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Growing importance of brain morphometry analysis in the clinical routine: The hidden impact of MR sequence parameters 脑形态分析在临床常规工作中的重要性与日俱增:磁共振序列参数的隐性影响
IF 3.5 3区 医学 Q1 Medicine Pub Date : 2024-02-01 DOI: 10.1016/j.neurad.2023.04.003
Michael Rebsamen , Milena Capiglioni , Robert Hoepner , Anke Salmen , Roland Wiest , Piotr Radojewski , Christian Rummel

Volumetric assessment based on structural MRI is increasingly recognized as an auxiliary tool to visual reading, also in examinations acquired in the clinical routine. However, MRI acquisition parameters can significantly influence these measures, which must be considered when interpreting the results on an individual patient level.

This Technical Note shall demonstrate the problem. Using data from a dedicated experiment, we show the influence of two crucial sequence parameters on the GM/WM contrast and their impact on the measured volumes. A simulated contrast derived from acquisition parameters TI/TR may serve as surrogate and is highly correlated (r=0.96) with the measured contrast.

在临床常规检查中,基于结构性核磁共振成像的容积评估越来越多地被认为是肉眼判读的辅助工具。然而,核磁共振成像采集参数会对这些测量结果产生重大影响,在解释个体患者的结果时必须考虑到这一点。我们利用专门实验的数据,展示了两个关键序列参数对 GM/WM 对比度的影响及其对测量体积的影响。根据采集参数 TI/TR 得出的模拟对比度可作为替代对比度,与测量对比度高度相关(r=0.96)。
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引用次数: 0
Acknowledging our 2023 reviewers 感谢我们的 2023 年审查员
IF 3.5 3区 医学 Q1 Medicine Pub Date : 2024-02-01 DOI: 10.1016/S0150-9861(24)00085-3
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引用次数: 0
Percutaneous transluminal angioplasty and stenting of post-irradiated stenosis of subclavian artery: A matched case-control study 锁骨下动脉放射后狭窄的经皮腔内血管成形术和支架植入术:匹配病例对照研究
IF 3.5 3区 医学 Q1 Medicine Pub Date : 2024-02-01 DOI: 10.1016/j.neurad.2023.06.004
Chun-Chao Huang , Hsin-Fan Chiang , Cheng‑Chih Hsieh , Hui-Chen Lin , Chia-Hung Wu , Te-Ming Lin , Jung-Hsuan Chen , Chao-Bao Luo , Feng-Chi Chang

Background

Although radiotherapy is common for head/neck and chest cancers (HNCC), it can result in post-irradiation stenosis of the subclavian artery (PISSA). The efficacy of percutaneous transluminal angioplasty and stenting (PTAS) to treat severe PISSA is not well-clarified.

Aims

To compare the technical safety and outcomes of PTAS between patients with severe PISSA (RT group) and radiation-naïve counterparts (non-RT group).

Methods

During 2000 and 2021, we retrospectively enrolled patients with severe symptomatic stenosis (>60%) of the subclavian artery who underwent PTAS. The rate of new recent vertebrobasilar ischaemic lesions (NRVBIL), diagnosed on diffusion-weight imaging (DWI) within 24 h of postprocedural brain MRI; symptom relief; and long-term stent patency were compared between the two groups.

Results

Technical success was achieved in all 61 patients in the two groups. Compared with the non-RT group (44 cases, 44 lesions), the RT group (17 cases, 18 lesions) had longer stenoses (22.1 vs 11.1 mm, P = 0.003), more ulcerative plaques (38.9% vs 9.1%, P = 0.010), and more medial- or distal-segment stenoses (44.4% vs 9.1%, P<0.001). The technical safety and outcome between the non-RT group and the RT group were NRVBIL on DWI of periprocedural brain MRI 30.0% vs 23.1%, P = 0.727; symptom recurrence rate (mean follow-up 67.1 ± 50.0 months) 2.3% vs 11.8%, P = 0.185; and significant in-stent restenosis rate (>50%) 2.3% vs 11.1%, P = 0.200.

Conclusion

The technical safety and outcome of PTAS for PISSA were not inferior to those of radiation-naïve counterparts. PTAS for PISSA is an effective treatment for medically refractory ischaemic symptoms of HNCC patients with PISSA.

