Neuroradiology最新文献

{"title":"Natural history of brain arteriovenous malformations in hereditary hemorrhagic telangiectasia: a longitudinal neuroimaging study and review of the literature.","authors":"Boyi Li, Karen Smith, Brayan Corona-Macedo, Bilal Battal, Raj Kasthuri, Sheng-Che Hung","doi":"10.1007/s00234-026-04208-0","DOIUrl":"https://doi.org/10.1007/s00234-026-04208-0","url":null,"abstract":"<p><strong>Purpose: </strong>The natural history of brain arteriovenous malformations (bAVMs) in Hereditary Hemorrhagic Telangiectasia (HHT) remains poorly understood and it has been suggested that they may have a benign course different from sporadic bAVMs. Here, we present a single-center longitudinal study evaluating the growth of bAVMs over time as assessed by serial MRIs.</p><p><strong>Methods: </strong>We performed a retrospective analysis of 44 patients with suspected bAVMs followed at an HHT Center of Excellence from 2014 to 2024. We excluded patients that did not have serial MRIs and/or poor-quality MRIs, and patients without radiographic bAVMs. Primary outcome was growth of bAVM as measured by largest dimension on T1 post-contrasted weighted sequences of serial MRIs. Secondary outcome was hemorrhage from bAVM rupture.</p><p><strong>Results: </strong>Twelve patients (3 male, 9 female) met our criteria. Average age at first MRI was 39.9 years (range 6-65 years). Ten patients had micro-bAVMs and 3/10 of these patients had multiple micro-bAVMs. None of the micro-bAVMs showed any growth on serial MRIs. The other two patients in our study had bAVMs with niduses > 1 cm and showed an average rate of growth of 1.61 mm/year. Ultimately, none of our patients had rupture of bAVMs over an average radiographic follow-up of 4.15 years and a total of 49.78 patient years.</p><p><strong>Conclusion: </strong>Our study suggests that bAVMs in HHT patients may have a benign natural history. We found no hemorrhages and noted minimal growth of bAVMs on serial MRIs. Our results suggest HHT patients with bAVMs may not warrant frequent surveillance imaging.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112853","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":"Safety and efficacy of endovascular treatment in symptomatic pediatric cerebral venous sinus thrombosis.","authors":"Jinyi Li, Chunmei Wang, Kai Liu, Xiaojie Fu, Shuo Liu, Haowen Xu, Yuan Gao, Xinbin Guo, Bo Song, Sheng Guan, Tao Quan","doi":"10.1007/s00234-026-04196-1","DOIUrl":"https://doi.org/10.1007/s00234-026-04196-1","url":null,"abstract":"<p><strong>Objective: </strong>Current guidelines recommend anticoagulation as the first-line treatment for pediatric cerebral venous sinus thrombosis (CVST), while the application, safety, and standardized regimen of endovascular treatment (EVT) in children remain controversial. This study aimed to evaluate the safety and efficacy of EVT for pediatric CVST and summarize the individualized endovascular strategy of thrombolysis and thrombectomy.</p><p><strong>Methods: </strong>A retrospective analysis was performed on pediatric patients (aged < 18 years) who received EVT for CVST at a single comprehensive medical center from March 2013 to November 2024. Baseline clinical data, imaging characteristics, procedural methods, perioperative complications, and follow-up outcomes were collected and analyzed.</p><p><strong>Results: </strong>A total of 45 pediatric CVST patients were enrolled, with a mean age of 14.8 years. The main clinical manifestations included headache (82.2%) and impaired consciousness (37.8%), and 88.9% of patients presented with multi-sinus thrombosis, accompanied by parenchymal hemorrhage in 31.1% of cases. The treatment strategies included simple thrombolysis (22.2%), simple thrombectomy (37.8%), and combined therapy (40.0%). The median daily individualized urokinase dose was 13,000 U/kg for 5-7 days. The median AVOIS score decreased from 5 at baseline to 2 at discharge. Two cases of intraoperative venous sinus perforation and one case of symptomatic intracranial hemorrhage were observed. At a median follow-up of 68 months, all patients achieved favorable functional outcomes.</p><p><strong>Conclusion: </strong>Endovascular treatment represents a valuable rescue option for pediatric CVST patients with severe neurological symptoms. The dose of urokinase should be individualized during thrombolysis with or without mechanical thrombectomy.