Clinical Neuroradiology最新文献

{"title":"Automated Deep Learning-Based Demyelination Load Segmentation in Metachromatic Leukodystrophy.","authors":"Pascal Martin, Joël Schaerer, Thomas Cajgfinger, Alessandro Delmonte, Benjamin Bender, David Whiteman, C J Malanga, Alexandre Fusellier, David Scott, Joyce Suhy, Hendrik Rosewich, Samuel Groeschel, Luc Bracoud","doi":"10.1007/s00062-026-01652-6","DOIUrl":"10.1007/s00062-026-01652-6","url":null,"abstract":"<p><strong>Purpose: </strong>Metachromatic leukodystrophy (MLD) is a rare lysosomal storage disorder characterized by progressive white matter demyelination. Quantification of demyelinated white matter on MRI-typically expressed as the demyelination load-serves as a key imaging biomarker of disease burden, enabling objective monitoring beyond visual rating scales. However, current semi-automated pipelines are limited by manual interaction, pediatric brain variability, and differences in MRI acquisition. This study aimed to develop and validate a self-configuring convolutional neural network (CNN) for automated segmentation of demyelinated white matter in MLD and to compare its performance with a conventional semi-automated method across heterogeneous MRI datasets.</p><p><strong>Methods: </strong>An nnU-Net was trained on 189 3D T1- and axial T2-weighted scans from 35 MLD patients using visually controlled conventional masks as ground truth. Independent testing was performed on 130 scans (73 high-resolution 3D, 57 lower-resolution 2D T1-weighted) from 49 patients. Performance was assessed by Dice coefficient, Bland-Altman bias, correlation with Gross Motor Function Classification (GMFC-MLD), MLD MRI severity score, longitudinal consistency, and qualitative review of outliers.</p><p><strong>Results: </strong>CNN-based segmentation showed strong spatial agreement with the reference method, with a median Dice coefficient of 0.82 for 3D T1-weighted scans and 0.75 for 2D scans. Volumetric bias was minimal on Bland-Altman analysis. CNN-derived demyelination load correlated significantly with motor impairment (r_S = 0.38 for 3D and r = 0.56 for 2D; both p < 0.001) and showed a stronger association with the MLD MRI severity score than conventional segmentation (3D: r_S = 0.48 vs. 0.28; 2D: r_S = 0.83 vs. 0.29). Correlations with clinical status were slightly lower (CNN: r_S = 0.38, p < 0.001; conventional: (r_S = 0.26, p < 0.025)) Longitudinal analyses demonstrated stable, monotonic changes over time, and qualitative review revealed fewer boundary misclassifications.</p><p><strong>Conclusion: </strong>The nnU-Net enables fast, reproducible, and clinically meaningful segmentation of demyelinated white matter in MLD. It generalizes across MRI protocols, correlates with motor function, and offers a scalable tool for standardized biomarker extraction in clinical trials and other leukodystrophies.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"1009-1021"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764469","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}

{"title":"Correction to: Transient Horner's Syndrome Following CT-Guided C7 Nerve Root Block-A Case Report.","authors":"Leonhard Mann, Valentina Correa Martelo, Elke Hattingen, Christophe T Arendt","doi":"10.1007/s00062-026-01683-z","DOIUrl":"10.1007/s00062-026-01683-z","url":null,"abstract":"","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"1143"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204330","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}

{"title":"Correction to: Predicting Aneurysm Occlusion After Flow Diversion.","authors":"Hye Won Choi, Tae Keun Jee, Danbee Kang, Je Young Yeon, Keon Ha Kim, Pyoung Jeon, Jong-Soo Kim","doi":"10.1007/s00062-026-01698-6","DOIUrl":"10.1007/s00062-026-01698-6","url":null,"abstract":"","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"1145"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812081","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}

