Clinical Neuroradiology最新文献

Purpose: To evaluate the potential overestimation of cerebral microbleed (CMB) burden by Quantitative Susceptibility Mapping (QSM) compared to 2D gradient recalled echo (2D GRE), as well as the impact of increased motion degradation due to longer scan times, reduced CMB detection from skull-stripping failures, and the relative visibility of CMBs between techniques.

Methods: Seventy-nine adult subjects with intracranial hemorrhage underwent same-session brain MRI including 2D GRE and multi-echo GRE for QSM processing, as part of routine clinical care. Images were reviewed by a neuroradiologist and trained research assistant for CMB detection, visibility rating, and anatomical distribution. Motion artifacts and areas of non-visualized brain due to skull-stripping were assessed. Statistical analysis included Wilcoxon signed-rank tests for CMB counts, Mann-Whitney U test for motion assessment, and Fisher's exact testing for anatomical distribution patterns.

Results: QSM showed no significant difference in median CMB counts compared to 2D GRE (1 vs 2, p = 0.175) with strong correlation (r = 0.879, p < 1.65e-26). No significant difference in motion degradation was found between techniques (p = 0.7465). Skull-stripping failures affected only 2% of candidate CMBs, in 5 of 79 (6%) subjects. QSM-detected CMBs showed superior conspicuity (73 vs 33 better visualized lesions, p = 0.00975) with 261 rated equally visible. QSM identified 26 calcifications in 20 subjects, 25 of which were misclassified as CMBs on 2D GRE.

Conclusion: QSM demonstrates comparable or slightly lower CMB counts than 2D GRE while offering superior lesion conspicuity and ability to distinguish calcifications, supporting its potential clinical implementation for CMB detection.

Purpose: Primary Familial Brain Calcification (PFBC) is a disorder characterized by basal ganglia calcification. A CT visual rating scale known as the Total Calcification Score (TCS) is often used to quantify brain calcification, but volume measurements are a novel approach. This study evaluated the association between the (modified) TCS, volume measurements, and clinical symptoms, and their ability to detect calcification progression.

Methods: In patients with PFBC, the (modified) TCS and volumes were calculated for each brain CT. Clinical symptoms were assessed using the Montreal Cognitive Assessment (MoCA), Unified Parkinson's Disease Rating Scale (UPDRS), and Neuropsychiatric Inventory-Questionnaire (NPI-Q). Calcification progression was determined for patients with a second CT available. Annual median progression rates were calculated.

Results: Of the 66 included patients (median age 60 years, 56% male), 26 had a follow-up CT after 1 year (IQR 0.5-1.3 year). The median TCS was 28.5, modified TCS was 32.5, and volume was 7.6 cm³. Volume measurements showed a significant association with clinical symptoms (MoCA β = -0.44[SE 0.02] and UPDRS β = 0.61[SE 0.04]), comparable to the (modified) TCS, and accounted for the largest proportion of explained variance (MoCA R² = 0.19, UPDRS R² = 0.37). There were no significant associations between the methods and NPI‑Q. Volume measurements showed an annual progression rate of 6.2%, whereas the (modified) TCS showed no annual change.

Conclusion: Volume measurements of brain calcification were significantly associated with clinical symptoms, explained more variance, and appeared in this small sample to be better in detecting calcification progression compared with visual scores, although further diagnostic and longitudinal testing is required.

Purpose: Hypertension is the most prevalent RF for cerebrovascular disease (CVD). Although previous studies have employed ultrasonography and phase-contrast magnetic resonance image (MRI) to assess cerebral hemodynamics, the quantitative impact of hypertension on cerebral arterial flow characteristics remains incompletely understood. This study focused on the relationship between hypertension, other risk factors (RF), and arterial velocity gradient using the signal intensity gradient (SIG) from time-of-flight magnetic resonance angiography (TOF-MRA).

Methods: This cross-sectional study included individuals who underwent health screening at our institution between January 2015 and June 2021. Participants with no history of CVD who underwent intracranial TOF-MRA were included. Arterial wall SIGs was measured in the cerebral arteries. Participants were categorized into four groups according to vascular RFs: none (no RF), other RFs (RFs except hypertension), hypertension-only, and hypertension-plus (hypertension with other RFs).

