Pub Date : 2025-09-08DOI: 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.
{"title":"Differential cortical hemodynamics during standard and reversed visually guided navigation: An fNIRS-based investigation","authors":"Sang Seok Yeo , Chae-Won Kwon , In Hee Cho","doi":"10.1016/j.neurad.2025.101387","DOIUrl":"10.1016/j.neurad.2025.101387","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 6","pages":"Article 101387"},"PeriodicalIF":3.3,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034607","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 : 2025-09-06DOI: 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。
{"title":"MRI versus CT before endovascular thrombectomy in the early time window: A systematic review and meta-analysis","authors":"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","doi":"10.1016/j.neurad.2025.101384","DOIUrl":"10.1016/j.neurad.2025.101384","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 6","pages":"Article 101384"},"PeriodicalIF":3.3,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004433","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 : 2025-09-06DOI: 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}
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