{"title":"Distal Thrombectomy Reconsidered: Lessons from DISTALS and ORIENTAL-MEVO.","authors":"Senta Frol, Matija Zupan, René Chapot, Tudor G Jovin","doi":"10.1007/s00062-026-01659-z","DOIUrl":"10.1007/s00062-026-01659-z","url":null,"abstract":"","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"1137-1139"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived Safety and Efficacy of Middle Meningeal Artery Embolization: Results from an International Survey.","authors":"Rosalie Morrish, Yu Zhou, Alexander Stebner, Salome Bosshart, Nima Kashani, Thanh Nguyen, Kazutaka Uchida, Satoru Fujiwara, Shinichi Yoshimura, Charlotte Weyland, Razvan Radu, Ondrej Volny, Pengfei Yang, Jianmin Liu, Johanna Ospel","doi":"10.1007/s00062-026-01646-4","DOIUrl":"10.1007/s00062-026-01646-4","url":null,"abstract":"<p><strong>Background: </strong>Middle meningeal artery embolization (MMAE) is a promising new treatment for chronic SDH (cSDH). We conducted an international multi-disciplinary survey among physicians involved in the care of cSDH patients to understand the perceived safety profile and efficacy of MMAE in real-world clinical practice.</p><p><strong>Methods: </strong>The survey was distributed via several neurointerventional society mailing lists. We collected data on participant demographics, practice patterns, volumes and experience, perceived MMAE safety, complication tolerance, and decision-making. Data were analyzed using descriptive statistics, non-parametric tests and multi-variable regression.</p><p><strong>Results: </strong>Five-hundred-seventy-seven physicians completed the survey between November 20th, 2024 and May 1st, 2025 (median age 42.0 years, 489 [84.7%] male, comprised of endovascular neurosurgeons [185/577, 32.1%], interventional neuroradiologists [181/577, 31.4%]). The recent positive MMAE trials led to cSDH management, particularly in among endovascular neurosurgeons (adjusted odds ratio 2.56 [95% CI 1.51-4.35] compared to interventional neuroradioligists [reference]), and less so among other specialties. There were region-specific differences in rates of practice change and a negative association of physician age and practice change (adjusted odds ratio 0.72 [95% CI 0.53-0.99]). Most participants would now consider MMAE in patients with a new cSDH diagnosis with high perceived recurrence risk (192/424 [45.3%]), while 101/424 (23.8%) would consider MMAE for all cSDH patients. The highest acceptable risk for major complications was 4.0% (median, IQR, 2-5%), although this differed between regions and specialties.</p><p><strong>Conclusion: </strong>Recent trials on MMAE for cSDH treatment have changed practice patterns of cSDH management globally. MMAE is now considered a viable option by most physicians even for patients with first-time cSDH. Most would tolerate a maximum of 4% major complications, although rates of practice change and acceptable risk thresholds vary by region and specialty.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"931-939"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147589949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Learning Reconstruction Versus Hybrid Iterative Reconstruction for Acute Cerebral Infarction Detection on 135 kVp Non-Contrast Brain CT.","authors":"Hirofumi Sekino, Shiro Ishii, Tatsuya Ando, Yumi Saito, Anna Yamaki, Ryo Yamakuni, Kenji Fukushima, Hiroshi Ito","doi":"10.1007/s00062-026-01661-5","DOIUrl":"10.1007/s00062-026-01661-5","url":null,"abstract":"<p><strong>Purpose: </strong>Deep learning reconstruction (DLR) is useful to reduce image noise and improve contrast resolution compared with hybrid iterative reconstruction (Hybrid IR). This study compared image quality and infarct detection between DLR and Hybrid IR using thin-slice brain CT.</p><p><strong>Materials and methods: </strong>Eighty-one patients (39 with acute infarction, 42 without) underwent 135 kVp non-contrast brain CT and MRI within 24 h of admission. CT images (2-mm thickness) were reconstructed using both Hybrid IR and DLR. Image noise was measured in white matter, gray matter, and infarct lesions. Three general radiologists independently assessed infarct presence. Sensitivity was evaluated using patient- and region-based analyses.</p><p><strong>Results: </strong>DLR demonstrated significantly lower image noise than Hybrid IR in white matter, gray matter, and infarct lesions (1.69 vs. 4.40, 1.43 vs. 3.93, and 1.68 vs. 3.94 HU, respectively; all p < 0.001). Contrast-to-noise ratio was significantly higher with DLR (5.10 vs. 2.36, p < 0.001). In patient-based analysis, infarct detection sensitivity was higher with DLR (66.7%-71.8%) than with Hybrid IR (59.0%-69.2%) (p > 0.05). In region-based analysis, DLR showed significantly higher sensitivity for one reader (60.5% vs. 50.0%, p = 0.004).</p><p><strong>Conclusion: </strong>In this study, DLR significantly reduces image noise and improves contrast-to-noise ratio in thin-slice brain CT. These improvements may help general radiologists in diagnosing acute cerebral infarction.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"1049-1059"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of Radiation Exposure in Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Single-Center Cohort Study.","authors":"Gregor Peter, Lukas Meyer, Luca Meucci, Felix Schlicht, Helge Kniep, Alexander Heitkamp, Christian Heitkamp, Laurens Winkelmeier, Bogdana Tokareva, Vincent Geest, Maxim Bester, Jens Fiehler, Matthias Bechstein, Christian Thaler","doi":"10.1007/s00062-026-01662-4","DOIUrl":"10.1007/s00062-026-01662-4","url":null,"abstract":"<p><strong>Purpose: </strong>To identify patient- and procedure-related factors associated with radiation exposure during middle meningeal artery (MMA) embolization for chronic subdural hematoma (cSDH), with particular focus on embolic agent (particle vs. liquid) and arterial access route (transradial vs. transfemoral).</p><p><strong>Methods: </strong>In this retrospective single-center cohort study, we included all patients who underwent MMA embolization for cSDH between February 2021 and October 2025. MMA embolization was performed by fourteen experienced board-certified neuroradiologists. The primary outcome was dose area product (DAP, Gy · cm²). Univariable and multivariable linear regression analyses were performed to assess associations between DAP and age, sex, access route, treated side (unilateral vs bilateral), embolic agent, anesthesia, interventionalist, and guiding catheter.</p><p><strong>Results: </strong>A total of 112 patients (median age 81 years; 20% female) were included; 69 (62%) underwent embolization with particles and 43 (38%) with liquid agents. Transradial access was used in 17 (15%) and transfemoral access in 95 (85%) procedures. Overall median (IQR) DAP was 74.7 Gy · cm² (55.6-102.4), with 65.5 Gy · cm² (50.6-82.0) for unilateral and 107.6 Gy · cm² (84.1-161.6) for bilateral embolization. Univariable analyses showed no significant association between DAP and age, sex, embolic agent, access route, anesthesia, guiding catheter, or interventionalist. In multivariable analysis, unilateral right and left MMA embolization remained independently associated with significantly lower DAP compared with bilateral procedures, while embolic agent and access route were not significantly associated with radiation exposure.</p><p><strong>Conclusion: </strong>In MMA embolization for cSDH, radiation exposure is primarily driven by procedural extent, with higher DAP in bilateral than in unilateral embolization, whereas the choice of embolic material and arterial access route is not associated with radiation dose. These findings support selecting embolic agents and access routes based on anatomical and clinical considerations rather than radiation concerns.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"1061-1067"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764461","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}