Results: A total of 1154 healthy subjects (mean age 63.2 ± 9.5 years, 43.2% women) were enrolled. The hypertension-plus group had the highest systolic (125.3 ± 19.1 mm Hg) and diastolic (74.7 ± 10.5 mm Hg) blood pressures, HbA1c (6.1 ± 0.7%), intima-media thickness (0.86 ± 0.24 mm), and the highest rates of intracranial artery stenosis (14.4%) and chronic kidney disease (6.1%). The hypertension-plus group showed the lowest SIG values among all cerebral arteries. After adjusting for confounding factors, the hypertension-plus group showed significantly lower SIG values in the intracranial arteries but not in the extracranial arteries.

Conclusion: The arterial wall SIG was significantly associated with hypertension and other vascular RFs. SIG may offer quantitative information on the arteriopathic effects of hypertension, especially intracranial cerebral arteries.

Background: The efficacy and safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT) for distal, medium vessel occlusions (DMVO) is not well established. This study investigates whether IVT impacts outcomes in DMVO patients, particularly in those with unsuccessful or partial recanalization after MT.

Methods: We conducted a retrospective, multicenter study using data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry. The study population included AIS patients with DMVO in the M2, M3, and M4 segments of the MCA, treated with or without IVT followed by MT and a final modified Thrombolysis in Cerebral Infarction (mTICI) score of 0, 1, or 2a. The primary outcome was functional independence, assessed by the 90-day modified Rankin Scale (mRS) of 0-1 or 0-2.

Results: The study comprised 210 patients with final mTICI 0 to 2a, with 130 undergoing MT alone and 80 receiving IVT followed by MT. Logistic regression analysis revealed no significant differences in clinical outcomes between groups. The odds ratios (ORs) for achieving a 90-day mRS of 0-1 and 0-2 were 1.55 (95% CI 0.62 to 3.87; p = 0.34) and 1.55 (95% CI 0.72 to 3.37; p = 0.26), respectively. The odds of symptomatic intracerebral hemorrhage (sICH) were similar between groups (OR 0.64, 95% CI 0.28 to 1.47; p = 0.29), as were the odds of intracranial hemorrhage (ICH) of any type (OR 1.39, 95% CI 0.71 to 2.73; p = 0.34).

Conclusions: In AIS patients with DMVO and unsuccessful or partial recanalization after MT, IVT did not significantly improve clinical outcomes. Additionally, IVT did not increase the risk of hemorrhagic complications. These findings suggest that while IVT preceding MT is safe in this context, it may not improve outcomes for patients with unsuccessful MT.

Purpose: Fabry disease (FD), an X‑linked lysosomal disorder caused by deficient α‑galactosidase A (α-Gal A), leads to glycosphingolipid accumulation and multi-organ damage. The specific characteristics and clinical relevance of white matter microstructural damage in FD remain insufficiently explored. This study therefore aimed to explore these specific changes using automated fiber quantification (AFQ), as well as to analyze their correlations with neuropsychological scales and clinical indicators.

Methods: 19 FD patients and 22 healthy controls (HC) underwent neuropsychological assessments and diffusion tensor imaging (DTI). The AFQ technique was used to extract fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) values at 100 equidistant nodes along 18 major white matter tracts. Partial correlation analysis explored relationships between DTI indicators and neuropsychological as well as clinical indicators. ROC analysis was performed to evaluate the diagnostic efficacy of the FA and MD values in differentiating FD patients from HC.

Results: FD patients showed decreased FA values and increased MD, AD, and RD values in several fiber tracts, particularly in the corticospinal tract (CST) and the cingulum cingulate (CC). Diffusion metrics in the left CC (CC_L) showed significant correlations with neuropsychological scores: the FA values were positively correlated with the MMSE score, while the MD and RD values were negatively correlated with the MMSE score. Additionally, the MD and RD values were positively correlated with the HAMD and HAMA scores, respectively. The AD values of the left CST (CST_L), as well as the MD and AD values of the left arcuate fasciculus (AF_L), were negatively correlated with α‑galactosidase A (α-Gal A) activity in FD patients. Furthermore, ROC analysis demonstrated that the MD values of the right CST (CST_R) achieved superior diagnostic performance (AUC = 0.933).

