AJNR. American journal of neuroradiology最新文献

Background and purpose: Patients with intracranial hypotension from spinal CSF leaks have increased choroid plexus volumes in response to CSF leakage. The purpose of this study was to assess changes in choroid plexus volumes in patients before and after spinal CSF leak repair.

Materials and methods: This was a retrospective, institutional review board-approved study on patients with spinal CSF leak who had pre- and post-CSF leak repair MRI examinations. Brain MRIs with contrast were performed on a 1.5/3T scanner with acquisition of 3D T1 postcontrast (eg, Bravo, MPRAGE, and so forth). Choroid plexus volumes at the level of the trigonum ventriculi were calculated for the left and right sides on all pre- and posttreatment MRIs using Visage-7 segmentation tools. Basic demographic data, type of CSF leak, and choroid plexus volumes were recorded for all patients. Basic 2-tailed t tests were used to compare choroid plexus volumes between the pre- and posttreatment groups.

Results: Twenty patients with spontaneous intracranial hypotension from spinal CSF leaks were included. Eleven patients (55%) had a type 1a (ventral tear) spinal CSF leak, 5 patients (25%) had type 1b (lateral tear), and 4 patients (20%) had a type 3 spinal CSF leak. The mean age was 47.6 years (SD, 13.8 years). The mean choroid plexus volumes pretreatment were 0.82 cm³ (SD, 0.29 cm³) compared with 0.38 cm³ (SD, 0.19 cm³) posttreatment (P value 0.01).

Conclusions: Significantly decreased choroid plexus volumes were seen in patients with spontaneous intracranial hypotension following spinal CSF leak repair. This finding highlights the modulation and dynamic role of the choroid plexus in states of low CSF volumes.

Background: The Basilar Artery on Computed Tomography Angiography (BATMAN) score is a 10-point grading system assessing arterial opacification and thrombus burden in the posterior circulation. It predicts outcomes in endovascular thrombectomy, with lower scores reflecting poor opacification.

Purpose: This systematic review and meta-analysis evaluated the BATMAN score's efficacy in predicting 90-day functional outcomes after thrombectomy.

Data sources: We systematically searched PubMed, EMBASE, Scopus, and Cochrane Library and adhered PRISMA guidelines for relevant English and Chinese articles published between January 1, 2017, and December 1, 2024.

Study selection: The inclusion criteria were as follows: including patients who had undergone endovascular therapy (EVT) for posterior circulation acute ischemic stroke; assessing the BATMAN score through angiographic examinations, such as CTA, DSA, and MRA before EVT; and assessing functional outcomes on day 90 by using the mRS. We excluded duplicate articles, conference summaries, review articles, articles lacking original data, and articles for which the full text was unavailable.

Data analysis: We determined the standardized mean difference in BATMAN scores between patients with favorable and unfavorable outcomes. Binormal receiver operating characteristic curve analysis determined the BATMAN score's diagnostic performance and the optimal threshold. The Bayesian approach validated the mean between-group difference in the BATMAN scores DATA SYNTHESIS: A higher BATMAN score was significantly associated with a favorable functional outcome (standardized mean difference in Cohen's d: 0.82; 95% CI: 0.56-1.08). Binormal receiver operating characteristic curve analysis revealed an optimal BATMAN score threshold of ≥6, indicating a sensitivity of 76.1%, a specificity of 52.0%, and an area under the curve value of 0.71 (95% CI: 0.69-0.73). The Bayesian estimate of the mean between-group difference in BATMAN score was 1.52 (95% highest posterior density: 1.41-1.62).

Limitations: All of the included studies were observational in design and varied in terms of sample size. Nonetheless, our comprehensive statistical approach, with both frequentist and Bayesian approaches, might have overcome the limitations associated with sample size discrepancies.

Conclusions: Our findings suggest the BATMAN score of ≥6 predicts post-thrombectomy favorable functional outcomes in patients with posterior circulation acute ischemic stroke.

Abbreviations: BATMAN = Basilar Artery on Computed Tomography Angiography; EVT = endovascular therapy.

Background and purpose: The venous sinus balloon protection technique is regarded as a safe and effective method for treating transverse-sigmoid sinus (TSS) dural arteriovenous fistulas (DAVFs). However, large cohort studies on this technology are still lacking. This study aims to present a large single-center experience on the safety and efficacy of venous sinus balloon protection in the treatment of TSS DAVFs.

Materials and methods: We conducted a retrospective review of our database, identifying all patients with low-and intermediate-grade TSS-DAVFs who underwent transarterial embolization (TAE) between 2002 and 2020. The patients were categorized into two groups: the Venous Sinus Balloon Protection (VSBP) group and the Non-Venous Sinus Balloon Protection (NVSBP) group, based on the use of the venous sinus balloon protection technique. The safety and efficacy of the venous sinus balloon protection technique were subsequently analyzed.

