Neuroradiology Journal最新文献

We describe a novel application of photon-counting detector CT (PCD-CT) in neurovascular imaging by harnessing the improved spatial resolution, attenuation of electronic noise, and reduction of metal artifacts. The presented case offers the unique challenge of high-quality imaging for the assessment of treated and untreated intracranial saccular aneurysms, in the setting of metal artifacts from embolization coils. Our goal was to explore optimized reconstruction parameters for ultra-high-resolution imaging (UHR) using a dedicated, sharp neurovascular kernel (Hv72) and the highest strength of quantum iterative reconstruction (QIR-4) for detailed characterization of the vasculature. Virtual monoenergetic images (VMIs) and iterative metal artifact reduction (IMAR) were employed to investigate metal artifact reduction techniques. PCD-CT has the promising potential to enhance patient care in the follow-up of patients with treated aneurysms requiring more complex imaging parameters and image post-processing due to intracranial artifacts.

Background and PurposeSuccessful and complete reperfusion should be the aim of every endovascular thrombectomy (EVT) procedure. However, the effect of time delays on successful reperfusion in late window stroke patients presenting 6-to-24 h from onset has not been investigated.Materials and MethodsWe pooled individual patient-level data from seven trials and registries for anterior circulation stroke patients treated with EVT between 6 and 24 h from onset. We explored the impact of delays across multiple interval times, including onset to hospital arrival; hospital arrival to arterial puncture; imaging to arterial puncture; and onset to arterial puncture. Our primary outcome was successful reperfusion, defined as a modified thrombolysis in cerebral infarction (mTICI) score of 2b-3. Logistic regression analyses were performed to assess the association between each of the interval times and successful reperfusion.ResultsWe included 608 patients. The median age was 70 years (IQR 58-79), and 307 (50.5%) were females. Successful reperfusion was achieved in 494 (81.2%) patients. Patients with successful reperfusion had lower NIHSS scores (median 15 [IQR11-19] vs 17 [11-21], p = .02) and significantly shorter hospital arrival to arterial puncture time (90 min [60-150] vs 110 min [84.5-150], p = .01) than unsuccessful reperfusion. The odds of successful reperfusion decreased by 15% for every one-hour delay in arrival-to-puncture time (adjusted odds ratio 0.85, 95% CI: 0.75-0.95). Other workflow times did not impact the rate of successful reperfusion.ConclusionFaster hospital arrival to arterial puncture time is associated with higher odds of successful reperfusion in late window stroke patients.

IntroductionAmide proton transfer (APT) imaging is one of the imaging methods in Magnetic Resonance Imaging (MRI). It is a molecular imaging technique that visualizes contrast based on the concentration or exchange rate of amide groups of amino acids, which increases in tumors. Methionine-positron emission tomography (MET-PET), on the other hand, has been found to be useful in the imaging diagnosis of glioma because of its clear contrast in the accumulation of tumor cells. In this study, we compared APT and MET-PET on the basis of pathological diagnostic results and backwardly examined whether APT is useful for the imaging diagnosis of glioma.MethodForty-six patients with malignant glioma (World Health Organization 2016 (WHO2016) Grade: GII/III/IV) and suspected pseudoprogression who underwent APT and MET-PET were included in the study. For APT, APT signals were measured in the tumor region of interest, and for MET-PET, 370 MBq was administered to measure the tumor-to-normal tissue ratio (TNR).ResultIn the correlation verification, the actual APT and TNR were correlated with 2.22 ± 1.01 and 2.58 ± 1.5, respectively (r = 0.6, p < 0.001). The accuracy of the differentiation between GII/III/IV (32 patients) and suspected pseudoprogression (14 patients) by actual APT measurements was verified with a sensitivity of 91% and specificity of 100% at a cutoff value of 1.81. In the validation of malignancy diagnosis, the measured APT value of GII (6 cases) was 2.18 ± 0.43 and the TNR was 3.53 ± 2.12, the measured APT value of GIII (11 cases) was 2.67 ± 0.69 and TNR was 2.81 ± 0.72, and the measured APT value of GIV (15 cases) was 2.99 ± 0.61 and the TNR was 3.44 ± 1.28. The APT measured value and TNR differed significantly in malignancy diagnoses, with higher grades having higher values. Genetic diagnosis validation revealed that the oligodendroglioma group (GII/III: 10 cases) had an APT of 2.37 ± 0.66 and a TNR of 3.52 ± 1.41, while the astrocytoma group (GII/III: 7 cases) had an APT of 2.67 ± 0.45 and a TNR of 2.41 ± 0.87.ConclusionAPT may be comparable to MET-PET in differentiating suspected pseudoprogression and in diagnosing malignancy. Patients with an actual APT of 1.81 or higher should be considered for a treatment plan, whereas follow-up may be an option for those with an APT of 1.81. Although the TNR tends to be higher in the oligodendroglioma group (GII/III), APT, which is not affected by the blood-brain barrier, has less variability in actual measurements and is useful for the imaging diagnosis of glioma.

