Clinical Neuroradiology最新文献

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.

Purpose: Subacute sclerosing panencephalitis (SSPE) is a progressive neurological disorder caused by persistent measles virus infection in the brain. Traditionally a pediatric disorder, adult-onset cases are increasingly reported. Imaging characteristics in adult-onset SSPE remain underexplored. We aimed to characterize radiological abnormalities in adult-onset SSPE and explore clinico-radiological associations.

Methods: A cross-sectional study was conducted. Patients with SSPE with symptom onset at age 18 years and above were included. Clinical, demographic, laboratory and MRI brain features were recorded and analyzed.

Results: Fifty-three patients (male: female = 43:10) were included. The median age at presentation was 19 (19-21.5) years and median symptom duration was 10 (10-19) months. The median Jabbour stage was 2 (2-3). Forty-three (81.1%) had MRI abnormalities. Subcortical and periventricular white matter signal change was noted in 28 (65.1%) and 33 (76.7%) patients respectively. The most frequently involved lobes were parietal (39, 90.7%) and frontal (35, 81.4%). Diffusion restriction occurred in 10 (23.3%). Tremor (p = 0.018) and elevated CSF protein (P < 0.001) correlated with overall MRI abnormality. Myoclonus correlated with occipital signal change (p = 0.036). Tremor (p = 0.034) and visual abnormality (p = 0.024) correlated with subcortical involvement. Dysphagia was associated with cortical involvement (p = 0.018), basal ganglia abnormality (p = 0.041), and diffusion restriction (p = 0.008). Symptom duration correlated with periventricular white matter involvement (p = 0.0034), supratentorial atrophy (p < 0.001), and symmetrical involvement (p = 0.027).

Conclusion: MRI abnormalities are frequent in adult-onset SSPE, with diffusion restriction being more prevalent than previously recognized. Our findings highlight the role of neuroimaging in adult-onset SSPE cases, to guide diagnosis and prognostication.

Objective: This case report aims to describe an unusual presentation of multinodular and vacuolating neuronal tumor (MVNT) in a pediatric patient, highlighting its atypical radiological and clinical features.

Methods: We present the case of an 8-year-old boy with a 7-month history of seizures that progressed to daily episodes. Diagnostic workup included electroencephalography (EEG) and magnetic resonance imaging (MRI) with contrast. The lesion was resected surgically, and the diagnosis was confirmed histopathologically and immunohistochemically.

Results: EEG revealed ictal discharges in the left central, parietal, and mid-posterior temporal regions. MRI showed a left frontal cortical lesion with T1 hypointensity, T2/FLAIR hyperintensity, and unusual marked contrast enhancement, mimicking ganglioglioma. Histopathological examination confirmed MVNT. Postoperatively, the patient experienced mild left limb weakness but remained seizure-free at one-month follow-up.

Conclusion: This case illustrates that MVNT can rarely occur in children and may exhibit prominent contrast enhancement and a ganglioglioma-like imaging appearance, posing a diagnostic challenge. Neurosurgeons and neuroradiologists should consider MVNT in the differential diagnosis of enhancing cortical lesions in pediatric epilepsy patients. Histopathological verification remains essential for definitive diagnosis.

Purpose: Direct oral anticoagulants (DOACs) have equivalent efficacy and fewer complications than vitamin K antagonists (VKAs) and are widely used for atrial fibrillation. However, data on how DOACs affect mechanical thrombectomy (MT) and influence the occlusion site are limited. This study aimed to investigate the efficacy and safety of MT before DOAC administration and how DOAC influences the occlusion site eligible for MT.

Methods: The NeuroEndovascular and Management from Multicenter Observation to Build a PHILosophical Approach (NEMMOPHILA) study analyzed 331 patients treated between January 2015 and March 2019 who underwent MT. The primary outcome was modified Rankin scale (mRS) of 0-3 at discharge, and the secondary outcomes included in-hospital mortality, and parenchymal hemorrhage (PH).

Result: Of the 331 patients, 39 had prior DOAC therapy, 25 had prior VKA therapy, and 267 had non- anticoagulant therapy (non-AC). The internal carotid artery (ICA) occlusion rate was significantly lower in the DOAC group (DOAC, 25.6%; VKA, 56.0%; non-AC, 45.3%; p = 0.030). No significant difference was found in the mRS at discharge (DOAC, 51.3%; VKA, 36.0%; non-AC, 50.9%; p = 0.354), mortality (DOAC, 7.5%; VKA, 7.9%; non-AC, 10.9%; p = 0.66), and PH (DOAC, 2.6%; VKA, 12.0%; non-AC, 9.0%; p = 0.362). Multiple regression analysis revealed that DOAC significantly reduced ICA occlusion (odds ratio, 0.429; 95% confidence interval, 0.195-0.943; p = 0.035).

Conclusion: Patients with prior DOAC had low ICA occlusion rates. DOAC administration history did not lead to mRS improvement at discharge and did not increase PH after MT.

Purpose: Stentretrievers are key devices for endovascular treatment of acute ischemic stroke. Aim of this post market clinical follow-up study was to asses safety and outcomes of interventions using the APERIO® Hybrid/Hybrid^17|21 thrombectomy device (AHD) in routine clinical use.

