Clinical Neuroradiology最新文献

{"title":"Mismatch Vs No Mismatch in Large Core-A Matter of Definition.","authors":"Vivek Yedavalli, Hamza Adel Salim, Dhairya A Lakhani, Janet Mei, Aneri Balar, Basel Musmar, Nimer Adeeb, Meisam Hoseinyazdi, Licia Luna, Francis Deng, Nathan Z Hyson, Adam A Dmytriw, Adrien Guenego, Hanzhang Lu, Victor C Urrutia, Kambiz Nael, Elisabeth B Marsh, Raf Llinas, Argye E Hillis, Max Wintermark, Tobias D Faizy, Jeremy J Heit, Gregory W Albers","doi":"10.1007/s00062-024-01470-8","DOIUrl":"10.1007/s00062-024-01470-8","url":null,"abstract":"<p><strong>Background: </strong>Endovascular thrombectomy (EVT) has shown promise in randomized controlled trials (RCTs) for large ischemic core stroke patients, yet variability in core definition and onset-to-imaging time creates heterogeneity in outcomes. This study aims to clarify the prevalence and implications of core-perfusion mismatch (MM) versus no mismatch (No MM) in such patients, utilizing established imaging criteria.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted including patients from 7/29/2019 to 1/29/2023, with data extracted from a continuously maintained database. Patients were eligible if they met criteria including multimodal CT imaging performed within 24 h from last known well (LKW), AIS-LVO diagnosis, and ischemic core size defined by specific rCBF thresholds. Mismatch was assessed based on different operational definitions from the EXTEND and DEFUSE 3 trials.</p><p><strong>Results: </strong>Fifty-two patients were included, with various time windows from LKW. Using EXTEND criteria, a significant portion of early window patients exhibited MM; however, fewer patients met MM criteria in the late window. Defining MM using DEFUSE 3 criteria yielded similar patterns, but with overall lower MM prevalence in the late window. When employing rCBF <38% as a surrogate for ischemic core, a higher percentage of patients were classified as MM across both time windows compared to rCBF <30%.</p><p><strong>Conclusion: </strong>The prevalence of MM in large ischemic core patients varies significantly depending on the imaging criteria and time from LKW. Notably, MM was more prevalent in the early time window across all criteria used. Additional RCTs are needed to determine if this definition of MM identifies patients who will benefit most from EVT.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"165-172"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649467","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":"Transient Horner's Syndrome Following CT-Guided C7 Nerve Root Block-A Case Report.","authors":"Leonhard Mann, Valentina Correa, Elke Hattingen, Christophe T Arendt","doi":"10.1007/s00062-024-01453-9","DOIUrl":"10.1007/s00062-024-01453-9","url":null,"abstract":"","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"203-205"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114001","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":"MRI-based Quantitative Collateral Assessment in Acute Stroke : A Comparison with Single-phase CTA in Drip-and-ship Patients with Serial Imaging.","authors":"Christoph Polkowski, Niklas Helwig, Marlies Wagner, Alexander Seiler","doi":"10.1007/s00062-024-01456-6","DOIUrl":"10.1007/s00062-024-01456-6","url":null,"abstract":"<p><strong>Purpose: </strong>In acute ischemic stroke with large-vessel occlusion (LVO), collateral assessment with single-phase computed tomography angiography (CTA) might underestimate pial collateral supply in a considerable proportion of patients. We aimed to compare time-resolved magnetic resonance imaging (MRI)-based quantitative collateral mapping to conventional collateral imaging with CTA.</p><p><strong>Methods: </strong>This retrospective single-center study covering a period of 6 years (2012-2018) included drip-and-ship LVO patients who underwent MR imaging after initial imaging evaluation with CT. For MRI-based collateral assessment, T2*-weighted time series from perfusion-weighted imaging (PWI) were processed to compute a quantitative collateral vessel index (CVI_PWI) based on the magnitude of signal variance across the entire acquisition time. CTA-based collateral scores (Tan and Maas) and CVI_PWI were investigated in terms of inter-modality associations between collateral measures, as well as their relationships with stroke severity, infarct volume and early functional outcome.