Journal of Neuroradiology最新文献

Perivascular spaces (PVS) are fluid-filled structures that form the immediate peripheral environment of small cerebral vessels. They are a central component of the glymphatic system, which plays a crucial role in maintaining cerebral homeostasis. Their involvement in central nervous system diseases is currently a major focus of research, particularly in neuroimaging. Pathological enhancement of PVS on post-contrast MRI sequences creates a distinctive pattern due to their topography. As with other intracranial enhancement patterns, a differential diagnosis approach can be applied to perivascular enhancement (PVE). However, it is particularly challenging due to the rarity and complexity of the conditions involved. This article aims to facilitate the recognition of PVE pattern, to highlight the various causal conditions and to propose a practical diagnostic approach.

Background: The potential for early white matter hyperintensities(WMH) regression and associated contributory factors remains uncertain. The purpose of this study is to investigate whether WMH regress at early time of three months after minor ischemic stroke (MIS) or transient ischemic attack (TIA), while also identifying factors that may influence this outcome.

Methods: A retrospective analysis of a prospective subcohort from the CHANCE trial comprising individuals with MIS and TIA was conducted. All patients underwent brain MRI at the onset and at three months. Deep learning algorithms were employed for the automatic segmentation of WMH volumes in four distinct regions. Scores for lacunes, cerebral microbleeds (CMB), perivascular spaces (PVS), WMH, and overall cerebral small vessel disease (CSVD) burden were quantified. Patients were divided into the stable, regression and progression groups according to change in WMH volume. The demographic, clinical, and imaging data of the participants in the three groups were collected and statistically analyzed.

Results: A total of 98 patients with minor ischemic stroke or TIA were included. There were 22 patients in the stable group, 41 patients in the regression group and 35 patients in the progression group. Age and hypertension status were significantly different among the three groups. The lacunes, CMB,WMH, and total CSVD burden scores differed notably among groups, with all the CSVD markers being severely elevated in the progression group, moderately elevated in the regression group, and subtly elevated in the stable group.

Conclusion: The findings suggest that WMH could exhibit regression within three months following minor ischemic stroke or TIA. Patients under the age of 65, without a hypertension history, and with a low CSVD burden are more likely to experience WMH regression.

Objective: Flow diversion is increasingly used as an endovascular treatment for intracranial aneurysms. FRED-EPI is a prospective, multicenter, French study, conducted to analyze the safety and efficacy of aneurysm treatment with FRED/FRED Jr (Microvention, AlisoViejo, CA, USA) in current clinical practice.

Patients and methods: Patients with intracranial aneurysms treated with FRED and FRED Jr who agreed to participate were prospectively and consecutively included in all French centers using these devices.

Results: From June 2020 to January 2022, 135 patients (110 females, 81.5%, and 25 males, 18.5%) with 154 aneurysms were included in 13 French interventional neuroradiology centers. The mean age was 53.9 ± 12.2 years (range: 20 - 77 years). Aneurysm was unruptured in 123 cases (79.9%), ruptured in 4 cases (2.6%), and recanalized in 27 cases (17.5%). Most aneurysms were small (135/154, 87.7%). Aneurysm locations were supraclinoid ICA in 83 (53.9%), cavernous and petrous ICA in 25 (16.2%), anterior cerebral artery or anterior communicating artery in 19 (12.3%), MCA in 7 (4.5%), and posterior circulation in 20 (13.0%). Three patients (2.2%) had hemorrhagic complications (1 delayed aneurysm rupture and 2 delayed remote hematoma) and 3 (2.2%) ischemic complications (2 intrastent thrombosis and 1 stroke related to atherosclerosis) leading to 1-year morbimortality of 4.4%. Complete aneurysm occlusion was reported in 105/139 aneurysms (75.5%).

Conclusions: FRED-EPI confirms good safety of aneurysm treatment with FRED/FRED Jr in current clinical practice with 4.4% 1-year morbimortality.

Introduction: Landmark thrombectomy trials demonstrated improved functional outcomes after endovascular therapy (EVT) for large core strokes (LCSs). This study explored the impact of recanalization attempts and procedure time (PT) on outcomes in LCS patients.

Patients and methods: This was a retrospective study of patients with LCSs who underwent EVT from a prospective multicentre cohort. LCS was defined as an Alberta Stroke Program Early Computed Tomography Score of 0 to 5. Patients were divided into 6 groups (unsuccessful reperfusion [modified Thrombolysis in Cerebral Infarction Scale (mTICI) 0-2a] and successful reperfusion [mTICI, 2b/3]) after 1, 2, 3, 4, or >4 attempts. The primary outcome was a favorable 90-day mRS score of 0-3. Secondary outcomes included mRS 0-4, 90-day mortality, and 48-hour rates of symptomatic (sICH) and any intracranial hemorrhage (aICH).