Results: The study included 161 patients with low-and intermediate-grade TSS-DAVFs who received TAE, comprising 72 individuals in the VSBP group and 89 in the NVSBP group. The objective of the study was to evaluate the safety and efficacy of sinus balloon protection by comparing clinical and angiographic outcomes, as well as complication rates, between the two groups. Favorable clinical outcomes were similar between the two groups (VSBP 93.1% vs. NVSBP 96.6%, P=0.501), with no statistically significant difference in the incidence of the rate of complications (VSBP 1.4% vs. NVSBP 2.2%, P=1.000). However, the rate of complete occlusion was significantly higher in the VSBP group compared to the NVSBP group (87.5% vs. 69.7%, P=0.007).

Conclusions: The sinus balloon protection technique demonstrates excellent safety and effectiveness, significantly improving the complete occlusion rate of low-and intermediate-grade TSS-DAVFs in the near term, without increasing the incidence of complications. In the future, larger prospective cohorts are needed to further elucidate and confirm the safety and effectiveness of the sinus balloon protection technique for all dural arteriovenous fistulas.

Abbreviations: Dural arteriovenous fistula; Transverse-sigmoid sinus; Transarterial embolization; Venous sinus balloon protection.

Norrie Disease is a rare X-linked condition characterized by early childhood blindness and later onset sensorineural hearing loss. We report two male infants with genetically confirmed Norrie Disease and characteristic ocular abnormalities consisting of bilateral funnel retinal detachments, anterior segment dysgenesis, and/or buphthalmos and microphthalmia. MRI demonstrated enhancement of the cranial nerves, cochleae, and cerebellum with cerebellar restricted diffusion. Intracranial findings mimicked meningitis, labyrinthitis, and cerebellitis. Neither infant showed clinical signs of infection. Labyrinthine and cerebellar signal abnormalities have not been previously reported in the context of Norrie Disease. Clinicians should consider Norrie Disease when encountering such findings and be aware that the described intracranial features of Norrie Disease do not necessarily indicate central nervous system infection.ABBREVIATIONS: ND, Norrie disease; NDP, Norrin Cystine Knot Growth Factor NDP; PFV, persistent fetal vasculature; FEVR, familial exudative vitreoretinopathy; ROP, retinopathy of prematurity.

Background and purpose: Charcot-Bouchard Aneurysms (CBA) are tiny aneurysms arising from small perforating arteries. Despite the potentially catastrophic consequences of rupture of these aneurysms, the existence and prevalence of CBAs is controversial. The literature in this area is sparse with most previous studies based on radiological case reports of single hemorrhage or histopathological analysis. 7T MRI provides higher spatial resolution than 3T MRI that enables imaging of the small perforating arteries. We determined whether CBAs could be detected in vivo using 7T MRI.

Materials and methods: 94 patients with ischemic stroke collected in the Cam-SVD prospective cohort were retrospectively included; 75 of them had lacunar infarcts due to presumed small vessel disease and 19 had non-lacunar infarcts due to presumed cardioembolism or large artery disease. Contrast enhanced 3D time-of-flight (TOF) angiography (MRA) and structural sequences were performed by 7T MRI. Two neuroradiologists independently reviewed the MR scans to identify aneurysms on the lenticulostriate arteries (LSA) bilaterally.

Results: In 4 of the 94 subjects, CBAs were detected in the LSAs; of these three had a single CBA and one had two. The diameter of the parent vessel ranged from 0.26mm - 0.37mm, and the maximum diameter of the CBA ranged from 0.73mm - 1.39mm. Use of 3D images allowed differentiation of looped vessels, which could mimic aneurysms on 2D images, from true CBA.

Conclusions: We have demonstrated that 7T MRI can detect CBAs in vivo in humans. This technique could allow further longitudinal studies to determine the true prevalence and prognostic significance of CBAs.

Abbreviations: CBA: Charcot-Bouchard Aneurysms; LSA: lenticulostriate arteries; CamSVD: Cambridge 7T Cerebral Small Vessel Disease study; eGFR: estimated glomerular filtration rate; FA: flip angle.

Background and purpose: Intracranial solitary fibrous tumors (SFTs) and meningiomas are CNS tumors that share similar imaging manifestations but exhibit different clinical behaviors. This study aimed to compare ADC values and conventional imaging features, particularly pre-contrast T1-weighted signal intensity, between intracranial SFTs and meningiomas.