Based on the World Health Organization (WHO) 2021 brain tumor pathology classification, we evaluated the usefulness of dual-energy CT (DECT) for differentiating malignancy grades in malignant gliomas and examined its correlation with amide proton transfer (APT). A prospective observational study was conducted on 49 patients: 16 with glioblastoma (GBM, grade 4), 13 with astrocytoma (A3, grade 3), 10 with oligodendroglioma (O3, grade 3), and 10 with oligodendroglioma (O2, grade 2). Effective atomic number (Zeff) and electron density (ED) from DECT were analyzed for tumor grade differentiation and correlation with APT. High-grade gliomas, which are influenced by vascular endothelial growth factor (VEGF) and microvascular proliferation, showed significant differences and correlations in post-contrast Zeff. A correlation between Zeff and MIB-1 suggests its potential as an indicator of cell proliferation. Additionally, correlations between Zeff and APT, as well as between ED and APT, indicate that DECT may be useful for grading malignant gliomas.

In this study, we aimed to compare the treatment outcomes of patients with unruptured aneurysms treated using stent-assisted coil embolization with and without systemic heparinization to examine the intraoperative systemic heparinization efficacy. We included 106 consecutive patients enrolled at Fukuoka Neurosurgical Hospital, Japan, between November 2021 and March 2023. The patients were divided into two groups: the systemic heparinization and nonsystemic heparinization groups. Head magnetic resonance imaging (MRI) performed on postoperative day 1 showed that the number of ischemic foci <2 mm was higher in the nonsystemic heparinization group than in the systemic heparinization group, although the difference was not statistically significant (2 [0-6] vs 1 [0-3], P = .0583). No significant between-group difference was observed concerning the incidence of ischemic and hemorrhagic complications. There was no significant between-group difference regarding the modified Rankin scale (mRS) score; however, the systemic heparinization group had a higher proportion of patients with poor outcomes than did the nonsystemic heparinization group, with one (2.4%) patient with an mRS score of 5 and one (2.4%) patient with an mRS score of 6. In conclusion, intraoperative systemic heparinization during stent-assisted coil embolization of unruptured cerebral aneurysms may suppress diffusion-weighted imaging high-signal spots on head MRI performed on postoperative day 1. Moreover, systemic heparinization may worsen the outcomes of hemorrhagic complications.

BackgroundMechanical thrombectomy (MT) is a well-established treatment for acute large-vessel occlusion. While the transfemoral approach (TFA) is the standard, it can be challenging in elderly patients with tortuous vasculature. The transbrachial approach (TBA) offers a shorter and more direct route but is associated with more puncture site complications. This study investigates the effectiveness and feasibility of TBA for right anterior circulation strokes.MethodsA total of 23 patients who underwent MT via TBA between September 2023 and January 2025 were retrospectively analyzed and compared with 23 patients treated via TFA from March 2021 to April 2023. Patient characteristics, procedural times, recanalization rates, and complications were evaluated.ResultsThe TBA group showed a shorter median puncture-to-guiding (PtoG) time (13 vs 16 min) and puncture-to-recanalization (PtoR) time (37 vs 52 min) compared to the TFA group. Successful recanalization (TICI ≥2b) was achieved in 95.7% of TBA cases versus 87.0% in TFA. One minor puncture site complication occurred in the TBA group. In rare instances, catheter kinking at the subclavian-CCA junction was observed. Sheathless technique was employed in most TBA cases to minimize puncture complications.ConclusionTBA is a feasible alternative for MT in right anterior circulation strokes, providing improved procedural efficiency. While associated with a higher rate of puncture complications, TBA offers a practical solution in cases where TFA or TRA may be technically challenging.

