AJNR. American journal of neuroradiology最新文献

Background and purpose: Coronal clival cleft is a congenital corticated defect traversing the basioccipital portion of the clivus, beneath the spheno-occipital synchondrosis. It has been reported in cases of CHARGE syndrome, Cornelia de Lange syndrome, anencephaly, hemifacial microsomia, Chiari deformities, and in asymptomatic patients, but it may be underdiagnosed and underestimated on imaging. This study aims to estimate the prevalence of coronal clival cleft and expand its genetic and clinical associations.

Materials and methods: In this retrospective study, the imaging report database from a single children's hospital was queried for the terms "clival cleft", "clivus cleft", "clefts of the clivus", and "cleft of the clivus". The search was restricted to head and neck, brain, and cervical spine CTs and MRIs. reports from a consecutive 2-year period (May 2022 to June 2024) authored by either of two neuroradiologists with expertise in the diagnosis of clival clefts. Electronic medical records were reviewed for demographics and to confirm final diagnosis and genetic disorders. Descriptive statistics were used to calculate frequency, demographic characteristics, and percentage distribution.

Results: The search yielded 13 patients with coronal clival cleft (estimated prevalence: 4.2/1,000; 95% CI 1.67-10.52 per 1,000). The distribution between the sexes was 7 females and 6 males. Partial coronal clival cleft (n=9) was more frequent than complete coronal clival cleft (n=4). Clival clefts were associated with 9 different disorders, including CHARGE syndrome (n=4), Chiari I deformities (n=2), Cornelia de Lange (n=1), and others (n=6).

Conclusion: Coronal clival clefts are potentially more common than previously anticipated. Radiologists should be able to recognize and differentiate coronal clival clefts from anatomic variants in the skull base and, when a coronal clival cleft is found, must actively search for additional cerebral and craniovertebral junction abnormalities, often found in combination.

Background and purpose: Gadopiclenol is a next-generation macrocyclic gadolinium-based contrast agent (GBCA) distinguished by its high T1 relaxivity and kinetic stability. It was developed to address the clinical need for reduced gadolinium dosing while maintaining high diagnostic accuracy, thereby minimizing potential long-term risks associated with gadolinium retention. Although various neuroradiology applications have been explored, the potential benefits of gadopiclenol's increased T1 relaxivity have not been investigated for the purpose of evaluating endolymphatic hydrops (EH) using delayed contrast-enhanced inner ear imaging.

Materials and methods: We prospectively enrolled 26 consecutive patients at our institution's Otology clinic based on the 2015 American Academy of Otolaryngology-Head and Neck Surgery criteria for Ménière disease (MD), including acute or fluctuating symptoms of vertigo, hearing loss, tinnitus, or aural fullness. Each patient underwent 4-hour delayed contrast-enhanced inner ear imaging at 3T with half-dose (0.05 mmol/kg) GBCA administration using gadopiclenol. The contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were determined. Assessment of blood-labyrinthine barrier (BLB) permeability, utricle-saccule discrimination, and endolymphatic hydrops was performed by two head and neck neuroradiologists. Image quality, SNR, and CNR was compared to previously published data that utilized the same technical parameters with a contrast dose of 0.1 mmol/kg.

Results: Fifty-one ears were analyzed. One ear was excluded based on a prior history of left labyrinthectomy after failed medical management of MD. There were 31 symptomatic and 20 asymptomatic ears determined by clinical and hearing evaluation. Delayed contrast-enhanced inner ear imaging with gadopiclenol at 0.05 mmol/kg provided comparable CNR and SNR to gadobenate dimeglumine at 0.1 mmol/kg, with no statistically significant difference (P > 0.05). There was excellent interobserver agreement for the grading EH (κ>0.80).

Conclusions: Our study demonstrates that 3D-FLAIR inner ear imaging using gadopiclenol at 0.05 mmol/kg is a reliable method for detecting clinically concordant EH and that image quality, based on qualitative and quantitative metrics, is comparable to a previously published study using gadobenate dimeglumine at a single-dose of 0.1 mmol/kg.

