Frontiers in Neurology最新文献

{"title":"Correction: Efficacy and exploratory analysis of potential mechanisms of stellate ganglion block in alleviating sleep disturbance in generalized anxiety disorder: a randomized controlled trial excluding comorbid depression.","authors":"Na Liu, Qinying Ma, Moqing Zhou, Lin Yang, Wenyuan Wang, Yanyong Wang","doi":"10.3389/fneur.2026.2015094","DOIUrl":"https://doi.org/10.3389/fneur.2026.2015094","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.3389/fneur.2025.1554841.].</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"2015094"},"PeriodicalIF":3.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13702059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265712","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":"From emergency myelopoiesis to trained immunity? Reframing post-stroke myeloid reprogramming along the brain-bone marrow axis.","authors":"TongZhu Wei, YongJiu Wang","doi":"10.3389/fneur.2026.1976078","DOIUrl":"https://doi.org/10.3389/fneur.2026.1976078","url":null,"abstract":"<p><p>Ischemic stroke rapidly mobilizes myeloid cells from anatomically distinct bone-marrow niches, while emerging evidence indicates that severe cerebral injury can also leave a durable imprint on hematopoiesis. These observations have encouraged the use of the term trained immunity in stroke biology, but acute myeloid expansion is not equivalent to innate immune memory. In this Mini review, we distinguish acute myeloid activation, myelopoietic responses consistent with emergency myelopoiesis, and central trained immunity involving hematopoietic stem and progenitor cells (HSPCs). We use an operational four-feature framework-persistence, progenitor involvement, epigenetic or metabolic reprogramming, and functional recall-to grade the strength of current evidence. We consider a sequential transition from emergency myelopoiesis to trained immunity as one testable possibility rather than an established pathway, while allowing for parallel or independent mechanisms. The key unresolved questions are where durable memory is stored, when acute hematopoietic adaptation becomes stabilized, and which outputs are maladaptive versus reparative. Resolving these boundaries is essential before marrow-directed immunomodulation can be translated to patients with ischemic stroke.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1976078"},"PeriodicalIF":3.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13696791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265749","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":"Botulinum toxin type a within function-oriented management of post-stroke spasticity: a narrative review.","authors":"Baoling Su, Yating Huang, Xiaotong Li, Kun Wang, Bing Bao","doi":"10.3389/fneur.2026.1921220","DOIUrl":"https://doi.org/10.3389/fneur.2026.1921220","url":null,"abstract":"<p><p>Post-stroke spasticity (PSS) is a heterogeneous complication of stroke that affects motor recovery, care needs, pain, positioning, and participation in daily life. Current management frameworks commonly stratify patients by time since stroke, but disease duration alone does not capture differences in neural mechanisms, residual voluntary control, functional priorities, or response to intervention. This narrative review searched PubMed, the Cochrane Library, and Wanfang databases from inception to May 2026, prioritizing randomized controlled trials, prospective cohort studies, systematic reviews, real-world studies, Goal Attainment Scaling research, the Upper Limb International Spasticity cohort series, best-practice guidance, and clinical trials including BEST and InTENSE. We synthesize evidence that PSS heterogeneity can be understood across central and peripheral mechanisms, temporal trajectories, and active versus passive functional consequences. Available studies suggest that active and passive functional goals differ in baseline functional profiles, outcome assessment, treatment response, and intervention requirements. However, patients sharing a functional goal type may still differ in residual voluntary control, neural and non-neural contributors to movement restriction, pain, mobility, and care dependency. Botulinum toxin type A is well aligned with focal tone reduction and passive goals, including pain relief, hygiene, and limb positioning. It may also support contracture-prevention strategies when modifiable neural muscle overactivity remains, whereas active functional gains usually require preserved motor potential and integration with task-oriented training, rehabilitation, and adjunctive modalities. We propose that functional goal type should complement time-based staging as a decision dimension rather than serve as a complete clinical phenotype. This combined framework may better align patient selection, intervention matching, outcome assessment, and longitudinal treatment planning. Prospective goal-stratified studies and standardized assessment tools are needed to test its clinical utility.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1921220"},"PeriodicalIF":3.