Pub Date : 2025-09-06DOI: 10.1016/j.neurad.2025.101385
Yuting Wu , Chunxiu Yuan , Dongju Li , Xiaowei Ma , Jiqin Yang
{"title":"Increased 18F-FAPI-04 uptake in neurofibromatosis type 1 in a patient with synchronous bilateral breast cancer","authors":"Yuting Wu , Chunxiu Yuan , Dongju Li , Xiaowei Ma , Jiqin Yang","doi":"10.1016/j.neurad.2025.101385","DOIUrl":"10.1016/j.neurad.2025.101385","url":null,"abstract":"","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 6","pages":"Article 101385"},"PeriodicalIF":3.3,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024639","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}
Pub Date : 2025-09-05DOI: 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.
{"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}
Pub Date : 2025-08-13DOI: 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.
{"title":"Intraoperative and long-term multimodal radiological assessment of brain MR-guided laser interstitial thermal therapy (MRgLITT) in children","authors":"Alice Hu , Lelio Guida , Ludovic Fillon , Rima Nabbout , François Doz , Oumaima Aboubakr , Thomas Blauwblomme , Nathalie Boddaert , Volodia Dangouloff-Ros","doi":"10.1016/j.neurad.2025.101377","DOIUrl":"10.1016/j.neurad.2025.101377","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 6","pages":"Article 101377"},"PeriodicalIF":3.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859858","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}
Pub Date : 2025-08-12DOI: 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.
{"title":"Defining optimal thrombectomy-per-ischemic-stroke targets: a methodology for guiding procedure volumes per center in France","authors":"Fabien de Oliveira , Lucas Léger , Chris Serrand , Vincent Costalat , Jean-Paul Beregi , Thibault Mura , Thierry Boudemaghe , Julien Frandon","doi":"10.1016/j.neurad.2025.101375","DOIUrl":"10.1016/j.neurad.2025.101375","url":null,"abstract":"<div><h3>Background and purpose</h3><div>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.</div></div><div><h3>Materials and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 5","pages":"Article 101375"},"PeriodicalIF":3.3,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827152","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}
Pub Date : 2025-08-09DOI: 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。
{"title":"5.0T MRA techniques for evaluating Moyamoya disease: 4D-ASL-MRA vs. 3D-TOF-MRA","authors":"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","doi":"10.1016/j.neurad.2025.101376","DOIUrl":"10.1016/j.neurad.2025.101376","url":null,"abstract":"<div><h3>Purpose</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 <em>p</em> < 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, <em>p</em> < 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 <em>p</em> < 0.05) and more visible distal MCA branches (24.83 ± 5.49 vs 15.03 ± 5.99, <em>p</em> < 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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 6","pages":"Article 101376"},"PeriodicalIF":3.3,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823116","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}
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
{"title":"The Role of MRI as a key evaluator of mesenchymal stem Cell Therapy in Multiple Sclerosis: A systematic review and meta-analysis","authors":"Mohammadreza Elhaie , Abolfazl Koozari , Mohammadhossein Mozafari , Iraj Abedi","doi":"10.1016/j.neurad.2025.101374","DOIUrl":"10.1016/j.neurad.2025.101374","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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 (<em>n</em> = 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.</div></div><div><h3>Results</h3><div>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, <em>P</em> = 0.03, I²=93 %) and higher likelihood of no new T2 lesions (risk ratio 1.69, 95 % CI 1.31–2.19, <em>P</em> < 0.0001, I²=0 %). High heterogeneity and small sample sizes limited findings.</div></div><div><h3>Conclusion</h3><div>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</div></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 5","pages":"Article 101374"},"PeriodicalIF":3.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144704096","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}
Pub Date : 2025-07-21DOI: 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,
{"title":"Single-stent strategy for a dissected carotid loop in acute tandem occlusion: Technical considerations","authors":"Jean Papaxanthos, Malgorzata Milnerowicz, Xavier Barreau, Omer Eker, Jerome Berge, Gaultier Marnat, Thomas Courret","doi":"10.1016/j.neurad.2025.101373","DOIUrl":"10.1016/j.neurad.2025.101373","url":null,"abstract":"<div>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, </div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 5","pages":"Article 101373"},"PeriodicalIF":3.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679965","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}
Pub Date : 2025-07-19DOI: 10.1016/j.neurad.2025.101372
Jildaz Caroff , Cristian Mihalea , Jens Fiehler , Mario Martinez-Galdamez , Saleh Lamin , Markus Holtmannspötter , Laurent Spelle
Background
Dual Antiplatelet Therapy (DAPT) prescription following flow-diverter stent treatment of intracranial aneurysms is standard of care but evidence regarding the drugs of choice and duration of DAPT remains limited. We aim report to report practitioners’ DAPT prescribing habits and to analysis their impact on adverse events in real-world use of Pipeline™ Flex with Shield Technology stent.
