprocedural and postprocedural complications. Comparative meta-analysis between WEB-17 and its predecessor versions (pvWEB) was performed. Subgroup analyses by IA rupture status were also conducted for the primary outcomes.ResultsEleven studies with 880 patients and 933 IAs were included. Regarding efficacy, the rate of adequate occlusion at last follow-up was 91% (95% CI 86%-94%) and the complete occlusion rate was 69% (95% CI 65%-73%). Safety outcomes demonstrated a composite complication rate of 7% (95% CI 4%-11%), an intraprocedural complication rate of 7% (95% CI 5%-9%; I2 = 0%), and a postprocedural complication rate of 2% (95% CI 1%-5%; I2 = 0%). No differences were found between WEB-17 and pvWEB in terms of adequate occlusion (WEB-17: 87.7% vs pvWEB: 80.4%; OR = 1.35, 95% CI 0.71-2.55) and safety composite outcome (WEB-17: 8.7% vs pvWEB: 10%; OR = 1.05, 95% CI 0.51-2.16). Subgroup analysis did not evidence heterogeneity between subgroups.ConclusionsThe WEB-17 device demonstrates promising efficacy and safety profiles for the treatment of IAs. However, these results should be interpreted with caution due to the limited quality of evidence in the included studies. Further prospective, randomized studies are needed to validate these findings.

BackgroundCarotid artery tortuosity (CAT) may complicate mechanical thrombectomy (MT), potentially causing delays or preventing recanalization. However, the relationship between CAT and MT outcomes remains largely unexplored. This systematic review aims to evaluate the existing evidence regarding the impact of CAT on MT outcomes.MethodsFollowing PRISMA guidelines, a systematic literature search was conducted using MEDLINE, EMBASE, Web of Science, Cochrane, and Scopus databases. Studies providing data for MT outcomes based on CAT status were included. Outcomes of interest included successful recanalization, first-pass efficacy (FPE), procedure time, functional independence, and procedure-related complications.ResultsOur search identified nine studies with 2737 patients. Three studies employed DSA to assess tortuosity, whereas the remaining six studies preferred CTA. In seven studies, CAT was associated with prolonged procedure times. In five studies, successful recanalization rates were significantly lower in CAT patients as compared to patients with non-tortuous arteries. Two studies showed that CAT could alter FPE or successful recanalization rates of first-line MT techniques. No study found statistically significant relationships between CAT and functional independence. Three studies examined the association between CAT and safety outcomes, and only one study found increased intracranial hemorrhage rates in patients with CAT. All nine studies employed different CAT criteria.ConclusionsDespite the vast MT literature, the number of studies reporting CAT status remains low. CAT may affect procedure time and technical outcomes of MT. Therefore, employing a uniform CAT definition and reporting CAT more frequently can provide insights into management of patients with acute large vessel occlusions.

Cerebral angiography is essential for diagnosing cerebrovascular diseases and crucial to separate the internal and external carotid arteries during angiography. The femoral artery approach is more invasive than the brachial artery approach. In some cases, guiding the catheter through the right brachial artery to the left internal and external carotid arteries is feasible. This study retrospectively investigated factors influencing successful catheter guidance to the left carotid arteries. We studied 30 patients (17 men; mean age 64.9 years) in whom catheter guidance to the left internal and external carotid arteries was attempted via the right brachial artery. A 4Fr Simmons-type catheter and a 0.035-inch diameter guidewire were used. We retrospectively analyzed patient characteristics and aortic arch anatomy. Guidance was successful in 20 patients (66.7%). There were no significant differences in sex, age, height, weight, BMI, aorta type, or bifurcation type between the brachiocephalic and left common carotid arteries between the successful and unsuccessful cases. However, a significant difference was observed in the angle formed by the Simmons catheter during insertion into the left common carotid artery (45.7° vs 19.3° p < .01). The rising angles of the catheter entering the aortic arch from the brachiocephalic artery were 64.2° versus 84.8°, respectively (p < .01). Cut-off values were 30.9° (AUC = 0.985) and 77.5° (AUC = 0.9). Safe guidance to the left internal and external carotid arteries was achievable when the angle of the Simmons catheter curve was 30.9° or greater and the rising angle of the catheter entering the aortic arch from the brachiocephalic artery was 77.5° or less.