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13700919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265742","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":"Clinical study of isokinetic training with joint control tasks on lower limb function in stroke patients with proprioceptive impairment: a preliminary randomized controlled trial.","authors":"Zhendong Zhang, Huixian Yu, Ping Li, Na Li, Yumei Zhang","doi":"10.3389/fneur.2026.1881854","DOIUrl":"https://doi.org/10.3389/fneur.2026.1881854","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effects of isokinetic training with joint control tasks on lower limb proprioceptive and motor function in stroke patients with proprioceptive impairment.</p><p><strong>Methods: </strong>A randomized controlled trial design was adopted. Stroke patients with proprioceptive dysfunction who were admitted to the Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, between April 2025 and November 2025 were prospectively and consecutively enrolled. Participants were randomly assigned to an experimental group or a control group using a random number table. Both groups received conventional rehabilitation for 4 weeks, while the experimental group additionally underwent isokinetic training with joint control tasks during the same intervention period. General demographic and clinical data were collected. Before and after intervention, proprioception, motor function, and activities of daily living (ADL) were assessed.</p><p><strong>Results: </strong>Based on the predefined inclusion and exclusion criteria, 58 eligible patients were finally enrolled and randomly allocated into two groups (29 patients per group). Within-group comparisons showed that both groups exhibited significant post-intervention improvements in proprioceptive function, motor function, and activities of daily living (ADL) (all <i>P</i> < 0.05). In the control group, the Modified Nottingham Sensory Assessment (NSA), Joint Position Reproduction (JPR) tests at 30°, 45°, and 60°, Threshold to Detect Passive Motion (TTDPM), Berg Balance Scale (BBS), Fugl-Meyer Assessment for the lower extremity (FMA-LE), and Modified Barthel Index (MBI) scores all improved significantly compared with baseline (<i>P</i> < 0.05). Similarly, in the experimental group, all aforementioned indicators demonstrated significant improvements after intervention (<i>P</i> < 0.05). Between-group comparisons revealed that improvements in proprioceptive, motor, and ADL functions were significantly greater in the experimental group than in the control group. Specifically, the changes in NSA, JPR (30°, 45°, 60°), and TTDPM scores were significantly higher in the experimental group (<i>P</i> < 0.05). Furthermore, the experimental group exhibited larger gains in BBS and FMA-LE scores (<i>P</i> < 0.05), as well as greater improvements in MBI scores (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Isokinetic joint control training combined with conventional rehabilitation was associated with improvements in proprioceptive function, lower-limb motor performance, and activities of daily living in stroke patients with proprioceptive impairment. These findings suggest that this approach may serve as a useful adjunct to stroke rehabilitation; however, further studies with more rigorous designs are required to confirm these results.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1881854"},"PeriodicalIF":3.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13696264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265760","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":"Mapping the neural basis of the perception of \"flow of time\": interval timing and mental time travel in the human brain.","authors":"Ryuta Ochi, Mitsuru Kawamura","doi":"10.3389/fneur.2026.1960572","DOIUrl":"https://doi.org/10.3389/fneur.2026.1960572","url":null,"abstract":"<p><p>Although neurodegenerative diseases and brain injuries have been reported to impair the perception of \"the flow of time,\" the underlying neural mechanisms remain uncertain. We examined symptoms related to interval timing and mental time travel, two neuropsychological phenomena associated with the perception of the flow of time that have been relatively well characterized. In addition, we reviewed the current evidence and proposed a potential underlying brain mechanism.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1960572"},"PeriodicalIF":3.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13696792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265660","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":"A machine learning model for predicting cognitive improvement after scalp cluster needling therapy in patients with post-stroke mild cognitive impairment.","authors":"Yican Hao, Xia Wei, Pingli Zhao, Hewei Qin","doi":"10.3389/fneur.2026.1884682","DOIUrl":"10.3389/fneur.2026.1884682","url":null,"abstract":"<p><strong>Background: </strong>Cognitive recovery varies substantially among patients with post-stroke mild cognitive impairment (PSCI-MCI), whereas individualized models for predicting post-treatment cognitive improvement remain limited. This study aimed to develop and internally validate a machine learning model for predicting cognitive improvement after 1 month of scalp cluster needling therapy with prolonged needle retention (SCNT-PR) in patients with PSCI-MCI.