Clinical Neuroradiology最新文献

{"title":"Nimodipine as Vasodilator in Guide Catheter Flush to Prevent Vasospasm During Endovascular Stroke Treatment.","authors":"Louisa J Sommer, Jessica Jesser, Omid Nikoubashman, Thanh N Nguyen, Joao Pinho, Arno Reich, Martin Wiesmann, Charlotte S Weyland","doi":"10.1007/s00062-024-01424-0","DOIUrl":"10.1007/s00062-024-01424-0","url":null,"abstract":"<p><strong>Purpose: </strong>The clinical importance and management of vasospasm as a complication during endovascular stroke treatment (EVT) has not been well studied. We sought to investigate the effect of adding nimodipine to the guiding catheter flush (GCF) to prevent vasospasm during EVT.</p><p><strong>Methods: </strong>This is a single-center retrospective analysis including patients with EVT (stent-retriever and/or distal aspiration) treated for anterior or posterior circulation intracranial vessel occlusion from January 2018 to June 2023. Exclusion criteria were intracranial or extracranial stenosis, intra-arterial alteplase, patient age over 80 years. Study groups were patients with (nimo+) and without (nimo-) nimodipine in the GCF. They were compared for occurrence of vasospasm as primary endpoint and clinical outcome in univariate analysis.</p><p><strong>Results: </strong>477 patients were included in the analysis (nimo+ n = 94 vs. nimo- n = 383). Nimo+ patients experienced less vasospasm during EVT (e.g. vasospasm in target vessel n (%): nimo- = 113 (29.6) vs. nimo+ = 9 (9.6), p < 0.001; extracranial vasospasm, n (%): nimo- = 68 (17.8) vs. nimo+ = 7 (7.4), p = 0.017). Patients of the two study groups had a comparable clinical outcome (90 day mRS, median (IQR): 3 (1-6) for both groups, p = 0.896). In general, patients with anterior circulation target vessel occlusion (TVO) experienced more vasospasm (anterior circ. TVO 38.7% vs. posterior circ. 7.5%, p = 0.006).</p><p><strong>Conclusion: </strong>Prophylactic adding of nimodipine reduces the risk of vasospasm during EVT without affecting the clinical outcome. Patients with anterior circulation TVO experienced more vasospasm compared to posterior circulation TVO.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"809-815"},"PeriodicalIF":4.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11564371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180371","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":"Y Stent-Assisted Coiling Technique for Bifurcation Aneurysms Using Double Neuroform® Stent: a Large Restrospective Series.","authors":"Isabel Rodriguez Caamaño, Sebastián Remollo, Mikel Terceño, Alberto Blanco, Saima Bashir, Carlos Castaño","doi":"10.1007/s00062-024-01437-9","DOIUrl":"10.1007/s00062-024-01437-9","url":null,"abstract":"<p><strong>Background: </strong>Stent assisted coiling technique have shown to be an effective and safe endovascular strategy for wide neck bifurcation aneurysms in achieving greater packing, allowing the closure of the aneurysm and preserving the parent arteries, compared to simple coiling.</p><p><strong>Material and methods: </strong>We conducted a retrospective analysis of 79 patients with cerebral aneurysms treated using 'Y'-configuration double Neuroform® stent-assisted coiling at our center from July 2009 to July 2022.</p><p><strong>Results: </strong>Of the 79 patients, 76% (60/79) were incidental unruptured cerebral aneurysm and 24% were patients treated for aneurysm recanalization of a previous ruptured aneurysm (19/79). The most frequent locations were anterior communicating artery (AComA) 44.3% (35/79) and middle cerebral artery (MCA) 32.9% (26/79). We found a complete and almost complete aneurysm occlusion (Raymond-Roy occlusion classification (RROC) 1 and 2): in 100% (79/79) in the angiography after procedure, in 97.6% (42/43) at the first follow-up at 6-8 months and 100% (57/57) at the first 1-2 years of follow-up. No mortality related to treatment was detected. We registered 2.5% (2/79) major ipsilateral strokes, one due to acute in stent thrombosis (patient had a mRS: 0 in follow up at 90 days) and a spinal anterior artery occlusion (patient had a mRS: 3 in follow up at 90 days).</p><p><strong>Conclusion: </strong>The 'Y' stent-assisted coiling technique with double Neuroform® is a safe and effective technique for the treatment of wide-neck bifurcation aneurysms, with high rates of complete occlusion, preserving the permeability of the afferent and efferent arteries and low rate of complications.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"919-928"},"PeriodicalIF":4.