Clinical Neuroradiology最新文献

{"title":"Long and Large Stentrievers Improve Reperfusion Outcomes in Acute Intracranial Terminal Internal Carotid Artery Occlusion: Interim Results of the Rossetti Registry.","authors":"Antonio Lopez-Rueda, Josep Puig, Pepus Daunis-I-Estadella, Mariano Werner, Eva González, Ion Labayen, Pedro Vega, Eduardo Murias, Elvira Jimenez-Gomez, Isabel Bravo Rey, Manuel Moreu, Carlos Pérez-García, Oscar Chirife Chaparro, Sonia Aixut, Mikel Terceño, Guillem Dolz, José Manuel Pumar, Yeray Aguilar Tejedor, Jose Carlos Mendez, Fernando Aparici-Robles, Lluis Morales-Caba, José Carlos Rayón, Luis San Roman, Jordi Blasco","doi":"10.1007/s00062-024-01486-0","DOIUrl":"10.1007/s00062-024-01486-0","url":null,"abstract":"<p><strong>Introduction: </strong>Although stentrievers (SRs) are widely used for mechanical thrombectomy (MT), the impact of device dimensions on optimizing reperfusion outcomes in high clot burden cases is unclear. Our study aimed to investigate the effect of SR size on angiographic and clinical outcomes in patients with acute terminal internal cerebral artery (TICA) occlusion.</p><p><strong>Methods: </strong>We analyzed ROSSETTI registry data to compare technical and clinical outcomes of TICA occlusion patients treated with MT without rescue therapy, according to SR diameter and length: 6 × 41-50 mm, 6 × 20-40 mm, and <6 × 20-50 mm. The first-pass effect (FPE) was defined as achieving a TICI2c‑3 after a single pass.</p><p><strong>Results: </strong>We included 491 patients, 240 (41.5%) in 6 × 41-50 group, 117 (20.2%) in 6 × 20-40 group, and 134 (23.2%) in < 6 × 20-50 group. The MT procedure time for the 6 × 41-50 group was shorter, but the FPE rate was similar across all groups. The highest final mTICI 2c‑3 rate was in 6 × 41-50 group (81.2%), compared to 6 × 20-40 group (68.4%) and 4-6 × 20-50 group (72.4%) (p = 0.016). Distal catheter use was associated with final mTICI 0-2b (62% of patients). Clinical outcomes were similar between the groups. Larger diameter and longer length of the SR, as well as not using an intermediate catheter, were independent predictors of final mTICI 2c‑3. The use of 6 × 41-50 SRs (OR 1.64, 95% CI 1.06-2.52; p = 0.024) and distal catheter use (OR 0.62, 95%CI 0.40-0.96; p = 0.034) were independent predictors of final mTICI 2c‑3.</p><p><strong>Conclusions: </strong>Use of longer and larger SRs in acute intracranial TICA occlusion improves final reperfusion rate.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"295-301"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822817","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":"Non-Stenotic Carotid Plaques and Rate of DWI-positive MRI in Patients with Lower-Risk Transient or Persistent Minor Neurologic Events: DOUBT Sub Study.","authors":"Nishita Singh, Fouzi Bala, Francois Moreau, Thalia S Field, Mayank Goyal, Michael D Hill, Shelagh B Coutts, Mohammed Almekhlafi","doi":"10.1007/s00062-024-01483-3","DOIUrl":"10.1007/s00062-024-01483-3","url":null,"abstract":"<p><strong>Background & purpose: </strong>Non-stenotic (< 50%) carotid plaques are increasingly recognized as a potential mechanism for ischemic stroke. We assessed the prevalence of such plaques in patients with low-risk neurologic events and evidence of DWI (Diffusion Weighted Imaging)-positive ischemia.</p><p><strong>Methods: </strong>This is a post-hoc exploratory analysis from the DOUBT study, a prospective, observational, multicenter study of patients with low-risk transient or persistent minor focal neurological symptoms. Patients who had baseline CT angiography (CTA) and an MRI within 8 days of their event were included in the study. We aimed to assess the prevalence of non-stenotic carotid disease in patients with versus without DWI-positive events, and in patients with ipsilateral DWI-positive events. A carotid-level analysis with univariable logistic regression analysis was performed to assess whether any of the assessed plaque features were associated with ipsilateral stroke.</p><p><strong>Results: </strong>Of the 334 patients (mean age 62.7 years, 50.4% females) with available vascular neuroimaging, 153 (45.9%) had non-stenotic carotid plaques (≤50% stenosis), 174 (52.1%) had no stenosis and 7 (2.1%) patients had >50% stenosis. Of those with non-stenotic carotid plaques, 31/153 (20.3%) had evidence of DWI-positive ischemia, approximately half (15/31; 48.4%) of which was in the territory of the carotid plaque. Amongst patients with DWI-positive ischemia, non-stenotic plaques were significantly more common on the side of DWI-positive lesions [31/49 (63.3%) versus 18/49(36.7%)]. Presence of non-stenotic plaque was a risk marker for DWI-positive events (RR 1.4, 95% CI 1.1-1.8, p 0.012). On matched analysis, non-stenotic plaques were more likely on the side of DWI+ ischemia (odds ratio 1.14, 95% CI 0.36-3.70, McNemar's p value 0.80). Plaque features, including hypodensity, irregularity and greater plaque thickness were significantly associated with a higher likelihood of ipsilateral DWI+ ischemia.