</p><p><strong>Methods: </strong>This retrospective study included hospitalized patients diagnosed with PSCI-MCI between January 1, 2010, and January 1, 2023. Baseline data included demographics, vascular risk factors, stroke severity, imaging features, cognitive and functional assessments, emotional and sleep-related indicators, treatment-related variables, and laboratory findings. The outcome was defined as an increase of at least 2 points in the corrected Montreal Cognitive Assessment (MoCA) score after treatment compared with baseline. Least absolute shrinkage and selection operator (LASSO) regression and the Boruta algorithm were used to identify key predictors. Seven supervised machine learning algorithms were applied to develop pretreatment prediction models. Model performance was assessed in terms of discrimination, calibration, and clinical utility, and Shapley Additive Explanations (SHAP) were used for model interpretation.</p><p><strong>Results: </strong>A total of 750 patients were included and randomly assigned to a training set (<i>n</i> = 526) and a validation set (<i>n</i> = 224). Seven key predictors were identified from the intersection of LASSO regression and Boruta. Among the evaluated models, LightGBM showed the acceptable performance, with an area under the receiver operating characteristic curve of 0.759. Calibration curves and decision curve analysis indicated acceptable calibration and favorable clinical utility. SHAP analysis identified baseline corrected MoCA score, years of education, National Institutes of Health Stroke Scale total score, Barthel Index score for activities of daily living, age, frontal lobe lesion, and diabetes as the major contributors to model prediction. Sensitivity analyses demonstrated consistent predictor patterns under alternative outcome definitions and predictor configurations.</p><p><strong>Conclusion: </strong>We developed and internally validated a machine learning model based on multidimensional pretreatment clinical data to predict cognitive improvement after SCNT-PR in patients with PSCI-MCI. This model may provide preliminary support for patient stratification and individualized clinical assessment, although external validation in independent cohorts is required before clinical implementation.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1884682"},"PeriodicalIF":3.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244193","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":"Regional spontaneous brain activity abnormalities in ischemic stroke patients with motor dysfunction: protocol for an AES-SDM coordinate-based meta-analysis.","authors":"Jia Zhao, Yao Rao, Jiali Wu, Ming Zeng, Jingjing Zhang, Jiawei Ni, Hui Xu, Zhiwei Zhao, Yaxin Zheng, Cong Wang, Chunlei Shan","doi":"10.3389/fneur.2026.1933104","DOIUrl":"https://doi.org/10.3389/fneur.2026.1933104","url":null,"abstract":"<p><strong>Introduction: </strong>Most ischemic stroke survivors experience motor deficits, yet the underlying patterns of spontaneous brain activity change remain unclear. Individual rs-fMRI studies on this population have yielded contradictory findings, likely due to small sample sizes and between-study differences in lesion profiles, stroke stage, rehabilitation history, and imaging pipelines. These inconsistencies have not been resolved by existing reviews, many of which combine ischemic and hemorrhagic stroke, pool conceptually distinct rs-fMRI metrics without sufficient stratification, or focus on functional connectivity rather than local spontaneous activity. This protocol plans a coordinate-based meta-analysis restricted to ischemic stroke and local rs-fMRI metrics to address that gap.</p><p><strong>Methods and analysis: </strong>This study will systematically identify and synthesise whole-brain rs-fMRI studies that compared ALFF, fALFF, or ReHo between adult ischemic stroke patients with motor dysfunction and healthy controls. We will search PubMed, Embase, Web of Science, and the Cochrane Library up to 6 February 2026. To be included, a study must report whole-brain voxel-wise group comparisons and provide stereotactic peak coordinates in MNI or Talairach space. Studies will be excluded if they are non-original reports, case reports or case series, use task-state fMRI or ROI-only analyses, lack extractable standard-space coordinates, involve duplicate or overlapping datasets, include hemorrhagic or mixed stroke without separable ischemic-stroke data, or do not provide clearly extractable motor dysfunction-related data. Two reviewers will independently screen, extract, and assess methodological quality. Using anisotropic effect-size seed-based d mapping (AES-SDM), the quantitative synthesis will pool coordinates to detect convergent patterns of both increased and decreased regional spontaneous activity. Where data allow, we will conduct subgroup analyses, jackknife sensitivity testing, heterogeneity assessment, and meta-regression. The protocol follows the PRISMA-P statement, and the completed review will adhere to PRISMA 2020.