</p><p><strong>Results: </strong>The final analysis included n = 56 patients (n = 31 female, mean age 69.9 ± 14.21 years). No significant relationship was found between MR-based quantitative collateral supply (CVI_PWI) and CT-based collateral scores (r = -0.00057, p = 0.502 and r = -0.124, p = 0.797). In contrast to CVI_PWI, CTA-based collateral scores showed no significant relationship with clinical stroke severity and infarct volume. While MR-based CVI_PWI was independently associated with favorable early functional outcome in multivariate analysis (OR 1.075, 95% CI 1.001-1.153, p = 0.046), CTA-based collateral scores were not significantly associated with outcome.</p><p><strong>Conclusions: </strong>Since collateral scores based on single-phase CTA do not accurately reflect infarct progression and might underestimate pial collateralization in a relevant proportion of patients, they are not associated with early functional outcome in LVO patients. In contrast, CVI_PWI represents a robust imaging parameter of collateral supply and is independently associated with functional outcome.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"95-103"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308900","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":"Non-contrast-enhanced MR-angiography of Extracranial Arteries in Acute Ischemic Stroke at 1.5 Tesla Using Relaxation-Enhanced Angiography Without Contrast and Triggering (REACT).","authors":"Jan P Janssen, Sarah Rose, Kenan Kaya, Robert Terzis, Robert Hahnfeldt, Roman J Gertz, Lukas Goertz, Andra-Iza Iuga, Jan-Peter Grunz, Christoph Kabbasch, Philip Rauen, Thorsten Persigehl, Kilian Weiss, Jan Borggrefe, Lenhard Pennig, Carsten Gietzen","doi":"10.1007/s00062-024-01458-4","DOIUrl":"10.1007/s00062-024-01458-4","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate a novel flow-independent sequence (Relaxation-Enhanced Angiography without Contrast and Triggering (REACT)) for imaging of the extracranial arteries in acute ischemic stroke (AIS) at 1.5 T.</p><p><strong>Methods: </strong>This retrospective single-center study included 47 AIS patients who received REACT (scan time: 3:01 min) and contrast-enhanced MRA (CE-MRA) of the extracranial arteries at 1.5 T in clinical routine. Two radiologists assessed scans for proximal internal carotid artery (ICA) stenosis, stated their diagnostic confidence and rated the image quality of cervical arteries, impact of artifacts and image noise. Apparent signal- and contrast-to-noise ratios (aSNR/aCNR) were measured for the common carotid artery and ICA.</p><p><strong>Results: </strong>REACT achieved a sensitivity of 95.0% and a specificity of 97.3% for ICA stenoses in high agreement with CE-MRA (κ = 0.83) with equal diagnostic confidence (p = 0.22). Image quality was rated higher for CE-MRA at the aortic arch (p = 0.002) and vertebral arteries (p < 0.001), whereas REACT provided superior results for the extracranial ICA (p = 0.008). Both sequences were only slightly affected by artifacts (p = 0.60), while image noise was more pronounced in CE-MRA (p < 0.001) in line with higher aSNR (p < 0.001) and aCNR (p < 0.001) values in REACT for all vessels.</p><p><strong>Conclusion: </strong>Given its good diagnostic performance while yielding comparable image quality and scan time to CE-MRA, REACT may be suitable for the imaging of the extracranial arteries in acute ischemic stroke at 1.5 T.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"105-114"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Fibrin-Heparine Coated Self-Expanding Stent for the Rescue Treatment of Intracranial Stenosis-a Multicentric Study.","authors":"Franziska Dorn, Yves Leonard Voss, Mousa Zidan, Stephanie Neuhaus, Nils Lehnen, Paul Stracke, Wolfram Schwindt, Mostafa Ergawy, Christian Dyzmann, Markus Moehlenbruch, Jessica Jesser, Dominik Vollherbst, Manuel Moreu, Carlos Pérez-García, Maxim Bester, Fabian Flottmann, Andreas Simgen, Stefan Schob, Ansgar Berlis, Christoph Maurer, Jan Hendrik Buhk, Hannah Hentschel, Christian Loehr, Bernd Eckert, Javier Saura, Fernando Delgado, Daniel Paech, Hannes Nordmeyer","doi":"10.1007/s00062-024-01448-6","DOIUrl":"10.1007/s00062-024-01448-6","url":null,"abstract":"<p><strong>Introduction: </strong>Rescue intracranial stenting is necessary to provide sufficient recanalization after mechanical thrombectomy (MT) in patients with acute large vessel occlusions (LVO) due to an underlying intracranial atherosclerotic disease (ICAD). The CREDO heal is a novel stent that provides a potentially lower thrombogenicity due to surface modification. We present the first multicentric experience with the CREDO heal for acute rescue stenting.