</p><p><strong>Conclusion: </strong>In patients with low-risk transient or persistent neurologic events, non-stenotic carotid plaques are more common in patients with DWI-positive ischemia. Plaque features like hypodense and irregular plaque were more common with DWI-positive changes in the territory of the affected carotid.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"337-345"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873305","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":"Air Embolism-induced Stroke Linked to Esophago-atrial Fistula: a Diagnostic and Therapeutic Challenge.","authors":"Elisa Antolinos-Macho, Beatriz Alba-Pérez, Teresa Presa-Abos, José Montilla","doi":"10.1007/s00062-025-01527-2","DOIUrl":"https://doi.org/10.1007/s00062-025-01527-2","url":null,"abstract":"","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Performance of Quantitative Susceptibility Mapping in Cerebral Microbleed Detection Relative to 2D GRE.","authors":"Sabina Iqbal, Nikita Seth, Tamkin Shahraki, Aristotelis Filippidis, Magdy Selim, Ajith J Thomas, Yan Wen, Pascal Spincemaille, Yi Wang, Salil Soman","doi":"10.1007/s00062-025-01529-0","DOIUrl":"https://doi.org/10.1007/s00062-025-01529-0","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the potential overestimation of cerebral microbleed (CMB) burden by Quantitative Susceptibility Mapping (QSM) compared to 2D gradient recalled echo (2D GRE), as well as the impact of increased motion degradation due to longer scan times, reduced CMB detection from skull-stripping failures, and the relative visibility of CMBs between techniques.</p><p><strong>Methods: </strong>Seventy-nine adult subjects with intracranial hemorrhage underwent same-session brain MRI including 2D GRE and multi-echo GRE for QSM processing, as part of routine clinical care. Images were reviewed by a neuroradiologist and trained research assistant for CMB detection, visibility rating, and anatomical distribution. Motion artifacts and areas of non-visualized brain due to skull-stripping were assessed. Statistical analysis included Wilcoxon signed-rank tests for CMB counts, Mann-Whitney U test for motion assessment, and Fisher's exact testing for anatomical distribution patterns.</p><p><strong>Results: </strong>QSM showed no significant difference in median CMB counts compared to 2D GRE (1 vs 2, p = 0.175) with strong correlation (r = 0.879, p < 1.65e-26). No significant difference in motion degradation was found between techniques (p = 0.7465). Skull-stripping failures affected only 2% of candidate CMBs, in 5 of 79 (6%) subjects. QSM-detected CMBs showed superior conspicuity (73 vs 33 better visualized lesions, p = 0.00975) with 261 rated equally visible. QSM identified 26 calcifications in 20 subjects, 25 of which were misclassified as CMBs on 2D GRE.</p><p><strong>Conclusion: </strong>QSM demonstrates comparable or slightly lower CMB counts than 2D GRE while offering superior lesion conspicuity and ability to distinguish calcifications, supporting its potential clinical implementation for CMB detection.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133120","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":"Bacterial Contamination of Angiographic Materials in Diagnostic and Interventional Neuroangiography.","authors":"Christiane Franz, Claudia Fleu, Sophia Honecker, Manuela Schmiech, Dimah Hasan, Hani Ridwan, Omid Nikoubashman, Sebastian Lemmen, Martin Wiesmann","doi":"10.1007/s00062-025-01526-3","DOIUrl":"https://doi.org/10.1007/s00062-025-01526-3","url":null,"abstract":"<p><strong>Purpose: </strong>Bacterial contamination has been reported to occur during angiographies, although data on its frequency and relevance are limited. The purpose of our study was to determine whether angiographic materials such as catheters and guide wires remain sterile during angiographies. We sought to differentiate between different materials, and to detect the frequency, the extent and the spectrum of bacterial contamination.