Journal of Neuroradiology最新文献_第3页

AI-assisted detection of cerebral aneurysms on 3D time-of-flight MR angiography: User variability and clinical implications 在三维飞行时间磁共振血管造影上人工智能辅助检测脑动脉瘤：用户差异和临床意义。

IF 3.3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2025-09-10 DOI: 10.1016/j.neurad.2025.101388

Liang Liao , Ulysse Puel , Ophélie Sabardu , Oana Harsan , Luana Lopes De Medeiros , Wassim Abou Loukoul , René Anxionnat , Erwan Kerrien

Background

The generalizability and reproducibility of AI-assisted detection for cerebral aneurysms on 3D time-of-flight MR angiography remain unclear. We aimed to evaluate physician performance using AI assistance, focusing on inter- and intra-user variability, identifying factors influencing performance and clinical implications.

Methods

In this retrospective study, four state-of-the-art AI models were hyperparameter-optimized on an in-house dataset (2019–2021) and evaluated via 5-fold cross-validation on a public external dataset. The two best-performing models were selected for evaluation on an expert-revised external dataset. Inclusion: saccular aneurysms without prior treatment. Five physicians, grouped by expertise, each performed two AI-assisted evaluations, one with each model. Lesion-wise sensitivity and false positives per case (FPs/case) were calculated for each physician–AI pair and AI models alone. Agreement was assessed using kappa. Aneurysm size comparisons used the Mann–Whitney U test.

Results

The in-house dataset included 132 patients with 206 aneurysms (mean size: 4.0 mm); the revised external dataset, 270 patients with 174 aneurysms (mean size: 3.7 mm). Standalone AI achieved 86.8 % sensitivity and 0.58 FPs/case. With AI assistance, non-experts achieved 72.1 % sensitivity and 0.037 FPs/case; experts, 88.6 % and 0.076 FPs/case; the intermediate-level physician, 78.5 % and 0.037 FPs/case. Intra-group agreement was 80 % for non-experts (kappa: 0.57, 95 % CI: 0.54–0.59) and 77.7 % for experts (kappa: 0.53, 95 % CI: 0.51–0.55). In experts, false positives were smaller than true positives (2.7 vs. 3.8 mm, p < 0.001); no difference in non-experts (p = 0.09). Missed aneurysm locations were mainly model-dependent, while true- and false-positive locations reflected physician expertise. Non-experts more often rejected AI suggestions and added fewer annotations; experts were more conservative and added more.

Conclusion

Evaluating AI models in isolation provides an incomplete view of their clinical applicability. Detection performance and patterns differ between standalone AI and AI-assisted use, and are modulated by physician expertise. Rigorous external validation is essential before clinical deployment.

背景：人工智能辅助下3D飞行时间磁共振血管造影检测脑动脉瘤的普遍性和可重复性尚不清楚。我们的目的是利用人工智能辅助评估医生的表现，重点关注用户之间和用户内部的可变性，确定影响表现和临床意义的因素。方法：在这项回顾性研究中，对四个最先进的人工智能模型在内部数据集（2019-2021）上进行了超参数优化，并在公共外部数据集上通过5倍交叉验证进行了评估。选择两个表现最好的模型在专家修订的外部数据集上进行评估。包括：未经治疗的囊状动脉瘤。五名医生按专业知识分组，每人进行两次人工智能辅助评估，每个模型一次。每个医生-人工智能配对和人工智能模型单独计算每个病例的病变敏感性和假阳性（FPs/case）。使用kappa评估一致性。动脉瘤大小的比较采用Mann-Whitney U测试。结果：内部数据集包括132例206个动脉瘤（平均大小：4.0 mm）；修改后的外部数据集，270例患者174个动脉瘤（平均大小：3.7 mm）。独立AI实现了86.8%的灵敏度和0.58 FPs/case。在人工智能的帮助下，非专家达到72.1%的灵敏度和0.037 FPs/case；专家88.6%,0.076 FPs/case；中级医师为78.5%，0.037 FPs/病例。非专家组内一致性为80% (kappa: 0.57, 95% CI: 0.54-0.59)，专家组内一致性为77.7% （kappa: 0.53, 95% CI: 0.51-0.55）。在专家中，假阳性小于真阳性（2.7 vs 3.8 mm, p < 0.001）；非专家无差异（p = 0.09）。遗漏的动脉瘤位置主要依赖于模型，而真阳性和假阳性位置反映了医生的专业知识。非专家更经常拒绝AI建议并添加更少的注释；专家们则更为保守，增加了更多。结论：孤立地评估人工智能模型不能完整地反映其临床适用性。在独立使用人工智能和人工智能辅助使用之间，检测性能和模式有所不同，并受到医生专业知识的调节。在临床部署之前，严格的外部验证是必不可少的。