</p><p><strong>Conclusion: </strong>This protocol outlines a systematic review and AES-SDM coordinate-based meta-analysis aimed at synthesizing regional spontaneous activity abnormalities in ischemic stroke patients with motor dysfunction. The results should identify convergent areas of local functional alteration, generating testable predictions for future research on post-stroke motor-network reorganization and rehabilitation.</p><p><strong>Clinical trial registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD420261359426, identifier CRD420261359426.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1933104"},"PeriodicalIF":3.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13692926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265702","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":"Effect of epidural spinal cord stimulation combined with personalized neurorehabilitation in chronic motor-complete spinal cord injury: study protocol for the phase II single-arm feasibility RESTORES (RESToration Of Rehabilitative function with Epidural spinal Stimulation) trial.","authors":"Kai Rui Wan, Zhi Yan Valerie Ng, Seng Kwee Wee, Fatimah Misbaah, Wen Li Lui, Min Wee Phua, Tegan Plunkett, Neethu Robinson, Aung Aung Phyo Wai, Cuntai Guan, Ananda Sidarta, Rosa Qi Yue So, Brian Premchand, Kezia Susanto, Luca Cocchi, Seyed Ehsan Saffari, Rui Xin Justin Ker, Wai Hoe Ng","doi":"10.3389/fneur.2026.1967078","DOIUrl":"https://doi.org/10.3389/fneur.2026.1967078","url":null,"abstract":"<p><strong>Background: </strong>Chronic motor-complete spinal cord injury (SCI) results in profound neurological disability with minimal prospects for functional recovery using conventional rehabilitation strategies. Emerging evidence suggests that epidural spinal cord stimulation (eSCS) can activate dormant spinal locomotor networks and restore volitional and autonomic functions when combined with intensive activity-based training. However, systematic evaluation of multimodal neuromodulation approaches integrating advanced rehabilitation and computational neurophysiology remains limited.</p><p><strong>Methods: </strong>The RESTORES trial (RESToration Of Rehabilitative function with Epidural spinal Stimulation) is a prospective, single-arm Phase II feasibility study enrolling 15 adults with chronic (≥1 year) motor-complete SCI (American Spinal Injury Association Impairment scale (AIS) A or B) between C5 and T12. Participants will undergo implantation of an epidural spinal cord stimulator followed by a 24-week program of structured stimulation-coupled personalised neurorehabilitation (five sessions per week). Clinical outcomes will be evaluated using standardized neurological and functional measures including the AIS motor score, Spinal Cord Independence Measure version III (SCIM-III), Walking Index for Spinal Cord Injury II (WISCI-II), and Trunk Assessment Scale (TASS). Autonomic function and quality of life will also be assessed. Multimodal neurophysiological measurements-including surface electromyography (sEMG), electroencephalography (EEG), resting-state functional magnetic resonance imaging (rs-fMRI), and computer-vision-based movement analysis-will be performed to investigate neural recovery mechanisms and inform the development of adaptive neuromodulation systems.</p><p><strong>Study outcomes: </strong>The primary outcome is the safety of epidural spinal cord stimulation implantation, defined as the absence of device explantation for safety-related reasons within 6 months following implantation. Secondary outcomes include changes in AIS motor score, functional outcomes (SCIM, WISCI-II, TASS), autonomic function, quality of life, and neurophysiological biomarkers.</p><p><strong>Discussion: </strong>This study integrates neuromodulation, advanced rehabilitation technologies, and multimodal computational neurophysiology to evaluate both clinical efficacy and neural mechanisms of recovery following chronic SCI. Findings from the RESTORES trial will provide critical safety and feasibility data to inform future multicenter trials and the development of closed-loop spinal cord stimulation systems.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov, Identifier NCT05644171.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1967078"},"PeriodicalIF":3.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13692923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265761","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":"Patient counseling across neurologic subspecialties-a single academic center study.","authors":"Raed Hailat, Benjamin Templeton, Nicholas Capaci, Andrew George, Ankit Annapareddy, Kevin Kerber, James Burke","doi":"10.3389/fneur.2026.1884883","DOIUrl":"10.3389/fneur.2026.1884883","url":null,"abstract":"<p><strong>Background and objectives: </strong>Counseling is a routine part of neurologic care, but little is known about how commonly it is documented. We sought to characterize counseling in routine neurologic care by determining the proportion of visits with documented counseling, describe forms of counseling, and investigate factors that predict documentation of counseling.