Neuroradiology最新文献

{"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":"<p><strong>Objective: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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}

{"title":"The impact of teleradiology: balancing clinical benefits and operational limitations.","authors":"Reza Mosaddeghi-Heris, Kimia Bagheri, Ali Adib, Amir Tahavvori, Hadi Sahrai, Ali Norouzi, Saba Mehrtabar, Niloofar Taheri, Maryam Farzaneh, Houman Sotoudeh","doi":"10.1007/s00234-026-04183-6","DOIUrl":"https://doi.org/10.1007/s00234-026-04183-6","url":null,"abstract":"<p><strong>Purpose: </strong>This review provides a global overview of the clinical benefits and operational limitations of teleradiology. It synthesizes evidence from diverse healthcare settings and considers how teleradiology may evolve alongside ongoing digital transformation.</p><p><strong>Materials and methods: </strong>Search and screening were informed by PRISMA principles and covered PubMed, Scopus, and Web of Science from 2018 to 2025. Eligible studies were peer-reviewed articles addressing the clinical use, operations, costs, and regulation of teleradiology, with an emphasis on international perspectives.</p><p><strong>Results: </strong>Teleradiology improves access to subspecialty expertise and enables round-the-clock coverage; reported turnaround-time reductions reached up to 89% in individual studies, though the magnitude varied substantially by setting and should not be generalized as a single effect. It may also help reduce diagnostic disparities in resource-limited settings, though this benefit depends on local staffing and infrastructure. Reported cost savings vary by model; associated environmental benefits are plausible, but the evidence does not support a single generalized estimate of emissions reduction across service models. However, important limitations persist: unreliable internet connectivity remains a substantial and unevenly distributed barrier, particularly in rural and low-resource settings; missing prior imaging and incompatible PACS systems can reduce interpretation quality and completeness; and data security breaches remain a concern. Cross-border practice also raises legal challenges, with 82% of respondents in one national survey ranking liability concerns among the top barriers to adoption.</p><p><strong>Conclusion: </strong>Teleradiology has become central to contemporary radiology practice, advancing efficiency and equity in imaging access worldwide. Addressing its remaining challenges will require structured quality-assurance systems, interoperable and resilient digital infrastructure, practical regulatory evolution supporting cross-border licensing, and evidence-based integration of artificial intelligence with continued radiologist oversight.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017692","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":"Multi-pedicle versus single-pedicle middle meningeal artery embolization for nonacute subdural hematoma.","authors":"Garrett W Thrash, Bluyé DeMessie, Elijah L Wang, Jesse G Jones, Muhammed Amir Essibayi, Hamza Adel Salim, Alireza Karandish, Deepak Khatri, Neil Haranhalli, Amanda Baker, Richard Zampolin, Allan L Brook, Seon-Kyu Lee, Nimer Adeeb, Dhairya A Lakhani, Yan-Lin Li, Davide Simonato, Diego Alejandro Ortega, Nicole Cancelliere, Jose Danilo Diestro, Joseph Carnevale, Craig Schreiber, Atakan Orscelik, Zachary Abecassis, Spencer Raub, Georgios S Sioutas, Abdulrhman Alsalama, Clairice Pearce, Giancarlo Salsano, Rahim Abo Kasem, Svetlana Kvint, Andrew Falzon, Vance Cantrell, Brian Holliday, Jefferson O Abaricia, Pedram D Maleknia, Leonardo Cruz-Criollo, Samantha Schimmel, Basel Musmar, Matthew Alexander, Jorge Rios Zermeno, Prateeka Koul, Ahmed Aljuboori, Dominik F Vollherbst, Domagoj Gajski, Jared Cooper, Omar Alwakaa, Mohamad Ezzeldin, James Grist, Fulvio Zaccagna, Christopher S Ogilvy, Fawaz Al-Mufti, Vladimir Kalousek, Markus A Möhlenbruch, Luca Scarcia, William W Wroe, Hussein A Zeineddine, Si Zhao Tang, Peter B Sporns, Anil Gopinathan, Robert W Regenhardt, Spiros L Blackburn, Clemens M Schirmer, Thien Huynh, Rabih G Tawk, Fabio Settecase, Stavropoula Tjoumakaris, Pascal Jabbour, Kunal Vakharia, Mario Zanaty, Santiago Ortega-Gutierrez, Marco Colasurdo, Hussein H Nasser, Sri Hari Sundararajan, Pascal J Mosimann, Erez Nossek, Eytan Raz, Sami Al Kasab, Alejandro M Spiotta, Lucio Castellan, Bruno Del Sette, Ali Alaraj, Caterina Michelozzi, Davide Saraceno, Pietro Panni, Visish M Srinivasan, Jan-Karl