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引用次数: 0

Differential cortical hemodynamics during standard and reversed visually guided navigation: An fNIRS-based investigation 在标准和反向视觉引导导航中的皮质血流动力学差异：一项基于fnir的研究。

IF 3.3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2025-09-08 DOI: 10.1016/j.neurad.2025.101387

Sang Seok Yeo , Chae-Won Kwon , In Hee Cho

Visuospatial perception, which is based on the comprehension of objects and space, requires spatial attention to the surrounding environment. Stimulus-related elements that affect visuospatial tasks include object geometry, familiarity, complexity, and picture plane versus depth rotation. The dorsal stream pathway from the visual cortex, which is implicated in spatial processing, reflects the spatial component needed to orient the focus of attention to the location of the expected target stimulus. It is activated during spatial localization. While processing spatial information, visual, somatosensory, and auditory information is received from the inferotemporal cortex, medial and superior parietal cortices, and transverse temporal gyrus, and is projected directly toward the prefrontal cortex, which includes the premotor cortex. In this study 10 volunteers performed standard and reverse visually guided weight-shifting training tasks. This study aimed to investigate the hemodynamic response of the parietal to occipital cortex during these tasks using a 41-channel functional near-infrared spectroscopy system. During the standard navigation task, the right supramarginal gyrus showed a significant increase in oxy-hemoglobin (HbO) and total-hemoglobin (HbT) values. In contrast, the reverse navigation task showed significant increments in HbO values in the right angular gyrus (AG) and left somatosensory association cortex (SAC) and in HbT values in the left SAC and both AG. Thus, according to our results, spatial processing based on reversal may be different. Moreover, a difference in the amount of oxygen was observed. Further studies are required to understand the activated neural mechanisms when sensory inputs differ during spatial information processing.

视觉空间感知以对物体和空间的理解为基础，需要对周围环境进行空间关注。影响视觉空间任务的刺激相关元素包括物体几何、熟悉度、复杂性和画面平面与深度旋转。来自视觉皮层的背侧流通路与空间加工有关，反映了将注意力焦点定向到预期目标刺激位置所需的空间成分。它在空间定位过程中被激活。在处理空间信息时，视觉、体感和听觉信息从颞下皮层、顶叶内侧和顶叶上部皮层以及颞横回接收，并直接投射到包括前运动皮层在内的前额叶皮层。在这项研究中，10名志愿者完成了标准和反向视觉引导的体重转移训练任务。本研究旨在利用41通道功能近红外光谱系统研究这些任务中顶叶到枕叶皮层的血流动力学反应。在标准的导航任务中，右侧边缘上回的氧血红蛋白（HbO）和总血红蛋白（HbT）值显著增加。相反，反向导航任务显示右侧角回（AG）和左侧体感关联皮层（SAC）的HbO值显著增加，左侧SAC和两个AG的HbT值显著增加。因此，根据我们的结果，基于反转的空间处理可能会有所不同。此外，还观察到氧气量的差异。在空间信息处理过程中，当感觉输入不同时，被激活的神经机制需要进一步的研究。

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引用次数: 0

MRI versus CT before endovascular thrombectomy in the early time window: A systematic review and meta-analysis 早期时间窗内血管内血栓切除术前MRI与CT对比：一项系统回顾和荟萃分析

IF 3.3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2025-09-06 DOI: 10.1016/j.neurad.2025.101384

Nourou Dine Adeniran Bankole , Adnan Mujanovic , Yao Christian Hugues Dokponou , Corentin Provost , Marco Pasi , Hocine Redjem , Mikael Mazighi , Catherine Oppenheim , Urs Fischer , Thomas R Meinel , Johannes Kaesmacher , Grégoire Boulouis , Fouzi Bala

Background

Selection of acute stroke patients for endovascular thrombectomy (EVT) within 6 h from symptom onset can be done using MRI or CT. However, association of either imaging modality with better clinical outcomes or shorter workflow times is still not fully understood.