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112858","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":"Differentiating pituitary metastases from pituitary neuroendocrine tumors in patients with a history of malignancy: clinical and magnetic resonance imaging features and quantitative morphometric analysis.","authors":"Miduo Zhu, Jingcheng Hu, Yiwen Yang, Wensheng Wang, Peng He, Tiantian Zhang, Xiaoquan Xu, Feiyun Wu, Yan Ren, Chunhong Hu","doi":"10.1007/s00234-026-04200-8","DOIUrl":"https://doi.org/10.1007/s00234-026-04200-8","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the clinical and MRI findings of pituitary metastases (PMs) and pituitary neuroendocrine tumors (PitNETs) in patients with a history of malignancy and to assess quantitative morphologic parameters in dumbbell-shaped lesions.</p><p><strong>Methods: </strong>Clinical and MRI data from 13 patients with PMs and 31 patients with PitNETs were retrospectively reviewed. For 27 dumbbell-shaped lesions, quantitative linear measurements were performed, and the R value was defined as the ratio of the neck diameter to the combined suprasellar and intrasellar widths. Receiver operating characteristic analysis assessed diagnostic performance.</p><p><strong>Results: </strong>Patients with PMs had a shorter symptom-to-detection interval (P = 0.003) and more commonly presented with headache (P = 0.004). Compared with the PitNET group, the PM group showed a higher contrast-enhanced T1-weighted signal intensity ratio (P = 0.035), more frequent pituitary stalk involvement (P = 0.024), less frequent preservation of the posterior pituitary bright spot (P < 0.001), and less frequent sellar enlargement (P = 0.010). In the subgroup with dumbbell-shaped lesions, the PM group had a smaller coronal suprasellar width (P = 0.004), smaller coronal and sagittal neck diameters, and lower coronal and sagittal R values (all P < 0.001). Coronal neck diameter and coronal R value yielded AUCs of 0.986 and 0.971, respectively.</p><p><strong>Conclusion: </strong>In patients with a history of malignancy and a newly detected sellar lesion, a shorter symptom-to-detection interval, headache, pituitary stalk involvement, loss of the posterior pituitary bright spot, marked enhancement, and limited sellar enlargement may suggest PM. In dumbbell-shaped lesions, a smaller neck diameter and lower R value may provide supplementary quantitative information for differentiating PMs from PitNETs.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112827","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":"Predictors of adjacent level fractures following kyphoplasty for vertebral compression fractures of all etiologies: A retrospective cohort study.","authors":"Santiago Quiceno-Ramirez, Chi M Trinh, Rebecca Choi, Jordan Darden, Julianna Barbaro, Lisa Apfel, Jacob Schick, Sasicha Manupipatpong, Majid Khan","doi":"10.1007/s00234-026-04204-4","DOIUrl":"https://doi.org/10.1007/s00234-026-04204-4","url":null,"abstract":"<p><strong>Background and purpose: </strong>Adjacent-level fracture (ALF) is frequently observed following vertebral augmentation, although recent evidence suggests it is largely a disease-related event rather than a consequence of the procedure itself. Existing data derive almost exclusively from osteoporotic fractures treated with vertebroplasty. We sought to identify predictors of ALF after kyphoplasty for vertebral compression fractures (VCFs) of all etiologies.</p><p><strong>Materials and methods: </strong>This retrospective, single-center cohort study included adults undergoing first-time kyphoplasty for VCFs between 2015 and 2025 with pre-procedural imaging and at least one post-procedural follow-up imaging study. Fracture mechanism was dichotomized as atraumatic (spontaneous or pathological) versus traumatic (fall or trauma). The primary outcome was radiologically confirmed new fracture immediately adjacent to an augmented level. Time to ALF was analyzed with Cox proportional-hazards regression; univariably significant variables were entered into a multivariable model.