背景虽然放疗是头颈部和胸部癌症(HNCC)的常见治疗方法,但放疗可能导致锁骨下动脉放疗后狭窄(PISSA)。目的 比较重度 PISSA 患者(RT 组)和放射治疗无效患者(非 RT 组)PTAS 的技术安全性和疗效。方法 2000 年至 2021 年期间,我们回顾性地纳入了接受 PTAS 的锁骨下动脉重度无症状狭窄(60%)患者。比较了两组患者术后 24 小时内脑核磁共振弥散加权成像(DWI)诊断的新近椎基底动脉缺血性病变(NRVBIL)发生率、症状缓解率和支架长期通畅率。与非 RT 组(44 例,44 个病灶)相比,RT 组(17 例,18 个病灶)的血管狭窄时间更长(22.1 mm vs 11.1 mm,P = 0.003),溃疡性斑块更多(38.9% vs 9.1%,P = 0.010),内侧或远端血管狭窄更多(44.4% vs 9.1%,P<0.001)。非 RT 组与 RT 组的技术安全性和结果分别为:围手术期脑 MRI DWI 上的 NRVBIL 为 30.0% vs 23.1%,P = 0.727;症状复发率(平均随访 67.1 ± 50.0 个月)为 2.结论PISSA的PTAS的技术安全性和结果并不逊色于未接受放射治疗的同行。PISSA的PTAS是治疗HNCC患者PISSA药物难治性缺血症状的有效方法。
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引用次数: 0
Retrograde placement of flow diversion for the treatment of giant internal carotid artery aneurysm 逆行置放分流治疗颈内巨动脉瘤。
IF 3.5 3区 医学 Q1 Medicine Pub Date : 2024-02-01 DOI: 10.1016/j.neurad.2023.11.001
Haoyu Zhu , Shikai Liang , Yupeng Zhang , Chuhan Jiang

The use of flow diverters has been well-validated for the treatment of giant internal carotid artery aneurysms. However, in certain complex cases, the navigation of stent microcatheters across the neck may pose a relative challenge.1, 2, 3 In this technical video (video 1), we present the case of a patient in their 50s experiencing discomfort in the left eye. Angiography identified a giant aneurysm in the ophthalmic segment of the left internal carotid artery. Before seeking care at our institution, the patient had two interventional procedures, both unsuccessful due to difficulties in navigating the microcatheter past the aneurysm neck.4, 5 In our management, after multiple unsuccessful anterograde attempts, we employed a retrograde strategy via the vertebral-basilar-posterior communicating artery route. This approach facilitated the successful deployment of the flow diverter and led to effective aneurysm embolization, underscoring the value of retrograde techniques for challenging cases.

血流分流器的应用已被证实可用于治疗巨大的颈内动脉瘤。然而,在某些复杂的情况下,支架微导管穿过颈部的导航可能会带来相对的挑战。1-3在这段技术视频(视频1)中,我们介绍了一位50多岁的患者左眼不适的病例。血管造影发现在左颈内动脉眼段有一个巨大的动脉瘤。在本院就诊前,患者进行了两次介入手术,均因微导管难以通过动脉瘤颈部而失败。4-5在我们的治疗中,在多次逆行尝试失败后,我们采用了椎-基底-后交通动脉路线的逆行策略。这种方法促进了分流器的成功部署,并导致了有效的动脉瘤栓塞,强调了逆行技术在具有挑战性的病例中的价值。
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引用次数: 0
Thrombectomy alone vs thrombectomy with over 2/3-dose intravenous thrombolysis pretreatment in the DIRECT-MT trial DIRECT-MT试验中单纯血栓切除术与血栓切除术加2/3剂量以上静脉溶栓预处理的比较
IF 3.5 3区 医学 Q1 Medicine Pub Date : 2024-02-01 DOI: 10.1016/j.neurad.2023.04.004
Wenjin Yang , Hongjian Zhang , Lei Zhang , Zifu Li , Pengfei Xing , Hongjian Shen , Yongxin Zhang , Xiaoxi Zhang , Xiaofei Ye , Qinghai Huang , Yi Xu , Yongwei Zhang , Jianmin Liu , Conghui Li , Pengfei Yang , DIRECT-MT Investigators

Background

The DIRECT-MT trial showed that endovascular thrombectomy (EVT) alone was noninferior to EVT preceded by intravenous alteplase. However, the infusion of intravenous alteplase was uncompleted before the initiation of EVT in most cases of this trial. Therefore, the additional benefit and risk of over 2/3-dose intravenous alteplase pretreatment remain to be assessed.

