Clinical Neuroradiology最新文献

{"title":"Breath-Hold-Triggered BOLD fMRI in Drug-Resistant Nonlesional Focal Epilepsy—A Pilot Study","authors":"Christian M. Boßelmann, Josua Kegele, Leonie Zerweck, Uwe Klose, Silke Ethofer, Constantin Roder, Alexander M. Grimm, Till-Karsten Hauser","doi":"10.1007/s00062-023-01363-2","DOIUrl":"https://doi.org/10.1007/s00062-023-01363-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Individuals with drug-resistant epilepsy may benefit from epilepsy surgery. In nonlesional cases, where no epileptogenic lesion can be detected on structural magnetic resonance imaging, multimodal neuroimaging studies are required. Breath-hold-triggered BOLD fMRI (bh-fMRI) was developed to measure cerebrovascular reactivity in stroke or angiopathy and highlights regional network dysfunction by visualizing focal impaired flow increase after vasodilatory stimulus. This regional dysfunction may correlate with the epileptogenic zone. In this prospective single-center single-blind pilot study, we aimed to establish the feasibility and safety of bh-fMRI in individuals with drug-resistant non-lesional focal epilepsy undergoing presurgical evaluation.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>In this prospective study, 10 consecutive individuals undergoing presurgical evaluation for drug-resistant focal epilepsy were recruited after case review at a multidisciplinary patient management conference. Electroclinical findings and results of other neuroimaging were used to establish the epileptogenic zone hypothesis. To calculate significant differences in cerebrovascular reactivity in comparison to the normal population, bh-fMRIs of 16 healthy volunteers were analyzed. The relative flow change of each volume of interest (VOI) of the atlas was then calculated compared to the flow change of the whole brain resulting in an atlas of normal cerebral reactivity. Consequently, the mean flow change of every VOI of each patient was tested against the healthy volunteers group. Areas with significant impairment of cerebrovascular reactivity had decreased flow change and were compared to the epileptogenic zone localization hypothesis in a single-blind design.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Acquisition of bh-fMRI was feasible in 9/10 cases, with one patient excluded due to noncompliance with breathing maneuvers. No adverse events were observed, and breath-hold for intermittent hypercapnia was well tolerated. On blinded review, we observed full or partial concordance of the local network dysfunction seen on bh-fMRI with the electroclinical hypothesis in 6/9 cases, including cases with extratemporal lobe epilepsy and those with nonlocalizing 18F-fluorodeoxyglucose positron emission tomography (FDG-PET).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>This represents the first report of bh-fMRI in individuals with epilepsy undergoing presurgical evaluation. We found bh-fMRI to be feasible and safe, with a promising agreement to electroclinical findings. Thus, bh-fMRI may represent a potential modality in the presurgical evaluation of epilepsy. Further studies are needed to establish clinical utility.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"9 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138576806","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":"Preoperative Direct Puncture Embolization Using a Nonadhesive Ethylene Vinyl Alcohol (EVOH) Liquid Embolic Agent for Head and Neck Paragangliomas","authors":"Andrea M. Alexandre, Luca Scarcia, Frédéric Clarençon, Arianna Camilli, Andrea Bartolo, Francesca Incandela, Dario Antonio Mele, Mario Rigante, Marco Natola, Iacopo Valente, Francesco D’Argento, Jacopo Galli, Yamume Tshomba, Alessandro Pedicelli","doi":"10.1007/s00062-023-01364-1","DOIUrl":"https://doi.org/10.1007/s00062-023-01364-1","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>This retrospective study aimed to assess the safety and technical efficacy of preoperative direct puncture embolization using a nonadhesive ethylene vinyl alcohol (EVOH) copolymer-based liquid embolic agent (LEA) combined with balloon occlusion at the origin of the external carotid artery for head and neck paragangliomas (HNP).</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We conducted a review of all consecutive cases of HNPs treated with direct puncture embolization using EVOH-based LEAs between 2017 and 2022 in 2 tertiary high-volume hospitals.