Materials and methods: We retrospectively evaluated 13 patients with pathologically proven intracranial SFTs and 27 patients with meningiomas who attended our hospital between January 2002 and December 2023. Signal intensity on pre-contrast T1-weighted imaging (compared to cerebral cortex), presence of dural tail sign, flow voids, hyperostosis, calcification, and normalized mean T1-weighted imaging values and mean ADC values were assessed.

Results: T1-weighted hyperintensity was significantly more frequent in SFTs (10/13, 76.9%) compared to meningiomas (5/27, 18.5%) (P=0.0010). Normalized mean T1-weighted imaging values (P=0.035) and normalized mean ADC values (P=0.039) were significantly higher in SFTs compared to meningiomas. A significant inverse correlation between normalized mean T1-weighted imaging and ADC values was observed in SFTs (R-squared=0.42, P=0.017). Binomial logistic regression analysis showed moderate efficacy in differentiating these tumors (mean cross-validation score=0.83). Dural tail sign, hyperostosis, and calcification were more frequent in meningiomas, although these differences were not statistically significant.

Conclusions: Pre-contrast T1-weighted signal intensity is a useful characteristic for differentiating intracranial SFTs from meningiomas, with hyperintensity compared to cerebral cortex being a distinctive feature of SFTs. The combination of normalized T1-weighted imaging and ADC values provides moderate diagnostic accuracy.

Abbreviations: SFT = solitary fibrous tumors.

Several recent reports have discussed real-time artificial intelligence (AI) assistance in elective neuroendovascular procedures such as carotid artery stenting, coil embolization for cerebral aneurysms, and liquid embolization. We present our preliminary experience with real-time AI-assisted mechanical thrombectomy (MT) for acute ischemic stroke (AIS) under local anesthesia. A real-time deep learning-based AI software (Neuro-Vascular Assist, iMed technologies, Tokyo, Japan) was used during MT for 16 consecutive patients with AIS. The AI system provided real-time notifications when the guiding catheter (GC) moved out of the fluoroscopic image. The efficacy, accuracy, and safety of the notifications were evaluated using video recordings. The AI system functioned properly in all cases. The mean number of notifications per case for the GC moving out of view was 8.1. The overall precision and recall of AI notifications were 97% and 99%, respectively. Of the 126 true-positive AI notifications, 25 (20%) prompted operators to reposition the GC within 10 s when it became unobservable in both frontal and lateral imaging planes. This response indicates the potential effectiveness of the AI system. No adverse events or delays in procedures due to the AI system occurred. In this preliminary study, the software was sufficiently accurate and safe for MT procedures, suggesting its usefulness. To the best of our knowledge, this is one of the first studies to report using a real-time AI system for MT in patients with AIS as an emergent procedure. Large-scale studies are warranted to validate its impact on procedural workflow and clinical outcomes.ABBREVIATIONS: AI = artificial Intelligence; MT = mechanical thrombectomy; AIS = acute ischemic stroke; GC = guiding catheter; TP = true positive; FP = false positive; FN = false negative; CAS = carotid artery stenting.

Background and purpose: Epilepsy, a globally prevalent neurological disorder, necessitates precise identification of the epileptogenic zone (EZ) for effective surgical management. While the individual utilities of FDG PET and FMZ PET have been demonstrated, their combined efficacy in localizing the epileptogenic zone remains underexplored. We aim to improve the non-invasive prediction of epileptogenic zone (EZ) in temporal lobe epilepsy (TLE) by combining FDG PET and FMZ PET with statistical feature extraction and machine learning.

Materials and methods: This study included 20 drug-resistant unilateral TLE patients (14 mesial TLE, 6 lateral TLE), and two control groups (N=29 for FDG, N=20 for FMZ). EZ of each patient was confirmed by post-surgical pathology, and one-year follow-up, while propagation zone (PZ) and non-involved zone (NIZ) were derived from the epileptogenicity index based on presurgical stereo-encephalography (SEEG) monitoring. Whole brain PET scans were obtained with dual tracers [¹⁸F]FDG and [¹⁸F]FMZ on separate days, from which standard uptake value ratio (SUVR) was calculated by global mean scaling. Low-order statistical parameters of SUVRs and t-maps derived against control groups were extracted. Additionally, fused FDG and FMZ features were created using arithmetic operations. Spearman correlation was used to investigate the associations between FDG and FMZ, while multiple linear regression analysis was used to explore the interaction effects of imaging features in predicting epileptogenicity. Crafted imaging features were used to train logistic regression models to predict EZ, whose performance was evaluated using 10-fold cross-validation at ROI-level, and leave-one-patient-out cross-validation at patient-level.

