Journal of Neuroradiology最新文献

英文中文

Impaired iron metabolism and cerebral perfusion patterns in unilateral middle cerebral artery stenosis or occlusion: Insights from quantitative susceptibility mapping. 单侧大脑中动脉狭窄或闭塞时受损的铁代谢和大脑灌注模式：定量易感图的启示。

IF 3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2024-11-14 DOI: 10.1016/j.neurad.2024.101233

Yu Guo, Huimin Mao, Kunjian Chen, Weiqiang Dou, Xinyi Wang

Background and purpose: Cerebral hypoperfusion caused by stenosis or occlusion of the middle cerebral artery (MCA) may be followed by impaired iron metabolism. We explored the association between iron changes of gray matter (GM) nuclei subregions and different cerebral perfusion patterns in patients with chronic unilateral middle cerebral artery (MCA) stenosis or occlusion using quantitative susceptibility imaging (QSM).

Methods: Sixty-one patients with unilateral MCA stenosis or occlusion were recruited and scored with Alberta-Stroke-Program-Early-CT-Score (ASPECTS) based on relative cerebral blood flow (rCBF) measurements to calculate the number of corresponding hypoperfusion subregions, and then divided into an extensive-hypoperfusion group (EH group), regional-hypoperfusion group (RH group), and normal-perfusion group (Control group) accordingly. The measured magnetic susceptibility of GM nuclei subregions was compared between the lesion and contralateral side for each group and among the three groups. Correlation analysis was performed to assess the relationships of magnetic susceptibility of GM nuclei with mean rCBF, National-Institutes-of-Health-stroke-scale (NIHSS) and modified-Rankin-scale (mRS) scores.

Results: Magnetic susceptibility in the putamen (PU) and globus pallidus (GP) at the lesion side was higher in the EH and RH groups compared with the contralateral side (all P < 0.05). Susceptibility in the lesion side PU and GP showed negative correlations with mean rCBF and positive correlations with NIHSS and mRS scores (all P < 0.05).

Conclusion: Our findings demonstrate that chronic cerebral hypoperfusion might be one cause of cerebral abnormal iron metabolism. In addition, magnetic susceptibility of PU and GP seems to be correlated with stroke scale scores, suggesting that iron deposition may play an important role in neurologic deficits after ischemic stroke.

背景和目的：大脑中动脉（MCA）狭窄或闭塞引起的脑灌注不足可能会导致铁代谢受损。我们利用定量易感成像（QSM）探讨了慢性单侧大脑中动脉（MCA）狭窄或闭塞患者灰质（GM）核亚区铁变化与不同脑灌注模式之间的关联：招募61名单侧MCA狭窄或闭塞患者，根据相对脑血流（rCBF）测量结果，用Alberta-Stroke-Program-Early-CT-Score（ASPECTS）评分，计算出相应的低灌注亚区数量，然后相应地分为广泛低灌注组（EH组）、区域低灌注组（RH组）和正常灌注组（对照组）。比较各组和三组之间病变侧和对侧的 GM 核团亚区的磁感应强度。进行相关性分析以评估GM核团磁感应强度与平均rCBF、美国国立卫生研究院卒中量表（NIHSS）和改良Rankin量表（mRS）评分的关系：EH组和RH组患者病变侧的丘脑（PU）和苍白球（GP）的磁感应强度高于对侧（P均<0.05）。病变侧 PU 和 GP 的易感性与平均 rCBF 呈负相关，与 NIHSS 和 mRS 评分呈正相关（均 P < 0.05）：我们的研究结果表明，慢性脑灌注不足可能是大脑铁代谢异常的原因之一。结论：我们的研究结果表明，慢性脑灌注不足可能是导致大脑铁代谢异常的原因之一，此外，PU 和 GP 的磁感应强度似乎与卒中量表评分相关，这表明铁沉积可能在缺血性卒中后的神经功能缺损中扮演重要角色。

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引用次数: 0

Deep learning segmentation-based bone removal from computed tomography of the brain improves subdural hematoma detection 基于深度学习分割的脑部计算机断层扫描骨质移除改进了硬膜下血肿检测。

IF 3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2024-11-08 DOI: 10.1016/j.neurad.2024.101231

Masis Isikbay , M.Travis Caton , Jared Narvid , Jason Talbott , Soonmee Cha , Evan Calabrese

Purpose

Timely identification of intracranial blood products is clinically impactful, however the detection of subdural hematoma (SDH) on non-contrast CT scans of the head (NCCTH) is challenging given interference from the adjacent calvarium. This work explores the utility of a NCCTH bone removal algorithm for improving SDH detection.