Methods
Data from 3 post-market core lab adjudicated studies were retrospectively analyzed. Patients with acutely ruptured aneurysms, or on single APT were excluded. DAPT durations were collected, and patients were divided in 2 DAPT duration groups (< or ≥ 6 months).
Results
The analysis included 707 patients with 776 aneurysms. The P2Y12 inhibitor of choice was mainly clopidogrel in 68.7 %, ticagrelor in 15.8 % and prasugrel in 12.2 %. Median DAPT duration was 177 days (IQR 93–227). Younger patients and those with mRS ≤ 2 significantly received longer DAPT. Global ischemic stroke rate was 3.2 % (2.5 % before and 0.7 % after DAPT discontinuation) whereas major bleeding risk was 3.5 % (3.5 % before and 0 % after DAPT discontinuation). Post-discharge ischemic stroke and major bleeding rates were 1.8 % and 1.4 % respectively. Cumulative rates of both thromboembolic complications and ischemic strokes were higher in the < 6 months group (7.5 %) vs < 6 months group (4.6 %) without reaching statistical significance.
Conclusion
In this large real-world retrospective analysis, most major adverse events were reported within 30 days post-FDS procedure. Complications rates after discharge and after DAPT discontinuation were very low and similar between DAPT duration groups. These data provide a foundation for designing future prospective studies to evaluate optimal DAPT protocols—both in terms of drug type and duration—which could potentially inform future clinical guidelines.
{"title":"Dual antiplatelet therapy practices following Pipeline Shield embolization and their impact on adverse events in three large real-life registries","authors":"Jildaz Caroff , Cristian Mihalea , Jens Fiehler , Mario Martinez-Galdamez , Saleh Lamin , Markus Holtmannspötter , Laurent Spelle","doi":"10.1016/j.neurad.2025.101372","DOIUrl":"10.1016/j.neurad.2025.101372","url":null,"abstract":"<div><h3>Background</h3><div>Dual Antiplatelet Therapy (DAPT) prescription following flow-diverter stent treatment of intracranial aneurysms is standard of care but evidence regarding the drugs of choice and duration of DAPT remains limited. We aim report to report practitioners’ DAPT prescribing habits and to analysis their impact on adverse events in real-world use of Pipeline™ Flex with Shield Technology stent.</div></div><div><h3>Methods</h3><div>Data from 3 post-market core lab adjudicated studies were retrospectively analyzed. Patients with acutely ruptured aneurysms, or on single APT were excluded. DAPT durations were collected, and patients were divided in 2 DAPT duration groups (< or ≥ 6 months).</div></div><div><h3>Results</h3><div>The analysis included 707 patients with 776 aneurysms. The P2Y12 inhibitor of choice was mainly clopidogrel in 68.7 %, ticagrelor in 15.8 % and prasugrel in 12.2 %. Median DAPT duration was 177 days (IQR 93–227). Younger patients and those with mRS ≤ 2 significantly received longer DAPT. Global ischemic stroke rate was 3.2 % (2.5 % before and 0.7 % after DAPT discontinuation) whereas major bleeding risk was 3.5 % (3.5 % before and 0 % after DAPT discontinuation). Post-discharge ischemic stroke and major bleeding rates were 1.8 % and 1.4 % respectively. Cumulative rates of both thromboembolic complications and ischemic strokes were higher in the < 6 months group (7.5 %) vs < 6 months group (4.6 %) without reaching statistical significance.