Conclusions: FD patients demonstrated segment-specific white matter damage. The abnormalities in these specific fiber segments were associated with symptoms such as cognitive impairment and depression, especially in the CC and CST. These findings may provide novel insights into the clinical symptoms associated with FD and offer new neuroimaging support for disease monitoring in this condition.

Purpose: With the expanding use of endovascular thrombectomy (EVT) for distal and medium vessel occlusions (DMVOs), evaluating how anesthesia type affects clinical outcomes is essential. This meta-analysis compared outcomes between general anesthesia (GA) and non-GA in patients undergoing EVT for DMVOs.

Methods: We systematically searched PubMed, Embase, Cochrane Library, and Web of Science for eligible studies. Primary outcomes included successful reperfusion, 90-day mortality, excellent functional outcome (Modified Rankin Scale [mRS] 0-1), and symptomatic intracranial hemorrhage (sICH). Risk ratios (RR) with 95% confidence intervals (CI) were calculated using the Mantel-Haenszel method and a random-effects model. Heterogeneity was assessed with I² and Cochran's Q test.

Results: Five studies comprising 1643 patients were included. There was no significant difference in successful reperfusion between GA and non-GA groups (RR 1.01; 95% CI 0.94-1.08; I² = 32.3%). However, GA was associated with significantly higher 90-day mortality (RR 1.55; 95% CI 1.23-1.96; I² = 0%). Excellent functional outcomes (mRS 0-1 at 90 days) were similar between groups (RR 0.92; 95% CI 0.78-1.10; I² = 24.2%). No statistically significant difference in sICH was observed between the GA and non-GA groups (RR 2.61; 95% CI 0.99-6.86; I² = 40.8%). However, the leave-one-out analysis revealed a significant association indicating a higher risk of sICH with GA (RR 3.88; 95% CI 1.79-8.41; I² = 0%).

Conclusion: GA was linked to increased 90-day mortality in EVT for DMVOs, with no differences in reperfusion or functional recovery. A possible higher risk of sICH was noted. Further prospective studies are needed to guide anesthetic strategy.

Purpose: Spinal muscular atrophy (SMA) is a rare neuromuscular disease treated with intrathecal nusinersen. In patients with complex spinal anatomy or spinal instrumentation, repeated lumbar punctures can be challenging. This study evaluated the feasibility, safety, and radiation exposure of CT-guided nusinersen administration in SMA.

Methods: In this retrospective single-center study, 458 CT-guided nusinersen injections in 44 SMA patients (October 2017-August 2024) were analyzed. Technical success, complications, procedure and puncture times, and radiation exposure were compared between subgroups. Procedures were performed in prone, lateral, or combined (oblique) positions depending on anatomy.

Results: Technical success was 98.3% (449/458). Rates were slightly lower in patients with dorsal spondylodesis (97.1% vs. 98.8%). Complications occurred in 1.1% (5/458), including transient pain and two hematomas. Spondylodesis was associated with longer puncture (11.9 vs. 10.3 min) and procedure durations (16.3 vs. 14.0 min) and higher radiation doses (effective dose 2.22 vs. 1.74 mSv; all p < 0.01). Failed or complicated procedures showed prolonged durations and higher exposure. Needle repositioning correlated with duration and dose.

Conclusion: CT-guided lumbar puncture for intrathecal nusinersen injection is a safe and effective technique, even in complex spinal anatomy. Dorsal spondylodesis increases procedural complexity. Tailored puncture level selection, optimized positioning, and dose-reduction strategies are essential for high success rates and minimal radiation. While CT guidance ensures excellent anatomical visualization, fluoroscopy may reduce radiation and procedure time; future comparative studies should define optimal modality selection.

