Neuroradiology Journal最新文献

Spinal epidural arteriovenous fistulas (SEAVFs) with intradural reflux are rare but important vascular lesions that may cause progressive myelopathy due to spinal cord venous hypertension. Although traditionally managed by means of arterial embolization or surgical disconnection, these approaches can pose risks, particularly when critical vascular structures, such as the artery of Adamkiewicz, originate in close proximity to the fistulous site. We report the case of a patient in their 60s who presented with progressive paraparesis over approximately 1 year, ultimately attributed to an SEAVF located adjacent to the right L1-L2 neural foramen, with radiculo-perimedullary reflux. The artery of Adamkiewicz was visualized with its origin near the shunt site, rendering arterial embolization unsafe and prompting selection of a purely transvenous endovascular approach. Venous access was obtained via the azygos system, and a microcatheter was navigated through the epidural venous pouch to reach a cranially directed draining vein extending toward the perimedullary venous system, which was then embolized using detachable platinum coils. The procedure achieved complete occlusion of the targeted vein, with early neurological improvement and significant reduction in spinal cord edema on follow-up imaging. This case supports the feasibility, safety, and efficacy of transvenous embolization for SEAVFs and underscores its expanding role in the treatment of complex spinal vascular lesions.

Stroke poses a significant health challenge, with ischemic and hemorrhagic subtypes requiring timely and accurate diagnosis for effective management. Traditional imaging techniques like CT have limitations, particularly in early ischemic stroke detection. Recent advancements in artificial intelligence (AI) offer potential improvements in stroke diagnosis by enhancing imaging interpretation. This meta-analysis aims to evaluate the diagnostic accuracy of AI systems compared to human experts in detecting ischemic and hemorrhagic strokes. The review was conducted following PRISMA-DTA guidelines. Studies included stroke patients evaluated in emergency settings using AI-Based models on CT or MRI imaging, with human radiologists as the reference standard. Databases searched were MEDLINE, Scopus, and Cochrane Central, up to January 1, 2024. The primary outcome measured was diagnostic accuracy, including sensitivity, specificity, and AUROC and the methodological quality was assessed using QUADAS-2. Nine studies met the inclusion criteria and were included. The pooled analysis for ischemic stroke revealed a mean sensitivity of 86.9% (95% CI: 69.9%-95%) and specificity of 88.6% (95% CI: 77.8%-94.5%). For hemorrhagic stroke, the pooled sensitivity and specificity were 90.6% (95% CI: 86.2%-93.6%) and 93.9% (95% CI: 87.6%-97.2%), respectively. The diagnostic odds ratios indicated strong diagnostic efficacy, particularly for hemorrhagic stroke (DOR: 148.8, 95% CI: 79.9-277.2). AI-Based systems exhibit high diagnostic accuracy for both ischemic and hemorrhagic strokes, closely approaching that of human radiologists. These findings underscore the potential of AI to improve diagnostic precision and expedite clinical decision-making in acute stroke settings.

Acute basilar artery occlusion (BAO) can lead to severe stroke and is linked to significant disability or death if not treated. This meta-analysis evaluated the effectiveness and safety of first-line thrombectomy options: Direct Aspiration (DA) and Stent Retriever Thrombectomy (SRT) for acute BAO. Electronic databases, including PubMed, Cochrane Central, ScienceDirect, Embase, and Web of Science were searched from inception until July 2025. Studies were included if they were RCTs or observational cohorts involving adults with acute BAO, comparing DA and SRT. The risk ratios (RR) and mean differences (MD) were pooled using Review Manager version. The Newcastle-Ottawa Scale (NOS) was used to assess quality. This meta-analysis included fifteen observational studies pooling 2214 patients. DA significantly increased the postoperative successful (RR = 1.04; 95% CI: 1.01 to 1.07; p = 0.008) and complete (RR = 1.19; 95% CI: 1.03 to 1.38; p = 0.02) recanalization compared to SRT. Similarly, symptomatic intracerebral hemorrhage (sICH) incidence was significantly reduced in the DA arm (RR = 0.65; 95% CI: 0.44 to 0.97; p = 0.04). DA is also associated with decreased procedural duration (MD = -35.17 min; 95% CI: -47.97 to -22.37; p < 0.00001). Meanwhile other outcomes, including postoperative mortality, rescue therapy, and favorable functional outcome were comparable between the 2 groups. DA demonstrated superior recanalization rates, reduced procedural duration, and a lower incidence of sICH compared to SRT. However, both techniques were comparable regarding other outcomes. Nevertheless, the observational study design limits the strength of the conclusion drawn.

