Clinical Neuroradiology最新文献

Purpose: The optimal anesthetic approach for intracranial stenting in acute stroke remains unclear. We compared outcomes of patients under general anesthesia (GA) versus local anesthesia or conscious sedation.

Methods: The RESISTANT registry is a multicenter observational study on acute intracranial stenting during thrombectomy. Patients treated between January 2016 and June 2023 were included and stratified into GA and local anestesia/conscious sedation groups. The primary outcome was an adjusted shift analysis of the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included mRS 0-2 at 90 days and final modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 scores. Safety outcomes were symptomatic intracranial hemorrhage (sICH) and mortality. Adjusted ordinal and logistic regression with mixed-effects models were performed.

Results: Of 876 patients, 445 (50.8%) received GA. Median age was 67 years [59-77]; 567 (64.8%) were men. No differences were found in 90-day mRS (adjusted common OR = 1.256 [0.887-1.780], p = 0.199). Rates of functional independence (39.0% vs 44.5%; aOR = 0.956 [0.606-1.507], p = 0.846), mTICI 2c/3 (68.9% vs 68.7%; aOR = 0.941 [0.602-1.471], p = 0.790), and sICH (8.0% vs 8.6%; aOR = 0.769 [0.374-1.584], p = 0.477) were comparable. In-hospital (23.0% vs 12.0%; aOR = 2.39 [1.35-4.22], p = 0.003) and 90-day mortality (33.3% vs 21.1%; aOR = 2.017 [1.227-3.315], p = 0.006) were higher in the GA group.

Conclusion: In patients undergoing intracranial stenting during thrombectomy, anesthesia modality was not associated with better outcomes. GA was linked to higher mortality, likely due to indication bias.

Purpose: This study aimed to provide a representative overview of the current research conditions in neuroradiology at German hospitals.

Methods: In 2024, the German Society of Neuroradiology (DGNR) conducted an anonymous online survey targeting neuroradiology researchers working at German hospitals. Participants were recruited via targeted e-mail-outreach and professional social media channels. Data were collected using the Easyfeedback platform. A total of 60 individuals participated, of whom 33 completed the full 33-item questionnaire. Data were analyzed descriptively.

Results: Among respondents who completed the survey, 50% reported being satisfied or very satisfied with their current research conditions. Respondents from non-independent departments expressed more dissatisfaction than those of independent institutes. Major challenges for researchers included insufficient research time, lack of funding, and limited infrastructure. Scientific work was most frequently conducted alongside clinical duties or during personal time, while only a minority of respondents reported receiving continuousely protected research time. Intramural university funding represented the most common funding source. Any type of structured research program was available at approximately half of the institutions. Mentoring opportunities within these programs were reported by a majority of respondents, with generally positive evaluations and corresponding higher satisfaction with research conditions.

Conclusion: Structural independence, expanding protected research time, improving funding opportunities, and promoting structured research and mentoring programs appear essential to ensure sustainable academic development and innovation in the field.

Purpose: Mechanical thrombectomy (MT), in combination with intravenous thrombolysis, have been widely accepted as effective therapies for acute ischemic stroke (AIS) secondary to large vessel occlusion. However, the presence of calcified cerebral emboli (CCE) has been associated with worse angiographic and clinical outcomes. Therefore, this systematic review aimed to evaluate the efficacy and safety of MT in the management of AIS secondary to CCE.

Methods: A systematic review was registered and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (CRD420251031539). PubMed, Ovid Medline, SCOPUS, The Cochrane Library and EMBASE were searched for publications until 13th April 2025.

Results: The search yielded 2102 publications. 14 studies met inclusion criteria (160 patients with AIS due to CCE). Two multi-centre studies reported recanalisation rates of only 57.5% and 57% respectively across 75 participants. Only 11.1-28.0% of patients in the included case series and cohort studies had a modified rankin score 2 at 3 months, suggesting that most patients did not regain functional independence following MT for CCE. MT for CCE was also associated with a 3-month mortality rate of 0-62.5%. Haemorrhagic complications were the most common adverse effect associated with MT.

Conclusion: The available evidence from 14 studies elucidated poor recanalisation rates and functional outcomes when MT was used in the management of AIS secondary to CCE. However, the available evidence is primarily low-level evidence from observational studies, hence the conclusions should be interpreted with caution.