Background and purpose: Endovascular therapy (EVT) has become the standard of care for selected patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, the impact of advanced age on EVT outcomes remains unclear. This study evaluated the safety, efficacy, and outcomes of EVT in elderly patients (≥85 years) compared to younger individuals in a real-world cohort.

Materials and methods: We conducted a retrospective analysis of the Stroke Research Consortium in Northern Bavaria (STAMINA) database, identifying 581 patients with occlusion in the anterior circulation who underwent EVT. Patients were stratified by age (≥85 years: n=95; <85 years: n=486). The primary outcome was functional recovery at 90 days, defined as a modified Rankin Scale (mRS) score ≤ pre-stroke mRS or pre-stroke mRS +1. Secondary outcomes included good functional outcome (mRS ≤2), mortality, successful EVT (TICI ≥ 2b), and symptomatic intracerebral hemorrhage (sICH).

Results: Elderly patients had a significantly higher 90-day mortality rate (53.8% vs 22.3%, p<0.001) and lower rates of good functional outcomes (1.1% vs. 27.0%, p<0.001). Functional recovery occurred in 13.7% of elderly patients compared to 21.0% in younger patients (p=0.14). Rates of sICH were similar (12.6% vs. 8.8%, p=0.34). Pre-stroke mRS was a significant predictor of good outcome in the elderly, with each one-point increase associated with a 56% decrease in the odds of achieving independence (OR 0.43, 95% CI 0.32-0.61; p<0.001).

Conclusion: EVT is technically feasible in elderly patients but associated with worse outcomes and higher mortality. Age alone should not exclude patients from EVT, though careful consideration of pre-stroke status is essential for individualized decision-making.

Background and purpose: Isolated congenital middle ear malformation (CMEM) contributes significantly to congenital hearing loss and growth problems. This study aims to compare 0.1-mm isotropic ultra-high-resolution CT (U-HRCT) and conventional high-resolution CT (HRCT) for assessing isolated CMEM, using surgical exploration as the standard.

Materials and methods: This single-center retrospective study included patients with surgically confirmed isolated CMEM who underwent U-HRCT or HRCT from January 2015 to April 2025. Middle ear abnormalities were identified based on operative outcomes and 4 subtypes were classified via the Teunissen standard. Two neuroradiologists blinded to surgical outcomes reviewed CT images for 10 subtle structural abnormalities and specific subtypes. The comparison of U-HRCT and HRCT in terms of interobserver and intraobserver agreement and detection of structural abnormalities and subtypes of CMEM were analyzed.

Results: The U-HRCT and HRCT groups included 61 patients (69 ears) and 37 patients (44 ears), respectively. U-HRCT exhibited significantly higher interobserver and intraobserver agreement and stronger concordance with surgical findings for all 10 abnormalities compared with HRCT. It also showed superior diagnostic sensitivity for CMEM (100.0% versus 90.9%; P = .013) and outperformed HRCT in differentiating clinical subtypes (0.774 versus 0.352; P<.001). U-HRCT achieved accuracies exceeding 0.85 in identifying all abnormalities and outperformed HRCT in detecting specific abnormalities including abnormal long process of the incus, lenticular process, abnormal stapes superstructure, stapes footplate fixation, and oval window atresia (P < .05).

Conclusions: Isotropic 0.1-mm U-HRCT significantly outperforms conventional HRCT in diagnosing CMEM, differencing subtypes, and detecting subtle abnormalities, supporting its clinical superiority for precise preoperative evaluation.

Background and purpose: Fetal ventriculomegaly (VM) is common and largely benign when isolated. However, it can occasionally progress to hydrocephalus, a more severe condition associated with increased mortality and neurodevelopmental delay that may require surgical postnatal intervention. Accurate differentiation between VM and hydrocephalus is essential but remains challenging, relying on subjective assessment and limited 2D measurements. Deep learning-based segmentation offers a promising solution for objective and reproducible volumetric analysis. This work presents an artificial intelligence-powered method for segmentation, volume quantification, and classification of the ventricles in fetal brain MRI to predict the need for postnatal intervention.