</p><p><strong>Materials and methods: </strong>We performed a cross-sectional study via retrospective chart reviews of 994 neurologic subspeciality outpatient encounters at a tertiary academic medical center from September 2023 to October 2023. The main outcome of this analysis was documented counseling (Yes/No) which was established via protocol-driven pre-specified chart review with assessment of abstraction reliability. Secondary outcomes included lifestyle modification (e.g., exercise, sleep, diet, alcohol, safety) and medication/disease specific education counseling (e.g., headache, seizure, medication, cognitive, stroke). We used a multivariable generalized estimating equations regression model with clustering at the provider level to compare how patient counseling varied across provider subspecialities.</p><p><strong>Results: </strong>Out of 994 outpatient encounters, 38% (<i>n</i> = 374) of visits had any documented counseling. Counseling on medication/disease specific education (28%, <i>n</i> = 276) was more common than on lifestyle education (6%, <i>n</i> = 60). The neurologic subspecialties with highest percentage of documented counseling were headache (73%), epilepsy (51%), and stroke (41%) while the neurologic subspecialties with the lowest percentage of any documented patient counseling were neuromuscular (19%), cognitive (15%), and multiple sclerosis (11%). Headache subspecialists were the only provider group to have increased odds of counseling (OR = 3.6, CI: 1.3-9.9) compared to general neurologists, while cognitive and multiple sclerosis subspecialists had 73% (CI: 42%-78%) and 72% (CI: 25%-89%) lower odds of documenting any counseling. Patient demographics were not statistically significantly associated with frequency of counseling.</p><p><strong>Discussion: </strong>Our study demonstrated significant variability in frequency and types of counseling documented across neurologic outpatient encounters and between subspecialists. The findings suggest that patient counseling may be undocumented and/or under-employed in certain fields. Future multi-centered studies are needed to understand documentation practices, actual performance of counseling relative to documentation, and patient clinical outcomes after participating in counseling.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1884883"},"PeriodicalIF":3.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244169","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":"VB-ROI-focused segmentation-to-morphometry workflow for vertebrobasilar dolichoectasia assessment on MRA.","authors":"Jianheng Guan, Zhihua Liu, Hongkai Qiu, Chuanming Chen, Shujuan Yang, Jinfeng Cui, Zhibin Dai, Jin Zhang","doi":"10.3389/fneur.2026.1943260","DOIUrl":"10.3389/fneur.2026.1943260","url":null,"abstract":"<p><strong>Introduction: </strong>Vertebrobasilar dolichoectasia (VBD) is closely associated with posterior circulation infarction; however, reliable MRA-based morphometric quantification is hindered by the challenges of delineating the basilar artery (BA) and bilateral vertebral arteries (R-VA and L-VA). These vessels are characterized by their thin, elongated structure, spatial localization, and high sensitivity to boundary deviations, endpoint instability, and centerline discontinuity, which render generic full-image vessel segmentation suboptimal for VBD-oriented morphometric analysis.</p><p><strong>Methods: </strong>In this study, we address this clinical-computational mismatch using a vertebrobasilar region-of-interest (VB-ROI)-focused segmentation-to-morphometry workflow. Initially, a full-image nnU-Net is employed for coarse anatomical localization, from which a prediction-derived VB-ROI is generated. Subsequently, a second nnU-Net performs fine segmentation of the BA/R-VA/L-VA within this anatomically focused field of view, and the restored full-size mask is utilized for segmentation evaluation and downstream morphometric quantification.</p><p><strong>Results: </strong>Compared to the direct full-image nnU-Net, the proposed two-stage VB-ROI workflow improved the mean Dice coefficient from 0.7974 to 0.9681, the mean Intersection over Union (IoU) from 0.7145 to 0.9412, and the mean centerline Dice from 0.7398 to 0.9206, while reducing the Hausdorff Distance at 95th percentile (HD95) from 8.6245 mm to 1.1709 mm. The prediction-derived VB-ROI demonstrated performance comparable to the ground-truth-based ROI setting without necessitating test-time ground truth, thus supporting the robustness of the localization strategy. Morphometric analysis indicated strong agreement in diameter-related measurements, while length, displacement, tortuosity, and curvature-related indices exhibited greater sensitivity to centerline extraction and endpoint definition.</p><p><strong>Discussion: </strong>These findings illustrate the technical feasibility of VB-ROI-focused segmentation for MRA-based vertebrobasilar morphometric quantification and provide a methodological foundation for future studies on VBD and posterior circulation infarction.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1943260"},"PeriodicalIF":3.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244185","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}