Methods

A deep learning segmentation algorithm was designed/trained for bone removal using 100 NCCTH. Segmentation accuracy was evaluated on 15 NCCTH from the same institution and 22 NCCTH from an independent external dataset using quantitative overlap analysis between automated and expert manual segmentations. The impact of bone removal on detecting SDH by junior radiology trainees was evaluated with a reader study comparing detection performance between matched cases with and without bone removal applied.

Results

Average Dice overlap between automated and manual segmentations from the internal and external test datasets were 0.9999 and 0.9957, which was superior to other publicly available methods. Among trainee readers, SDH detection was statistically improved using NCCTH with and without bone removal applied compared to standard NCCTH alone (P value <0.001). Additionally, 12/14 (86 %) of participating trainees self-reported improved detection of extra axial blood products with bone removal, and 13/14 (93 %) indicated that they would like to have access to NCCTH bone removal in the on-call setting.

Conclusion

Deep learning segmentation-based NCCTH bone removal is rapid, accurate, and improves detection of SDH among trainee radiologists when used in combination with standard NCCTH. This study highlights the potential of bone removal for improving confidence and accuracy of SDH detection.

目的：及时识别颅内血制品对临床具有重要影响，但由于受到邻近颅骨的干扰，在头部非对比 CT 扫描（NCCTH）上检测硬膜下血肿（SDH）具有挑战性。这项工作探索了一种 NCCTH 骨去除算法在改善 SDH 检测方面的实用性：方法：设计/训练了一种深度学习分割算法，用于使用 100 个 NCCTH 去除骨骼。使用自动分割和专家手动分割之间的定量重叠分析，对来自同一机构的 15 个 NCCTH 和来自独立外部数据集的 22 个 NCCTH 的分割准确性进行了评估。通过一项读者研究，比较了去骨和未去骨匹配病例的检测性能，评估了去骨对放射科初级学员检测 SDH 的影响：结果：来自内部和外部测试数据集的自动分割和人工分割的平均 Dice 重叠率分别为 0.9999 和 0.9957，优于其他公开可用的方法。在受训读者中，与单独使用标准 NCCTH 相比，使用去除和不去除骨骼的 NCCTH 在统计学上提高了 SDH 检测率（P 值结论）：基于深度学习分割的 NCCTH 骨去除快速、准确，与标准 NCCTH 结合使用可提高放射科实习医生对 SDH 的检测率。这项研究强调了骨切除在提高 SDH 检测的可信度和准确性方面的潜力。

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引用次数: 0

Intra-operative use of Augmented Reality for 3D visualisation of rotational angiography data: Feasibility and workflow demonstration using a PCOM aneurysm case 术中使用增强现实技术实现旋转血管造影数据的三维可视化：使用 PCOM 动脉瘤病例进行可行性和工作流程演示。

IF 3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2024-11-05 DOI: 10.1016/j.neurad.2024.101232

Mikkel V. Petersen, Mia H. Christiansen, Ronni Mikkelsen

In this Neuro-Interventional Video, we demonstrate a novel Augmented Reality (AR) platform for visualising vascular imaging data during interventional procedures. The platform allows clinicians to interact with 3D patient data through head-mounted displays while remaining sterile. Our workflow converts rotational angiography data to 3D models in real-time, and enables intuitive hand-tracked manipulation of patient data, including tools for cropping, size measurement, and C-arm projection assessment. We show how AR can enhance understanding of patient vascular pathology.