Burkhardt, Gaultier Marnat, Pietro Mario Santini, Michael R Levitt, Giuseppe Lanzino, Waleed Brinjikji, Jared Knopman, Tareq Kass-Hout, Julian Spears, Thomas Marotta, Vitor Mendes Pereira, Maurizio Fuschi, Tufail Patankar, David J Altschul, Adam A Dmytriw","doi":"10.1007/s00234-026-04187-2","DOIUrl":"https://doi.org/10.1007/s00234-026-04187-2","url":null,"abstract":"<p><strong>Introduction: </strong>Nonacute subdural hematomas (nSDH) are common yet serious extra-axial hemorrhages that result in significant morbidity and mortality. Middle meningeal artery (MMA) embolization (MMAE) is a recent endovascular treatment that involves occlusion of the MMA, inducing hemostasis in and around the hematoma. While many aspects of MMAE have been explored, there is currently limited data on the optimal extent of embolization.</p><p><strong>Objective: </strong>To determine whether single or multiple pedicle embolization of the MMA is superior in inducing hemostasis in nSDH.</p><p><strong>Methods: </strong>We compared single versus multi pedicle embolization by a retrospective multicenter analysis of nSDH patients who underwent MMAE between 2019 and 2024 at participating centers in the MESH (MMA Embolization for Subdural Hematoma) Registry. 679 patients who received a liquid embolic agent with branch-level embolization data were included.</p><p><strong>Results: </strong>While multi-pedicle embolization hastened nSDH thinning at 1 month (5.7 vs. 3.3 mm reduction; difference 2.4 mm, 95% CI 1.0-3.8; P = .002), by 3 months thickness reduction had converged between groups (8.2 vs. 8.4 mm; P = .91). Among 679 patients (456 multi-pedicle, 223 single-pedicle), favorable functional outcome (mRS 0-2) was more frequent with multi-pedicle embolization (53.5% vs. 43.0%; adjusted OR 1.81, 95% CI 1.26-2.60; P = .001), whereas recurrence, rescue surgery, and treatment failure did not differ.</p><p><strong>Conclusion: </strong>Future, multi-center randomized prospective trials are warranted to address confounding variables that limit this observational study. Follow-up beyond 3 months was limited, so durability is unknown.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017726","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":"Multimodal clinical-radiomic-deep learning model for preoperative classification of pediatric pineal region tumors.","authors":"Xuening Zhao, Ying Yan, Xiaochen Wang, Sihui Wang, Lingxu Chen, Mengyuan Yuan, Shengjun Sun","doi":"10.1007/s00234-026-04175-6","DOIUrl":"https://doi.org/10.1007/s00234-026-04175-6","url":null,"abstract":"<p><strong>Background: </strong>Accurate preoperative differentiation among germinomas, non-germinomatous germ cell tumors (NGGCTs), and pineal parenchymal tumors (PPTs) is clinically crucial for treatment strategies.</p><p><strong>Objectives: </strong>To develop and compare predictive models integrating clinical, radiomic, and deep learning (DL) features for the preoperative classification of pediatric pineal region tumors.</p><p><strong>Methods: </strong>This retrospective study included 280 pediatric patients with pineal region tumors (94 germinomas, 119 NGGCTs, and 67 PPTs), randomly divided into training and testing cohorts (7:3 ratio). Clinical features included demographic, imaging, and laboratory variables. Radiomic and 2.5D DL features were extracted from multiparametric MRI (T1WI, T2WI, CE-T1WI). After z-score normalization and feature selection with Pearson correlation and least absolute shrinkage and selection operator (LASSO) regression, logistic regression classifiers were built to develop clinical, radiomics, DL, and combined clinic-radiomic-deep learning (CRDL) models. Class weights inversely related to sample frequencies were used to balance the classes during training. Model performance was evaluated using ROC analysis, with DeLong's test for AUC comparison and decision curve analysis (DCA) for clinical utility. A reader study assessed diagnostic improvement with model assistance.</p><p><strong>Results: </strong>The CRDL model achieved the best overall diagnostic performance with a macro-average AUC of 0.912, statistically outperforming the other models. DCA further validated the clinical value of the CRDL model in preoperative tumor classification. Model-assisted interpretation improved diagnostic accuracy for both junior and senior radiologists.</p><p><strong>Conclusion: </strong>The proposed CRDL model showed promising performance for the noninvasive preoperative classification of pediatric pineal region tumors and may provide a potential decision-support tool for treatment planning.