Methods: We conducted a prospectively monitored, multicenter, national registry study with single-arm data collection including patients with acute intracranial vessel occlusion (anterior and posterior circulation, including medium vessel occlusions) who were treated with the AHD in Germany between November 2020 and June 2023. Patients (n = 173) with low pre-stroke morbidity (modified Rankin Scale [mRS] ≤ 2) were included. We assessed technical recanalization success (mTICI ≥ 2b), the occurrence of periprocedural symptomatic intracranial hemorrhages (sICH), good clinical outcome (mRS ≤ 2 at 90 days), and secondary outcomes.

Results: Recanalization mTICI ≥ 2b was achieved in 84.4% with the AHD only, including 47.4% first pass success. Good clinical outcome at 90 days (mRS ≤ 2) was observed in 68.8%. Good primary safety outcome (no periprocedural sICH) was observed, notably even despite a high rate (79.8%) of stentretriever oversizing.

Conclusion: The AHD is effective and safe. Technical success, primary safety and clinical outcomes surpassed earlier registries on different stentretrievers of the same and earlier generations. However, further studies are warranted to clarify whether these outcomes reflect true advantages of the device, improvements in thrombectomy setups and techniques, or selection biases.

Purpose: The Woven EndoBridge (WEB) device is an established endovascular treatment method for wide-neck intracranial aneurysms. Digital subtraction angiography (DSA) is the reference standard for posttreatment evaluation; however, its invasive nature limits its repeated use. This study aimed to compare the diagnostic accuracy and reproducibility of intravenous cone-beam computed tomography (IVCBCT) and DSA in the follow-up of aneurysms treated with the WEB device.

Methods: This prospective single-center study included 16 patients with unruptured intracranial aneurysms who were treated with the WEB device. All patients underwent both DSA and IVCBCT at the 6‑month follow-up, performed on the same day. Aneurysm occlusion status was independently evaluated by two experienced neuroradiologists using the 8‑point modified Bicêtre Occlusion Scale Score (BOSS). Intermodality and interobserver agreement were assessed using Cohen's kappa statistics.

Results: Complete agreement between IVCBCT and DSA was observed in all 16 cases (κ = 1.0 for both raters). Interobserver agreement for IVCBCT grading was also excellent (κ = 0.86). The BOSS distribution for IVCBCT was as follows: grade 0 or 0' in eight cases (50.0%), grade 1 in five cases (31.3%), grade 2 in two cases (12.5%), and grade 3 in one case (6.2%). IVCBCT demonstrated consistent diagnostic performance across various occlusion grades.

Conclusion: IVCBCT offers a reliable, noninvasive alternative to DSA for the follow-up of WEB-treated aneurysms, providing excellent diagnostic concordance and reproducibility.

Purpose: Mechanical thrombectomy (MT) is standard care for acute large vessel occlusion (LVO), but it fails in 10-20% of cases, often due to underlying intracranial artery stenosis (ICAS). In such cases, rescue stenting (RS), with or without angioplasty, may improve recanalization, but its clinical benefit remains debated. The purpose of this study was to define predictors of clinical outcome in this patient population.

Methods: We conducted a retrospective multicenter study including 115 patients with ICAS-related occlusion of the middle cerebral artery (MCA) treated with MT and RS across 27 international stroke centers. Baseline, procedural, and post-procedural variables were analyzed. The outcome measure was the ordinal shift of the 90-day modified Rankin Scale (mRS) score. Stepwise multivariate regression and structural equation modeling (SEM) were used to identify outcome predictors and explore mediation pathways.

Results: Successful recanalization (modified Treatment in Cerebral Infarction (mTICI) score ≥ 2b) was achieved in 94.8% of patients, with 73.0% reaching mTICI 2c‑3. SEM showed that baseline Alberta Stroke Program Early CT Score (ASPECTS), stenting with angioplasty and achieving mTICI 2c‑3 were associated with improved functional outcome, mediated by higher post-procedural ASPECTS. Post-procedural ASPECTS influenced functional outcome both directly (estimate = -0.45, p < 0.001) and indirectly by reducing the occurrence of symptomatic intracranial hemorrhage (sICH) (estimate = -0.09, p = 0.004). This model explained 36.5% of the variance in 90-day mRS scores.

Conclusion: In patients with acute ICAS-related MCA occlusion, stenting with angioplasty and achieving mTICI 2c-3 recanalization are associated with improved clinical outcome. These benefits are mediated by better post-procedural ASPECTS and reduced sICH. Prospective studies are warranted to confirm these findings.

Over the past decade, major advances have transformed the understanding and management of cerebrospinal fluid (CSF) leaks leading to spontaneous intracranial hypotension (SIH). Among the most impactful developments has been the identification and characterization of CSF-venous fistulae (CVF), a distinct and still underrecognized cause of SIH. This discovery has prompted a paradigm shift in both diagnostic and therapeutic strategies. Novel imaging techniques-including lateral decubitus CT myelography and digital subtraction myelography-have markedly improved detection rates, while targeted interventions such as transvenous embolization have emerged as safe and effective treatment options. In this review, we first outline the general pathophysiology and imaging principles related to SIH and CSF leaks, followed by a focused and comprehensive analysis of the current evidence managing CVFs. We discuss their diagnostic challenges, therapeutic approaches, and evolving clinical implications, aiming to provide a thorough update for diagnostic and interventional neuroradiologists involved in the care of patients with SIH.