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of 25 cases of HNPs in 24 patients underwent direct puncture embolization (12 males, 12 females, mean age 50.9 ± 15.6 years). The average lesion volume was 299.95 mm³. The mean procedure time was 139.11 min, and the mean volume of EVOHs used per case was 19.38 mL. Successful complete devascularization was achieved in all cases, with a homogeneous and deep penetration of the embolic agent into the tumor vessel bed regardless of the LEA type.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Preoperative embolization of HNPs using a direct puncture technique and EVOHs is a safe, efficient, and feasible treatment option with a low risk of complications. This procedure facilitates surgery by transforming tumors into avascular masses that are well-delineated against the surrounding normal tissue.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"5 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138562663","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":"Radiation Exposure in Interventional Stroke Treatment : Analysis of the German Neurointerventional Database (DeGIR/DGNR) from 2019 to 2021.","authors":"Felix Bärenfänger, Peter Schramm, Stefan Rohde","doi":"10.1007/s00062-023-01303-0","DOIUrl":"10.1007/s00062-023-01303-0","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate patient-related radiation exposure in interventional stroke treatment by analyzing data from the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Society of Neuroradiology (DGNR) quality registry from 2019-2021.</p><p><strong>Methods: </strong>The DeGIR/DGNR registry is the largest database of radiological interventions in Germany. Since the introduction of the registry in 2012, the participating hospitals have entered clinical and dose-related data on the procedures performed. To evaluate the current diagnostic reference level (DRL) for mechanical thrombectomy (MT) in stroke patients, we analyzed interventional data from 2019 to 2021 with respect to the reported dose area product (DAP) and factors that might contribute to the radiation dose, such as the localization of the occlusion, technical success using the modified treatment in cerebral ischemia (mTICI) score, number of passages, technical approach, additional intracranial/extracranial stenting, and case volume per center.</p><p><strong>Results: </strong>A total of 41,538 performed MTs from 180 participating hospitals were analyzed. The median DAP for MT was 7337.5 cGy∙cm² and the corresponding interquartile range (IQR) Q₂₅ = 4064 cGy∙cm² to Q₇₅ = 12,263 cGy∙cm². In addition, we discovered that the dose was significantly influenced by occlusion location, number of passages, case volume per center, recanalization score, and additional stenting.</p><p><strong>Conclusion: </strong>We conducted a retrospective study on radiation exposure during MT in Germany. Based on the results of more than 41,000 procedures, we observed that the DRL of 14,000 cGy·cm² is currently appropriate but may be lowered over the next years. Furthermore, we identified several factors that contribute to high radiation exposure. This can aid in detecting the cause of an exceeded DRL and optimize the treatment workflow.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"1023-1033"},"PeriodicalIF":2.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9585970","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":"Sacral Dural Tears as a Cause of Spontaneous Intracranial Hypotension.","authors":"Niklas Lützen, Enrique Barvulsky Aleman, Amir El Rahal, Florian Volz, Christian Fung, Jürgen Beck, Horst Urbach","doi":"10.1007/s00062-023-01292-0","DOIUrl":"10.1007/s00062-023-01292-0","url":null,"abstract":"<p><strong>Purpose: </strong>Dural tears at the level of the cervical, thoracic, and lumbar spine cause spontaneous intracranial hypotension (SIH) in patients with a spinal longitudinal extradural CSF collection (SLEC); however, sacral dural tears have rarely been reported so far. This study focuses on sacral dural tears as a cause of SIH.</p><p><strong>Methods: </strong>Retrospective data from SIH patients with confirmed sacral dural tears studied between October 2020 and November 2022 were analyzed with respect to demographic, clinical and imaging features. Digital subtraction myelography (DSM) and lumbar epidural blood patch (EBP) were modified by placing the patient in reversed Trendelenburg position.