Clinical Neuroradiology最新文献

Purpose: Reocclusion after endovascular therapy (EVT) may worsen the clinical outcome of patients undergoing EVT for intracranial atherothrombotic stroke with large vessel occlusion (AT-LVO), but the details and risk factors have not been fully investigated.

Methods: Patients with intracranial AT-LVO were enrolled in a multicenter retrospective registry study conducted at 51 centers in Japan and were divided into two groups based on whether reocclusion occurred within 90 days after recanalization of intracranial AT-LVO with EVT: the reocclusion group and the patent group. The primary outcome was a modified Rankin Scale score of 0-2 at 90 days after EVT. Risk factors for reocclusion were also assessed.

Results: A total of 461 patients were enrolled, 66 (14.3%) in the reocclusion group and 395 (85.7%) in the patent group. Intracranial stenting and differences in antithrombotic regimens were not associated with reocclusion. The rate of patients with the primary outcome was significantly lower in the reocclusion group than in the patent group (15.4% vs. 46.4%, adjusted odds ratio 0.15 [95% confidence interval 0.06-0.33], P < 0.001). Reocclusion was associated with recurrent ischemic stroke, additional EVT or surgery, symptomatic intracranial hemorrhage, and all-cause death. Direct aspiration and vessel perforation were independent factors for reocclusion (adjusted odds ratio 1.82 [95% confidence interval 1.02-3.25], P = 0.043; adjusted odds ratio 5.91 [95% confidence interval 1.005-35.35], P = 0.049, respectively).

Conclusions: Reocclusion after EVT was associated with recurrent ischemic stroke, additional EVT or surgery, symptomatic intracranial hemorrhage, and poor clinical outcome at 90 days. Direct aspiration and vessel perforation were independent risk factors for reocclusion after EVT.

Purpose: Accurate reconstruction of language-related white matter pathways is essential for preoperative planning in brain surgery. While functional (f) MRI activation is often used to guide diffusion (d)MRI tractography, advanced automated protocols rely instead on subcortical anatomical priors. In this study, we evaluate the robustness of anatomically informed protocols without fMRI and compare them with fMRI-guided approaches.

Methods: Twenty healthy adults (aged 18-32) underwent fMRI during a language task and dMRI on a 3T MRI scanner. Six language-associated fiber bundles were reconstructed with XTRACT using unimodal and multimodal protocols. Reconstruction similarity was assessed using cross-correlations within-subjects, within-cohort, and across-cohorts. Normalized streamline counts served as a proxy for connectivity, and t-tests were used to quantify differences between tracking protocols.

Results: Protocols using anatomically informed subcortical seed and target masks, as well as their combination with functional masks, yielded higher agreement and greater normalized streamline counts than the fMRI-only protocol. The combined approach showed an additional advantage for reconstructing parieto-temporal white matter tracts.

Conclusions: These comparisons underscore how protocol choice shapes the reconstruction of language pathways and highlight the need to evaluate these tractography strategies in clinical cohorts.

Background: Distal medium vessel occlusions (DMVO) in stroke patients represent a complex clinical challenge, primarily due to lack of conclusive evidence supporting the superiority of mechanical thrombectomy (MT) over best medical therapy (BMT). This meta-analysis aims to compare clinical outcomes between these two treatment strategies, focusing on functional outcomes assessed by means of modified Rankin Scale (mRS), overall mortality, early neurological improvement (ENI), and incidence of symptomatic intracranial hemorrhage (sICH) or subarachnoid hemorrhage (SAH).

Material and methods: Three investigators independently researched all main medical search engines (Medline, Scopus and Cochrane Library) to identify original papers comparing MT and BMT in patients with ischemic stroke due to primary DMVO. Primary endpoint was functional independence at 90 days (mRS 0-2), while secondary outcomes included excellent clinical outcome at 90 days (mRS 0-1), all-cause mortality, ENI, sICH and SAH.

Results: A total of 28 studies (3 randomized control trials and 25 retrospective observational studies) comparing MT to BMT, involving 7512 patients were included. Our findings indicate no statistically significant differences in clinical outcomes, both for functional independence (OR: 1.05, 95% CI: 0.91-1.21) and excellent outcome (OR: 1.07, 95% CI: 0.92-1.24). No statistically significant differences were observed for overall mortality (OR: 1.01, 95% CI: 0.80-1.27), ENI (OR: 1.30, 95% CI: 0.67-2.51) and rate of sICH (OR: 0.93, 95% CI: 0.55-1.58). Statistically significant results were seen on SAH rate which was higher in the MT group (OR: 0.01, 95% CI: 0.00-0.11).