</p><p><strong>Results: </strong>Among 192 patients (median age, 71 years; 143 women [74.5%]), ALF occurred in 39 (20.3%) at a median of 125 days. Cumulative incidence was 16.7% at 180 days and 26.6% at 1 year. Factors independently associated with ALF were atraumatic mechanism (adjusted HR, 3.63; 95% CI, 1.82-7.23; P < 0.001), older age (adjusted HR, 1.26 per 5 years; 95% CI, 1.03-1.55; P = 0.027); a longer fracture-to-augmentation interval was protective (adjusted HR, 0.82 per 30 days; 95% CI, 0.68-0.99; P = 0.038). Multilevel augmentation was associated with ALF on univariable analysis (HR, 2.73; 95% CI, 1.42-5.24; P = 0.003). New fractures involved a cranial level in 22 patients (56.4%), a caudal level in 13 (33.3%) and both cranial and caudal levels in 4 (10.3%). Cement type, thoracolumbar junction involvement, bisphosphonate use, documented osteoporosis, and index fracture severity were not associated with ALF.</p><p><strong>Conclusions: </strong>In this cohort, older age, atraumatic fracture mechanism, and a shorter interval from fracture diagnosis to augmentation were associated with ALF after kyphoplasty across all VCF mechanisms, and multilevel augmentation was associated with ALF, with the association appearing to emerge predominantly beyond 180 days. These variables plausibly reflect a shared underlying burden of skeletal compromise. Given substantial loss to follow-up and limited follow-up duration, these associations require confirmation in prospective cohorts but may help identify patients who could benefit from closer clinical follow-up and increased awareness of subsequent fracture risk.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075379","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":"MRI findings of trigeminal nerve hypoplasia in congenital corneal anesthesia: a case series.","authors":"Romi Noy Achiron, Li-Tal Pratt, Iliya Simantov, Issac Levy, Azzam Ghaben, Raimo Tuuminen, Uri Elbaz","doi":"10.1007/s00234-026-04197-0","DOIUrl":"https://doi.org/10.1007/s00234-026-04197-0","url":null,"abstract":"<p><strong>Purpose: </strong>Congenital corneal anesthesia (CCA) is a rare pediatric disorder characterized by absent corneal sensation and potential for severe ocular complications. Imaging literature remains limited and radiologic awareness is low. We report MRI findings in pediatric CCA using high-resolution heavily T2-weighted sequences to characterize trigeminal nerve morphology and review the current literature systematically.</p><p><strong>Methods: </strong>A descriptive case series of consecutive pediatric patients with clinical suspicion of CCA, referred to the pediatric ophthalmology service at a tertiary medical center, with one additional patient from a second institution, between March 2021 and February 2025. All patients underwent brain MRI; high-resolution heavily T2-weighted sequences (FIESTA, DRIVE, or T2 SPACE) were used where available.</p><p><strong>Results: </strong>Four pediatric patients (age range 6 months to 3 years, one female) were evaluated. Trigeminal nerve abnormalities were identified in all four patients, including unilateral hypoplasia or thinning (three patients), bilateral thinning (one patient), and hypoplastic Meckel's cave in two patients. All patients demonstrated ipsilateral corneal anesthesia and pathology, including ulceration, scarring, and neovascularization.</p><p><strong>Conclusions: </strong>Trigeminal nerve hypoplasia on high-resolution T2-weighted MRI appears to be a consistent imaging finding in pediatric CCA. Dedicated high-resolution T2-weighted sequences depicting the trigeminal nerve course are essential. This series aims to increase awareness of this rare diagnosis, for which an early surgical procedure may save vision and prevent corneal blindness.