Methods

We searched Medline and Ovid-Embase for studies comparing outcomes and workflow metrics between patients selected for EVT using CT or MRI from inception to November 30, 2024. The primary outcome was the association of imaging modality with functional independence (modified Rankin Scale score, 0–2) at 90-days and workflow metrics. Pooled odds ratios with 95% CIs were calculated using a random-effects model.

Results

Nine studies with 11,202 patients (3018 with MRI vs 8184 with CT) were analysed. Patients selected with MRI had similar odds of 90-day mRS 0–2 (adjusted odds ratio [aOR] 1.1195% CI 0.84–1.47) and lower mortality (aOR 0.6695% CI 0.57–0.76) compared to those selected with CT. Door-to-imaging time (mean difference [MD] 11.2 min 95% CI 4.8 to 18.4) and door-to-intravenous thrombolysis initiation time (MD 10.1 min 95% CI 4.9 to 15.2) were longer in patients selected with MRI. However, door-to-arterial puncture time was similar between both groups (MD 6.8 min 95% CI -4.6 to 18.1).

Conclusion

In stroke patients undergoing EVT within 6 h from symptom onset, MRI before EVT could be a feasible alternative to CT without significant delays from door to puncture time. Randomized trials are needed before these findings can be generalized.

背景选择急性脑卒中患者在症状出现后6小时内进行血管内血栓切除术（EVT）可以通过MRI或CT进行。然而，成像方式与更好的临床结果或更短的工作流程时间之间的关系仍未完全了解。方法：我们检索Medline和ovd - embase，以比较从开始到2024年11月30日使用CT或MRI进行EVT的患者的结果和工作流程指标的研究。主要结果是成像方式与90天功能独立性（修改Rankin量表评分，0-2）和工作流程指标的关联。采用随机效应模型计算95% ci的合并优势比。结果9项研究共纳入11202例患者（MRI 3018例，CT 8184例）。与选择CT的患者相比，选择MRI的患者90天mr0 - 2的比值相似（校正比值比[aOR] 1.1195% CI 0.84-1.47），死亡率更低（aOR 0.6695% CI 0.57-0.76）。在选择MRI的患者中，门到成像时间（平均差[MD] 11.2分钟，95% CI 4.8至18.4）和门到静脉溶栓起始时间（MD 10.1分钟，95% CI 4.9至15.2）更长。然而，两组之间的门到动脉穿刺时间相似（MD 6.8 min, 95% CI -4.6至18.1）。结论对于症状出现后6小时内行EVT的脑卒中患者，EVT前MRI检查可替代CT检查，且从开门到穿刺时间无明显延迟。在这些发现可以推广之前，需要进行随机试验。

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引用次数: 0

Increased 18F-FAPI-04 uptake in neurofibromatosis type 1 in a patient with synchronous bilateral breast cancer 同步双侧乳腺癌患者1型神经纤维瘤病中18F-FAPI-04摄取增加

IF 3.3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2025-09-06 DOI: 10.1016/j.neurad.2025.101385

Yuting Wu , Chunxiu Yuan , Dongju Li , Xiaowei Ma , Jiqin Yang

引用次数: 0

Diagnostic value of centrally restricted diffusion in differentiating radiation necrosis from tumor progression in brain metastases: A single-center observational study 中枢限制性弥散在鉴别脑转移灶放射性坏死与肿瘤进展中的诊断价值：一项单中心观察研究。

IF 3.3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2025-09-05 DOI: 10.1016/j.neurad.2025.101386

Valentin Laigle , Laure Thomas , Thiebaud Picart , Emanuele Tommasino , Chloé Dumot , Anne d’Hombres , Loïc Feuvret , Emilien Jupin-Delevaux , Delphine Gamondès , Marc Hermier , François Cotton , Jérôme Honnorat , François Ducray , Yves Berthezène , Alexandre Bani-Sadr

Background

Distinguishing radiation necrosis (RN) from true progression (TP) in irradiated brain metastases is challenging. We evaluated the diagnostic performance of the centrally restricted diffusion sign on diffusion-weighted imaging (DWI).