Conclusions: Our meta-analysis did not support the routine use of MT in the treatment of DMVO. Rather, it indicates that MT + BMT does not lead to an increased proportion of patients achieving functional independence or excellent outcome at 3 months, nor does it reduce mortality rates compared to BMT alone.

Purpose: To assess the incidence and patterns of injuries after non-fatal self-inflicted (SIS) and non-self-inflicted strangulation (NSIS) and evaluate diagnostic utility of computed tomography (CT) and magnetic resonance imaging (MRI).

Methods: Single-center retrospective analysis (2013-2024) of patients undergoing CT and/or MRI following SIS/NSIS. Demographics, psychiatric comorbidity, strangulation mechanism, clinical symptoms and imaging findings were analyzed. Imaging was assessed for strangulation-associated injuries (e.g., fractures of the hyoid-larynx-complex [HLC], soft tissue hematoma [STH], blunt cervicovascular injury [BCVI]). Descriptive statistics were performed to detect risk factors for strangulation-associated injuries.

Results: 106 patients (55.7% female; mean age 40.2 years) and 124 events of strangulation with subsequent neuroimaging were included (CT: 96.8%, MRI: 3.2%). SIS comprised 80.6% of cases, mostly ligature strangulation (68.0%), followed by near-hanging (29.0%). NSIS accounted for 18.5% of cases. Eleven patients sustained strangulation-associated injuries, primarily HLC fractures and STH (6 cases each), but no BCVI. Older age (odds ratio: 1.04; 95% confidence interval: 1.01-1.07; p = 0.021) showed a weak association and male sex (6.32, 1.31-30.59, p = 0.022), near-hanging (12.36, 3.19-47.81, p < 0.001) and intubation (8.65, 2.04-36.78, p < 0.001) a moderate association with strangulation-associated injuries. We identified a distinct patient subgroup with recurrent SIS, characterized by predominant female sex, younger age and psychiatric disorders presenting with emotional instability. Injuries were not detected in any of these cases.

Conclusion: Severe strangulation-associated injuries are rare. CT should be used selectively, particularly in alert patients lacking relevant clinical findings. MRI may be preferable in younger patients and for forensic evaluation, particularly in NSIS.

Purpose: The national diagnostic reference level (DRL) for intracranial aneurysm therapy is set at 20,000 cGy cm² for the patient. An adjustment between the expected dosage and exposure time requirement among a variety of applicable techniques is not commonly provided. Therefore patient dose and exposure times were analyzed when using the following techinques; dosimetric data of coils (CE), flow diverter (FD), stent-assisted coiling (SAC), intra-aneurysmatic flow diverter (IaFD), balloon-assisted coiling (BAC), flow diverter assisted coiling (FDAC), IaFD-assisted coiling (IaFDAC), x, y or t‑remodeling stent-assisted coiling (xyt-SAC), and stent-assisted IaFD (SAIaFD).

Methods: A retrospective analysis of the German DeGIR-QS registry was conducted between 2018 and 2023. This study aimed to investigate the median dose-area product and exposure time for each technique, aneurysm location, type and size. The goal was to ascertain which technique is the most time- and dose-efficient.

Results: FD (84.13%/79.41%) and IaFD (89.64%/73.53%) exhibited superior performance in terms of both effectiveness and efficiency when compared to CE (100% dose-area product/100% exposure time). However, certain aneurysm types and location combinations resulted in lower dose-area product and exposure time when CE was used rather than IaFD or FD. A comparison of the median dose-area product technique with the DRL reveals that all of the aforementioned procedures fall below this value. Aneurysm size has little impact on the finding that FD and IaFD are more efficient in terms of dose and time consumption than CE.

Conclusion: Patients' exposure can be reduced by selecting a technique associated with lower exposure levels, depending on the aneurysm's location and type. However, conformity is provided for all techniques mentioned.

Objectives: To conduct a comprehensive comparative assessment of clinical performance between the novel TaminoVIA stent and the LVIS stent for endovascular treatment of unruptured intracranial aneurysms (UIAs).