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075373","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":"Development of a recurrence risk prediction model for intracranial atherosclerotic stroke using HR-VWI combined with radiomics.","authors":"Ru Xu, Jing Wang, Peng Yang","doi":"10.1007/s00234-026-04198-z","DOIUrl":"https://doi.org/10.1007/s00234-026-04198-z","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Based on high-resolution vessel wall imaging (HR-VWI) and radiomics, this study constructed a predictive model for stroke recurrence in patients with symptomatic intracranial atherosclerotic stenosis (sICAS), and evaluated the performance of the model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This study retrospectively included 90 patients with sICAS who were treated in a tertiary hospital in China from January 2020 to December 2024. No a priori power calculation was performed; the sample size was based on the availability of complete HR-VWI and follow-up data during the study period. The imaging features of plaques were measured in T1WI and enhanced T1WI images of all patients, and the regions of interest of plaques were delineated and radiomics features were extracted. All the samples were randomly divided into training set (n = 63) and validation set (n = 27) at a ratio of 7 : 3. To address class imbalance, we employed the Synthetic Minority Over-sampling Technique (SMOTE) within the training set during model development. After feature screening, radiomic score (rad-score) was constructed. Based on the conventional imaging features, radiomics features and clinical related information of vascular plaques, the clinical prediction model, radiomics prediction model and the combined model of the two were established in turn. Receiver operating characteristic (ROC), area under the curve (AUC), calibration curve and decision curve analysis (DCA) were used to comprehensively evaluate the predictive efficacy of various models. At the same time, a nomogram was constructed to visualize the model, providing an intuitive reference for clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;During the follow-up period, a total of 26 patients (28.9%) had stroke recurrence. Patients in the recurrence group had higher levels of low-density lipoprotein and total cholesterol, lower plaque load, and higher degree of plaque enhancement, and the differences were statistically significant (P = 0.004), and plaque enhancement grade was an independent risk factor (OR = 11.023, P = 0.001). Finally, a total of 14 radiomics features were selected to construct the rad-score scoring system. In the training set and validation set, the AUC corresponding to the combined prediction model reached 0.947 and 0.925, respectively, and its prediction efficiency was significantly better than that of a single clinical model and an independent radiomics model. The nomogram showed good calibration and high clinical net benefit.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The combined model of HR-VWI radiomics features and traditional imaging indicators has excellent performance in the prediction of stroke recurrence in sICAS patients. However, due to the limited sample size (n = 90, with only 26 recurrent events) and the high-dimensional radiomic feature space (n = 1920), Our findings are at a high risk of overfitting. Despite the use of rigorous regularization tech","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149062902","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":"Endovascular straightening of tortuous dissected cervical ICA: a retrospective study in acute stroke.","authors":"Jawid Madjidyar, Mate Czencz, Anna Kyselyova, Patrick Thurner, Tilman Schubert, Christoph Globas, Zsolt Kulcsar","doi":"10.1007/s00234-026-04199-y","DOIUrl":"https://doi.org/10.1007/s00234-026-04199-y","url":null,"abstract":"<p><strong>Purpose: </strong>Endovascular treatment of acute symptomatic internal carotid artery (ICA) dissection with severe tortuosity can be technically challenging. Conventional anatomy-preserving stenting in highly tortuous anatomy may result in suboptimal stent-wall apposition and acute vessel re-occlusion. We describe an endovascular straightening technique designed to geometrically correct vessel tortuosity and report preliminary experience compared to conventional treatment.</p><p><strong>Methods: </strong>This retrospective single-center study included consecutive patients with acute ischemic stroke due to ICA dissection treated endovascularly between 2021 and 2026. Patients received either geometric vessel straightening of the cervical ICA (n = 15) or conventional anatomy-preserving stenting (n = 16). Endpoints were acute stent occlusion (≤ 24 h), 90-day functional independence (modified Rankin Scale 0-2), and symptomatic intracranial hemorrhage (sICH).