</div></div><div><h3>Conclusion</h3><div>In this large real-world retrospective analysis, most major adverse events were reported within 30 days post-FDS procedure. Complications rates after discharge and after DAPT discontinuation were very low and similar between DAPT duration groups. These data provide a foundation for designing future prospective studies to evaluate optimal DAPT protocols—both in terms of drug type and duration—which could potentially inform future clinical guidelines.</div></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 5","pages":"Article 101372"},"PeriodicalIF":3.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663279","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}
Pub Date : 2025-07-16DOI: 10.1016/j.neurad.2025.101371
Osama Elshafei , Jonathan Cortese , Ali Gaber , Eman Eltantawy , Adrian Dan Popica , Léon Ikka , Cristian Mihalea , Vanessa Chalumeau , Mariana Sarov , Olivier Chassin , Christian Denier , Jildaz Caroff , Laurent Spelle
Background
Mechanical thrombectomy (MT) for M2-segment occlusions of the middle cerebral artery can be an effective treatment for acute ischemic stroke but its effectiveness and the choice of the first line strategy remains unanswered questions. The angiographic shape of the occlusion has been suggested to impact the recanalization rates in M1-segment occlusions. We aimed to investigate whether the angiographic shape of the M2-segment impacts the outcomes of MT with stent retriever (SR) or contact aspiration (CA).
Methods
From January 2015 to December 2022, consecutive patients admitted to a single high-volume institution for acute ischemic stroke with an M2-segment occlusion treated by MT were included and retrospectively analyzed. Patients were classified into two groups, regular or irregular, according to the angiographic occlusion shape. Patients demographic, procedural, clinical and safety outcomes data were reviewed.
Results
A total of 214 MT procedures were included and categorized as regular (39 %) and irregular (61 %) shape occlusion groups. Interrater agreement was high (k = 94 %). There were no significant differences between the two groups as regard demographic, procedural, clinical and safety outcomes except for smoking (33.5 % vs 16.8 %, p = 0.01). Procedural outcomes, recanalization rates and clinical outcomes did not significantly differ between the regular and irregular occlusion groups. In subgroup analysis, for irregular occlusions SR as a first-line strategy was associated with higher rates of excellent recanalization (mTICI 2c - 3) after the first pass compared to CA±SR (44 % vs 27.16 %, p = 0.05), and also better clinical outcomes, with lower 24-hour NIHSS (p < 0.01) and lower 3-month mRS (p = 0.04). In regular occlusions, no significant differences were found in recanalization rates or clinical outcomes when using SR or CA±SR.
Conclusion
Choosing SR as the first line strategy for irregular shape M2-segment occlusions is associated with higher rates of recanalization after the first pass and better clinical outcomes. Further prospective studies are needed to confirm our findings.