Methods: This prospective, multi-center, randomized, open-label, parallel positive-controlled, non-inferiority trial was conducted by 13 centers in China. Patients with UIAs were randomized in a 1:1 ratio to receive endovascular treatment (EVT) with the TaminoVIA stent or the LVIS stent. The primary outcome was successful occlusion at 6‑month follow-up, assessed by a blinded core laboratory. The non-inferiority boundary was set at 12%. Secondary outcomes included immediate procedural success, recanalization rates, and safety endpoints.

Results: Between March 2022 and April 2024, 203 patients were enrolled and randomized. Full Analysis Set (FAS) analysis showed a 6-month successful occlusion rate of 89.90% (89/99) in the TaminoVIA stent group, compared to 87.00% (87/100) in the LVIS stent group, with a difference of +2.90% (95% CI, -5.97% to 11.77%; P < 0.01). Immediate occlusion rates were comparable (68.89% vs. 61.54%; P = 0.35), and recanalization rates at 6 months were identical (1.11% vs. 1.10%; P > 0.99). The incidence of severe adverse events (SAEs, 13.13% vs. 15.00%, P = 0.84), device-related complications (2.02% vs. 0%, P = 0.25) and procedure-related SAEs (2.02% vs. 2.00%, P > 0.99) were comparable between the two groups. Both PPS and FAS analyses exceeded the non-inferiority boundary.

Conclusions: The TaminoVIA stent demonstrated non-inferiority to LVIS in both efficacy and safety for IA embolization. These findings support its clinical adoption, though long-term durability requires further validation.

Clinical trial registration number: ChiCTR2400092436.

Background: Magnetic resonance imaging (MRI) is a crucial tool for visualizing orbital structures and detecting eye pathologies. However, manual segmentation of orbital anatomy is challenging due to the complexity and variability of the structures. Recent advancements in deep learning (DL), particularly convolutional neural networks (CNNs), offer promising solutions for automated segmentation in medical imaging. This study aimed to train and evaluate a U-Net-based model for the automated segmentation of key orbital structures.

Methods: This retrospective study included 117 patients with various orbital pathologies who underwent orbital MRI. Manual segmentation was performed on four anatomical structures: the ocular bulb, ocular tumors, retinal detachment, and the optic nerve. Following the UNet autoconfiguration by nnUNet, we conducted a five-fold cross-validation and evaluated the model's performances using Dice Similarity Coefficient (DSC) and Relative Absolute Volume Difference (RAVD) as metrics.

Results: nnU-Net achieved high segmentation performance for the ocular bulb (mean DSC: 0.931) and the optic nerve (mean DSC: 0.820). Segmentation of ocular tumors (mean DSC: 0.788) and retinal detachment (mean DSC: 0.550) showed greater variability, with performance declining in more challenging cases. Despite these challenges, the model achieved high detection rates, with ROC AUCs of 0.90 for ocular tumors and 0.78 for retinal detachment.

Conclusions: This study demonstrates nnU-Net's capability for accurate segmentation of orbital structures, particularly the ocular bulb and optic nerve. However, challenges remain in the segmentation of tumors and retinal detachment due to variability and artifacts. Future improvements in deep learning models and broader, more diverse datasets may enhance segmentation performance, ultimately aiding in the diagnosis and treatment of orbital pathologies.

Purpose: Bacterial contamination has been reported to occur during angiographies, although data on its frequency and relevance are limited. The purpose of our study was to determine whether angiographic materials such as catheters and guide wires remain sterile during angiographies. We sought to differentiate between different materials, and to detect the frequency, the extent and the spectrum of bacterial contamination.

Methods: We prospectively collected 698 fluid or material samples from 100 neuroangiographies. Per angiography we analyzed proximal ends and distal tips of catheters and guide wires, and fluid samples from the water container (working bowl) in which materials were stored during the angiography. We analyzed the frequency and extent of contamination and determined the bacterial spectrum.

Results: The majority of samples (51.4%) were contaminated. There was no angiography that showed no contamination (0%). The highest proportion of contaminated samples was found in the fluid from the working bowl after completion of the examination (92.9%). Catheters and wires were contaminated in 34.1-49.2% of samples. Contamination of the samples increased with longer duration of the angiographic procedures. Most of the bacterial species were environmental or skin contaminants (86.2%).

Conclusion: Bacterial contamination during diagnostic neuroangiographies or interventions is a frequent finding although its clinical significance is believed to be small. Bacterial contamination increases with longer duration of angiographic procedures.