Clinical Neuroradiology最新文献

{"title":"Liquid Embolic Volume Does Not Predict Outcome After Middle Meningeal Artery Embolization for Chronic Subdural Hematoma.","authors":"Abdulrhman Alsalama, Bluyé DeMessie, Muhammed Amir Essibayi, Gaultier Marnat, Hamza Adel Salim, Alireza Karandish, Nimer Adeeb, Dhairya A Lakhani, Yan-Lin Li, Diego Alejandro Ortega, Joseph Carnevale, Atakan Orscelik, Zachary Abecassis, Georgios S Sioutas, Giancarlo Salsano, Rahim Abo Kasem, Andrew Falzon, Jefferson O Abaricia, Pedram D Maleknia, Leonardo Cruz-Criollo, Samantha Schimmel, Basel Musmar, Matthew Alexander, Ahmed Aljuboori, Dominik F Vollherbst, Domagoj Gajski, Jared Cooper, Omar Alwakaa, Mohamad Ezzeldin, Christopher S Ogilvy, Fawaz Al-Mufti, Vladimir Kalousek, Markus A Möhlenbruch, Luca Scarcia, Tang Si Zhao, Peter B Sporns, Anil Gopinathan, Robert W Regenhardt, Spiros L Blackburn, Clemens M Schirmer, Thien Huynh, Rabih G Tawk, Fabio Settecase, Pascal Jabbour, Kunal Vakharia, Mario Zanaty, Santiago Ortega-Gutierrez, Jesse G Jones, Marco Colasurdo, Hussein H Nasser, Sri Hari Sundararajan, Pascal J Mosimann, Erez Nossek, Eytan Raz, Alejandro M Spiotta, Bruno Del Sette, Caterina Michelozzi, Davide Saraceno, Pietro Panni, Visish M Srinivasan, Jan-Karl Burkhardt, Pietro Mario Santini, Michael R Levitt, Giuseppe Lanzino, Jared Knopman, Vitor Mendes Pereira, Tufail Patankar, Adam A Dmytriw, David J Altschul, Ali Alaraj","doi":"10.1007/s00062-026-01729-2","DOIUrl":"https://doi.org/10.1007/s00062-026-01729-2","url":null,"abstract":"<p><strong>Purpose: </strong>Middle meningeal artery embolization (MMAE) is increasingly used for chronic subdural hematoma (CSDH), but the relationship between injected liquid-embolic volume and outcomes is unclear. We evaluated dose-outcome associations and searched for a minimum effective dose.</p><p><strong>Methods: </strong>This retrospective multicenter cohort included 313 patients treated with liquid embolic agents at 12 MESH Registry centers from 2016 to 2024. MMAE was performed alone in 172 patients (55.0%) and adjunctively with surgical evacuation in 141 (45.0%). Dose was assessed as total injected volume per patient and normalized to middle meningeal artery diameter, baseline hematoma thickness, and estimated hematoma volume. The primary outcome was a 180-day composite of retreatment, residual or recurrent hematoma > 10 mm, or death. Logistic regression with multiple imputation, restricted cubic splines, and sensitivity analyses evaluated associations and nonlinearity.</p><p><strong>Results: </strong>Median injected volume was 0.60 mL (interquartile range, 0.50-0.90). Center accounted for 44.5% of variation in log volume, whereas hematoma burden accounted for 0.3%. No dose metric was significantly associated with the primary outcome or 90-day recurrence/reoperation. For absolute volume, the odds ratio per interquartile-range increment was 0.80 (95% confidence interval, 0.56-1.16; p = 0.24). No reliable minimum effective dose was identified. Findings remained consistent across sensitivity analyses and treatment indications (interaction p = 0.30). Procedural complications occurred in 6.4% and were not dose-associated.</p><p><strong>Conclusion: </strong>Within the observed range, injected volume alone was not a consistent determinant of outcome and should not be a procedural target after a satisfactory angiographic endpoint. Future studies should evaluate embolic distribution, distal penetration, and vascular territory coverage.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196553","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":"Detection of Brachial Plexus and Extraplexal Involvement in Neuralgic Amyotrophy Using MR Neurography: a Single-Center Retrospective Study.","authors":"Stefan Sondermann, Katharina Fieseler, Peter Trillenberg, Peter Schramm, Tobias Boppel","doi":"10.1007/s00062-026-01733-6","DOIUrl":"https://doi.org/10.1007/s00062-026-01733-6","url":null,"abstract":"<p><strong>Purpose: </strong>Neuralgic amyotrophy (NA) is an underrecognized idiopathic inflammatory disorder and MR Neurography (MRN) has become an essential tool for depicting nerve lesions and muscle edema. Imaging is frequently restricted to the brachial plexus and shoulder. However, involvement of distal arm nerves and muscles is common. This study aims to explore imaging findings in patients with NA by utilizing MRN of both the plexus and the associated limb.