</p><p><strong>Results: </strong>Of the SIH patients, 9 (all women; mean age, 38.5 years; mean body mass index, BMI, 22.9) out of 149 had a sacral dural leak (6%) that occurred spontaneously in 7/9, while 2/9 were likely associated with minor trauma. None had a sacral fracture. The mean SIH score was 6.8. All patients showed SLEC on heavily T2-weighted MR myelography (T2-MRM), 4/9 exclusively sacral and 5/9 with partial or complete involvement of the remaining spine. 4/9 had none, but 5/9 had meningeal sacral cysts, 2/5 had large cysts/ectasia. Confirmation of the sacral origin of the leak was provided in 4/9 by T2-MRM, in 2/9 by DSM and 3/9 by CT myelography (CTM) whereas 0/9 revealed the exact site of leak within the sacrum.</p><p><strong>Conclusion: </strong>Sacral dural tears should be considered as a possible cause for SIH. It is concluded to implement T2-MRM covering the entire sacrum in the standard MRI protocol and propose EBP in the reverse Trendelenburg position as a therapeutic approach.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"957-964"},"PeriodicalIF":2.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9740371","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":"Tumefactive Demyelinating Lesion Around a Developmental Venous Anomaly : A Rare Association.","authors":"Alessandra Cicia, Vincenzo Carlomagno, Massimiliano Mirabella, Matteo Lucchini","doi":"10.1007/s00062-023-01307-w","DOIUrl":"10.1007/s00062-023-01307-w","url":null,"abstract":"","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"1155-1158"},"PeriodicalIF":2.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9622330","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":"Early Outcomes of the Pipeline Vantage Flow Diverter : A Multicentre Study.","authors":"Sara Sciacca, Ahmed Bassiouny, Nina Mansoor, Thais Minett, Parthiban Balasundaram, Juveria Siddiqui, Yogish Joshi, Shahram Derakhshani, Naga Kandasamy, Thomas Calvert Booth, Jeremy Lynch","doi":"10.1007/s00062-023-01314-x","DOIUrl":"10.1007/s00062-023-01314-x","url":null,"abstract":"<p><strong>Purpose: </strong>The recently introduced Pipeline Vantage Embolization Device with Shield Technology is the fourth generation of Pipeline flow diverter devices. Due to the relatively high rate of intraprocedural technical complications, modifications were subsequently made to the device after a limited release of the device in 2020. This study aimed to evaluate the safety and efficacy of the modified version of this device.</p><p><strong>Methods: </strong>This was a multicentre retrospective series. The primary efficacy endpoint was aneurysm occlusion in the absence of retreatment. The primary safety endpoint was any neurological morbidity or death. Ruptured and unruptured aneurysms were included in the study.</p><p><strong>Results: </strong>A total of 52 procedures were performed for 60 target aneurysms. Treatment was performed on 5 patients with ruptured aneurysms. The technical success rate was 98%. The mean clinical follow-up time was 5.5 months. In patients presenting with unruptured aneurysms there were no deaths, 3 (6.4%) major complications and 7 (13%) minor complications. In the five patients presenting with subarachnoid haemorrhage there were 2 (40%) major complications with 1 (20%) of these resulting in death, and 1 (20%) minor complication. Of the patients 29 (56%) had undergone 6‑monthly postprocedural angiographic imaging with a mean time of 6.6 months demonstrating that 83% of patients had achieved adequate occlusion (RROC1/2) of the aneurysm.</p><p><strong>Conclusions: </strong>In this non-industry-sponsored study, the occlusion rates and safety outcomes were similar to those seen in previously published studies with flow diverter devices and earlier generation Pipeline devices. Modifications to the device appear to have improved ease of deployment.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"887-896"},"PeriodicalIF":2.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9690767","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":"Clinical Evaluation of a Quantitative Imaging Biomarker Supporting Radiological Assessment of Hippocampal Sclerosis.","authors":"Michael Rebsamen, Baudouin Zongxin Jin, Tomas Klail, Sophie De Beukelaer, Rike Barth, Beata Rezny-Kasprzak, Uzeyir Ahmadli, Serge Vulliemoz, Margitta Seeck, Kaspar Schindler, Roland Wiest, Piotr Radojewski, Christian Rummel","doi":"10.1007/s00062-023-01308-9","DOIUrl":"10.1007/s00062-023-01308-9","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the influence of quantitative reports (QReports) on the radiological assessment of hippocampal sclerosis (HS) from MRI of patients with epilepsy in a setting mimicking clinical reality.