Artery of Percheron (AOP) infarction is a rare form of ischemic stroke resulting from the occlusion of a single arterial trunk that supplies both sides of the paramedian thalamus and the midbrain. Its occlusion can lead to bilateral and symmetrical infarctions of the paramedian thalami, and occasionally, the midbrain. Due to its atypical presentation, this condition is often diagnosed late. We report a case of a 39-year-old male with no significant medical history who arrived at the emergency department with drowsiness and confusion. During the physical examination, the patient was drowsy but responsive, with poor speech. Motor deficits in all four limbs were not apparent. Vital signs, routine blood tests, and an initial CT scan were unremarkable. The diagnosis was confirmed the following day through a subsequent CT scan and brain MRI. This case emphasizes the diagnostic challenge posed by AOP infarction and highlights the importance of considering this condition even when initial CT imaging appears normal.

BackgroundThe patient-associated prevalence of Clopidogrel (CPG)-and Aspirin (ASS)-nonresponse is not well understood and varies depending on the patient population. The influence of responder status for platelet inhibition in patients eligible for carotid artery stenting (CAS) on post-interventional cerebral ischemia is unknown.MethodsWe conducted a retrospective, mono-center analysis of all patients with response-test undergoing elective CAS between 2010 and 2024 and available MRI before and after CAS. Study groups were formed according to ASS- and CPG-response. Cerebral ischemia patterns were compared between study groups in univariate analysis and patient-associated co-morbidities were tested for association with drug resistance or infarction frequency.ResultsIn total, 50/68 (73.5%) of patients showed adequate response to ASS and CPG. Non-response to CPG was higher than to ASS (clopidogrel resistance rate: 14.8%, aspirin resistance rate: 9.2%). All patients with non-response were bridged with GP IIb/IIIa antagonist tirofiban during CAS. Under these conditions, the responder status did not influence post-interventional cerebral infarction patterns.ConclusionAntiplatelet non-response, especially for CPG, is very frequent in patients undergoing CAS. When bridging patients with tirofiban during intervention, responder status had no influence on post-interventional cerebral infarction patterns.

IntroductionPosterior circulation aneurysms are particularly challenging to treat due to their anatomical complexity and the high perforator density within this region. The pipeline vantage flow diverter (PVFD) has shown promising results in treating anterior circulation aneurysms. However, its efficacy and safety in treating posterior circulation saccular aneurysms are not well investigated.MethodsSingle-center study reviewed patients with posterior circulation aneurysms treated with the PVFD between September 2021 and March 2024. Patients and aneurysm characteristics, clinical results, and radiological results were documented.Results22 patients harboring 24 aneurysms were identified. All aneurysms had a saccular morphology. Complications included ischemic events in two patients (8.3%), one leading to mRS deterioration from 0 to 3. One cerebral hemorrhage leading to mRS shift from 0 to 1 was also documented. At the latest imaging follow-up available (median 14.3 months), complete aneurysm occlusion (Class I, Raymond-Roy occlusion classification (RROC) was achieved in 50% of the cases, residual neck (Class II) in 41.7%, and residual aneurysm (Class III) in 8.3%. Basilar bifurcation aneurysms had lower complete occlusion rates (RROC I: 33.3%) and higher complication rates (16.7% with mRS shift) compared to other locations. In-stent stenosis was rare (4.5%). A limitation of the study is the retrospective, single-center study design.ConclusionThe PVFD demonstrates high occlusion rates and a favorable safety profile in the treatment of saccular aneurysms in the posterior circulation. However, treatment of basilar bifurcation aneurysms with the PVFD remains challenging due to the complex anatomy and high-flow dynamics in this location.

The Woven EndoBridge (WEB) device's effectiveness and safety have been thoroughly assessed in several clinical practice trials. The availability of new WEB sizes expanded the indications for the endovascular treatment of intracranial wide-necked aneurysms. We retrospectively analysed data from all patients with intracranial aneurysms treated with a 6 × 2 or 7 × 2 WEB in two institutions; endovascular embolization was performed both in unruptured and ruptured aneurysms. Seven patients with 7 wide-necked aneurysms were included; one aneurysm was ruptured. All aneurysms involved the anterior circulation. Technical success of embolization performed with flat WEB devices was accomplished and no intraprocedural complications occurred. At 3 months follow-up, adequate occlusion was obtained for six treated aneurysms. With the availability of new WEB sizes, broad-based aneurysms with unfavourable height and aspect ratio are suitable for embolization using intrasaccular flow disruption in our preliminary experience; larger series are needed to confirm their long-term efficacy.