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635175","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":"Comparative Efficacy of Flow Diverter Devices in the Treatment of Carotid Sidewall Intracranial Aneurysms: a Retrospective, Multicenter Study.","authors":"Adam A Dmytriw, Hamza Adel Salim, Basel Musmar, Nicole M Cancelliere, Christoph J Griessenauer, Robert W Regenhardt, Jesse Jones, Vincent Tutino, Zuha Hasan, Nicola Limbucci, Sovann V Lay, Julian Spears, James D Rabinov, Mark R Harrigan, Adnan H Siddiqui, Elad I Levy, Christopher J Stapleton, Leonardo Renieri, Christophe Cognard, Hamza Shaikh, Anna Luisa Kühn, Markus A Möhlenbruch, Stavropoula I Tjoumakaris, Pascal Jabbour, Philipp Taussky, Fabio Settecase, Manraj K S Heran, Anh Nguyen, David Volders, Pablo Harker, Diego A Devia, Ajit S Puri, Marios Psychogios, Juan C Puentes, Giuseppe Leone, Giuseppe Buono, Margherita Tarantino, Mario Muto, Francesco Briganti, Shamsher Dalal, Vamsi Gontu, Rodolfo E Alcedo Guardia, Juan C Vicenty-Padilla, Patrick Brouwer, Matthias H Schmidt, Clemens Schirmer, Gwynedd E Pickett, Tommy Andersson, Michael Söderman, Thomas R Marotta, Hugo Cuellar-Saenz, Ajith J Thomas, Aman B Patel, Vitor Mendes Pereira, Nimer Adeeb","doi":"10.1007/s00062-024-01435-x","DOIUrl":"10.1007/s00062-024-01435-x","url":null,"abstract":"<p><strong>Background: </strong>The comparative efficacy and safety of first-generation flow diverters (FDs), Pipeline Embolization Device (PED) (Medtronic, Irvine, California), Silk (Balt Extrusion, Montmorency, France), Flow Re-direction Endoluminal Device (FRED) (Microvention, Tustin, California), and Surpass Streamline (Stryker Neurovascular, Fremont, California), is not directly established and largely inferred.</p><p><strong>Purpose: </strong>This study aimed to compare the efficacy of different FDs in treating sidewall ICA intracranial aneurysms.</p><p><strong>Methods: </strong>We conducted a retrospective review of prospectively maintained databases from eighteen academic institutions from 2009-2016, comprising 444 patients treated with one of four devices for sidewall ICA aneurysms. Data on demographics, aneurysm characteristics, treatment outcomes, and complications were analyzed. Angiographic and clinical outcomes were assessed using various imaging modalities and modified Rankin Scale (mRS). Propensity score weighting was employed to balance confounding variables. The data analysis used Kaplan-Meier curves, logistic regression, and Cox proportional-hazards regression.</p><p><strong>Results: </strong>While there were no significant differences in retreatment rates, functional outcomes (mRS 0-1), and thromboembolic complications between the four devices, the probability of achieving adequate occlusion at the last follow-up was highest in Surpass device (HR: 4.59; CI: 2.75-7.66, p < 0.001), followed by FRED (HR: 2.23; CI: 1.44-3.46, p < 0.001), PED (HR: 1.72; CI: 1.10-2.70, p = 0.018), and Silk (HR: 1.0 ref. standard). The only hemorrhagic complications were with Surpass (1%).</p><p><strong>Conclusion: </strong>All the first-generation devices achieved good clinical outcomes and retreatment rates in treating ICA sidewall aneurysms. Prospective studies are needed to explore the nuanced differences between these devices in the long term.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"907-917"},"PeriodicalIF":4.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635174","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":"Multiple Severe Intracranial Stenoses with Ischemic Stroke in Neuroborreliosis-associated Cerebral Vasculitis: Endovascular Treatment Strategies and Literature Review.","authors":"Kamran Hajiyev, Michael Forsting, Alexandru Cimpoca, Ali Khanafer, Hansjörg Bäzner, Hans Henkes","doi":"10.1007/s00062-024-01447-7","DOIUrl":"10.1007/s00062-024-01447-7","url":null,"abstract":"<p><strong>Introduction: </strong>Neuroborreliosis is the disseminated form of Lyme borreliosis and refers to the involvement of the central nervous system by Borrelia burgdorferi sensu lato spirochetes. Several reports suggest its emergence as a potential cause of cerebral vasculitis and stroke in children and young adults. The objective of this paper is to highlight endovascular treatment options within this context.</p><p><strong>Methods: </strong>The medicinal and endovascular treatments of three patients-two adults and one child-with ischemic stroke resulting from neuroborreliosis-associated severe cerebral vasculitis were retrospectively assessed. Detailed descriptions of the clinical course, treatments, and follow-up data for each patient are provided. Additionally, a literature review focusing on endovascular treatment options within this topic was conducted.</p><p><strong>Results: </strong>Both endovascular and medicinal treatments resulted in excellent clinical outcomes in all three patients, with no observed periprocedural complications. Significant clinical improvement was noted during mid-term follow-up. Follow-up angiographies confirmed stent patency.</p><p><strong>Conclusion: </strong>Endovascular interventions as a bailout strategy may enhance clinical outcomes in patients with vascular complications of neuroborreliosis, especially when medicinal therapy alone fails to achieve further improvement. In the setting of severe ischemic stroke with sub-occlusive large vessel stenosis or occlusion, the cause of which is often unknown, it should be considered to prioritize prompt endovascular treatment, even if neuroborreliosis is suspected on admission.