</p><p><strong>Methods: </strong>Data of 81 patients who underwent rescue stenting after MT at 12 centers in Germany and Spain were prospectively collected and retrospectively evaluated.</p><p><strong>Results: </strong>Final mTICI 2b‑3 was reached in 95.1% after median two MT maneuvers and stenting. Four periprocedural complications resulted in clinical deterioration (4.9%). Intraparenchymal hemorrhage occurred in one patient (1.2%) and functional independence at FU was reached by 42% of the patients. Most interventions were performed under Gp IIb/IIIa inhibitors.</p><p><strong>Conclusion: </strong>CREDO heal was effective and safe in our case series. However, more data is needed to define the optimal antithrombotic regime. The use under single antiplatelet medication is not supported by our study.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"43-50"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037522","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":"Llama 3.1 405B Is Comparable to GPT-4 for Extraction of Data from Thrombectomy Reports-A Step Towards Secure Data Extraction.","authors":"Nils C Lehnen, Johannes Kürsch, Barbara D Wichtmann, Moritz Wolter, Zeynep Bendella, Felix J Bode, Hanna Zimmermann, Alexander Radbruch, Philipp Vollmuth, Franziska Dorn","doi":"10.1007/s00062-025-01500-z","DOIUrl":"https://doi.org/10.1007/s00062-025-01500-z","url":null,"abstract":"<p><strong>Purpose: </strong>GPT‑4 has been shown to correctly extract procedural details from free-text reports on mechanical thrombectomy. However, GPT may not be suitable for analyzing reports containing personal data. The purpose of this study was to evaluate the ability of the large language models (LLM) Llama3.1 405B, Llama3 70B, Llama3 8B, and Mixtral 8X7B, that can be operated offline, to extract procedural details from free-text reports on mechanical thrombectomies.</p><p><strong>Methods: </strong>Free-text reports on mechanical thrombectomy from two institutions were included. A detailed prompt was used in German and English languages. The ability of the LLMs to extract procedural data was compared to GPT‑4 using McNemar's test. The manual data entries made by an interventional neuroradiologist served as the reference standard.</p><p><strong>Results: </strong>100 reports from institution 1 (mean age 74.7 ± 13.2 years; 53 females) and 30 reports from institution 2 (mean age 72.7 ± 13.5 years; 18 males) were included. Llama 3.1 405B extracted 2619 of 2800 data points correctly (93.5% [95%CI: 92.6%, 94.4%], p = 0.39 vs. GPT-4). Llama3 70B with the English prompt extracted 2537 data points correctly (90.6% [95%CI: 89.5%, 91.7%], p < 0.001 vs. GPT-4), and 2471 (88.2% [95%CI: 87.0%, 89.4%], p < 0.001 vs. GPT-4) with the German prompt. Llama 3 8B extracted 2314 data points correctly (86.1% [95%CI: 84.8%, 87.4%], p < 0.001 vs. GPT-4), and Mixtral 8X7B extracted 2411 (86.1% [95%CI: 84.8%, 87.4%], p < 0.001 vs. GPT-4) correctly.</p><p><strong>Conclusion: </strong>Llama 3.1 405B was equal to GPT‑4 for data extraction from free-text reports on mechanical thrombectomies and may represent a data secure alternative, when operated locally.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494500","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":"Clinically Silent Microinfarct Incidence and Risk Factors After Treatment of Unruptured Intracranial Aneurysms with Hydrophilic Polymer-Coated Flow Diverters.","authors":"Ali Khanafer, Pablo Albiña-Palmarola, Philipp von Gottberg, Kamran Hajiyev, Sebastian J Müller, Jose E Cohen, Hans Henkes","doi":"10.1007/s00062-025-01497-5","DOIUrl":"https://doi.org/10.1007/s00062-025-01497-5","url":null,"abstract":"<p><strong>Purpose: </strong>Although flow diverters (FDs) revolutionized the treatment of unruptured intracranial aneurysms (UIAs), clinically silent microinfarcts (SMs) are consistently detected in postprocedural diffusion-weighted imaging (DWI), and their clinical consequences remain unknown. This study examined the incidence of, and factors associated with, SM development after the use of two surface-modified FDs: the p48MW-HPC and p64MW-HPC.