</p><p><strong>Methods: </strong>The study included 40 patients with epilepsy, among them 20 with structural abnormalities in the mesial temporal lobe (13 with HS). Six raters blinded to the diagnosis assessed the 3T MRI in two rounds, first using MRI only and later with both MRI and the QReport. Results were evaluated using inter-rater agreement (Fleiss' kappa [Formula: see text]) and comparison with a consensus of two radiological experts derived from clinical and imaging data, including 7T MRI.</p><p><strong>Results: </strong>For the primary outcome, diagnosis of HS, the mean accuracy of the raters improved from 77.5% with MRI only to 86.3% with the additional QReport (effect size [Formula: see text]). Inter-rater agreement increased from [Formula: see text] to [Formula: see text]. Five of the six raters reached higher accuracies, and all reported higher confidence when using the QReports.</p><p><strong>Conclusion: </strong>In this pre-use clinical evaluation study, we demonstrated clinical feasibility and usefulness as well as the potential impact of a previously suggested imaging biomarker for radiological assessment of HS.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"1045-1053"},"PeriodicalIF":2.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9740038","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":"Distinct Alterations in Oxygenation, Ion Composition and Acid-Base Balance in Cerebral Collaterals During Large-Vessel Occlusion Stroke.","authors":"Jörn Feick, Mirko Pham, Alexander G März, Marius L Vogt, Marc Strinitz, Guido Stoll, Michael K Schuhmann, Alexander M Kollikowski","doi":"10.1007/s00062-023-01296-w","DOIUrl":"10.1007/s00062-023-01296-w","url":null,"abstract":"<p><strong>Purpose: </strong>Disturbances of blood gas and ion homeostasis including regional hypoxia and massive sodium (Na⁺)/potassium (K⁺) shifts are a hallmark of experimental cerebral ischemia but have not been sufficiently investigated for their relevance in stroke patients.</p><p><strong>Methods: </strong>We report a prospective observational study on 366 stroke patients who underwent endovascular thrombectomy (EVT) for large-vessel occlusion (LVO) of the anterior circulation (18 December 2018-31 August 2020). Intraprocedural blood gas samples (1 ml) from within cerebral collateral arteries (ischemic) and matched systemic control samples were obtained according to a prespecified protocol in 51 patients.</p><p><strong>Results: </strong>We observed a significant reduction in cerebral oxygen partial pressure (-4.29%, p_aO_2ischemic = 185.3 mm Hg vs. p_aO_2systemic = 193.6 mm Hg; p = 0.035) and K⁺ concentrations (-5.49%, K⁺_ischemic = 3.44 mmol/L vs. K⁺_systemic = 3.64 mmol/L; p = 0.0083). The cerebral Na⁺:K⁺ ratio was significantly increased and negatively correlated with baseline tissue integrity (r = -0.32, p = 0.031). Correspondingly, cerebral Na⁺ concentrations were most strongly correlated with infarct progression after recanalization (r = 0.42, p = 0.0033). We found more alkaline cerebral pH values (+0.14%, pH_ischemic = 7.38 vs. pH_systemic = 7.37; p = 0.0019), with a time-dependent shift towards more acidotic conditions (r = -0.36, p = 0.055).</p><p><strong>Conclusion: </strong>These findings suggest that stroke-induced changes in oxygen supply, ion composition and acid-base balance occur and dynamically progress within penumbral areas during human cerebral ischemia and are related to acute tissue damage.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"973-984"},"PeriodicalIF":2.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9942630","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":"Intracranial Spotty Calcium Predicts Recurrent Stroke in Patients with Symptomatic Intracranial Atherosclerotic Stenosis : A Prospective Cohort Study.","authors":"Rui Li, Moqi Liu, Jialu Li, Xueqiao Jiao, Xiuhai Guo","doi":"10.1007/s00062-023-01299-7","DOIUrl":"10.1007/s00062-023-01299-7","url":null,"abstract":"<p><strong>Purpose: </strong>Accumulating evidence highlights the association of calcium characteristics and cardiovascular events, but its role in cerebrovascular stenosis has not been well studied. We aimed to investigate the contribution of calcium patterns and density to recurrent ischemic stroke in patients with symptomatic intracranial atherosclerotic stenosis (ICAS).