Methods

We assessed patients with acute anterior circulation ischemic stroke who received EVT alone or with over 2/3-dose intravenous alteplase pretreatment from the DIRECT-MT trial. Patients were assigned to the thrombectomy-alone group and the alteplase pretreatment group. The primary outcome was the distribution of modified Rankin Scale (mRS) at 90 days. The interaction of treatment allocation and collateral capacity was assessed.

Results

A total of 393 patients (thrombectomy alone: 315; alteplase pretreatment: 78) were identified. The thrombectomy alone was comparable with alteplase pretreatment prior to the thrombectomy on the distribution of mRS at 90 days without significant effect modification by collateral capacity (adjusted common odds ratio (acOR), 1.12; 95% CI, 0.72–1.74; adjusted P for interaction = 0.83). Successful reperfusion before thrombectomy and the number of passes in the thrombectomy alone group differed significantly from the alteplase pretreatment group (2.6% vs. 11.5%; corrected P = 0.02 and 2 vs. 1; corrected P = 0.003). There was no interaction between treatment allocation and collateral capacity on all outcomes.

Conclusions

EVT alone and EVT preceded by over 2/3-dose intravenous alteplase might have equal efficacy and safety for patients with acute anterior circulation large vessel occlusion, except for successful perfusion before thrombectomy and the number of passes.

背景DIRECT-MT试验显示,单纯血管内血栓切除术(EVT)的效果并不优于先进行静脉注射阿替普酶的EVT。然而,在该试验的大多数病例中,静脉阿替普酶输注在开始 EVT 之前尚未完成。方法我们评估了 DIRECT-MT 试验中单纯接受 EVT 或接受超过 2/3 剂量静脉阿替普酶预处理的急性前循环缺血性卒中患者。患者被分配到单纯血栓切除术组和阿替普酶预处理组。主要结果是90天时改良Rankin量表(mRS)的分布情况。结果 共确定了 393 名患者(单纯血栓切除术:315 人;阿替普酶预处理:78 人)。单纯血栓切除术与阿替普酶预处理在 90 天后的 mRS 分布方面具有可比性,但并不因侧支容量的不同而产生显著的影响(调整后的共同几率比(acOR),1.12;95% CI,0.72-1.74;调整后的交互作用 P = 0.83)。单纯血栓切除术组与阿替普酶预处理组在血栓切除术前再灌注成功率和通过次数上有显著差异(2.6% 对 11.5%;校正后 P = 0.02;2 对 1;校正后 P = 0.003)。结论对于急性前循环大血管闭塞患者,除血栓切除术前成功灌注和通过次数外,单纯EVT和EVT前超过2/3剂量静脉注射阿替普酶可能具有相同的疗效和安全性。
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引用次数: 0
MRI features and disability in multiple sclerosis: A systematic review and meta-analysis 多发性硬化症的 MRI 特征与残疾:系统回顾和荟萃分析。
IF 3.5 3区 医学 Q1 Medicine Pub Date : 2024-02-01 DOI: 10.1016/j.neurad.2023.11.007
Fardin Nabizadeh , Rasa Zafari , Mobin Mohamadi , Tahereh Maleki , Mohammad Sadegh Fallahi , Nazanin Rafiei

Background

In this systematic review and meta-analysis, we aimed to investigate the correlation between disability in patients with Multiple sclerosis (MS) measured by the Expanded Disability Status Scale (EDSS) and brain Magnetic Resonance Imaging (MRI) features to provide reliable results on which characteristics in the MRI can predict disability and prognosis of the disease.

Methods

A systematic literature search was performed using three databases including PubMed, Scopus, and Web of Science. The selected peer-reviewed studies must report a correlation between EDSS scores and MRI features. The correlation coefficients of included studies were converted to the Fisher's z scale, and the results were pooled.

Results

Overall, 105 studies A total of 16,613 patients with MS entered our study. We found no significant correlation between total brain volume and EDSS assessment (95 % CI: -0.37 to 0.08; z-score: -0.15). We examined the potential correlation between the volume of T1 and T2 lesions and the level of disability. A positive significant correlation was found (95 % CI: 0.19 to 0.43; z-score: 0.31), (95 % CI: 0.17 to 0.33; z-score: 0.25). We observed a significant correlation between white matter volume and EDSS score in patients with MS (95 % CI: -0.37 to -0.03; z-score: -0.21). Moreover, there was a significant negative correlation between gray matter volume and disability (95 % CI: -0.025 to -0.07; z-score: -0.16).