Methods

From August 2014 to August 2024, we screened 321 patients with histologically confirmed brain metastases treated with radiation therapy and follow-up MRI for new or enlarging necrotic lesions ≥1 cm. Two board-certified neuroradiologists independently assessed the centrally restricted diffusion sign—central hyperintensity on b1000 images with corresponding ADC reduction—by rigidly co-registering DWI to postcontrast 3D T1-weighted sequences. Quantitative analysis included mean ADC measurement within manually drawn regions of interest in the necrotic core and the contrast-enhancing rim. Final diagnoses were established by histopathology (n = 17) or multidisciplinary consensus (n = 90).

Results

Of 107 patients (median age, 62 years; 57.9 % male), 62 had TP and 45 had RN. Median interval from radiotherapy completion to index MRI was 10.8 months. Overall survival was longer in patients with RN (median not reached) than in those with TP (17.5 months; P < 0.0001). Interobserver agreement for the centrally restricted diffusion sign was moderate (κ =0.55). The sign appeared in 34/45 RN cases and 13/62 TP cases (P < 0.0001). For RN diagnosis, sensitivity was 75.6 %, specificity 79.0 %, and accuracy 77.6 %. Quantitative ADC metrics did not enhance performance.

Conclusion

The centrally restricted diffusion sign on DWI may aid differentiation of RN from TP in irradiated brain metastases, despite moderate interrater reliability.

背景：区分放射性脑转移瘤的放射性坏死（RN）和真进展（TP）是具有挑战性的。我们评估了弥散加权成像（DWI）上中央限制性弥散征象的诊断性能。方法：从2014年8月至2024年8月，我们筛选了321例组织学证实的脑转移患者，这些患者接受了放疗，并随访MRI，发现新的或扩大的坏死灶≥1 cm。两名委员会认证的神经放射学家通过严格地将DWI与对比后的3D t1加权序列共同配准，独立评估了b1000图像上的中心限制性弥散征象-相应ADC降低的中心高强度。定量分析包括在坏死核心和对比度增强边缘手动绘制的感兴趣区域内的平均ADC测量。最终诊断由组织病理学（n=17）或多学科共识（n=90）确定。结果：107例患者中位年龄62岁，男性57.9%，TP 62例，RN 45例。从放疗完成到MRI指数的中位时间间隔为10.8个月。结论：DWI上的中枢性弥散受限征象可能有助于放射脑转移灶中RN与TP的鉴别，尽管两者间的可靠性不高。

{"title":"Diagnostic value of centrally restricted diffusion in differentiating radiation necrosis from tumor progression in brain metastases: A single-center observational study","authors":"Valentin Laigle , Laure Thomas , Thiebaud Picart , Emanuele Tommasino , Chloé Dumot , Anne d’Hombres , Loïc Feuvret , Emilien Jupin-Delevaux , Delphine Gamondès , Marc Hermier , François Cotton , Jérôme Honnorat , François Ducray , Yves Berthezène , Alexandre Bani-Sadr","doi":"10.1016/j.neurad.2025.101386","DOIUrl":"10.1016/j.neurad.2025.101386","url":null,"abstract":"<div><h3>Background</h3><div>Distinguishing radiation necrosis (RN) from true progression (TP) in irradiated brain metastases is challenging. We evaluated the diagnostic performance of the centrally restricted diffusion sign on diffusion-weighted imaging (DWI).</div></div><div><h3>Methods</h3><div>From August 2014 to August 2024, we screened 321 patients with histologically confirmed brain metastases treated with radiation therapy and follow-up MRI for new or enlarging necrotic lesions ≥1 cm. Two board-certified neuroradiologists independently assessed the centrally restricted diffusion sign—central hyperintensity on b1000 images with corresponding ADC reduction—by rigidly co-registering DWI to postcontrast 3D T1-weighted sequences. Quantitative analysis included mean ADC measurement within manually drawn regions of interest in the necrotic core and the contrast-enhancing rim. Final diagnoses were established by histopathology (<em>n</em> = 17) or multidisciplinary consensus (<em>n</em> = 90).</div></div><div><h3>Results</h3><div>Of 107 patients (median age, 62 years; 57.9 % male), 62 had TP and 45 had RN. Median interval from radiotherapy completion to index MRI was 10.8 months. Overall survival was longer in patients with RN (median not reached) than in those with TP (17.5 months; <em>P</em> < 0.0001). Interobserver agreement for the centrally restricted diffusion sign was moderate (κ =0.55). The sign appeared in 34/45 RN cases and 13/62 TP cases (<em>P</em> < 0.0001). For RN diagnosis, sensitivity was 75.6 %, specificity 79.0 %, and accuracy 77.6 %. Quantitative ADC metrics did not enhance performance.</div></div><div><h3>Conclusion</h3><div>The centrally restricted diffusion sign on DWI may aid differentiation of RN from TP in irradiated brain metastases, despite moderate interrater reliability.</div></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 6","pages":"Article 101386"},"PeriodicalIF":3.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intraoperative and long-term multimodal radiological assessment of brain MR-guided laser interstitial thermal therapy (MRgLITT) in children 儿童脑磁共振引导的激光间质热治疗术中及长期多模态放射学评价。