在这段神经介入视频中，我们展示了一个新颖的增强现实（AR）平台，用于在介入手术过程中可视化血管成像数据。该平台允许临床医生通过头戴式显示器与三维患者数据进行交互，同时保持无菌状态。我们的工作流程可将旋转血管造影数据实时转换为三维模型，并可对患者数据进行直观的手控操作，包括裁剪、尺寸测量和 C 臂投影评估工具。我们展示了 AR 如何增强对患者血管病理学的理解。

引用次数: 0

Progressive T1 high-intensity plaques in carotid stenosis: Comparative MRI analyses in asymptomatic and symptomatic phases of low-grade stenosis 颈动脉狭窄的进行性 T1 高强度斑块：低级狭窄无症状期和有症状期的 MRI 比较分析

IF 3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2024-11-01 DOI: 10.1016/j.neurad.2024.101223

Yoshitaka Kurosaki , Masanori Kinosada , Hiroyuki Ikeda , Haruki Yamashita , Kazumichi Yoshida , Masaki Chin

Background and Purpose

Carotid artery stenosis, particularly the progression from asymptomatic to symptomatic lesions, is a key factor in cerebrovascular events. This study identifies predictors of symptom development in low-grade carotid stenosis (<50%), focusing on intraplaque hemorrhage (IPH) and dynamic plaque changes.

Materials and Methods

We conducted a retrospective study analyzing 30 cases of symptomatic low-grade carotid stenosis, using carotid MRI before and after symptom onset. Key measures included relative plaque signal intensity (rSI) and high-intensity plaque (HI plaque) volume. Stepwise regression analysis examined the influence of these factors on Symptomatic rSI, Symptomatic plaque volume, and NIHSS scores.

Results

Significant increases were observed in rSI (1.32 ± 0.32 to 1.69 ± 0.25, p < 0.001) and HI plaque volume (296.4 ± 362.7 mm³ to 717.5 ± 554.9 mm³, p < 0.001) from asymptomatic to symptomatic phases. Past smoking (p = 0.008) and statin use (p = 0.04) were associated with higher Symptomatic rSI, while poor risk factor control (p = 0.03) was negatively associated. Female sex (p = 0.007) and current smoking (p = 0.009) were linked to smaller Symptomatic plaque volumes, while ischemic heart disease (p = 0.0002) and poor risk factor control (p = 0.002) predicted larger plaque volumes. Larger plaques were correlated with higher NIHSS scores (p = 0.002).

Conclusions

IPH and plaque volume are key markers of progression in low-grade carotid stenosis. Poor control of cardiovascular risk factors and a history of ischemic heart disease contribute to plaque burden and stroke severity. Continuous monitoring and strict risk management are essential in reducing stroke severity in these patients.

背景和目的：颈动脉狭窄，尤其是从无症状病变发展为有症状病变，是导致脑血管事件的关键因素。本研究确定了低级别颈动脉狭窄症状发展的预测因素：我们对 30 例有症状的低级别颈动脉狭窄病例进行了回顾性研究，在症状出现前后使用颈动脉磁共振成像进行分析。主要测量指标包括相对斑块信号强度（rSI）和高强度斑块（HI斑块）体积。逐步回归分析检验了这些因素对症状rSI、症状斑块体积和NIHSS评分的影响：从无症状阶段到有症状阶段，观察到 rSI（1.32 ± 0.32 到 1.69 ± 0.25，p < 0.001）和 HI 斑块体积（296.4 ± 362.7 mm³ 到 717.5 ± 554.9 mm³，p < 0.001）显著增加。既往吸烟（p = 0.008）和他汀类药物的使用（p = 0.04）与较高的无症状rSI相关，而风险因素控制不佳（p = 0.03）则呈负相关。女性性别（p = 0.007）和目前吸烟（p = 0.009）与症状斑块体积较小有关，而缺血性心脏病（p = 0.0002）和风险因素控制不佳（p = 0.002）则预示着斑块体积较大。较大的斑块与较高的 NIHSS 评分相关（p = 0.002）：结论：IPH和斑块体积是低级别颈动脉狭窄进展的关键标志。结论：IPH 和斑块体积是低级别颈动脉狭窄进展的关键标志。心血管危险因素控制不佳和缺血性心脏病史会加重斑块负担和卒中严重程度。持续监测和严格的风险管理对于降低这些患者的中风严重程度至关重要。