Purpose: Lesions in the spinal cord (SC) can be found in up to 83% of patients with multiple sclerosis (MS). As they are mainly located in the cervical segment, many centers exclude the thoracic part from SC imaging. The aim of our study was to quantify the decrease in sensitivity resulting from this approach.

Methods: MR images (3T) of 543 consecutive patients with clinically isolated syndrome (CIS) (n: 37) and MS (n: 506) were analyzed retrospectively. Lesions were segmented semi-automatically on axial T2-weighted images of the whole SC using BrainSeg3D. The volume of lesions was related to vertebral levels.

Results: Altogether 1782 lesions (CIS: 19; MS: 1763) were found in 409 patients. 70% of the lesion volume was located in the SC above the 3rd thoracic vertebral body, in a segment that is commonly covered by an isolated examination of the cervical SC. However, 26 patients (6%) showed lesions exclusively below the 3rd thoracic vertebral body, thus 94% of all patients with SC lesions could be detected with isolated MR imaging of the cervical SC.

Conclusion: Though the majority of lesions can be detected in an isolated examination of the upper part of the SC, some patients showed lesions exclusively below the 3rd thoracic vertebral body. We recommend routine scanning of the whole SC in suspected MS.

Introduction: Hydrocephalus is traditionally managed with ventriculoperitoneal shunting (VPS), which is associated with high rates of infection, mechanical failure, and surgical revisions. Recent innovations in endovascular techniques have led to the development of minimally invasive cerebrospinal fluid (CSF) diversion techniques. This literature review systematically examines the development, procedural techniques, efficacy, and safety profile of endovascular treatments for communicating hydrocephalus.

Methods: A systematic search was conducted in PubMed/MEDLINE, Embase, Scopus and clinicaltrials.gov from inception until March 15, 2025, following the PRISMA guidelines (PROSPERO registration number: CRD420251012455). Two reviewers independently screened and extracted data. Results are summarized descriptively.

Results: Of 5319 records identified, 16 studies were included. Of those, six were published as original articles and 10 as conference abstracts. Overall, two technical reports of endovascular treatment of hydrocephalus were found: eShunt® (n = 14 studies) and choroidal artery embolization (n = 1 studies). Outcome data are available for 70 patients treated with the eShunt®. In patients with idiopathic normal pressure hydrocephalus treated with eShunt® implantation, the Timed Up and Go test improved by 35.7%, Montreal Cognitive Assessment scores by +1.6 points, and neurogenic bladder symptom scores by -3.6s at one year. No device-related serious adverse events were reported.

Discussion: Endovascular CSF diversion represents an emerging, minimally invasive alternative to traditional shunting techniques for communicating hydrocephalus. While early results demonstrate technical feasibility and encouraging safety profiles, long-term data from ongoing clinical trials are critical to establish its role in standard neurosurgical and neurointerventional practice.

Purpose: This study examined whether task-based functional MRI (fMRI) can provide metrics of local brain activity and hemodynamics typically derived from resting-state fMRI (rsfMRI).

Methods: Two publicly open datasets from healthy individuals and brain tumor patients were retrospectively used to compare amplitude of low-frequency fluctuations (ALFF) and global signal metrics, namely, global signal correlation (GSC), global signal cross-correlation (GSXC), and global signal time delay (GSTD) derived from motor and language fMRI with those from a reference rsfMRI scan (rest-1). Factors influencing the correlations between each measurement were examined using a mixed-effects model with post-hoc pairwise comparisons.

Results: Our study included 50 healthy subjects (mean age: 29 ± 3 years; 32 women) and 38 patients (45 ± 14 years; 24 men). Significant correlations (p < 0.001) were found for all metrics between those derived from motor, language, or a second rest scan (rest-2) against rest-1 scans for both healthy subjects and patients. Both fMRI type and motion magnitude affected the measurements of healthy subjects' GSC (fMRI type: F [2, 69.1] = 15.4, p < 0.001; motion: F [1, 123.1] = 8.5, p = 0.004), GSXC (fMRI type: F [2, 69.5] = 18.9, p < 0.001; motion: F [1, 123.2] = 9.89, p = 0.002), and GSTD (fMRI type: F [2, 58.7] = 9.89, p < 0.001; motion: F [1, 123.2] = 15.26, p < 0.001). FMRI type by motion interaction was significant for ALFF (F [2, 65.9] = 6.13, p = 0.004). The effects were less pronounced and observed only for GSC (F [2, 40.4] = 6.1, p = 0.005) and GSXC (F [2, 41.2] = 6.4, p = 0.004) in the clinical dataset.