</p><p><strong>Methods: </strong>In this prospective study, 155 patients with symptomatic ICAS in the anterior circulation were included, and all subjects underwent computed tomography angiography. The median follow-up for all patients was 22 months and recurrent ischemic stroke were recorded. Cox regression analysis was performed to examine whether calcium patterns and density were associated with recurrent ischemic stroke.</p><p><strong>Results: </strong>During the follow-up, 29 patients who experienced recurrent ischemic stroke were older than those without recurrent ischemic stroke (62.93 ± 8.10 years vs. 57.00 ± 12.07 years, p = 0.027). A significantly higher prevalence of intracranial spotty calcium (86.2% vs. 40.5%, p < 0.001) and very low-density intracranial calcium (72.4% vs. 37.3%, p = 0.001) were observed in patients with recurrent ischemic stroke. Multivariable Cox regression analysis showed that intracranial spotty calcium, rather than very low-density intracranial calcium, remained an independent predictor of recurrent ischemic stroke (adjusted hazard ratio 5.35, 95% confidence interval 1.32-21.69, p = 0.019).</p><p><strong>Conclusion: </strong>In patients with symptomatic ICAS, intracranial spotty calcium is an independent predictor of recurrent ischemic stroke, which will further facilitate risk stratification and suggest that more aggressive treatment should be considered for these patients.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"985-992"},"PeriodicalIF":2.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9942631","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":"Ultra-High-Resolution Time-of-Flight MR-Angiography for the Noninvasive Assessment of Intracranial Aneurysms, Alternative to Preinterventional DSA?","authors":"Tilman Schubert, Hakim Shakir Husain, Patrick Thurner, Jawid Madjidyar, Isabelle Barnaure, Marco Piccirelli, Markus Klarhöfer, Michaela Schmidt, Peter Speier, Christoph Forman, Zsolt Kulcsar","doi":"10.1007/s00062-023-01320-z","DOIUrl":"10.1007/s00062-023-01320-z","url":null,"abstract":"<p><strong>Purpose: </strong>The 3D time-of-flight (TOF) magnetic resonance angiography (MRA) at 3T shows high sensitivity for intracranial aneurysms but is inferior to three-dimensional digital subtraction angiography (3D-DSA) regarding aneurysm characteristics. We applied an ultra-high-resolution (UHR) TOF-MRA using compressed sensing reconstruction to investigate the diagnostic performance in preinterventional evaluation of intracranial aneurysms compared to conventional TOF-MRA and 3D-DSA.</p><p><strong>Methods: </strong>In this study 17 patients with unruptured intracranial aneurysms were included. Aneurysm dimensions, configuration, image quality and sizing of endovascular devices were compared between conventional TOF-MRA at 3T and UHR-TOF with 3D-DSA as gold standard. Quantitatively, contrast-to-noise ratios (CNR) were compared between TOF-MRAs.</p><p><strong>Results: </strong>On 3D-DSA, 25 aneurysms in 17 patients were detected. On conventional TOF, 23 aneurysms were detected (sensitivity: 92.6%). On UHR-TOF, 25 aneurysms were detected (sensitivity: 100%). Image quality was not significantly different between TOF and UHR-TOF (p = 0.17). Aneurysm dimension measurements were significantly different between conventional TOF (3.89 mm) and 3D-DSA (4.2 mm, p = 0.08) but not between UHR-TOF (4.12 mm) and 3D-DSA (p = 0.19). Irregularities and small vessels at the aneurysm neck were more frequently correctly depicted on UHR-TOF compared to conventional TOF. Comparison of the planned framing coil diameter and flow-diverter (FD) diameter revealed neither a statistically significant difference between TOF and 3D-DSA (coil p = 0.19, FD p = 0.45) nor between UHR-TOF and 3D-DSA (coil: p = 0.53, FD 0.33). The CNR was significantly higher in conventional TOF (p = 0.009).</p><p><strong>Conclusion: </strong>In this pilot study, ultra-high-resolution TOF-MRA visualized all aneurysms and accurately depicted aneurysm irregularities and vessels at the base of the aneurysm comparably to DSA, outperforming conventional TOF. UHR-TOF with compressed sensing reconstruction seems to represent a non-invasive alternative to pre-interventional DSA for intracranial aneurysms.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"1115-1122"},"PeriodicalIF":2.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9744905","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}