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引用次数: 0

Using the sandwich technique for the treatment of sigmoid sinus diverticulum causing pulsatile tinnitus 使用三明治技术治疗引起搏动性耳鸣的乙状窦憩室。

IF 3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2024-10-24 DOI: 10.1016/j.neurad.2024.101230

Linggen Dong , Dachao Wei , Haoyu Zhu , Zizheng Wang , Ming Lv

引用次数: 0

Assessment of large-scale imaging practices in patients with acute brain hemorrhage in French emergency departments 评估法国急诊科对急性脑出血患者进行大规模影像学检查的做法：出血性中风的急诊造影实践。

IF 3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2024-09-28 DOI: 10.1016/j.neurad.2024.101222

Rozenn Mainguy , Amandine Crombe , Mylène Seux , Jérôme Bailleux , Berengère Delorme , Marco Pasi , Jean Philippe Cottier , Grégoire Boulouis , Guillaume Gorincour

Objective

Intracerebral hemorrhage (ICH) is a life-threatening condition, where imaging plays a crucial role but remains poorly standardized. Our main objective was to analyze the imaging protocols used during the acute phase of ICH and ascertain the proportion of patients diagnosed with secondary hemorrhage.

Patients and methods

A multicenter retrospective observational study was conducted across over 100 French hospitals affiliated with a national tele-imaging network dedicated to emergency imaging. Among patients managed in the “Stroke Alert” pathway for suspected acute stroke from March 2021 to April 2023, those with ICH diagnosed within 24 h of symptoms onset were identified. Their imaging reports were reviewed to identify the imaging modality used and protocols performed and investigate whether a secondary cause was identified.

Results

Of the 18,356 patients included in the ”Stroke Alert” pathway, 662 cerebral hemorrhages were identified (3.6 %). Computed tomography (CT) was the most widely used imaging modality in the acute phase (71.8 % of examinations). Vascular imaging was performed in 78 % of patients with cerebral hemorrhage, most often CT angiography or TOF magnetic resonance angiography. A secondary cause was identified in 8.2 % (54/662) of cerebral hemorrhages, including vascular imaging in the vast majority of cases (92.6 %).

Conclusion

Optimization and standardization of imaging protocols in the acute phase of ICH is essential to improve the detection of its secondary causes, particularly vascular, requiring urgent treatment. Vascular imaging improves their early detection.

目的：脑出血（ICH）是一种危及生命的疾病，影像学在其中发挥着至关重要的作用，但其标准化程度仍然很低。我们的主要目的是分析 ICH 急性期使用的成像方案，并确定诊断为继发性出血的患者比例：我们在法国 100 多家医院开展了一项多中心回顾性观察研究，这些医院隶属于一个专门用于急诊成像的全国远程成像网络。在 2021 年 3 月至 2023 年 4 月期间，在疑似急性中风的 "中风警报 "路径中管理的患者中，确定了在症状出现 24 小时内诊断为 ICH 的患者。对他们的成像报告进行审查，以确定所使用的成像方式和所执行的方案，并调查是否发现了继发性病因：结果：在纳入 "卒中警报 "路径的 18356 名患者中，发现了 662 例脑出血（3.6%）。计算机断层扫描（CT）是急性期使用最广泛的成像方式（71.8%的检查）。78%的脑出血患者接受了血管成像检查，最常见的是CT血管造影或TOF磁共振血管造影。8.2%的脑出血患者（54/662）发现了继发性病因，其中绝大多数病例（92.6%）进行了血管造影检查：结论：ICH 急性期成像方案的优化和标准化对于更好地发现需要紧急治疗的继发性病因（尤其是血管性病因）至关重要。血管成像可提高其早期发现率。