Materials and methods: This retrospective study included 222 patients with singleton pregnancies. An nnUNet was trained to segment the fetal ventricles on 20 manually segmented, institutional fetal brain MRIs combined with 80 studies from a publicly available data set. The validated model was then applied to 138 normal fetal brain MRIs to generate a normative reference range across a range of gestational ages (18-36 weeks). Finally, it was applied to 64 fetal brains with VM (14 of which required postnatal intervention). Receiver operating characteristic curves and area under curve (AUC) to predict VM and a need for postnatal intervention were calculated.

Results: The nnUNet predicted segmentation of the fetal ventricles in the reference data set were of high quality and accurate (median Dice score: 0.96; interquartile range: 0.93-0.99). A normative reference range of ventricular volumes across gestational ages was developed by using automated segmentation volumes. The optimal threshold for identifying VM was 2 SD from normal with a sensitivity of 92% and a specificity of 93% (AUC 0.97; 95% CI: 0.91-0.98). When normalized to intracranial volume, fetal ventricular volume was higher and subarachnoid volume lower among those who required postnatal intervention (P < .001, P = .003). The optimal threshold for identifying the need for postnatal intervention was 11 SD from normal, with a sensitivity of 86% and a specificity of 100% (AUC: 0.97; 95% CI: 0.86-1.00).

Conclusions: This work introduces a deep learning-based method for fast and accurate quantification of ventricular volumes in fetal brain MRI. A normative reference standard derived by using this method can predict VM and a need for postnatal CSF intervention. Increased ventricular volume is a strong predictor of postnatal intervention.

Background and purpose: Although high-resolution conebeam CT (HR-CBCT) is used for immediate evaluation of stent apposition, studies using this technique to evaluate flow diverter (FD) endothelialization during follow-up are limited. The study aims to investigate the potential of HR-CBCT in assessing FD endothelialization and identify factors influencing poor endothelialization.

Materials and methods: The clinical and imaging data of patients with unruptured intracranial aneurysms (UIAs) treated by FDs from March 2019 to October 2023 were retrospectively analyzed. HR-CBCT was used for immediate evaluation of stent apposition, and FD endothelialization at 3, 6, and 12 months postimplantation was evaluated by using HR-CBCT and digital subtraction angiography. Multivariate logistic regression analysis was used to identify factors associated with poor endothelialization.

Results: Among 402 FDs implanted for 446 aneurysms in 378 patients, 41 showed incomplete stent apposition (ISA) in postimplantation HR-CBCT scans. The aneurysm-occlusion rate at 12 months postimplantation was 84.8% (378/446), with 8.7% (35/402) of the FDs exhibiting in-stent stenosis (ISS). At 12 months postimplantation, 343 (85.1%) FDs showed good endothelialization, while 59 (14.9%) exhibited poor endothelialization. Multivariate logistic regression analysis identified age ≥60 years (OR = 2.209; 95% CI, 1.053-4.635; P = .04), a large aneurysm lumen inflow angle (OR = 1.102; 95% CI, 1.071-1.135; P < .001), parent artery excessive tortuosity (OR = 9.402; 95% CI, 1.141-77.479; P = .04), and ISA (OR = 10.967; 95% CI, 4.290-28.035; P < .001) as independent risk factors for poor endothelialization.

Conclusions: HR-CBCT can accurately evaluate FD endothelialization and ISS of UIAs after FD implantation. Age ≥60 years, a large aneurysm lumen inflow angle, parent artery excessive tortuosity, and ISA are independent risk factors for poor endothelialization.

Background and purpose: Brain imaging with MRI or CT is standard in screening for intracranial disease among ambulatory patients with cancer. Though MRI offers greater sensitivity, CT is frequently employed because of its accessibility, affordability, and faster acquisition time. However, the necessity of routinely performing a noncontrast CT with the contrast-enhanced study is unknown. This study evaluates the clinical and economic utility of the noncontrast portion of the brain CT examination.