</p><p><strong>Methods: </strong>We prospectively collected 698 fluid or material samples from 100 neuroangiographies. Per angiography we analyzed proximal ends and distal tips of catheters and guide wires, and fluid samples from the water container (working bowl) in which materials were stored during the angiography. We analyzed the frequency and extent of contamination and determined the bacterial spectrum.</p><p><strong>Results: </strong>The majority of samples (51.4%) were contaminated. There was no angiography that showed no contamination (0%). The highest proportion of contaminated samples was found in the fluid from the working bowl after completion of the examination (92.9%). Catheters and wires were contaminated in 34.1-49.2% of samples. Contamination of the samples increased with longer duration of the angiographic procedures. Most of the bacterial species were environmental or skin contaminants (86.2%).</p><p><strong>Conclusion: </strong>Bacterial contamination during diagnostic neuroangiographies or interventions is a frequent finding although its clinical significance is believed to be small. Bacterial contamination increases with longer duration of angiographic procedures.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129174","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":"Vertebral Arteriovenous Fistula from Blunt Cervical Trauma: a Correspondence.","authors":"Thomas A Hanks, Zachary A Abecassis, Raymond M Meyer, Stephanie H Chen, Daniel J Coughlin","doi":"10.1007/s00062-025-01521-8","DOIUrl":"https://doi.org/10.1007/s00062-025-01521-8","url":null,"abstract":"","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121451","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":"Neurological Adverse Effects Associated with Ozone Therapy.","authors":"Minoo Rouhi, Nafiseh Mohebi, Narges Yazdi","doi":"10.1007/s00062-025-01510-x","DOIUrl":"https://doi.org/10.1007/s00062-025-01510-x","url":null,"abstract":"","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630901","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":"A New Perspective On Arterioectatic Spinal Angiopathy with a Reversible Pattern: Cause or Consequence?","authors":"Civan Islak, Ömer Bağcılar, Hakan Hatem Selçuk, Sema Saltık, Bora Korkmazer, Tanyel Zubarioğlu, Serdar Arslan, Ahmet Üstündag, Osman Kızılkılıç","doi":"10.1007/s00062-024-01451-x","DOIUrl":"10.1007/s00062-024-01451-x","url":null,"abstract":"<p><strong>Objective: </strong>In 2022, arterioectatic spinal angiopathy (AESA) of childhood was reported as a fatal, progressive, multi-segment myelopathy associated with a unique form of non-inflammatory spinal angiopathy involving diffuse dilatation of the anterior spinal artery and cord congestion in children. In this study, we present four more cases of AESA, using early and long-term conventional imaging and flat detector computed tomography angiography (FDCTA) imaging to assess the probability of disease regression and prevent unnecessary interventions.</p><p><strong>Methods: </strong>We retrospectively reviewed the clinical and radiological findings of four patients with AESA seen in two neuroradiology departments between 2014 and 2023.</p><p><strong>Results: </strong>The study included three boys and one girl. Two of the boys were siblings. Although the clinical and radiological presentation in the early stages of the clinical course overlapped the definition of AESA, the clinical course was more benign in three of the cases. The clinical courses of the two siblings with monosegmental cord involvement and largely reversible radiological findings suggest that some of the features in the initial definition of the disease cannot be standardized for all patients. The siblings had a mutation of the NDUFS gene, which is involved in mitochondrial function and clinical-radiological reversibility in these patients.</p><p><strong>Conclusion: </strong>Many mitochondrial diseases, such as this NDUFS mutation, present with myelopathy, and mitochondrial diseases can sometimes show spontaneous recovery. It is crucial to identify other genetic mutations or environmental factors that trigger the accompanying vascular ectatic findings in AESA in larger multicenter studies to prevent its potential lethal course and possible unnecessary surgical-endovascular interventions.