</p><p><strong>Methods: </strong>Patients with NA who underwent MRN of the upper extremity between January 2017 and February 2026 were retrospectively identified. A total of 35 consecutive patients were enrolled, and their clinical features were reviewed. Two experienced neuroradiologists assessed the MRN images for the presence of nerve lesions and muscle edema. Associations between nerve lesions and muscle edema were analyzed.</p><p><strong>Results: </strong>In 35 patients (median age 46 years, 12 female; median onset-to-MRN 141 days), MRN revealed plexus (n = 28) and terminal branch-level (n = 20) abnormalities. Muscle edema was observed in 26 patients. Correlation analysis revealed significant associations between nerve lesions and edema; specifically, suprascapular lesions were associated with edema in the corresponding muscles. Further significant correlations were identified for the median, radial, musculocutaneous, and axillary nerves.</p><p><strong>Conclusion: </strong>NA is a multifocal neuropathy involving the brachial plexus and distal peripheral nerves. Limiting imaging to the plexus alone carries the risk of missing pathological findings. This study presents a single-center experience with an MRN approach that is sensitive in detecting both nerve lesions and muscle edema of the plexus and the associated limb.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171206","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":"Identifying Intracranial Atherosclerotic Disease in Emergent Large Vessel Occlusion.","authors":"Jens Fiehler, Senta Frol, Helge Kniep, Luca Meucci, Marios Psychogios, Ivan Lylyk, Pedro Lylyk","doi":"10.1007/s00062-026-01732-7","DOIUrl":"https://doi.org/10.1007/s00062-026-01732-7","url":null,"abstract":"<p><strong>Background: </strong>Intracranial atherosclerotic disease (ICAD) represents a substantial proportion of large vessel occlusion (LVO) strokes refractory to mechanical thrombectomy, yet its diagnosis in the hyperacute setting remains challenging without direct vessel-wall imaging.</p><p><strong>Methods: </strong>This narrative review is intended as a narrative and conceptual roadmap, acknowledging the inherent limitations of current methodologies for assessing ICAD in LVO patients. We evaluate clinical, pre-procedural imaging, angiographic, and intraprocedural features supporting a diagnosis of ICAD-related LVO, drawing on own experience and evidence from the literature. Articles were selected by authors for relevance to the conceptual framework. Randomized controlled trials, systematic reviews, and mechanistic pre-clinical studies were prioritized where available.</p><p><strong>Results: </strong>Truncal occlusion morphology, fixed residual stenosis after thrombectomy, and early reocclusion emerge as the most reproducible high-specificity markers, while clinical risk-factor profile, absence of the susceptibility vessel sign, and collateral or perfusion patterns provide corroborating rather than standalone evidence.</p><p><strong>Discussion: </strong>We propose a tiered diagnostic framework combining these markers to guide real-time decisions on bailout angioplasty or stenting, alongside a differential diagnosis of non-atherosclerotic mimics. Existing prediction scores show promising discriminative performance but remain largely unvalidated outside their Asian derivation cohorts. We propose illustrative enrollment criteria for future randomized trials, informed by recent studies.</p><p><strong>Conclusion: </strong>Systematic, reproducible recognition of ICAD is essential to guide bailout treatment decisions and to enable rigorous evaluation of endovascular strategies tailored to this distinct stroke subtype.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Learning Reconstruction Enables Substantial Radiation Dose Reduction in Ultra-High-Resolution Temporal Bone CT: a Body Donor Study.","authors":"Lavinia Brockstedt, Sebastian Altmann, Suam Kim, Mohammed Beshr, Andrea Kronfeld, Michael J Schmeisser, Sven Schumann, Filip Pavlas, Antoine Sanner, Marc A Brockmann, Ahmed E Othman","doi":"10.1007/s00062-026-01724-7","DOIUrl":"https://doi.org/10.1007/s00062-026-01724-7","url":null,"abstract":"<p><strong>Purpose: </strong>Deep learning reconstruction may enable substantial radiation dose reduction in ultra-high-resolution (UHR) temporal bone CT, but its performance across clinically relevant dose levels remains insufficiently defined. This study evaluated vendor-specific deep learning reconstruction (DLR) compared with hybrid iterative reconstruction (HIR) in UHR volume-mode temporal bone CT and aimed to propose an indication-adapted framework for dose optimization.