Materials and methods: A board-certified neuroradiologist reviewed 737 brain CT reports from outpatients at The University of Texas MD Anderson Cancer Center who underwent contrast and noncontrast CT for cancer staging (October 2014 to March 2016) to assess if clinically meaningful findings were identified only on noncontrast CT. A Generative Pretrained Transformers-3 (GPT-3) model was then fine-tuned to extract reports with a high likelihood of unique and meaningful noncontrast findings from 1980 additional brain CT reports (January 2017 to April 2022). These reports were manually reviewed by 2 neuroradiologists, with adjudication by a third reviewer if needed. The incremental cost-effectiveness ratio of noncontrast CT inclusion was then calculated based on Medicare reimbursement and the 95% CI of the proportion of all reports in which noncontrast CT was necessary for identifying meaningful findings.

Results: Seven of 737 reports in the initial data set revealed meaningful findings unique to the noncontrast CT, all of which were hemorrhage. The GPT-3 model identified 145 additional reports with a high unique noncontrast CT finding likelihood for manual review from the second data set of 1980 reports. Nineteen of these reports were found to have unique and meaningful noncontrast CT findings. In total, 0.96% (95% CI: 0.63-1.40) of reports had meaningful findings identified only on noncontrast CT. The incremental cost-effectiveness ratio for the identification of a single meaningful finding on noncontrast CT missed on the contrast-enhanced study was $1855 to $4122.

Conclusions: In brain CT for ambulatory screening for intracranial disease in patients with cancer, noncontrast CT offers limited additional diagnostic value compared with contrast-enhanced CT alone. Considering the associated financial cost, workload, and patient radiation exposure associated with performing a noncontrast CT, contrast-enhanced brain CT alone is sufficient for cancer staging in patients with asymptomatic cancer.

Background and purpose: There is an imperfect correlation between morphologic MRI findings and radiating low back pain (LBP). Nerve irritation, visualized as glucose hypermetabolism on [¹⁸F]FDG-PET/MRI, has the potential to identify symptomatic segments. This study aimed to investigate the association of foraminal [¹⁸F]FDG uptake on PET/MRI, radiologic abnormalities, and patient outcomes.

Materials and methods: Prospectively recruited patients with radiating LBP underwent [¹⁸F]FDG-PET/MRI of the lumbar spine in this observational study. Back pain and leg/buttock pain were assessed by using the visual analog scale (0-10). Foraminal stenosis, facet joint arthropathy, and annular fissures of the disc were graded by radiologists. As part of the standard clinical care, a subset of patients received image-guided nerve root blocks, by using a steroid/anesthetic mixture, and pain on visual analog scale was noted before and after injection. Standardized tracer uptake was quantitatively assessed in all neural foramina, facet joints, and discs. Generalized estimating equations were used to investigate associations between the maximum standardized uptake value of [¹⁸F]FDG in the neural foramina, degree of stenosis (none, mild, moderate, severe), and pain, additionally adjusted for tracer uptake in the adjacent tissues, age, sex, and body mass index.

Results: A total of 110 lumbar neural foramina in 11 patients were included in the analysis. Generalized estimating equations revealed significant associations between foraminal [¹⁸F]FDG uptake and degree of foraminal stenosis (β = 0.18; 95% CI, 0.03-0.33; P = .02). In patients with unilateral radicular symptoms but bilateral stenoses on MRI, [¹⁸F]FDG uptake was significantly higher on the symptomatic side (1.64 versus 1.88; P = .002). In segments treated with image-guided nerve root block, change in pain was positively associated with foraminal [¹⁸F]FDG uptake before injection (β = 2.24; 95% CI, 0.03-4.45; P = .05) but negatively associated with degree of stenosis (β = -1.27; 95%CI -2.24 to -0.31; P = .01).

Conclusions: Foraminal [¹⁸F]FDG uptake on PET/MRI as a surrogate marker of nerve irritation may improve differentiation between painful versus nonpainful foraminal stenosis.