ObjectiveTo evaluate the efficacy and safety of the Silk Vista flow diverter stent in treating recurrent cerebral bifurcation aneurysms, highlighting angiographic and clinical outcomes in a monocentric case series.MethodsA retrospective analysis of 12 patients (7 male, five female) with recurrent bifurcation aneurysms treated exclusively with the Silk Vista flow diverter was conducted. Aneurysms were located in the anterior communicating artery (75%), middle cerebral artery (17%), and basilar artery (8%). All patients received dual antiplatelet therapy for ten days pre-procedure and 6 months post-procedure, followed by aspirin monotherapy. The O'Kelly-Marotta (OKM) scale was used to assess aneurysm filling, where Grade D indicates complete occlusion. Clinical outcomes were measured using the modified Rankin Scale (mRS), with scores of 0-1 reflecting no or minimal disability.ResultsAt the end of the procedure, 75% (n = 9) of patients exhibited stagnant contrast filling within the aneurysm sac (OKM Grade C) during the venous phase. Periprocedural thromboembolic complications occurred in 17% (n = 2) of cases, without clinical sequelae. No post-hospital complications were observed, and all patients maintained mRS scores of 0-1 at discharge. At 1-year follow-up, complete aneurysm exclusion (OKM Grade D) was achieved in 83% (n = 10), while minimal neck perfusion (OKM Grade C) persisted in 17% (n = 2). No new neurological deficits or deterioration occurred.ConclusionDespite the small sample size and single-center design, the Silk Vista flow diverter demonstrated favorable angiographic and clinical outcomes, supporting its role as a viable and safe option in this complex patient population.

High grade torcular DAVFs can be challenging to treat, particularly when there is retrograde flow in the straight sinus and deep venous system. We describe the technical steps to safely sacrifice the straight sinus, including preoperative MRI findings, arterial and venous cerebral flow assessment and key points for endovascular treatment.

PurposeOxygen 6-methylguanine-DNA methyltransferase (MGMT) promoter methylation is associated with better chemotherapy response and prognosis in glioblastoma patients. This study evaluates the prognostic value of routine MRI findings at initial diagnosis to determine MGMT promoter methylation status.MethodsA retrospective study was performed on 85 patients with histologically confirmed IDH wild-type glioblastoma. Patients were divided into two groups based on MGMT promoter status: methylated (33 [38.8%]) and unmethylated (52 [61.1%]). MRI findings were assessed using the Visually Accessible Rembrandt Imaging lexicon, and variables were analyzed using univariate analysis (X²/Fisher's test) and logistic regression for independent predictors of MGMT promoter methylation.ResultsA thick enhancing tumoral margin (≥3 mm) was present in 67.3% of MGMT unmethylated glioblastomas and 32.7% of MGMT promoter methylated glioblastomas (p = .05). Tumoral cortical extension was observed in 68.7% of unmethylated cases versus 31.3% in methylated cases (p = .01). Non-enhancing tumors were predominantly MGMT methylated (83.3%). In multivariate analysis, tumoral cortical involvement and non-enhancing tumors were independent predictors of MGMT promoter methylation. In survival analysis, higher progression-free survival rates were identified in patients with MGMT promoter methylation (p = .05) and in patients without cortical tumoral extension (p = .05).ConclusionOur study suggests that while the predictive power of the assessed parameters is modest, thick enhancing tumoral margins and cortical tumor extension were more frequently identified in MGMT unmethylated glioblastomas. Conversely, 83.3% of non-enhancing tumors showed MGMT promoter methylation. Furthermore, MGMT promoter methylation and cortical extension were associated with progression-free survival.

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.

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.

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.