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"67-75"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114000","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":"Machine Learning Algorithms to Predict the Risk of Rupture of Intracranial Aneurysms: a Systematic Review.","authors":"Karan Daga, Siddharth Agarwal, Zaeem Moti, Matthew B K Lee, Munaib Din, David Wood, Marc Modat, Thomas C Booth","doi":"10.1007/s00062-024-01474-4","DOIUrl":"10.1007/s00062-024-01474-4","url":null,"abstract":"<p><strong>Purpose: </strong>Subarachnoid haemorrhage is a potentially fatal consequence of intracranial aneurysm rupture, however, it is difficult to predict if aneurysms will rupture. Prophylactic treatment of an intracranial aneurysm also involves risk, hence identifying rupture-prone aneurysms is of substantial clinical importance. This systematic review aims to evaluate the performance of machine learning algorithms for predicting intracranial aneurysm rupture risk.</p><p><strong>Methods: </strong>MEDLINE, Embase, Cochrane Library and Web of Science were searched until December 2023. Studies incorporating any machine learning algorithm to predict the risk of rupture of an intracranial aneurysm were included. Risk of bias was assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). PROSPERO registration: CRD42023452509.</p><p><strong>Results: </strong>Out of 10,307 records screened, 20 studies met the eligibility criteria for this review incorporating a total of 20,286 aneurysm cases. The machine learning models gave a 0.66-0.90 range for performance accuracy. The models were compared to current clinical standards in six studies and gave mixed results. Most studies posed high or unclear risks of bias and concerns for applicability, limiting the inferences that can be drawn from them. There was insufficient homogenous data for a meta-analysis.</p><p><strong>Conclusions: </strong>Machine learning can be applied to predict the risk of rupture for intracranial aneurysms. However, the evidence does not comprehensively demonstrate superiority to existing practice, limiting its role as a clinical adjunct. Further prospective multicentre studies of recent machine learning tools are needed to prove clinical validation before they are implemented in the clinic.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"3-16"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638757","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":"Remote Teleproctoring with the TEGUS System for Mechanical Thrombectomy in a Non-Comprehensive Stroke Center: Initial Preliminary Data On Clinical Experience.","authors":"Maria Lourdes Diaz, Tomás Carmona, Manuel Requena, Carlos Piñana, David Hernández, Francesco Diana, Marta De Dios, Jordi Farrero, Marc Ribo, Arturo Fredes Araya, Laura Ludovica Gramegna, Francisco Purroy, Leandro Fernandez, Jordi Villalba, Manuel Quintana, Alejandro Tomasello","doi":"10.1007/s00062-024-01440-0","DOIUrl":"10.1007/s00062-024-01440-0","url":null,"abstract":"<p><strong>Purpose: </strong>Mechanical thrombectomy (MT) is typically performed by experienced neurointerventional radiologists. However, logistical and geographic limitations often hinder access to rapid MT. This study reports the first clinical experience using TEGUS teleproctoring to support MT conducted by general interventional radiologists (IR) at non-comprehensive stroke centers, compared to on-site proctoring outcomes.</p><p><strong>Methods: </strong>The Arnau de Vilanova Hospital in Spain used to transfer stroke patients requiring MT to a comprehensive Stroke Center 160 km away. To overcome COVID-19 mobility restrictions, the Tegus Teleproctoring System was installed. Before teleproctoring, the general interventional radiologist underwent six months of neurointerventional training at a primary stroke center. From April 2021 to May 2023, general IR conducted MT either with on-site proctor supervision or teleproctoring support. We aim to compare clinical outcome of patients receiving MT according to proctoring method.</p><p><strong>Results: </strong>During the study, 49 MTs were performed: 15 with TEGUS teleproctoring and 34 with on-site proctoring. Both groups had similar baseline characteristics, except for NIHSS scores (Tegus 9 [IQR 6-20] vs 18 [IQR 12-22], p = 0.034). No significant differences were found in door-to-revascularization time (82 ± 28.2 vs 84 ± 26.4) min, p = (0.895). The final mTICI distribution and 90-day mRS scores were comparable after adjusting by stroke severity. There were no reports of symptomatic intracranial hemorrhage in either group.</p><p><strong>Conclusion: </strong>This study shows the feasibility of Tegus remote teleproctoring during emergent cases of MT in a remote hospital. It could improve the learning curve of interventional radiologists with limited experience in MT, and lower the territorial inequity associated to MT.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"35-41"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047412","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}