Conclusion

In conclusion, this systematic review and meta-analysis revealed that disability in patients with MS is linked to extensive changes in different brain regions, encompassing gray and white matter, as well as T1 and T2 weighted MRI lesions.

背景:在这篇系统性综述和荟萃分析中,我们旨在研究多发性硬化症(MS)患者通过扩展残疾状况量表(EDSS)测量的残疾程度与脑部磁共振成像(MRI)特征之间的相关性,从而为磁共振成像中哪些特征可以预测残疾程度和疾病预后提供可靠的结果:使用 PubMed、Scopus 和 Web of Science 等三个数据库进行了系统的文献检索。所选的同行评审研究必须报告 EDSS 评分与 MRI 特征之间的相关性。将纳入研究的相关系数转换成费雪z标度,并对结果进行汇总:共有 105 项研究,16613 名多发性硬化症患者参与了研究。我们发现大脑总体积与 EDSS 评估之间无明显相关性(95 % CI:-0.37 至 0.08;z 值:-0.15)。我们研究了 T1 和 T2 病变体积与残疾程度之间的潜在相关性。结果发现两者之间存在正相关(95 % CI:0.19 至 0.43;z-评分:0.31)和负相关(95 % CI:0.17 至 0.33;z-评分:0.25)。我们观察到多发性硬化症患者的白质体积与 EDSS 评分之间存在明显的相关性(95 % CI:-0.37 至 -0.03;z 评分:-0.21)。此外,灰质体积与残疾之间存在明显的负相关(95 % CI:-0.025 至 -0.07;z 评分:-0.16):总之,该系统综述和荟萃分析表明,多发性硬化症患者的残疾与不同脑区的广泛变化有关,包括灰质和白质,以及T1和T2加权磁共振成像病变。
{"title":"MRI features and disability in multiple sclerosis: A systematic review and meta-analysis","authors":"Fardin Nabizadeh ,&nbsp;Rasa Zafari ,&nbsp;Mobin Mohamadi ,&nbsp;Tahereh Maleki ,&nbsp;Mohammad Sadegh Fallahi ,&nbsp;Nazanin Rafiei","doi":"10.1016/j.neurad.2023.11.007","DOIUrl":"10.1016/j.neurad.2023.11.007","url":null,"abstract":"<div><h3>Background</h3><p>In this systematic review<span> and meta-analysis, we aimed to investigate the correlation between disability in patients<span><span> with Multiple sclerosis (MS) measured by the </span>Expanded Disability Status Scale (EDSS) and brain Magnetic Resonance Imaging (MRI) features to provide reliable results on which characteristics in the MRI can predict disability and prognosis of the disease.</span></span></p></div><div><h3>Methods</h3><p>A systematic literature search was performed using three databases including PubMed, Scopus, and Web of Science. The selected peer-reviewed studies must report a correlation between EDSS scores and MRI features. The correlation coefficients of included studies were converted to the Fisher's z scale, and the results were pooled.</p></div><div><h3>Results</h3><p>Overall, 105 studies A total of 16,613 patients with MS entered our study. We found no significant correlation between total brain volume and EDSS assessment (95 % CI: -0.37 to 0.08; z-score: -0.15). We examined the potential correlation between the volume of T1 and T2 lesions and the level of disability. A positive significant correlation was found (95 % CI: 0.19 to 0.43; z-score: 0.31), (95 % CI: 0.17 to 0.33; z-score: 0.25). We observed a significant correlation between white matter volume and EDSS score in patients with MS (95 % CI: -0.37 to -0.03; z-score: -0.21). Moreover, there was a significant negative correlation between gray matter volume and disability (95 % CI: -0.025 to -0.07; z-score: -0.16).</p></div><div><h3>Conclusion</h3><p>In conclusion, this systematic review and meta-analysis revealed that disability in patients with MS is linked to extensive changes in different brain regions, encompassing gray and white matter, as well as T1 and T2 weighted MRI lesions.</p></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139089256","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
Impact of Day 1 carotid patency on outcome in dissection-related tandem occlusions treated with mechanical thrombectomy 采用机械血栓切除术治疗夹层相关串联闭塞症时,第 1 天颈动脉通畅对疗效的影响
IF 3.5 3区 医学 Q1 Medicine Pub Date : 2024-02-01 DOI: 10.1016/j.neurad.2024.01.076
Guillaume Perrin , Elisabeth Molinier , Benjamin Gory , Maeva Kyheng , Julien Labreuche , Marco Pasi , Kevin Janot , Romain Bourcier , Igor Sibon , Arturo Consoli , Jean-Philippe Desilles , Jean-Marc Olivot , Chrysanthi Papagiannaki , Sebastien Soize , Jean-Christophe Gentric , Cyril Dargazanli , Jildaz Caroff , Raoul Pop , Olivier Naggara , Solene Moulin , Gaultier Marnat