</p><p><strong>Methods: </strong>A non-concurrent cohort study was conducted in 404 consecutive patients with UIAs treated with these two FDs between January 2020 and July 2023. The primary endpoint was the number of asymptomatic DWI lesions within 72 h after the procedure.</p><p><strong>Results: </strong>SMs were detected in 58.2% of the cases, and ≥ 20 lesions were identified in 7.2% of cases. Multivariate analysis revealed that the use of two specific types of microcatheters-Prowler Select Plus (P < 0.001; IRR, 3.2) and RapidTransit (P = 0.001; IRR, 2.2)-and difficulty in microcatheter navigation to the target vessel (P = 0.039; IRR, 1.8) were significantly associated with greater numbers of lesions. After exclusion of outlier cases, these devices remained associated with a significant 2‑ to 3‑fold increase in SMs. Diabetes was associated with fewer SMs (P = 0.024; IRR, 0.5), although this association disappeared after exclusion of outlier cases.</p><p><strong>Conclusion: </strong>The postprocedural incidence of SMs associated with hydrophilic polymer-coated FDs was similar to that previously reported. Interestingly, the main factor contributing to this phenomenon was the use of certain microcatheters. Careful device selection is crucial, and further research is needed to improve the safety of neurovascular interventions.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425770","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":"Treatment of Intracranial Aneurysms with the FRED X Flow Diverter Stent: Mid-term Angiographic and Safety Results.","authors":"David W Wen, James Ayre, Mani Puthuran, Paul Maliakal, Souhyb Masri, Richard Pullicino, Aubrey Smith, Feyi Babatola, Gilbert Gravino, Nasr Abdelsalam, Hamed Nejadhamzeeigilani, Arun Chandran","doi":"10.1007/s00062-024-01487-z","DOIUrl":"https://doi.org/10.1007/s00062-024-01487-z","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of our study was to assess the mid-term efficacy and safety of the FRED X flow diverting stent (FDS) in the treatment of intracranial aneurysms. The FRED X FDS is relatively new with limited data on its longer-term effectiveness and safety profile.</p><p><strong>Methods: </strong>Patients with intracranial aneurysms treated with the FRED X FDS at two UK centres, between March 2021 and July 2022 with at least 18 months follow-up, were retrospectively reviewed. Clinical, procedural and imaging data was analyzed.</p><p><strong>Results: </strong>Twenty-two patients with 24 aneurysms treated with the FRED X device, and had completed at least 18 months of follow-up, were included in this study. The rate of complete aneurysm occlusion (Raymond-Roy Class I) was 83.3% at a mean follow-up duration of 21.5 months. One case of major adverse event (4.3%) related to a post-procedural stroke which is also the only case of permanent neurological deficit (4.3%) in our cohort. Three cases of minor adverse events (13.0%) and 2 cases of asymptomatic adverse events (8.7%) were also recorded.</p><p><strong>Conclusion: </strong>Use of the FRED X FDS to treat intracranial aneurysms has acceptable safety profile and efficacy in the mid-term.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025399","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":"Ocular Involvement in Non-Ischemic Cerebral Enhancing (NICE) Lesions Following Intracranial Aneurysm Endovascular Treatment.","authors":"Julien Burel, Adrien Lefevre, Julie Gueudry, Chrysanthi Papagiannaki","doi":"10.1007/s00062-024-01495-z","DOIUrl":"https://doi.org/10.1007/s00062-024-01495-z","url":null,"abstract":"","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025397","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":"Longitudinal Dentate Nucleus MRI Changes in Hypertrophic Olivary Degeneration: a Case Report.","authors":"Lorenzo Gualco, Giacomo Rebella, Laura Saitta, Luca Roccatagliata","doi":"10.1007/s00062-024-01488-y","DOIUrl":"https://doi.org/10.1007/s00062-024-01488-y","url":null,"abstract":"","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980461","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}