Conclusion: Repurposing existing task-based functional MRI data for evaluating local brain activities and hemodynamics is feasible in the entire brain in healthy and brain tumor subjects.

Purpose: The cerebral blood flow (CBF) measured by multi-delay ASL (4D-ASL) offers superior diagnostic performance compared to single-delay ASL-CBF for glioma grading. Dynamic changes in signal intensity (SI) and arterial transit time (ATT) obtained from 4D-ASL may also be key factors in differentiating adult-type diffuse glioma. Furthermore, the longitudinal relaxation time (T1) of brain tumor may influence on CBF and ATT when using ASL techniques. Our purpose was to determine if time-intensity profiles from 4D-ASL using a variable-TR scheme and T1-corrected ATT (ATT_T1corr) could distinguish among adult-type diffuse gliomas.

Materials and methods: The 4D-ASL with a variable-TR scheme data were collected by changing the labeling duration (LD) and post-labeling delay (PLD). Data acquisition at each phase consisted of pre-saturation and control or labeling modules followed by data acquisition. A total of 14 LD and PLD combinations were used. In addition, T1 measurement was conducted using pseudo-continuous ASL with a variable-TR scheme, without label and background suppression pulses. The SI peak time was obtained based on the time-intensity curve. The SI peak time, ATT, and ATT_T1corr were compared among adult-type diffuse gliomas.

Results: Thirty patients were included in the study. ATT and the SI peak time in diffuse glioma with IDH-wildtype (IDHw) were significantly shorter than astrocytoma, IDH-mutant (p < 0.01, each). Moreover, ATT_T1corr in astrocytoma, IDH-mutant was longer than the other types of diffuse glioma (p < 0.0001).

Conclusion: The 4D-ASL with a variable-TR scheme includes ATT_T1corr and the SI peak time could potentially improve the differential diagnosis of adult-type diffuse gliomas.

Rationale and objectives: Diffusion-weighted imaging (DWI) of the head and neck is essential for various clinical applications but is often hampered by artifacts and reduced image quality. Deep learning (DL) reconstruction has the potential to enhance the quality of head and neck DWI. This study aims to evaluate the performance of an accelerated, DL-reconstructed DWI (DWI_DL) in terms of image quality and diagnostic confidence.

Materials and methods: This retrospective study included patients who underwent clinically indicated head and neck DWI at 1.5 T and 3 T between August 2023 and January 2024 at a tertiary care center. Imaging was performed at low b‑values (0 or 50 sec/mm²) and high b‑values (800 sec/mm²), and apparent diffusion coefficient (ADC) maps were computed. After acquiring standard single-shot echoplanar imaging DWI sequences, the raw MR datasets underwent simulated acceleration by reducing the number of signal averages. These accelerated exams were then reconstructed using a novel DL-based algorithm that combined DL-based k‑space to image reconstruction with DL-based super-resolution processing (DWI_DL). Three readers analyzed the images using a visual Likert score to evaluate image sharpness, artifacts, noise, overall image quality, and diagnostic confidence. Comparisons were made using the Wilcoxon signed-rank test. A quantitative analysis of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and apparent diffusion coefficient values (ADC) was also performed.

Results: The study included 30 patients (mean age, 55 ± 19 years; range, 24-84; 18 men) with various pathologies. Scan times were reduced by 67% at 1.5 T and up to 55% at 3 T. The quantitative analysis revealed a minimal but statistically significant decrease in SNR and CNR in the deep learning-reconstructed images (p = 0.002 and p < 0.001, respectively). However, readers reported no significant differences between DWI and DWI_DL regarding image quality parameters or diagnostic confidence for both low and high b‑value images, as well as the ADC (all p > 0.05).

Conclusion: DL reconstruction of head and neck DWI is feasible, significantly reducing examination time without compromising image quality or diagnostic confidence. This technique enables accelerated and effective diagnostic DWI of the head and neck.