Background

The clinical benefit of mechanical thrombectomy(MT) for stroke patients with tandem occlusion is similar to that of isolated intracranial occlusions. However, the management of cervical internal carotid artery(ICA) occlusion during the MT, particularly in the setting of carotid dissection, remains controversial. We aimed to investigate the clinical impact of cervical ICA patency at day 1 on 3-month functional outcome.

Methods

We collected data from the Endovascular Treatment in Ischemic Stroke, a prospective national registry in 30 French centers performing MT between January 2015 and January 2022. Inclusion criteria were consecutive tandem occlusions related to cervical ICA dissection treated with MT. Tandem occlusions of other etiology, isolated cervical ICA occlusions without intracranial thrombus and patients without day-1 ICA imaging were excluded. Primary endpoint was the 3-month functional outcome. Secondary endpoints included intracranial hemorrhage(ICH), excellent outcome, mortality and early neurological improvement. A sensitivity analysis was performed in patients with intracranial favorable recanalization after MT.

Results

During the study period, 137 patients were included of which 89(65%) presented ICA patency at day 1. The odds of favorable outcome did not significantly differ between patients with patent and occluded ICA at day 1(68.7 vs 59.1%;aOR=1.30;95%CI 0.56-3.00,p=0.54). Excellent outcome, early neurological improvement, mortality and ICH were also comparable between groups. Sensitivity analysis showed similar results.

Conclusion

ICA patency at day 1 in patients with tandem occlusions related to dissection did not seem to influence functional outcome. Endovascular recanalization of the cervical ICA including stenting might not be systematically required in this setting.

背景:机械取栓术(MT)对串联闭塞的卒中患者的临床获益与孤立的颅内闭塞相似。然而,在机械取栓术中如何处理颈内动脉(ICA)闭塞,尤其是在颈动脉夹层的情况下,仍存在争议。我们旨在研究颈部颈内动脉(ICA)第1天的通畅对3个月功能预后的临床影响:我们从缺血性中风的血管内治疗中收集了数据,这是一项前瞻性的国家登记,在 2015 年 1 月至 2022 年 1 月期间,法国有 30 个中心开展了 MT 治疗。纳入标准为接受 MT 治疗的颈部 ICA 夹层相关的连续串联闭塞。其他病因引起的串联闭塞、无颅内血栓的孤立性颈部ICA闭塞以及未进行ICA第一天成像的患者不在纳入之列。主要终点是 3 个月的功能预后。次要终点包括颅内出血(ICH)、优良预后、死亡率和早期神经功能改善。对MT术后颅内再通有利的患者进行了敏感性分析:在研究期间,共纳入了 137 名患者,其中 89 人(65%)在第 1 天时出现了 ICA 通畅。第 1 天 ICA 通畅和闭塞患者的良好预后几率无明显差异(68.7 vs 59.1%;aOR=1.30;95%CI 0.56-3.00,p=0.54)。两组患者的优良预后、早期神经功能改善、死亡率和 ICH 也相当。敏感性分析显示了相似的结果:结论:对于因夹层导致串联闭塞的患者,第1天的ICA通畅率似乎并不影响功能预后。在这种情况下,可能不需要系统性地进行包括支架在内的颈部 ICA 血管内再通路治疗。
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引用次数: 0
Anatomical differences of intracranial arteries according to sex: a systematic review and meta-analysis 颅内动脉在解剖学上的性别差异:系统回顾与荟萃分析
IF 3.5 3区 医学 Q1 Medicine Pub Date : 2024-02-01 DOI: 10.1016/j.neurad.2023.05.005
M.E.H. Ophelders , M.J.A. van Eldik , I.N. Vos , Y.S. Beentjes , B.K. Velthuis , Y.M. Ruigrok

Background and Purpose

Intracranial aneurysms are more common in women than in men. Some anatomical variants of the circle of Willis (CoW) are associated with a higher risk of developing intracranial aneurysms. We hypothesized that variations of the CoW are sex dependent which may partly explain why intracranial aneurysms are more common in women. We systematically reviewed and meta-analyzed the literature to compare the presence of anatomical variations of the CoW between women and men in the general population.