{"title":"Correction to: Comment on ESO/EANS/ESMINT Guideline on Aneurysmal Subarachnoid Haemorrhage.","authors":"Stephan Meckel, Matthias Gawlitza, Klaus Kaier, Franziska Dorn, Stefan Rohde, Peter Schramm, Ansgar Berlis","doi":"10.1007/s00062-026-01719-4","DOIUrl":"https://doi.org/10.1007/s00062-026-01719-4","url":null,"abstract":"","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volumetric Assessment of Vestibular Schwannomas Exhibiting Internal Growth After Stereotactic Radiosurgery: Application of Artificial Intelligence.","authors":"Ada Chung, Rithvik Ghankot, Daniel Li, Ariel Omiunu, Manwi Singh, Noemi Jester, Steven M Tommasini, James E Hansen, Veronica Chiang, Frank D Buono, Amit Mahajan, Nofrat Schwartz","doi":"10.1007/s00062-026-01707-8","DOIUrl":"10.1007/s00062-026-01707-8","url":null,"abstract":"<p><strong>Purpose: </strong>Vestibular schwannomas (VS) are monitored for growth after stereotactic radiosurgery (SRS) using serial MRI. Conventional measurements often miss internal regrowth within necrotic/cystic tumor components-a subtle and difficult-to-detect imaging scenario that may indicate treatment failure. We evaluated a custom AI-based segmentation tool to detect internal tumor regrowth after SRS, comparing it with expert segmentation for spatial agreement, volumetric change, and radiographic failure classification (≥ 20% volume increase).</p><p><strong>Methods: </strong>We retrospectively analyzed 170 MRI scans from 85 patients with unilateral VS treated with SRS at a tertiary academic center (2001-2023). Tumors were segmented using expert manual methods and a lab-developed convolutional neural network (CNN)-based AI model.</p><p><strong>Results: </strong>Tumors with internal regrowth comprised 4.7% of cases yet accounted for 27% of radiographic failures. Within the internal regrowth subset, the AI model achieved a median Dice similarity coefficient of 0.85, demonstrating favorable agreement with expert segmentation. Concordance between AI- and manually derived volumetric change was favorable (concordance correlation coefficient, 0.87), with a median percent difference of 9.29% (range, 3.57-20.78%). AI classification of radiographic failure within the internal regrowth subset was consistent with expert assessment, and performance remained comparable to the broader cohort.</p><p><strong>Conclusion: </strong>Internal tumor regrowth after SRS is a rare and potentially underrecognized post-treatment imaging pattern associated with radiographic failure that may be difficult to identify using conventional radiographic assessment. In this preliminary study, agreement between AI and expert assessment highlights the potential role of AI-based volumetric tools in improving recognition and longitudinal surveillance of structurally complex post-treatment tumor changes.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on ESO/EANS/ESMINT Guideline on Aneurysmal Subarachnoid Haemorrhage.","authors":"Stephan Meckel, Matthias Gawlitza, Klaus Kaier, Franziska Dorn, Stefan Rohde, Peter Schramm, Ansgar Berlis","doi":"10.1007/s00062-026-01708-7","DOIUrl":"10.1007/s00062-026-01708-7","url":null,"abstract":"","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700708","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}