</p><p><strong>Methods: </strong>In this single-center body donor study, 20 temporal bones from 10 donors without pathologic findings were scanned at 11 dose levels (CTDI_vol, 5.1-30.7 mGy). Images were reconstructed using HIR at standard resolution (0.5 mm, 512² matrix) and UHR (0.25 mm, 1024² and 2048² matrices), as well as DLR (AiCE Inner Ear) at UHR (0.25 mm, 1024² matrix). Three radiologists independently assessed 10 anatomical structures using a 5-point Likert scale. Signal-to-noise ratio was measured in predefined regions. Exploratory structure-specific generalized estimating equation models were used to estimate the probability of achieving optimal image quality as a function of radiation dose and reconstruction technique.</p><p><strong>Results: </strong>DLR significantly improved visualization of osseous structures compared with HIR (p < 0.001). The exploratory dose-response analysis demonstrated reconstruction-specific trajectories, with DLR achieving higher predicted probabilities of optimal image quality than HIR at lower dose levels. For routine clinical indications, diagnostically adequate image quality was achieved with DLR at a CTDI_vol of 13.3 mGy, representing a 48% dose reduction compared with HIR (CTDI_vol 25.6 mGy). For high-detail assessment of delicate microanatomical structures, including the stapes and cochlea, DLR achieved excellent visualization at a CTDI_vol of 17.4 mGy, corresponding to a 43% dose reduction compared with HIR (CTDI_vol 30.7 mGy).</p><p><strong>Conclusion: </strong>Vendor-specific DLR enables substantial radiation dose reduction in UHR volume-mode temporal bone CT while maintaining high diagnostic image quality. These findings support an indication-adapted framework for dose optimization, suggesting a routine clinical protocol at CTDI_vol 13.3 mGy and a microanatomy-optimized protocol at CTDI_vol 17.4 mGy.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026400","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":"AI-Assisted Compressed Sensing for Optimized Inner Ear Imaging: a Multi-Rater MRI Evaluation of CSAI T2-DRIVE.","authors":"Enrike Rosenkranz, Jennifer Köhler, Nora M Weiss, Martin Renz, Laura Leukert, Kilian Weiss, Barbara Wollenberg, Dennis M Hedderich, Jan S Kirschke, Wilhelm Wimmer, Jannis Bodden","doi":"10.1007/s00062-026-01716-7","DOIUrl":"https://doi.org/10.1007/s00062-026-01716-7","url":null,"abstract":"<p><strong>Purpose: </strong>High-resolution T2-weighted imaging is essential for preoperative assessment before cochlear implantation. Compressed sensing (CS) with AI-based reconstruction (CSAI) reduces acquisition times whilst preserving image quality. Although CSAI has been established in various clinical applications, its performance in inner ear imaging remains unclear. This study assesses CSAI-optimized T2-DRIVE sequences at different resolutions and acquisition times for visualizing inner ear structures.</p><p><strong>Methods: </strong>In 30 healthy participants, CS T2-DRIVE was acquired at isotropic resolutions of 0.65, 0.5, and 0.4 mm. 0.5 and 0.4 mm datasets were also reconstructed using a commercially available AI-based reconstruction algorithm. Three raters independently assessed the imaging quality of anatomical landmarks (cochlea, semicircular canals, vestibulocochlear nerve), artifacts, and signal-to-noise ratio (SNR) using a 5-point Likert scale. Each rater re-rated a subset of images after ≥ 4 weeks. Inter- and intra-rater reliability were calculated using quadratically weighted Cohen's kappa, and differences between sequences were analyzed using cumulative link mixed models (CLMM).</p><p><strong>Results: </strong>0.4 mm isotropic imaging exhibited lower SNR compared to CSAI 0.5 mm, regardless of reconstruction algorithm (p < 0.001). Across all raters, CSAI T2 at 0.5 mm resolution significantly improved delineation of the cochlea and vestibulocochlear nerve compared to 0.65 mm imaging (p < 0.001), while assessability of semicircular canals was reduced (p = 0.082). Acquisition times increased with higher resolutions (0.65/0.5/0.4 mm: 4:02/4:25/4:34 min).</p><p><strong>Conclusion: </strong>AI-driven reconstruction algorithms enable statistically significant improvements in imaging of key inner-ear structures with minimal increases in scan time at 0.5 mm resolution.