Background: Digital subtraction angiography lacks the ability to visualise intimal surface changes. Angioscopy, in contrast, enables direct imaging of the endoluminal surface, revealing luminal alterations, as established in cardiovascular imaging. Its application in the internal carotid artery (ICA) could allow assessment of pathological changes and the visualization of implant structures such as stents or flow diverters, including their apposition to the vessel wall. This study evaluates the feasibility of using a thin fibre-optic endoscope for angioscopy in the ICA anatomy.

Methods: Five 3D DSA image sets of the ICA with varying anatomies were selected. Tube-based vessel models were fabricated to replicate the corresponding vascular segments, incorporating a measurement scale and, optionally, a stent or a flow diverter. The advancement of a fibre-optic endoscope and the related influence on vessel deformation were assessed in each model. Spatial and colour resolution were evaluated by applying coloured markings to the inner tube surface to simulate vessel wall discolouration. The visibility of structural details, including flow diverter meshes and stent struts, was assessed based on image contrast and sharpness within the angioscope's defined field of view.

Results: The endoscope was successfully advanced to the distal end in all models. Increased vascular curvature required greater mechanical force for navigation and positioning, leading to observable straightening of the vessel model. In all cases, endoscopic imaging produced clear visualizations of vessel wall markings and implant structures. Stent struts and flow diverter meshes were distinguishable, as were discolorations simulating pathological changes.

Conclusion: Angioscopy of the ICA is technically feasible and enables endoluminal visualization, including implant structures. Feasibility was strongly dependent on vessel curvature and required substantial increases in delivery force in highly tortuous anatomies.

Purpose: This study aimed to assess the endothelialization of drug-eluting stents (DES) 3 months after implantation for the treatment of symptomatic vertebral artery stenosis using endovascular optical coherence tomography (OCT).

Methods: Between March and May 2024, OCT was performed on patients 3 months (90 ± 7 days) after undergoing surgery for stent implantation at the vertebral artery ostium in our center.

Results: Nine DES were implanted in nine patients. The mean follow-up period was 95.6 ± 12.6 days. OCT findings showed the vertebral artery lumen with fully endothelialized stent struts covered by neointima in all nine patients 3 months after implantation, indicating complete endothelialization.

Conclusions: Complete endothelialization of vertebral artery DES occurred 3 months after implantation, providing a theoretical basis for potentially reducing the duration of DAPT 3 months. Further clinical studies are essential to validate these findings.

Background: Endovascular trapping of the internal carotid artery (ICA) remains a definitive treatment for both aneurysmal and non-aneurysmal conditions when vessel-preserving strategies are not feasible. However, increasing attention has been directed toward the risk of de novo aneurysm formation following ICA sacrifice, presumably due to hemodynamic alterations within the Circle of Willis. This study aimed to evaluate the incidence and potential risk factors for de novo aneurysm development and the growth of pre-existing aneurysms after ICA trapping, particularly focusing on differences based on the underlying pathology, aneurysmal versus non-aneurysmal.

Methods: A retrospective, single-center study was conducted on patients who underwent unilateral endovascular ICA trapping between 2003 and 2023, with a minimum of one year of angiographic follow-up. Patients were categorized into the aneurysm-trapping (AT) or non-aneurysm-trapping (NT) group according to the underlying indication for ICA sacrifice. Clinical, angiographic, and procedural data were reviewed to evaluate the development of de novo aneurysms or the progression of pre-existing lesions.

Results: Among the 47 included patients (37 and 10 in the AT and NT groups, respectively), de novo aneurysm formation or significant growth of pre-existing aneurysms was observed exclusively in the AT group (10/37, 27.0%), with no such events in the NT group (0/10), showing a statistical trend that did not reach conventional significance (p = 0.064). Most newly developed aneurysms (60%) arose at the anterior communicating artery (ACoA), predominantly in patients with well-developed ACoA collateral flow. Most lesions appeared within two years after ICA trapping. Additional treatment was required in two patients due to progressive enlargement of pre-existing aneurysms.

Conclusion: De novo aneurysm formation following ICA trapping appears to occur exclusively in patients with an underlying aneurysmal etiology, particularly at sites of hemodynamic stress such as the ACoA. Close imaging surveillance is recommended during the first two years post-trapping, especially in patients with robust collateral circulation or pre-existing aneurysms.