背景：机械取栓治疗大脑中动脉m2段闭塞是治疗急性缺血性脑卒中的有效方法，但其有效性和一线策略的选择仍未得到解答。闭塞的血管造影形状被认为会影响m1段闭塞的再通率。我们的目的是研究血管成像的形状是否会影响支架回收器（SR）或接触吸入（CA）的MT结果。方法纳入2015年1月至2022年12月在同一家大容量医院连续收治的急性缺血性卒中m2段闭塞患者，并对其进行回顾性分析。根据血管造影闭塞形态将患者分为规则组和不规则组。回顾了患者的人口学、程序、临床和安全结局数据。结果共纳入214例MT手术，分为规则（39%）和不规则（61%）形状闭塞组。研究者间一致性高（k = 94%）。除吸烟外，两组在人口学、程序、临床和安全性方面均无显著差异（33.5% vs 16.8%, p = 0.01）。手术结果、再通率和临床结果在规则组和不规则组之间无显著差异。在亚组分析中，对于不规则闭塞，与CA±SR相比，SR作为一线策略在第一次通道后具有更高的优秀再通率（mTICI 2c - 3） （44% vs 27.16%, p = 0.05），并且具有更好的临床结果，24小时NIHSS较低(p <；3个月mRS较低（p = 0.04）。在常规闭塞情况下，使用SR或CA±SR在再通率和临床结果上无显著差异。结论选择SR作为不规则形状m2段闭塞的一线治疗策略，一遍通后再通率较高，临床效果较好。需要进一步的前瞻性研究来证实我们的发现。
{"title":"Impact of M2-segment occlusion angiographic shape on recanalization and clinical outcomes in mechanical thrombectomy","authors":"Osama Elshafei , Jonathan Cortese , Ali Gaber , Eman Eltantawy , Adrian Dan Popica , Léon Ikka , Cristian Mihalea , Vanessa Chalumeau , Mariana Sarov , Olivier Chassin , Christian Denier , Jildaz Caroff , Laurent Spelle","doi":"10.1016/j.neurad.2025.101371","DOIUrl":"10.1016/j.neurad.2025.101371","url":null,"abstract":"<div><h3>Background</h3><div>Mechanical thrombectomy (MT) for M2-segment occlusions of the middle cerebral artery can be an effective treatment for acute ischemic stroke but its effectiveness and the choice of the first line strategy remains unanswered questions. The angiographic shape of the occlusion has been suggested to impact the recanalization rates in M1-segment occlusions. We aimed to investigate whether the angiographic shape of the M2-segment impacts the outcomes of MT with stent retriever (SR) or contact aspiration (CA).</div></div><div><h3>Methods</h3><div>From January 2015 to December 2022, consecutive patients admitted to a single high-volume institution for acute ischemic stroke with an M2-segment occlusion treated by MT were included and retrospectively analyzed. Patients were classified into two groups, regular or irregular, according to the angiographic occlusion shape. Patients demographic, procedural, clinical and safety outcomes data were reviewed.</div></div><div><h3>Results</h3><div>A total of 214 MT procedures were included and categorized as regular (39 %) and irregular (61 %) shape occlusion groups. Interrater agreement was high (<em>k</em> = 94 %). There were no significant differences between the two groups as regard demographic, procedural, clinical and safety outcomes except for smoking (33.5 % vs 16.8 %, <em>p</em> = 0.01). Procedural outcomes, recanalization rates and clinical outcomes did not significantly differ between the regular and irregular occlusion groups. In subgroup analysis, for irregular occlusions SR as a first-line strategy was associated with higher rates of excellent recanalization (mTICI 2c - 3) after the first pass compared to CA±SR (44 % vs 27.16 %, <em>p</em> = 0.05), and also better clinical outcomes, with lower 24-hour NIHSS (<em>p</em> < 0.01) and lower 3-month mRS (<em>p</em> = 0.04). In regular occlusions, no significant differences were found in recanalization rates or clinical outcomes when using SR or CA±SR.</div></div><div><h3>Conclusion</h3><div>Choosing SR as the first line strategy for irregular shape M2-segment occlusions is associated with higher rates of recanalization after the first pass and better clinical outcomes. Further prospective studies are needed to confirm our findings.</div></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 5","pages":"Article 101371"},"PeriodicalIF":3.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634381","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}
{"title":"Would you board a plane if the pilot had never trained on a flight simulator?","authors":"Baptiste Donnard , Gregoire Boulouis , Aymeric Rouchaud , Gaultier Marnat , Thibault Agripnidis , Jean-Pierre Pruvo , Kevin Janot","doi":"10.1016/j.neurad.2025.101370","DOIUrl":"10.1016/j.neurad.2025.101370","url":null,"abstract":"","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 5","pages":"Article 101370"},"PeriodicalIF":3.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576841","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}
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