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907521","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":"Real-Time AI-Generated Guidewire-Out-of-View Notifications in Diagnostic Cerebral Angiography: Higher Observed Rates Among Trainees.","authors":"Syun Takano, Yoshikazu Matsuda, Kenichi Kono, Yuya Sakakura, Yuma Miki, Ryo Aiura, Eisuke Hirose, Tohru Mizutani, Yoichi Morofuji","doi":"10.1007/s00062-026-01720-x","DOIUrl":"https://doi.org/10.1007/s00062-026-01720-x","url":null,"abstract":"<p><strong>Purpose: </strong>Evaluation of technical proficiency plays a critical role in ensuring the safety and efficacy of neuroendovascular procedures. However, objective and quantitative assessment methods that are suitable for clinical practice remain scarce or unavailable. To address this limitation, this study examined whether real-time notifications from intraoperative artificial intelligence (AI)-assisted systems can serve as objective indicators of procedural skills.</p><p><strong>Methods: </strong>We retrospectively analyzed 200 consecutive digital subtraction angiography (DSA) cases performed at our institution using a real-time AI-assisted system called neuro-vascular assist (iMed Technologies, Tokyo, Japan). The procedures were performed by either board-certified neuroendovascular specialists with extensive experience or noncertified trainees. We compared AI notifications and procedural parameters between the groups and evaluated the association between certification status and AI notifications using mixed-effects logistic regression with a random intercept for operator and adjustment for case-mix.</p><p><strong>Results: </strong>Univariate analysis revealed that trainees exhibited significantly higher frequency of AI notifications (62.5% vs 41.9%; P = 0.01) and longer fluoroscopy times (P = 0.02) compared to specialists. Furthermore, multivariable mixed-effects logistic regression accounting for case-mix and within-operator clustering showed twofold higher odds of an AI notification in trainees, but the association was not statistically significant (adjusted OR 2.10, 95% CI 0.68-6.49; P = 0.20).</p><p><strong>Conclusion: </strong>This study provides preliminary evidence that intraoperative AI notifications may reflect differences in technical behavior according to operator certification status. Although the adjusted association was not statistically significant, these findings suggest the potential of AI-assisted systems as proof-of-concept tools for evaluating technical proficiency. Further validation involving a larger number of operators is required.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907606","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":"Carotid Artery Stenting vs Endarterectomy Across Procedural Eras : A Systematic Review and Meta-Analysis.","authors":"Andre Kemmling, Mohammad Almohammad, Tawfik Moher Alsady, Lars Timmermann, Jens Minnerup, Marie Luise Mono, Marios Psychogios, Thi Dan Linh Nguyen-Kim, Hassan Soda, Timo Kahles, Götz Thomalla, Marcel Arnold, Benjamin Gory, Mira Katan, Urs Fischer, Gabriel Broocks, Peter Sporns","doi":"10.1007/s00062-026-01718-5","DOIUrl":"https://doi.org/10.1007/s00062-026-01718-5","url":null,"abstract":"<p><strong>Purpose: </strong>Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are established revascularization strategies, but randomized evidence has often been interpreted without accounting for major changes in CAS technique. We assessed whether the comparative 30-day safety of CAS and CEA differs when trials are stratified by early-device versus contemporary embolic-protected procedural eras.</p><p><strong>Methods: </strong>PubMed, Embase and the Cochrane Library were searched from inception to 1 December 2025 for randomized trials of carotid revascularization in extracranial carotid stenosis. The prespecified novelty of this meta-analysis was era-based stratification according to CAS procedural standards: early-device trials (≤ 2010) versus contemporary embolic-protected CAS trials (≥ 2011), defined by operator credentialing, routine embolic protection, protocolized antiplatelet therapy and contemporary stent platforms. Direct CAS-CEA comparisons were pooled within era-specific strata; trials comparing revascularization with intensive medical therapy were analyzed separately. Fixed-effects models estimated odds ratios (ORs) with 95% confidence intervals (CIs). The primary outcome was 30-day stroke or death; secondary outcomes included peri-procedural myocardial infarction, cranial nerve injury, fatal or disabling stroke, and long-term ipsilateral stroke.