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"959-972"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11564264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972220","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":"Wernicke Encephalopathy: Typical and Atypical Findings in Alcoholics and Non-Alcoholics and Correlation with Clinical Symptoms.","authors":"C T Arendt, C Uckermark, L Kovacheva, F Lieschke, R Golbach, S Edwin Thanarajah, E Hattingen, S Weidauer","doi":"10.1007/s00062-024-01434-y","DOIUrl":"10.1007/s00062-024-01434-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Clinical diagnosis of Wernicke encephalopathy (WE) can be challenging due to incomplete presentation of the classical triad. The aim was to provide an update on the relevance of standard MRI and to put typical and atypical imaging findings into context with clinical features.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this two-center retrospective observational study, the local radiology information system was searched for consecutive patients with clinical or imaging suspicion of WE. Two independent raters evaluated T2-weighted imaging (WI), fluid-attenuation inversion recovery (FLAIR), diffusion WI (DWI), T2*WI and/or susceptibility WI (SWI), and contrast-enhanced (CE)-T1WI, and noted the involvement of typical (i.e., mammillary bodies (MB), periaqueductal grey (PAG), thalamus, hypothalamus, tectal plate) and atypical (all others) lesion sites. Unusual signal patterns like hemorrhages were also documented. Reported clinical features together with the diagnostic criteria of the latest guidelines of the European Federation of Neurological Societies (EFNS) were used to test for relationships with MRI biomarkers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;47 patients with clinically confirmed WE were included (Jan '99-Apr '23; mean age, 53 yrs; 70% males). Interrater reliability for imaging findings was substantial (κ = 0.71), with lowest agreements for T2WI (κ = 0.85) compared to all other sequences and for PAG (κ = 0.65) compared to all other typical regions. In consensus, 77% (n = 36/47) of WE cases were rated MRI positive, with FLAIR (n = 36/47, 77%) showing the strongest relation (χ&lt;sup&gt;2&lt;/sup&gt; = 47.0; P &lt; 0.001) compared to all other sequences. Microbleeds in the MB were detected in four out of ten patients who received SWI, not visible on corresponding T2*WI. Atypical findings were observed in 23% (n = 11/47) of cases, always alongside typical findings, in both alcoholics (n = 9/44, 21%) and non-alcoholics (n = 2/3, 67%). Isolated involvement of structures, explicitly PAG (n = 4/36; 11%) or MB (n = 1/36; 3%), was present but observed less frequently than combined lesions (n = 31/36; 86%). A cut-off width of 2.5 mm for the PAG on 2D axial FLAIR was established between cases and age- and sex-matched controls. An independent association was demonstrated only between short-term memory loss and changes in the MB (OR = 2.2 [95% CI: 1.1-4.5]; P = 0.024). In retrospect, EFNS criteria were positive (≥ 2 out of 4) in every case, but its count (range, 2-4) showed no significant (P = 0.427) relationship with signal changes on standard MRI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The proposed sequence protocol (FLAIR, DWI, SWI and T1WI + CE) yielded good detection rates for neuroradiological findings in WE, with SWI showing microbleeds in the MB with superior detectability. However, false negative results in about a quarter of cases underline the importance of neurological alertness for the diagnosis. Awareness of atypical MRI findings should be rai","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"881-897"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141628158","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":"Children with Congenital Heart Diseases Exhibit Altered Deep Gray Matter Structures.","authors":"Nils D Forkert, Sarah J MacEachern, Allison K Duh, Peter Moon, Sarah Lee, Kristen W Yeom","doi":"10.1007/s00062-024-01417-z","DOIUrl":"10.1007/s00062-024-01417-z","url":null,"abstract":"<p><strong>Background and objectives: </strong>Children with congenital heart diseases (CHDs) have an increased risk of developing neurologic deficits, even in the absence of apparent brain pathology. The aim of this work was to compare quantitative macro- and microstructural properties of subcortical gray matter structures of pediatric CHD patients with normal appearing brain magnetic resonance imaging to healthy controls.