IF 3.3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2025-08-13 DOI: 10.1016/j.neurad.2025.101377

Alice Hu , Lelio Guida , Ludovic Fillon , Rima Nabbout , François Doz , Oumaima Aboubakr , Thomas Blauwblomme , Nathalie Boddaert , Volodia Dangouloff-Ros

Objectives

Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has emerged as a minimally invasive alternative for drug-resistant epilepsy and pediatric brain tumors, particularly in deep-seated lesions where open surgery presents significant risks. However, the multimodal imaging characteristics of lesions during and after MRgLITT remain underexplored. This study aims to describe the MRI features of MRgLITT-treated lesions in pediatric patients both intraoperatively and during long-term follow-up.

Methods

We conducted a retrospective analysis of 26 pediatric patients(32 procedures) treated using MRgLITT, including focal cortical dysplasias, low-grade tumors and hamartomas. Imaging acquisition included preoperative, intraoperative, and postoperative MRI with advanced sequences(T1-weighted, FLAIR, DWI, ASL perfusion, and MR spectroscopy). Lesion evolution was assessed over a one-year follow-up period.

Results

Intraoperatively, lesions showed a rim of high signal on DWI and on post-contrast T1-weighted images, a lactate peak on MR spectroscopy, and the majority of them had peripheral high signal on FLAIR associated with a low signal core and increased CBF on ASL. During follow-up, lesions may increase in size in the first days or weeks, then decrease in size mainly in the first 3 months and tend to stabilize at 9 months, with persistent gliotic changes on FLAIR sequences. Contrast enhancement resolved in epilepsy-related lesions, but small areas remained in most tumors without correlation with progression.

Conclusion

MRgLITT results in a predictable pattern of imaging changes, with lesion contraction occurring primarily within the first 3 months. Understanding these radiological markers is essential for optimizing post-procedure management and treatment decisions in pediatric epilepsies and tumors.

目的：磁共振引导的激光间质热疗法（MRgLITT）已成为治疗耐药癫痫和儿童脑肿瘤的一种微创替代方法，特别是在开放性手术存在重大风险的深部病变中。然而，MRgLITT期间和之后病变的多模态成像特征仍未得到充分探讨。本研究旨在描述mrglitt治疗的儿科患者术中和长期随访期间病变的MRI特征。方法：我们对26例使用MRgLITT治疗的儿童患者（32种手术）进行了回顾性分析，包括局灶性皮质发育不良、低级别肿瘤和错构瘤。成像采集包括术前、术中和术后MRI先进序列（t1加权、FLAIR、DWI、ASL灌注和MR光谱）。在一年的随访期间评估病变演变。结果：术中，病变在DWI和造影后t1加权图像上显示高信号边缘，MR光谱上显示乳酸峰，大多数病变在FLAIR上呈外周高信号伴低信号核心，ASL上CBF增加。在随访期间，病变可能在最初的几天或几周内增大，然后主要在前3个月减小，并在9个月时趋于稳定，FLAIR序列显示持续的胶质样变化。对比增强在癫痫相关病变中消失，但在大多数肿瘤中仍存在小区域，与进展无关。结论：MRgLITT显示可预测的影像学改变模式，病变收缩主要发生在前3个月内。了解这些放射学标记对于优化小儿癫痫和肿瘤的术后管理和治疗决策至关重要。

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引用次数: 0

Defining optimal thrombectomy-per-ischemic-stroke targets: a methodology for guiding procedure volumes per center in France 定义最佳血栓切除术每缺血性中风的目标：一种方法，指导每中心的程序量在法国

IF 3.3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2025-08-12 DOI: 10.1016/j.neurad.2025.101375

Fabien de Oliveira , Lucas Léger , Chris Serrand , Vincent Costalat , Jean-Paul Beregi , Thibault Mura , Thierry Boudemaghe , Julien Frandon

Background and purpose

Mechanical thrombectomy (MT) has emerged as a groundbreaking treatment for large vessel occlusion strokes. There is limited data on the expected number of thrombectomies based on regional demographics, the ideal proximity to thrombectomy centers for the population, and the appropriate thrombectomy-per-ischemic-stroke ratio centers should target.