Material and Methods

A systematic search in Pubmed and EMBASE using predefined criteria, following the PRISMA guidelines was performed. The presence of different CoW anatomical variants and a complete CoW was compared between women and men using an inverse variance weighted random effects meta-analysis to calculate relative risks (RR) with 95% confidence intervals (95% CIs).

Results

Fourteen studies were included reporting on 5478 healthy participants (2511 women, 2967 men). Bilateral fetal type posterior cerebral arteries (RR 2.79; 95%CI 1.65–4.72, I2=0%), and a complete CoW (RR 1.24, 95%CI 1.13–1.36; I2=0%) were more prevalent in women than in men. The variants absence or hypoplasia of one of the anterior cerebral arteries (RR 0.58, 95%CI 0.38–0.88, I2=57%) and hypoplasia or absence of both posterior communicating arteries (RR 0.79, 95%CI 0.71–0.87, I2=0%) were more prevalent in men.

Conclusions

Several anatomical variations of the CoW are sex dependent, with some variants being more common in women while others in men. Future research should assess how these sex-specific CoW variants relate to the sex-specific occurrence of intracranial aneurysms.

背景和目的颅内动脉瘤在女性中的发病率高于男性。威利斯圈(CoW)的某些解剖变异与颅内动脉瘤的高发病风险有关。我们假设威利斯圈的变异与性别有关,这可能是颅内动脉瘤更常见于女性的部分原因。我们对文献进行了系统回顾和荟萃分析,以比较普通人群中女性和男性的 CoW 解剖变异情况。采用反方差加权随机效应荟萃分析法比较了男女之间是否存在不同的CoW解剖变异和完整的CoW,计算出相对风险(RR)和95%置信区间(95% CI)。结果共纳入14项研究,报告了5478名健康参与者(2511名女性,2967名男性)。双侧胎儿型大脑后动脉(RR 2.79;95%CI 1.65-4.72,I2=0%)和完全CoW(RR 1.24,95%CI 1.13-1.36;I2=0%)在女性中的发病率高于男性。结论CoW的一些解剖变异与性别有关,一些变异在女性中更为常见,而另一些变异则在男性中更为常见。未来的研究应评估这些性别特异性CoW变异与颅内动脉瘤的性别特异性发生率之间的关系。
{"title":"Anatomical differences of intracranial arteries according to sex: a systematic review and meta-analysis","authors":"M.E.H. Ophelders ,&nbsp;M.J.A. van Eldik ,&nbsp;I.N. Vos ,&nbsp;Y.S. Beentjes ,&nbsp;B.K. Velthuis ,&nbsp;Y.M. Ruigrok","doi":"10.1016/j.neurad.2023.05.005","DOIUrl":"10.1016/j.neurad.2023.05.005","url":null,"abstract":"<div><h3>Background and Purpose</h3><p>Intracranial aneurysms are more common in women than in men. Some anatomical variants of the circle of Willis (CoW) are associated with a higher risk of developing intracranial aneurysms. We hypothesized that variations of the CoW are sex dependent which may partly explain why intracranial aneurysms are more common in women. We systematically reviewed and meta-analyzed the literature to compare the presence of anatomical variations of the CoW between women and men in the general population.</p></div><div><h3>Material and Methods</h3><p>A systematic search in Pubmed and EMBASE using predefined criteria, following the PRISMA guidelines was performed. The presence of different CoW anatomical variants and a complete CoW was compared between women and men using an inverse variance weighted random effects meta-analysis to calculate relative risks (RR) with 95% confidence intervals (95% CIs).</p></div><div><h3>Results</h3><p>Fourteen studies were included reporting on 5478 healthy participants (2511 women, 2967 men). Bilateral fetal type posterior cerebral arteries (RR 2.79; 95%CI 1.65–4.72, I<sup>2</sup>=0%), and a complete CoW (RR 1.24, 95%CI 1.13–1.36; I<sup>2</sup>=0%) were more prevalent in women than in men. The variants absence or hypoplasia of one of the anterior cerebral arteries (RR 0.58, 95%CI 0.38–0.88, I<sup>2</sup>=57%) and hypoplasia or absence of both posterior communicating arteries (RR 0.79, 95%CI 0.71–0.87, I<sup>2</sup>=0%) were more prevalent in men.</p></div><div><h3>Conclusions</h3><p>Several anatomical variations of the CoW are sex dependent, with some variants being more common in women while others in men. Future research should assess how these sex-specific CoW variants relate to the sex-specific occurrence of intracranial aneurysms.</p></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0150986123002043/pdfft?md5=b3a3536322ab253d150012fb257ea1bb&pid=1-s2.0-S0150986123002043-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9531093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
MRI characterization of in vitro clots at 3T and 7T: A technical note 3T 和 7T 下体外血凝块的磁共振成像特征:技术说明
IF 3.5 3区 医学 Q1 Medicine Pub Date : 2024-02-01 DOI: 10.1016/j.neurad.2023.06.003
Daniela Dumitriu LaGrange , Lijing Xin , François Lazeyras , Karen M. Doyle , Isabel Wanke , Karl-Olof Lövblad