</p><p><strong>Methods: </strong>We retrospectively reviewed children with coarctation of the aorta (COA) and hypoplastic left heart syndrome (HLHS) admitted to our hospital. We identified 24 pediatric CHD patients (17 COA, 7 HLHS) with normal-appearing brain MRI. Using an atlas-based approach, the volume and apparent diffusion coefficient (ADC) were determined for the thalamus, caudate, putamen, pallidum, hippocampus, amygdala, nucleus accumbens, cerebral white matter, cerebral cortex, and brainstem. Multivariate statistics were used to compare the extracted values to reference values from 100 typically developing children without any known cardiac or neurological diseases.</p><p><strong>Results: </strong>Multivariate analysis of covariance using the regional ADC and volume values as dependent variables and age and sex as co-variates revealed a significant difference between pediatric CHD patients and healthy controls (p < 0.001). Post-hoc comparisons demonstrated significantly reduced brain volumes in most subcortical brain regions investigated and elevated ADC values in the thalamus for children with CHD. No significant differences were found comparing children with COA and HLHS.</p><p><strong>Conclusions: </strong>Despite normal appearing brain MRI, children with CHD exhibit wide-spread macro-structural and regional micro-structural differences of subcortical brain structures compared to healthy controls, which could negatively impact neurodevelopment, leading to neurological deficits in childhood and beyond.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"771-778"},"PeriodicalIF":4.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923602","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":"Haberland Syndrome (Encephalocraniocutaneous Lipomatosis) with Development of Diffuse Leptomeningeal Glioneural Tumor (DL-GNT) during Adolescence.","authors":"Suely Fazio Ferraciolli, Mario Tortora, Luis Felipe de Souza Godoy, Yuri Reis Casal, Leandro Tavares Lucato","doi":"10.1007/s00062-024-01389-0","DOIUrl":"10.1007/s00062-024-01389-0","url":null,"abstract":"","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"973-976"},"PeriodicalIF":4.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139730820","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":"Comparing the Diagnostic Performance of GPT-4-based ChatGPT, GPT-4V-based ChatGPT, and Radiologists in Challenging Neuroradiology Cases.","authors":"Daisuke Horiuchi, Hiroyuki Tatekawa, Tatsushi Oura, Satoshi Oue, Shannon L Walston, Hirotaka Takita, Shu Matsushita, Yasuhito Mitsuyama, Taro Shimono, Yukio Miki, Daiju Ueda","doi":"10.1007/s00062-024-01426-y","DOIUrl":"10.1007/s00062-024-01426-y","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the diagnostic performance among Generative Pre-trained Transformer (GPT)-4-based ChatGPT, GPT‑4 with vision (GPT-4V) based ChatGPT, and radiologists in challenging neuroradiology cases.</p><p><strong>Methods: </strong>We collected 32 consecutive \"Freiburg Neuropathology Case Conference\" cases from the journal Clinical Neuroradiology between March 2016 and December 2023. We input the medical history and imaging findings into GPT-4-based ChatGPT and the medical history and images into GPT-4V-based ChatGPT, then both generated a diagnosis for each case. Six radiologists (three radiology residents and three board-certified radiologists) independently reviewed all cases and provided diagnoses. ChatGPT and radiologists' diagnostic accuracy rates were evaluated based on the published ground truth. Chi-square tests were performed to compare the diagnostic accuracy of GPT-4-based ChatGPT, GPT-4V-based ChatGPT, and radiologists.</p><p><strong>Results: </strong>GPT‑4 and GPT-4V-based ChatGPTs achieved accuracy rates of 22% (7/32) and 16% (5/32), respectively. Radiologists achieved the following accuracy rates: three radiology residents 28% (9/32), 31% (10/32), and 28% (9/32); and three board-certified radiologists 38% (12/32), 47% (15/32), and 44% (14/32). GPT-4-based ChatGPT's diagnostic accuracy was lower than each radiologist, although not significantly (all p > 0.07). GPT-4V-based ChatGPT's diagnostic accuracy was also lower than each radiologist and significantly lower than two board-certified radiologists (p = 0.02 and 0.03) (not significant for radiology residents and one board-certified radiologist [all p > 0.09]).</p><p><strong>Conclusion: </strong>While GPT-4-based ChatGPT demonstrated relatively higher diagnostic performance than GPT-4V-based ChatGPT, the diagnostic performance of GPT‑4 and GPT-4V-based ChatGPTs did not reach the performance level of either radiology residents or board-certified radiologists in challenging neuroradiology cases.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"779-787"},"PeriodicalIF":4.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162013","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":"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":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-17","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":"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":"https://doi.org/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":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}