Materials and methods

This retrospective analysis (2018–2024) used data from the French National Uniform Hospital Discharge Dataset to establish benchmark indicators guiding public health policy. We defined the Thrombectomy Target Level (TTL) as the median standardized thrombectomy-per-ischemic-stroke ratio and the Thrombectomy Alert Level (TAL) as the 25th percentile of the standardized thrombectomy-per-stroke ratio across all administrative regions. These thresholds were calculated annually, and percentages were mapped. Using the TTL and the distribution of thrombectomy-treated stroke cases as a function of distance, we determined the maximum car travel time to achieve this goal.

Results

Over the study period, 803,058 strokes and 49,154 thrombectomies (6.1 % of all strokes) were reported in the PMSI. TTL rose from 4.4 % in 2018 to 7.0 % in 2024 and TAL rose from 3.6 % to 5.6 %. The geographic distribution of standardized thrombectomy-per-ischemic-stroke ratio revealed disparities in thrombectomy treatment levels across regions. To meet TTL objectives, the population should be within 50 min by car from a thrombectomy center.

Conclusion

We set epidemiological thresholds as targets (TTL) and alerts (TAL) to identify regions performing insufficient thrombectomies. Public health authorities can use these thresholds to adjust and optimize healthcare services. For optimal access, the population should be within an hour’s drive from a center.

背景和目的机械取栓术（MT）已成为治疗大血管闭塞性中风的突破性方法。基于区域人口统计数据、人群与取栓中心的理想距离以及适当的缺血卒中取栓率中心的预期取栓数量的数据有限。材料和方法本回顾性分析（2018-2024）使用法国国家统一医院出院数据集的数据来建立指导公共卫生政策的基准指标。我们将取栓目标水平（TTL）定义为每缺血卒中标准化取栓率的中位数，将取栓警戒水平（TAL）定义为所有行政区域每卒中标准化取栓率的第25百分位。这些阈值每年计算一次，并绘制百分比图。使用TTL和血栓切除治疗的中风病例的分布作为距离的函数，我们确定了实现这一目标的最大汽车行驶时间。结果在研究期间，PMSI报告了803058例中风和49154例血栓切除术（占所有中风的6.1%）。TTL从2018年的4.4%上升到2024年的7.0%，TAL从3.6%上升到5.6%。标准化取栓/缺血性卒中比率的地理分布揭示了不同地区取栓治疗水平的差异。为了达到生存时间目标，人群应在距离取栓中心50分钟车程的范围内。我们设置了流行病学阈值作为目标（TTL）和警报（TAL），以识别未充分切除血栓的地区。公共卫生当局可以使用这些阈值来调整和优化医疗保健服务。为了获得最佳的访问，人们应该在距离中心一个小时的车程内。

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引用次数: 0

5.0T MRA techniques for evaluating Moyamoya disease: 4D-ASL-MRA vs. 3D-TOF-MRA 评估烟雾病的t MRA技术：4D-ASL-MRA与3D-TOF-MRA。

IF 3.3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2025-08-09 DOI: 10.1016/j.neurad.2025.101376

Shi-hai Zhao , Yuan-ren Zhai , Yi-jun Zhou , Gan Sun , Ke Xue , Hua-lu Han , Dong Wang , Yu-xin Yang , Ming-li Li , Jun Ni , Dong Zhang , Yi-ning Wang , Feng Feng

Purpose

Three-dimensional time-of-flight MR-angiography (3D-TOF-MRA) at 5.0T showed comparable capacity to 7.0T for visualizing small vessels, but has not yet been compared with arterial spin labeling (ASL)-based four-dimensional MR-angiography (4D-ASL-MRA) at 5.0T. This study aimed to compare the performance of these two MRA techniques at 5.0T in evaluating Moyamoya disease (MMD).

Methods

This retrospective study included 20 consecutive MMD patients who underwent 4D-ASL-MRA with six labeling times (100 ms to 1800 ms) and 3D-TOF-MRA at 5.0T Analyses included Suzuki grades, contrast-to-noise ratio (CNR), number of branches in middle cerebral artery (MCA), and image scores of terminal internal carotid arteries (ICA), stenosis around terminal ICA, distal MCA, Moyamoya vessels, and leptomeningeal anastomosis (LMA) collateral vessels.