In acute ischemic stroke, the composition of the occlusive clot can be associated with the underlying pathophysiology and the response to treatment. For these reasons, it is important to characterize the clot composition from clinical scans. We examine the ability of 3T and 7T MRI to distinguish the composition of in vitro clots, using quantitative T1 and T2*, alternatively R2*, mapping. When comparing the two field strengths, we found a tradeoff between sensitivity for clot composition and confidence in the clot depiction associated with spatial resolution. The loss of sensitivity at 7T can be mitigated by combining the T1 and T2* signals.

在急性缺血性脑卒中中,闭塞性血栓的组成可能与潜在的病理生理学和治疗反应有关。因此,从临床扫描中确定血凝块的组成特征非常重要。我们利用定量 T1 和 T2*(或 R2*)映射检查了 3T 和 7T MRI 区分体外血凝块成分的能力。在比较两种磁场强度时,我们发现血凝块成分的灵敏度与空间分辨率相关的血凝块描绘可信度之间存在权衡。将 T1 和 T2* 信号结合在一起可减轻 7T 下灵敏度的损失。
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引用次数: 0
Extended monitoring of re-coiled cerebral aneurysms after initial postcoiling recanalization: Safety and durability of repeat coil embolization 对首次线圈栓塞后再堵塞的脑动脉瘤进行延伸监测:重复线圈栓塞的安全性和持久性
IF 3.5 3区 医学 Q1 Medicine Pub Date : 2024-02-01 DOI: 10.1016/j.neurad.2023.05.006
Jin Woo Bae , Han San Oh , Chang-eui Hong , Kang Min Kim , Dong Hyun Yoo , Hyun-Seung Kang , Young Dae Cho

Purpose

In the endovascular era, postcoiling recanalization of cerebral aneurysms is occurring with greater frequency. Repeat coiling is usually done to prevent rebleeding, although long-term outcomes of re-embolization have yet to be adequately investigated. The present study was undertaken to assess clinical and radiographic outcomes of re-embolization in recanalized aneurysms, focusing on procedural safety, efficacy, and durability.

Method

In this retrospective review, we examined 308 patients with 310 recurrent aneurysms. All lesions were re-coiled, once major recanalization (after initial coil embolization) was established. Medical records and radiologic data amassed during extended follow-up were then subject to review. Cox proportional hazards regression analysis was undertaken to identify risk factors for subsequent recurrence.

Result

During a lengthy follow-up (mean, 40.2 ± 33.0 months), major recanalization developed again in 87 aneurysms (28.1%). Multivariable Cox regression analysis linked re-recanalization to initial saccular neck width (p=.003) and autosomal dominant polycystic kidney disease (ADPKD; p<.001). Stent implantation (p=.038) and successful occlusion at second coiling (p=.012) were protective against later recanalization in this setting. The more recent the second embolization was performed, the lower the risk of further recurrence (p=.023). Procedure-related complications included asymptomatic thromboembolism (n = 9), transient ischemic neurologic deficits (n = 2), procedural bleeding (n = 1), and coil migration (n = 1), but there were no residual effects or deaths.