</p><p><strong>Results: </strong>Baseline characteristics were balanced between groups. Tandem occlusions were present in 86.7% and 75% of patients, respectively. Acute stent occlusion within 24 h occurred in 1 patient (6.7%) in the straightening group versus 4 patients (25%) in controls (p = 0.333). At 90 days, functional independence was achieved in 86.7% versus 62.5% (absolute difference 24.2%, p = 0.215). sICH occurred in 0% versus 18.8% (p = 0.226). All three patients with sICH developed subsequent stent occlusion.</p><p><strong>Conclusion: </strong>In this retrospective study, endovascular straightening of severely tortuous dissected cervical ICAs appeared technically feasible, with numerically lower rates of acute stent occlusion and sICH and improved functional independence, though differences were not statistically significant. Given the small sample size, findings should be considered exploratory and hypothesis-generating, warranting prospective, adequately powered validation.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149062865","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":"The value of \"Black-Bone\" MR imaging in pediatric spondylolysis: impact on diagnostic confidence and accuracy in experienced and non-experienced readers.","authors":"Francesco Pacchiano, Filippo Arrigoni, Chiara Doneda, Jacopo Carlo Poli, Giana Izzo, Mario Tortora, Irina Stavarache, Ferdinando Caranci, Cecilia Parazzini, Andrea Righini","doi":"10.1007/s00234-026-04195-2","DOIUrl":"https://doi.org/10.1007/s00234-026-04195-2","url":null,"abstract":"<p><strong>Introduction: </strong>Lumbar spondylolysis is a common cause of low back pain in adolescents, yet early and confident diagnosis often requires CT, exposing patients to radiation. The Black-Bone (BB) MR sequence is a 3D low-flip-angle gradient-echo (GRE) acquisition designed to enhance bone-soft tissue contrast. This study assessed whether adding BB to a standard pediatric lumbar MRI protocol improves diagnostic accuracy, interreader-agreement, and confidence.</p><p><strong>Methods: </strong>Forty-four adolescents (mean age, 12 years; 23 girls, 21 boys) with suspected spondylolysis underwent lumbar MRI including BB, with radiographs and/or CT as reference standard. Thirty patients had confirmed spondylolysis and 14 served as controls. Four blinded readers (2 senior neuroradiologists, 2 residents) independently reviewed all cases twice: first with standard MRI only, then with BB included. Readers scored each pars interarticularis level and side (0 = negative, 1 = probable, 2 = definite). Interrater agreement (weighted Cohen's κ), sensitivity, specificity, PPV, NPV, and accuracy were calculated.</p><p><strong>Results: </strong>BB improved interrater agreement across all pairs (κ 0.81-0.93 vs. 0.59-0.82 pre-BB). Sensitivity increased for all readers (+ 5-12% points), while specificity remained high (0.89-1.00). PPV was consistently excellent (0.93-1.00), and NPV improved with BB (0.83-0.87 vs. 0.75-0.83 pre-BB). Ambiguous ratings dropped from 58 pre-BB to 5 post-BB, resolving > 90% of indeterminate assessments. Accuracy increased by approximately 2-5% points, whereas diagnostic confidence showed a larger improvement.</p><p><strong>Conclusion: </strong>Incorporating BB into pediatric lumbar MRI protocols improved interreader agreement and diagnostic confidence while markedly reducing equivocal interpretations. Although diagnostic performance metrics improved, these findings should be interpreted cautiously given the limited CT correlation. BB may represent a practical radiation-free adjunct to standard MRI for evaluating suspected pediatric spondylolysis.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149062890","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":"Imaging features of adult-onset leukoencephalopathy with axonal spheroids and pigmented glia: a case report.","authors":"Mansi Shah, Michelle Rochman, Nicole Calautti, Tsao-Wei Liang, Joga Chaganti","doi":"10.1007/s00234-026-04209-z","DOIUrl":"https://doi.org/10.1007/s00234-026-04209-z","url":null,"abstract":"<p><strong>Background: </strong>Adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP) is a rare, progressive white matter disorder caused by pathogenic variants in the CSF1R gene. It typically presents in mid-adulthood with progressive cognitive, motor, and neuropsychiatric decline, but its phenotypic variability often leads to delayed diagnosis.