Results

Twenty patients (10 females, 33 ± 8 years) with 30 cerebral hemispheres were analyzed. Compared to 3D-TOF-MRA, 4D-ASL-MRA with 900 ms to 1800 ms labeling times demonstrated superior visualization scores for terminal ICA, stenosis around terminal ICA, and LMA (4D-ASL-MRA with 900 ms vs 3D-TOF-MRA: 4.00 ± 0.00 vs 3.50 ± 0.68, 3.00 ± 0.00 vs 2.68 ± 0.55, 2.37 ± 1.19 vs 1.40 ± 0.97, respectively, all p < 0.05), and 4D-ASL-MRA at 1800 ms showed higher CNR in the M4 segment (45.84 ± 20.28 vs 27.54 ± 24.46, p < 0.001) but lower in M1 to M3 segments (65.61 ± 36.22 vs 173.58 ± 148.25, 48.89 ± 29.44 vs 122.86 ± 104.23, 44.68 ± 30.05 vs 78.36 ± 72.64, respectively, all p < 0.05) and more visible distal MCA branches (24.83 ± 5.49 vs 15.03 ± 5.99, p < 0.001). The inter-modality agreement on Suzuki grades between 4D-ASL-MRA and digital subtraction angiography (DSA) was excellent (κ= 0.88), outperforming that between 3D-TOF-MRA and DSA (κ= 0.57).

Conclusion

At 5.0T, 4D-ASL-MRA demonstrated superior visualization of terminal ICA, distal MCA, and collateral vessels in MMD, as well as staging MMD more accurately than 3D-TOF-MRA.

目的：5.0T时三维飞行时间磁共振血管造影（3D-TOF-MRA）显示出与7.0T相当的小血管可视化能力，但尚未与5.0T时基于动脉自旋标记（ASL）的四维磁共振血管造影（4D-ASL-MRA）进行比较。本研究旨在比较这两种MRA技术在5.0T下评估烟雾病（MMD）的性能。方法：本回顾性研究包括20例连续接受6次4D-ASL-MRA （100ms至1800ms）和5.0T 3D-TOF-MRA的烟雾病患者。分析包括铃木分级、噪声对比比（CNR）、大脑中动脉（MCA）分支数量、颈动脉终末（ICA）、ICA终末周围狭窄、MCA远端、烟雾血管和小脑膜吻合（LMA）侧支血管的图像评分。结果：分析了20例患者（女性10例，33±8岁）30个大脑半球。与3D-TOF-MRA相比，标记时间为900ms至1800ms的4D-ASL-MRA在ICA末端、ICA周围狭窄和LMA的可视化评分上优于3D-TOF-MRA。4.00±0.00 vs 3.50±0.68,3.00±0.00 vs 2.68±0.55,2.37±1.19 vs 1.40±0.97,分别,p < 0.05),在1800 ms显示更高的中国北车和4 d-asl-mra M4段(45.84±20.28 vs 27.54±24.46,p < 0.001),但低M1, M3段(65.61±36.22 vs 173.58±148.25,48.89±29.44 vs 122.86±104.23,44.68±30.05 vs 78.36±72.64,分别为p < 0.05),可见远MCA分支(24.83±5.49 vs 15.03±5.99,pConclusion:在5.0T时，4D-ASL-MRA显示出MMD末端ICA，远端MCA和侧支血管的优越可视化，并且比3D-TOF-MRA更准确地分期MMD。

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引用次数: 0

The Role of MRI as a key evaluator of mesenchymal stem Cell Therapy in Multiple Sclerosis: A systematic review and meta-analysis MRI作为多发性硬化症间充质干细胞治疗的关键评估指标：一项系统综述和荟萃分析

IF 3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2025-07-25 DOI: 10.1016/j.neurad.2025.101374

Mohammadreza Elhaie , Abolfazl Koozari , Mohammadhossein Mozafari , Iraj Abedi

Background

Multiple Sclerosis (MS) is a chronic, immune-mediated disorder marked by inflammation, demyelination, and neurodegeneration, necessitating regenerative therapies. Mesenchymal stem cell (MSC) therapy offers immunomodulatory and neuroprotective potential, but clinical evaluation is challenging.