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引用次数: 0

Intracranial aneurysm stiffness assessment using 4D Flow MRI 利用 4D 流式磁共振成像评估颅内动脉瘤的硬度。

IF 3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2024-09-19 DOI: 10.1016/j.neurad.2024.101221

Satoshi Koizumi , Taichi Kin , Tetsuro Sekine , Satoshi Kiyofuji , Motoyuki Umekawa , Nobuhito Saito

Background

Although arterial stiffness is known as a biomarker for cardiovascular events and stroke, there is limited information in the literature regarding the stiffness of intracranial aneurysms. In this study, we aim to assess the stiffness of intracranial aneurysms using 4D Flow MRI.

Methods

A total of 27 aneurysms in 25 patients with internal carotid artery aneurysms were included in this study. Using 4D Flow MRI, we measured the arterial pulse wave form during a cardiac cycle at planes proximal and distal to the target aneurysm. The damping of these waveforms through the aneurysm was defined as the aneurysm damping index (ADI) and compared to the contralateral side. We also investigated the clinical factors related to the ADI.

Results

ADI assessment was successful in all cases. The average ADI was 1.18±0.28, which was significantly larger than 1.0 (P = 0.0027 [t-test]). The ADI on the aneurysm side was larger than on the contralateral side (1.19±0.30 vs 1.05±0.17, P = 0.029 [t-test]). On multivariate analysis, the use of beta-blockers (β=0.46, P = 0.015) and smoking history (β=-0.22, P = 0.024) showed a significant correlation with ADI.

Conclusion

We have proposed a novel method to observe arterial pulse wave dumping through intracranial aneurysm using 4D Flow MRI. The damping can be quantitatively observed, and the ADI has correlations with clinical factors such as antihypertensive drugs and smoking. Further studies should focus more on evaluating aneurysm stiffness and its clinical applications.

背景：尽管动脉僵化被认为是心血管事件和中风的生物标志物，但有关颅内动脉瘤僵化的文献资料却很有限。在这项研究中，我们旨在利用四维流磁共振成像技术评估颅内动脉瘤的硬度：本研究共纳入了 25 名颈内动脉瘤患者的 27 个动脉瘤。通过四维血流磁共振成像，我们测量了目标动脉瘤近端和远端平面在一个心动周期内的动脉脉搏波形。这些波形通过动脉瘤的阻尼被定义为动脉瘤阻尼指数（ADI），并与对侧进行比较。我们还调查了与 ADI 相关的临床因素：所有病例的 ADI 评估都很成功。平均 ADI 为 1.18±0.28，明显大于 1.0（P=0.0027 [t-检验]）。动脉瘤一侧的 ADI 大于对侧（1.19±0.30 vs 1.05±0.17，P=0.029 [t-test]）。多变量分析显示，使用β-受体阻滞剂（β=0.46，P=0.015）和吸烟史（β=-0.22，P=0.024）与 ADI 有显著相关性：我们提出了一种利用四维流磁共振成像观察动脉脉搏波通过颅内动脉瘤倾泻的新方法。可以定量观察阻尼，ADI 与抗高血压药物和吸烟等临床因素相关。进一步的研究应更侧重于评估动脉瘤的硬度及其临床应用。

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引用次数: 0

PET-MRI neuroimaging of neurovascular uncoupling related to BBB dysfunction: beyond mild traumatic injury 与 BBB 功能障碍有关的神经血管解偶联的 PET-MRI 神经成像：超越轻度创伤

IF 3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2024-08-29 DOI: 10.1016/j.neurad.2024.101219

Eric Guedj, Tatiana Horowitz, Brieg Dissaux, Douraied Ben Salem

引用次数: 0

Association of baseline blood pressure and outcomes in etiology subtypes of large vessel occlusion stroke: Data from ANGEL-ACT registry 大血管闭塞性卒中病因亚型中基线血压与预后的关系：来自 ANGEL-ACT 登记处的数据。

IF 3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2024-08-09 DOI: 10.1016/j.neurad.2024.101213

Haifeng Xu , Dapeng Sun , Ligang Song , Dapeng Mo , Ning Ma , Anxin Wang , Feng Gao , Xuelei Zhang , Baixue Jia , Zhongrong Miao , ANGEL-ACT study group

Background

Blood pressure (BP) management at the initial stage of stroke caused by large-vessel occlusion (LVO) remains challenging. We assessed the association between baseline BP and clinical and safety outcomes of endovascular treatment (EVT) in different stroke etiologies.