</p><p><strong>Case presentation: </strong>We describe a 41-year-old woman with no prior neurological history or relevant psychiatric tendencies who developed progressive cognitive impairment, urinary incontinence, gait disturbance, and sleep disruption over 3-4 years. Brain MRI revealed confluent frontoparietal and periventricular white matter hyperintensities with sparing of the posterior fossa and temporal lobes, chronic non-vascular diffusion restriction in the bilateral corona radiata and thinning of the corpus callosum. CT demonstrated punctate calcifications in the inferior corpus callosum. Genome sequencing identified a paternally inherited heterozygous pathogenic variant in the CSF1R gene (c.2344C>T; p.Arg782Cys), confirming ALSP.</p><p><strong>Discussion: </strong>ALSP results from microglial dysfunction leading to impaired myelin maintenance, chronic axonal injury, and reactive pigmented macrophage infiltration. The corpus callosum, due to its dense myelination, is particularly vulnerable, explaining its characteristic atrophy and calcifications. Persistent, non-vascular DWI restriction distinguishes ALSP from many mimics, including AARS2-related leukoencephalopathy, which typically lacks calcifications and presents earlier. Recognition of these imaging features is essential for timely access to genetic testing and confirmatory diagnosis.</p><p><strong>Conclusion: </strong>ALSP should be considered in adults with progressive neuropsychiatric symptoms and compatible imaging findings. Awareness of hallmark MRI and CT features-particularly corpus callosum calcifications and non-vascular diffusion restriction-can expedite genetic testing, improve diagnostic accuracy, and guide patient care.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137714","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":"Characterizing clot composition and stroke etiology through hounsfield units.","authors":"Andres Gudino, Carlos Dier, Martin Cabarique, Alexander Van Dam, Alina Rivadeneira-Limongi, Emily Baniewicz, Mario S Hinojosa-Figueroa, Arshaq Saleem, Divanshu Sharma, Navami Shenoy, Elena Sagues, Arathi Ashok, Susan A Walsh, Malik Ghannam, Osorio Lopes Abath Neto, Edgar A Samaniego","doi":"10.1007/s00234-026-04193-4","DOIUrl":"https://doi.org/10.1007/s00234-026-04193-4","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to analyze clot composition using Hounsfield Units (HU) in non-enhanced computed tomography (NECT).</p><p><strong>Methods: </strong>Thrombi retrieved from mechanical thrombectomy (MT) were imaged on micro-computed tomography (micro-CT) and histologically analyzed. Micro-CT slides were matched to histological sections. Spearman's rank correlation was performed to correlate micro-CT HU with red blood cells (RBCs) and fibrin composition. A sensitivity analysis was conducted between micro-CT HU and histological slides with > 70% of these components. The same clots were then localized in the pre-MT NECT, and NECT HU values were obtained. Micro-CT HU and NECT HU were correlated for histologically informed interpretation. Receiver operating characteristic analysis was performed to retrieve NECT HU thresholds. A dataset of patients who presented with large vessel occlusion of cardioembolic, large artery atherosclerosis (LAA), and cryptogenic strokes were then assessed through NECT HU.</p><p><strong>Results: </strong>Ten thrombi were analyzed. Micro-CT HU were strongly correlated with histological sections with > 70% of RBCs (Rho 0.675) but not to sections with > 70% of fibrin (Rho 0.325). Micro-CT HU and NECT HU of clots that had > 70% of RBCs were strongly correlated (Rho 0.774). NECT HU of 44 had a sensitivity of 67% and specificity of 86% to determine clots with > 70% of RBCs. A total of 240 NECT images were analyzed including 80 cardioembolic, 80 LAA and 80 cryptogenic strokes. NECT HU assessment showed that 75% of cardioembolic, 40% of LAA and 55% of cryptogenic clots are composed of RBCs.</p><p><strong>Conclusion: </strong>NECT HU is a promising tool to assess clot RBCs composition and infer stroke etiology.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031053","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}