Results: A total of 447 patients were analysed. 388 with successful reperfusion, 59 without.Successful reperfusion during the first 3 passes increased the odds of favourable functional outcomes [attempt 1: aOR, 4.454 (1.723-11.514),p=0.002; 2: aOR, 3.762 (1.437-9.847),p=0.07; or 3: aOR, 3.619 (1.254-10.440),p=0.017] and decreased mortality at 90 days [(attempt 1: aOR, 0.336 (0.155-0.727),p=0.006; 2: aOR, 0.346 (0.160-0.746),p=0.007; or 3: aOR, 0.395 (0.164-0.953),p=0.039]. A shorter PT increased the odds of a favourable functional outcome [aOR, 0.991 (0.985-0.997),p=0.002]. PT may reduce the association between the number of attempts and patient outcomes. No associations were found between the number of attempts and sICH or aICH, whereas there was an increasing trend in the proportion of aICH or sICH when the number of attempts was more than two.

Conclusion: In patients with LCSs who underwent EVT, successful reperfusion within the first 3 attempts and a shorter PT were associated with favourable functional outcomes. However, the effect size of the association between the number of attempts and clinical outcomes may gradually decrease with extension of the PT.

Background: Elderly patients are at high risk of acute ischemic stroke caused by large vessel occlusion (AIS-LVO) and usually suffer disability and fatality from stroke even after receiving endovascular treatment (EVT). Previous studies lacked the knowledge of comprehensive cerebral collateral for elderly patients. Hence, we explore the role of cerebral collateral recycle (CCR) status in clinical outcomes in a real-world setting among elderly AIS-LVO patients undergoing EVT.

Methods: This was a multicenter retrospective cohort study. Computed tomographic angiography (CTA) at admission was applied to evaluate cerebral venous outflow profiles by the Cortical Vein Opacification Score (COVES) and pial arterial collaterals by the Tan scale. According to the status of cerebral collaterals, enrolled patients were divided into the poor, moderate, and favorable CCR groups. The primary outcome was functional independence (90-day modified Rankin Scale score 0-2).

Results: Among 860 AIS-LVO patients receiving EVT, a total of 338 elderly patients were included in the present study after strict screening. Compared with the poor CCR group, the moderate CCR group (31.1 % vs. 10.2 %; adjusted odds ratio[aOR] 3.80; 95 % confidence interval[CI] 1.71-8.44; P = 0.001) and the favorable CCR group (63.3 % vs. 10.2 %; aOR 8.49; 95 % CI 4.02-17.92; P < 0.001) both had a significantly higher rate of functional independence. In subgroup analysis, similar results were found in AIS-LVO patients with older age, large core infarction, or late time window.

Conclusion: The cerebral collateral status in elderly patients with AIS-LVO treated by EVT is a strong predictor of functional outcomes and more robust CCR means better outcomes.

Background: Currently, there are no available recommendations or guidelines on how to perform MRI monitoring in the management of neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). The issue is to determine a valuable MRI monitoring protocol to be applied in the management of NMOSD and MOGAD, as previously proposed for the monitoring of multiple sclerosis.

Objectives: The objectives of this work are to establish proposals for a standardized and feasible MRI acquisition protocol, and to propose control time points for systematic MRI monitoring in the management of NMOSD and MOGAD.

Methods: A steering committee composed of 7 neurologists and 5 neuroradiologists, experts in NMOSD and MOGAD from the French group NOMADMUS, defined 8 proposals based on their expertise and a review from the literature. These proposals were then submitted to a Rating Group composed of French NMOSD / MOGAD experts.

Results: In the management of NMOSD and MOGAD, a consensus has been reached to perform systematic MRI of the brain, optic nerve and spinal cord, including cauda equina nerve roots, at the time of diagnosis, both without and after gadolinium administration. Moreover, it has been agreed to perform a systematic MRI scan 6 months after diagnosis, focusing on the area of interest, both without and after gadolinium administration. For long-term follow-up of NMOSD and MOGAD, and in the absence of clinical activity, it has been agreed to perform gadolinium-free MRI of the brain (+/- optic nerves) and spinal cord, every 36 months. Ideally, these MRI scans should be performed on the same MRI system, preferably a 3T MRI system for brain and optic nerve MRI, and at least a 1.5T MRI system for spinal cord MRI.

Conclusions: This expert consensus approach provides physicians with proposals for the MRI management of NMOSD and MOGAD.