</p><p><strong>Results: </strong>Ten randomized comparisons from nine trials including 14,211 patients were analyzed. In early-device trials, stroke or death occurred in 6.8% after CAS versus 4.4% after CEA (OR 1.72, 95% CI 1.41-2.10). In contemporary embolic-protected CAS-CEA trials, event rates were similarly low and no significant difference was observed (2.9% vs 3.1%; OR 1.29, 95% CI 0.98-1.70). CAS was associated with lower myocardial infarction (OR 0.47, 95% CI 0.31-0.72) and cranial nerve injury (OR 0.06, 95% CI 0.03-0.13). Long-term ipsilateral stroke rates were similar after CAS and CEA, with annualized rates of 0.64% and 0.60% per person-year, respectively (hazard ratio, 1.07; 95% CI, 0.81-1.41).</p><p><strong>Conclusion: </strong>The excess peri-procedural stroke risk associated with CAS in early trials was not observed in contemporary randomized evidence. Contemporary CAS and CEA showed similarly low peri-procedural event rates, supporting comparable safety when CAS is performed according to current procedural standards by experienced operators. These findings suggest that CAS and CEA have comparable peri-procedural safety when performed using contemporary procedural standards, supporting individualized selection of revascularization strategies.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907580","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 WEVO Technique: A Novel Dual-Device Endovascular Strategy for Non-Geometric Wide Neck Bifurcation Aneurysms.","authors":"Sarah J Snyder, Om H Gandhi, Sami Almasri, Jaeha Kim, Shirley Yuan, Nathan Yu, Aaron Anandarajah, Suehyb G Alkhatib, Sandeep Kandregula, Linda Bagley, Omar A Choudhri","doi":"10.1007/s00062-026-01640-w","DOIUrl":"10.1007/s00062-026-01640-w","url":null,"abstract":"<p><strong>Purpose: </strong>Non-geometric wide-neck bifurcation aneurysms (WNBAs) present with treatment challenges of unfavorable neck morphology at bifurcation sites combined with irregular saccular geometry. While microsurgical clipping remains the traditional standard treatment, unsuitable candidates often require endovascular alternatives. We developed the WEVO technique, combining a volumetrically matched Woven EndoBridge (WEB) placement with a LVIS EVO braided stent deployment to achieve device stabilization and neck reconstruction with enhanced metal coverage.</p><p><strong>Methods: </strong>We conducted a retrospective review of 21 patients treated for non-geometric WNBAs. Patient demographics, aneurysm characteristics, procedural parameters, and clinical outcomes were analyzed. The LVIS EVO stent was deployed using a \"shouldering\" technique to compress stent cells across the aneurysm neck. All patients received dual antiplatelet therapy. Aneurysm occlusion was assessed using the WEB Occlusion Scale (WOS) at 3 to 6 months and at 12 months.</p><p><strong>Results: </strong>Median age was 71 (IQR: 64-76); 71% were female. All aneurysms were unruptured with median volume 81.4 mm³ (IQR: 46.0-147.1). Most common locations included middle cerebral artery (33%) and basilar artery (33%). Upper extremity arterial access was used in all cases. Immediate contrast stasis was achieved in all patients. One patient developed transient intra-procedural stent thrombus that resolved with intra-arterial tirofiban. No other complications occurred. At 3 to 6‑month follow-up (n = 16), adequate occlusion (WOS Grade A or AB) was achieved in 87%. At 12-month follow-up (n = 11), adequate occlusion was maintained in all patients.</p><p><strong>Conclusion: </strong>The WEVO technique provides a safe and effective endovascular treatment option for non-geometric WNBAs by combining intrasaccular flow disruption with neck scaffolding and increased metal coverage.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"899-909"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516084","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":"Evans' Index and Frontal and Occipital Horn Ratio in Correlation to Volumetric Data of Lateral Ventricles in a Population-based MRI Study.","authors":"Daniel Cantré, Robin Bülow, Eiko Rathmann, Jörg Baldauf, Felix Streckenbach, Sönke Langner","doi":"10.1007/s00062-026-01665-1","DOIUrl":"10.1007/s00062-026-01665-1","url":null,"abstract":"<p><strong>Purpose: </strong>Evans' Index (EI) and Frontal and Occipital Horn Ratio (FOHR) are routinely used in screening for enlargement of the ventricular system. However, both lack epidemiological definition of normal values in adults. In a representative, randomized sample of adult normal population in Germany we studied the correlation of lateral ventricle volumes with EI and FOHR to evaluate the performance of pre-established cutoff values of EI > 0.3 and FOHR > 0.37, and to introduce age- and sex-specific thresholds, which for FOHR do not yet exist in adults.