High-grade astrocytoma with piloid features (HGAP) is a recently described IDH-wildtype tumor with limited literature describing its imaging features. We present our institution's experience and the largest imaging-focused cohort of HGAP reported to date, offering a comprehensive analysis of MRI features of seventeen intracranial and one spinal HGAP, while introducing novel imaging features that have not been previously described. These include focal areas of diffusion restriction, surrounding spiculated, finger-like enhancement and increased perfusion metrics. Additionally, we highlight imaging features of HGAP arising in patients with Neurofibromatosis Type 1, such as intraventricular tumor spread, unusual temporal lobe location and multifocal presentation.

PurposeDifferentiating cerebellopontine meningioma (CPM) from schwannoma (CPS) can be challenging. In this location, schwannomas alter the composition of the perilymphatic fluid differently from meningiomas, which has repercussions on magnetic resonance imaging. This study aims to distinguish between these tumors based on the labyrinthine fluid signal on 3D-CISS.MethodsPatients with histologically confirmed CPM and CPS were selected. Analyses were performed considering visual signal intensity from the vestibule and cochlea, and the signal ratios between the vestibules (aV/uV) and the cochleae (aC/uC) on affected and unaffected sides. The signal intensity ratio between vestibule and cerebellum (aV/aCH), vestibule and cerebrospinal fluid (aV/aCSF), and cochlea and cerebrospinal fluid (aC/aCSF), on affected sides, as well as the vestibule and cerebellum ratio between affected and unaffected sides ([aV/aCH]: [uV/uCH]), were also compared.ResultsStatistically significant differences were demonstrated for visual signal reduction (p < .001) and for aV/uV (p = .005), aC/uC (p < .001), [aV/aCH]: [uV/uCH] (p = .018), aV/aCSF (p = .036), and aC/aCSF (p = .001) ratios, with lower values associated with schwannomas. The aC/aCSF ratio showed the highest accuracy (84.2%), with a cutoff value of 0.63, and the second-largest area under the Receiver Operating Characteristic (ROC) curve (0.791). The visual reduction of cochlear signal showed the second-highest accuracy (83%). The aC/uC ratio demonstrated the largest area under the ROC curve (0.857) and the third-highest accuracy (75.5%), using 0.74 as the cutoff value.ConclusionThe visual reduction of cochlear signal and the aC/uC and aC/aCSF ratios proved to be the most effective parameters for distinguishing CPM from CPS when the labyrinthine fluid is utilized.

Medical errors are a significant cause of morbidity and mortality. Literature on common mechanisms to reduce radiological error are reviewed including shifting from general to subspecialized care, improving expertise, instituting shift volume and shift length limits, minimizing non-interpretive tasks, participating in focused educational and multidisciplinary conferences, and increasing practice size. Implementation of shift volume limits and full sub-specialization has the potential to significantly reduce radiologist error rates.

PurposeEndovascular removal of the Woven EndoBridge device (WEBectomy) is rarely reported but crucial for managing complications such as migration, compaction, and malposition, which may lead to recurrence and retreatment. This review aimed to assess treatment strategies, outcomes, and complications associated with WEBectomy.MethodsWe searched PubMed, Embase, and Web of Science databases from inception to January 14,2025,following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for studies reporting on cases of WEBectomy.ResultsEight studies with 16 patients (range age 30-89; 50% male) with 16 aneurysms were included. The basilar artery was the most common site in 25% (4/16) of the cases, and 50% (7/14) of the aneurysms were ruptured. Migration was the most frequent complication (11/16, 69%), followed by protrusion (4/16, 25%) and malposition (1/16, 6%) that required the removal of WEB. The Amplatz Goose Neck Microsnare was the most commonly used retrieval device (12/16, 75%), with no reported failures or major complications. Retreatment involved a new WEB in 50% (8/16) and coiling techniques in 31% (5/16). Among nine patients with follow-up imaging, most showed complete occlusion (67%, 6/9). Functional outcomes were favorable in 83% (4/6) (mRS 0-1).ConclusionReported cases show that WEBectomy can be successfully performed in selected situations, allowing tailored retreatment planning. However, due to the small number of cases and limited follow-up, no definitive conclusions about safety or efficacy can be drawn. This review provides a concise synthesis of current management strategies for this rare complication.