Methods

This systematic review and meta-analysis, registered on PROSPERO (CRD420251017175) and following PRISMA 2020 guidelines, evaluated MRI’s role in assessing MSC therapy for MS. We searched PubMed, Embase, Scopus, Web of Science, and Cochrane Library, screening 1687 records. Nine peer-reviewed clinical studies (n = 7–48 MS patients) were included. MRI modalities (e.g., T1/T2-weighted, diffusion tensor imaging) and outcomes (e.g., lesion load, remyelination) were analyzed narratively and quantitatively using Review Manager 5.1.

Results

Conventional MRI detected short-term reductions in lesion load and inflammation, while advanced techniques showed microstructural repair, notably with intrathecal MSCs. An exploratory Meta-analysis of four studies found a significant T2 lesion volume decrease (mean difference -5.12 mm³, 95 % CI -9.65 to -0.59, P = 0.03, I²=93 %) and higher likelihood of no new T2 lesions (risk ratio 1.69, 95 % CI 1.31–2.19, P < 0.0001, I²=0 %). High heterogeneity and small sample sizes limited findings.

Conclusion

MRI shows promise as a biomarker for MSC therapy efficacy in MS, capturing lesion dynamics. Larger, standardized trials are needed to address methodological inconsistencies and validate findings. This study uniquely emphasizes the role of MRI—including advanced modalities—as a primary outcome measure for MSC therapy in MS, highlighting gaps in imaging standardization across studies

多发性硬化症（MS）是一种慢性、免疫介导的疾病，以炎症、脱髓鞘和神经变性为特征，需要再生治疗。间充质干细胞（MSC）治疗具有免疫调节和神经保护的潜力，但临床评价具有挑战性。该系统综述和荟萃分析在PROSPERO （CRD420251017175）注册，遵循PRISMA 2020指南，评估MRI在评估ms的MSC治疗中的作用。我们检索了PubMed， Embase, Scopus， Web of Science和Cochrane Library，筛选了1687条记录。纳入9项同行评议的临床研究（n = 7-48例MS患者）。使用Review Manager 5.1对MRI模式（如T1/ t2加权、弥散张量成像）和结果（如病变负荷、髓鞘再生）进行叙述性和定量分析。结果常规MRI检测到病变负荷和炎症的短期减轻，而先进技术显示微结构修复，特别是鞘内MSCs。四项研究的探索性荟萃分析发现T2病变体积显著减少（平均差值-5.12 mm³，95% CI -9.65至-0.59,P = 0.03, I²= 93%），无新T2病变的可能性更高(风险比1.69,95% CI 1.31-2.19, P <；0.0001, i²=0 %)。高异质性和小样本量限制了研究结果。结论mri可捕捉病变动态，有望作为MSC治疗MS疗效的生物标志物。需要更大规模的标准化试验来解决方法上的不一致并验证研究结果。这项研究独特地强调了mri的作用，包括先进的模式，作为MS中MSC治疗的主要结果测量，突出了研究中成像标准化的差距

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Single-stent strategy for a dissected carotid loop in acute tandem occlusion: Technical considerations 急性串联闭塞中颈动脉袢夹层的单支架策略：技术考虑

IF 3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology

Pub Date : 2025-07-21 DOI: 10.1016/j.neurad.2025.101373

Jean Papaxanthos, Malgorzata Milnerowicz, Xavier Barreau, Omer Eker, Jerome Berge, Gaultier Marnat, Thomas Courret

Managing a dissected carotid loop in tandem occlusion stroke is a challenging situation. Despite the low stroke recurrence rate after spontaneous carotid dissection, some situations may require carotid stenting.1, 2, 3 After intracranial revascularization, several complex endovascular techniques have been reported, aiming to adapt to the tortuous anatomy of the carotid and involving extensive metal coverage through telescopic stenting and flow diverters in the acute phase.4, 5, 6 In this video,

处理颈动脉袢夹层在串联闭塞性中风是一个具有挑战性的情况。尽管自发性颈动脉夹层后卒中复发率低，但在某些情况下可能需要颈动脉支架植入术。1,2,3颅内血运重建术后，一些复杂的血管内技术已被报道，旨在适应颈动脉的扭曲解剖，并在急性期通过伸缩支架置入和血流分流器广泛覆盖金属。4,5,6在这个视频中，

引用次数: 0