Conclusion

Repeat coil embolization is a safe therapeutic option for recanalized cerebral aneurysms. Wide-necked status and ADPKD emerged as risks for subsequent recanalization, whereas successful occlusion and stent implantation seemed to reduce the likelihood of recurrence after re-embolization procedures.

目的 在血管内治疗时代,脑动脉瘤盘旋后再栓塞的发生率越来越高。尽管再栓塞的长期疗效尚未得到充分研究,但为了防止再出血,通常会进行再次栓塞。本研究旨在评估再栓塞动脉瘤的临床和影像学结果,重点关注程序的安全性、有效性和持久性。方法在这项回顾性研究中,我们对 308 名患者的 310 个复发性动脉瘤进行了检查。所有病变在确定主要再通(初始线圈栓塞后)后都重新进行了线圈栓塞。随后,我们对长期随访期间积累的病历和放射学数据进行了审查。结果在长期随访期间(平均 40.2 ± 33.0 个月),有 87 个动脉瘤(28.1%)再次出现大面积再闭塞。多变量考克斯回归分析将再狭窄与最初的囊颈宽度(p=.003)和常染色体显性多囊肾(ADPKD;p<.001)联系起来。在这种情况下,支架植入(p=.038)和第二次栓塞成功(p=.012)对以后的再狭窄具有保护作用。第二次栓塞的时间越近,进一步复发的风险越低(p=.023)。手术相关并发症包括无症状血栓栓塞(9 例)、一过性缺血性神经功能缺损(2 例)、手术出血(1 例)和线圈移位(1 例),但没有后遗症或死亡。宽颈状态和 ADPKD 是再次栓塞的风险因素,而成功闭塞和支架植入似乎降低了再次栓塞术后复发的可能性。
{"title":"Extended monitoring of re-coiled cerebral aneurysms after initial postcoiling recanalization: Safety and durability of repeat coil embolization","authors":"Jin Woo Bae ,&nbsp;Han San Oh ,&nbsp;Chang-eui Hong ,&nbsp;Kang Min Kim ,&nbsp;Dong Hyun Yoo ,&nbsp;Hyun-Seung Kang ,&nbsp;Young Dae Cho","doi":"10.1016/j.neurad.2023.05.006","DOIUrl":"10.1016/j.neurad.2023.05.006","url":null,"abstract":"<div><h3>Purpose</h3><p>In the endovascular era, postcoiling recanalization of cerebral aneurysms is occurring with greater frequency. Repeat coiling is usually done to prevent rebleeding, although long-term outcomes of re-embolization have yet to be adequately investigated. The present study was undertaken to assess clinical and radiographic outcomes of re-embolization in recanalized aneurysms, focusing on procedural safety, efficacy, and durability.</p></div><div><h3>Method</h3><p>In this retrospective review, we examined 308 patients with 310 recurrent aneurysms. All lesions were re-coiled, once major recanalization (after initial coil embolization) was established. Medical records and radiologic data amassed during extended follow-up were then subject to review. Cox proportional hazards regression analysis was undertaken to identify risk factors for subsequent recurrence.</p></div><div><h3>Result</h3><p>During a lengthy follow-up (mean, 40.2 ± 33.0 months), major recanalization developed again in 87 aneurysms (28.1%). Multivariable Cox regression analysis linked re-recanalization to initial saccular neck width (<em>p</em>=.003) and autosomal dominant polycystic kidney disease (ADPKD; <em>p</em>&lt;.001). Stent implantation (<em>p</em>=.038) and successful occlusion at second coiling (<em>p</em>=.012) were protective against later recanalization in this setting. The more recent the second embolization was performed, the lower the risk of further recurrence (<em>p</em>=.023). Procedure-related complications included asymptomatic thromboembolism (<em>n</em> = 9), transient ischemic neurologic deficits (<em>n</em> = 2), procedural bleeding (<em>n</em> = 1), and coil migration (<em>n</em> = 1), but there were no residual effects or deaths.</p></div><div><h3>Conclusion</h3><p>Repeat coil embolization is a safe therapeutic option for recanalized cerebral aneurysms. Wide-necked status and ADPKD emerged as risks for subsequent recanalization, whereas successful occlusion and stent implantation seemed to reduce the likelihood of recurrence after re-embolization procedures.</p></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9550908","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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Journal of Neuroradiology
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