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002236","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":"Pipeline Shield versus Pipeline Flex for unruptured intracranial aneurysms: a propensity-matched multicenter study.","authors":"Runze Ge, Chao Peng, Wenxin Chen, Guangzhong Chen, Can Li, Peifeng Guan, Lele Dai, Zhuohua Wen, Chi Huang, Jiwan Huang, Jiancheng Lin, Mengshi Huang, Hao Yuan, Fengying Yuan, Yushan Wang, Yiming Bi, Shixing Su, Xin Zhang, Xifeng Li, Aihua Liu, Shuyin Liang, Chuanzhi Duan, Xin Feng","doi":"10.1007/s00234-026-04186-3","DOIUrl":"https://doi.org/10.1007/s00234-026-04186-3","url":null,"abstract":"<p><strong>Background: </strong>Pipeline Flex Embolization Device with Shield Technology (PED Shield) is designed to reduce the incidence of thrombosis events through phosphorylcholine coating. However, the comparative efficacy and safety of PED Shield and PED/PED Flex remain unclear.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of a prospectively maintained database at three advanced stroke centers from February 2016 to October 2024. Propensity score matching was employed to adjust for sex, age, hypertension, diabetes, hyperlipidemia, smoking, aneurysm location, morphology, size, coiling and follow-up duration. After matching, perioperative complications and clinical and angiographic outcomes were compared.</p><p><strong>Results: </strong>1039 patients treated by PED/PED Flex and 172 patients treated by PED Shield were enrolled. For clinical outcomes, 164 pairs were matched. No significant differences were found in total perioperative complications (7.9% vs. 4.9%, p = 0.259) and favourable prognosis (mRS score 0-2, 98.0% vs. 97.5%, p = 0.760) between the PED Shield and PED/PED Flex group. For angiographic outcomes, 121 pairs were matched. No significant differences were observed in complete occlusion (80.2% vs. 73.6%, p = 0.223), significant in-stent stenosis (ISS, ISS rate > 50%) (3.3% vs. 5.0%, p = 0.749) and symptomatic ISS (0.0% vs. 2.5%, p = 0.247) between the PED Shield and PED/PED Flex group. However, PED Shield had a lower incidence of ISS (ISS rate ≥ 25%, 5.0 vs. 14.9%, p = 0.010) at a mean follow-up time of 6-7 months.</p><p><strong>Conclusion: </strong>Compared with PED/PED Flex, PED Shield has a lower rate of ISS at a mean follow-up time of 6-7 months. No significant differences are observed in perioperative complications, clinical outcomes, complete occlusion, significant ISS and symptomatic ISS.</p><p><strong>Registration: </strong>URL: https://www.</p><p><strong>Clinicaltrials: </strong>gov ; Unique identifier: NCT06446778.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002300","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":"Selective embolization of an uncatheterizable trans-osseous feeder using a dual-balloon pressure cooker technique: technical note.","authors":"Vishnu Suresh, Siddharth Srinivasan, Patrick Opperman, Daniel Surdell, William Thorell, Mithun Sattur, Nicholas Borg","doi":"10.1007/s00234-026-04194-3","DOIUrl":"https://doi.org/10.1007/s00234-026-04194-3","url":null,"abstract":"<p><strong>Background: </strong>Embolization of dural arteriovenous fistulas (dAVFs) supplied by tortuous trans-osseous occipital artery (OA) feeders remains challenging when distal catheterization is not achievable and competing runoff diverts Onyx from the fistulous connection. We describe a novel dual-balloon flow-isolation technique.</p><p><strong>Case description: </strong>A 79-year-old woman with a Cognard type IV transverse sinus dAVF presented with cognitive decline, headache, and pulsatile tinnitus. Angiography demonstrated tortuous trans-osseous OA feeders converging on a fistulous connection with cortical venous reflux and a venous varix. Following unsuccessful feeder catheterization, two Scepter Mini balloon microcatheters were positioned within a single OA pedicle. Proximal and distal flow arrest selectively isolated a single feeding vessel, permitting forceful injection of diluted Onyx. Onyx traversed the trans-osseous feeders, crossed the fistulous connection, and filled the draining vein and venous varix, achieving complete angiographic obliteration without complications.</p><p><strong>Conclusions: </strong>Dual-balloon flow isolation may facilitate curative embolization when distal catheterization is not feasible and competing runoff limits Onyx penetration.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002295","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}