Results: FDG SUVR significantly decreased in EZ and PZ compared to NIZ, while FMZ SUVR in EZ significantly differed from PZ. Interaction effects were found between FDG and FMZ in their prediction of epileptogenicity. Fusion of FDG and FMZ provided the best prediction model with an area under the curve (AUC) of 0.86 [0.84-0.87] for EZ vs. NIZ and an AUC of 0.79 [0.77-0.81] for EZ vs. PZ, eliminating 100% false positives in 50% of patients, and ≥80% FPs in 90% patients at patient level.

Conclusions: Combined FDG and FMZ offer a promising avenue for non-invasive localization of the epileptogenic zone in TLE, potentially refining surgical planning.

Abbreviations: AUC = Area under the curve; EI = Epileptogenicity index; EZ = Epileptogenic zone; FMZ = Flumazenil; GABA_A = Gamma-aminobutyric acid type A; NIZ = Non-involved zone; PZ = Propagation zone; SEEG = Stereo-electroencephalography; SUVR = Standard uptake value ratio; TLE = Temporal lobe epilepsy.

Background and purpose: The guided angiography system, an integrated angiography system, enables continuous guidance and flushing during diagnostic procedures. A guidewire provides guidance by remaining inside the catheter during contrast injection into tortuous vessels. While its feasibility was demonstrated in a retrospective study, this randomized controlled trial aims to evaluate its safety and effectiveness.

Materials and methods: This single-center, single-blind, randomized controlled trial was conducted from September 2021 to June 2022. Patients with unruptured intracranial aneurysms were enrolled and randomly assigned to either the guided or the conventional group. Primary outcomes were procedure time and serious adverse events. Secondary outcomes included catheterization success, adverse events, fluoroscopy time, fluoroscopy dose, and image quality.

Results: A total of 200 participants (mean age 59 ± 10 years, 71% women) were randomized into the guided (n = 100) and the conventional (n = 100) groups. The guided group demonstrated shorter procedure times compared to the conventional group (18.3 ±9.2 min vs. 21.3 ± 8.1 min, P < .001). There were no serious adverse events in either group, and adverse event rates were similar. Catheterization success rates were similar between the guided and conventional groups (93.9% vs. 96.8%, P = .226). However, the guided angiography system backed up more catheterization failures from the conventional angiography system, but not vice versa (57.1% vs. 11.1%, P = .003). Among catheterization successes, the guided group achieved shorter fluoroscopy time (7.0 min vs. 7.7 min, P = .033) and lower fluoroscopy dose (466.8 μGy·m² vs. 566.5 μGy·m², P = .015). Regarding imaging quality, clinical acceptability was comparable between the guided and conventional groups (95.3% vs. 95.5%, P = .781).

Conclusions: The guided angiography system offers a simple and effective alternative for diagnostic cerebral catheter angiography, with reduced radiation exposure and a favorable safety profile.

Abbreviations: AE = adverse events; Fr = French.

Background and purpose: Cancers show heterogeneity at various levels, from genome to radiological imaging. This study aimed to explore the interplay between genomic, transcriptomic, and radiophenotypic data in pediatric low-grade glioma (pLGG), the most common group of brain tumors in children.

Materials and methods: We analyzed data from 201 pLGG patients in the Children's Brain Tumor Network (CBTN), using principal component analysis and K-Means clustering on 881 radiomic features, along with clinical variables (age, sex, tumor location), to identify imaging clusters and examine their association with 2021 WHO pLGG classifications. To determine the transcriptome pathways linked to imaging clusters, we employed a supervised machine learning model with elastic net logistic regression based on the pathways identified through gene set enrichment and gene co-expression network analyses.

Results: Three imaging clusters with distinct radiomic characteristics were identified. BRAF V600E mutations were primarily found in imaging cluster 3, while KIAA1549::BRAF fusion occurred in subtype 1. The model's predictive accuracy (AUC) was 0.77 for subtype 1, 0.78 for subtype 2, and 0.70 for subtype 3. Each imaging cluster exhibited unique molecular mechanisms: subtype 1 was linked to oxidative phosphorylation, PDGFRB, and interleukin signaling, whereas subtype 3 was associated with histone acetylation and DNA methylation pathways, related to BRAF V600E pLGGs.

Conclusions: Our radiogenomics study indicates that the intrinsic molecular characteristics of tumors correlate with distinct imaging subgroups in pLGG, paving the way for future multi-modal investigations that may enhance understanding of disease progression and targetability.

Abbreviations: WHO = World Health Organization; CBTN = Children's Brain Tumor Network; pLGG = pediatric Low-Grade Glioma; EFS = Event-Free Survival; PC = Principal Component; CNS = Central Nervous System.