Methods

Patients with acute ischemic stroke and anterior circulation LVO were screened from a prospective, multicenter registry of EVT from November 2017 to March 2019. The primary outcome was poor 90-day outcome (modified Rankin Scale score 3–6). The safety outcome was 24 h post-procedure parenchymal hematoma (PH). The Trial of Org 101072 in Acute Stroke Treatment criteria were used for etiologic stroke classification. Restricted cubic spline and binary logistic regression analysis were performed to examine the association between study outcomes and natural log-transformed BP.

Results

In subgroup analyses, a U-shaped correlation existed between baseline mean arterial pressure (MAP) and poor outcome in large-artery atherosclerosis stroke only. Higher MAP was an independent risk factor compared with a central reference value (≥ 133 mm Hg vs 96–115 mm Hg; adjusted OR [aOR], 2.50; 95 % CI, 1.09 to 5.71, P = 0.030). Whereas elevated MAP was associated with PH (aOR, 1.58; 95 % CI 1.04 to 2.39, P = 0.030 for a ln10-unit increase in natural log-transformed MAP) in the range <110 mm Hg exclusively for cardioembolic stroke.

Conclusion

Whether it is cause or epiphenomenon, baseline BP was associated with 90-day outcome in large-artery atherosclerosis stroke, whereas in cardioembolic stroke baseline BP was correlated with post-procedure PH within a certain range. Identifying these features based on etiological subtypes may offer a reference for BP management in acute LVO stroke.

背景：由大血管闭塞（LVO）引起的卒中初期的血压（BP）管理仍然具有挑战性。我们评估了不同卒中病因的基线血压与血管内治疗（EVT）的临床和安全结果之间的关系：2017年11月至2019年3月，我们从EVT前瞻性多中心登记中筛选出急性缺血性卒中和前循环LVO患者。主要结果是90天不良预后（改良Rankin量表评分3-6分）。安全性结果为术后24小时实质血肿（PH）。急性卒中治疗中的 Org 101072 试验标准用于卒中病因分类。对研究结果与自然对数转换血压之间的关系进行了限制性三次样条分析和二元逻辑回归分析：结果：在亚组分析中，基线平均动脉压（MAP）与仅大动脉粥样硬化性卒中的不良预后之间存在 U 型相关性。与中心参考值相比，更高的 MAP 是一个独立的风险因素（≥ 133 mm Hg vs 96-115 mm Hg；调整 OR [aOR]，2.50；95% CI，1.09 至 5.71，P=0.030）。而 MAP 升高与 PH 相关（aOR，1.58；95% CI，1.04 至 2.39，P=0.030，自然对数转换后的 MAP 增加 ln10 单位），在小于 110 mm Hg 的范围内仅与心肌栓塞性卒中相关：结论：无论是病因还是表象，基线血压与大动脉粥样硬化性卒中的 90 天预后相关，而心肌栓塞性卒中的基线血压在一定范围内与术后 PH 相关。根据病因亚型确定这些特征可为急性低密度脂蛋白血症卒中的血压管理提供参考。

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引用次数: 0

Parallel placement of Woven EndoBridge (WEB) device for the treatment of wide-necked lobulated aneurysms at the basilar tip 平行放置 Woven EndoBridge（WEB）装置治疗基底动脉端宽颈分叶状动脉瘤。

IF 3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2024-07-04 DOI: 10.1016/j.neurad.2024.101212

Haoyu Zhu , Yupeng Zhang , Shikai Liang , Chuhan Jiang

引用次数: 0

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