</p><p><strong>Methods: </strong>In a population-based sample of 3058 subjects of the \"Study of Health in Pomerania\" (SHIP), aged 21-90 years, brain imaging with T1 weighted MPRAGE with 1 mm isotropic voxel-size was obtained. We semiautomatically determined the volumes of the lateral ventricles and manually performed measurements to calculate EI and FOHR for every individual. Besides descriptive statistics, ROC analyses were carried out to determine test performance of both parameters. Negative and positive predictive values were derived from contingency analyses.</p><p><strong>Results: </strong>Average values were 0.257 ± 0.025 for EI and 0.363 ± 0.024 for FOHR, with sex- and age-depending differences. Using the established cut-off value of EI > 0.3, this index achieved high specificity of 97.1% and moderate sensitivity of 55.3% for diagnosing ventricular enlargement. Using a threshold of > 0.4, FOHR achieved a specificity of 93.4%, and higher sensitivity of 81.4%. FOHR showed stronger correlation with actual lateral ventricle volumes, as compared to EI (r_{s FOHR} = 0.741 vs. r_{s EI} = 0.656; p < 0.001).</p><p><strong>Conclusion: </strong>For the first time, EI and FOHR were evaluated in a reasonable sized, randomized, representative sample of normal adult population in Germany, and were confirmed as useful screening tools in the diagnosis of ventricular enlargement. We introduce a cut-off value of > 0.4 for FOHR in adults, with emphasis on specific caveats.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"1069-1082"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845116","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":"Early Postthrombectomy Neurological Improvement: the NIHSS Drop as an Immediate Predictor of Good Functional Outcomes.","authors":"Pablo Baena-Palomino, Marta Aguilar-Pérez, Asier de Albóniga-Chindurza, Elena Zapata-Arriaza, Leire Ainz-Gómez, Henry A Andrade-Ruiz, Carlota Villar-Rodríguez, Diego Villagrán-Sancho, Manuel Medina-Rodríguez, Andrés Hermosín-Gómez, Blanca Pardo-Galiana, Juan Antonio Cabezas-Rodríguez, Joan Montaner, Francisco Moniche, Alejandro González","doi":"10.1007/s00062-026-01654-4","DOIUrl":"10.1007/s00062-026-01654-4","url":null,"abstract":"<p><strong>Purpose: </strong>Despite advances in mechanical thrombectomy for acute ischemic stroke (AIS), the relationship between successful angiographic reperfusion and functional outcome remains imperfect. We investigated the value of an optimal immediate postthrombectomy National Institutes of Health Stroke Scale (NIHSS) cutoff, termed the \"NIHSS drop,\" as a predictor of favorable 90-day outcome and compared its prognostic performance with first-pass effect (FPE).</p><p><strong>Methods: </strong>We conducted a single-center retrospective analysis of prospectively collected data from 554 patients with AIS who underwent mechanical thrombectomy between 2018 and 2024. Eligible patients presented with an NIHSS score > 8, an Alberta Stroke Program Early CT Score (ASPECTS) of 6-10, and M1 occlusion. Immediate postprocedural NIHSS assessment allowed calculation of the NIHSS drop. Receiver operating characteristic (ROC) analysis was used to determine the optimal cutoff, and logistic regression was used to assess its predictive value after adjustment for complete reperfusion (Thrombolysis in Cerebral Infarction [TICI] grade 3 vs 2b), FPE, and other major confounders.</p><p><strong>Results: </strong>An NIHSS drop ≥ 6 was strongly associated with favorable outcome (area under the curve [AUC] = 0.762, sensitivity 63%, specificity 82%). Patients with an NIHSS drop ≥ 6 (n = 235) had better outcomes (modified Rankin Scale [mRS] 0-2: 83% vs 40%, p < 0.001), fewer complications, and lower median NIHSS scores at 24 h (3 vs 12) and at discharge (1 vs 5), as well as lower in-hospital mortality (1.7% vs 15%, p < 0.001) and 90-day mortality (3.0% vs 19%, p < 0.001). In multivariable analysis, an NIHSS drop ≥ 6 remained the strongest predictor of favorable outcome (odds ratio [OR] 7.21, 95% confidence interval [CI] 4.62-11.5; p < 0.001), showing a stronger association than complete reperfusion or FPE individually.</p><p><strong>Conclusion: </strong>Immediate neurological improvement after thrombectomy was strongly associated with favorable functional outcome. An NIHSS drop ≥ 6 may serve as a useful early prognostic marker and may complement traditional procedural metrics such as TICI grade and FPE, although prospective validation is needed.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"997-1007"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730374","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}