Clinical Neuroradiology最新文献

{"title":"Data-efficient Neuroradiology MRI Imaging Protocol Prediction Using Open-weights Large Language Models.","authors":"Marius Vach, Christian Boschenriedter, Daniel Weiss, Vivien Lorena Ivan, Karl Ludger Radke, Julian Caspers, Christian Rubbert","doi":"10.1007/s00062-026-01701-0","DOIUrl":"10.1007/s00062-026-01701-0","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the feasibility of a locally deployable large language model (LLM) system for automated MRI protocol selection addressing data privacy, annotation burden, and scalability limitations.</p><p><strong>Methods: </strong>This retrospective study included 598 German-language MRI order entries from three neuroradiology domains (brain, head/neck, spine) between June 2018 and January 2023. A radiologist labeled entries for 27 protocol classes based on institutional standard operating procedures (SOP). An SOP-grounded AI system using MedGemma 27B was developed to predict the MRI protocol from the order entry. The system was optimized using Stochastic Introspective Mini-Batch Ascent (SIMBA), a self-reflective prompt optimization algorithm, and compared with a hierarchical system that first classified the body region and then the MRI protocol. Data efficiency was evaluated using training subsets of 10-119 examples across 3 optimization runs per subset size.</p><p><strong>Results: </strong>The flat zero-shot model achieved 73.07% accuracy in the three-domain setting on the held-out dataset (n = 479). In the hierarchical model, prompt optimization yielded 73.90% ± 3.24% with 30 labeled examples and a maximum of 74.46% ± 3.82% but did not outperform the flat approach. Prompt optimization benefited the hierarchical system, whereas the flat model already performed strongly without labeled examples for optimization. Performance on brain and head/neck cases remained broadly stable after expansion from 22 to 27 protocol classes, i.e., including spine.</p><p><strong>Conclusion: </strong>A locally deployable SOP-grounded open-weight LLM can support MRI protocol selection while preserving data privacy and needing minimal labeled data. In this dataset, hierarchical routing and prompt optimization did not improve overall performance over the flat baseline, although they altered optimization behavior and error profile. These findings support prospective evaluation in human-in-the-loop clinical workflows.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438563","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":"Procedural Framework for Combined Mechanical Thrombectomy and Continuous rtPA Thrombolysis in the Recanalization of Deep Cerebral Venous Thrombosis in a Pediatric Patient.","authors":"Theo Demerath, Hendryk Schneider, Matthias Eckenweiler, Luise Brado","doi":"10.1007/s00062-026-01699-5","DOIUrl":"https://doi.org/10.1007/s00062-026-01699-5","url":null,"abstract":"","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438548","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":"Swarm Learning for the Detection of Middle Cerebral Artery Occlusion On CT Angiography.","authors":"Julia K Harten, Soma Hansel, Dominik Creuzberg, Gianluca Brugnara, Daniel Kuetting, Mischa Uebachs, Johannes Weller, Gabor C Petzold, Franziska Dorn, Philipp Vollmuth, Anna C Aschenbrenner, Joachim L Schultze, Alexander Radbruch, Alexander Effland, Nils C Lehnen","doi":"10.1007/s00062-026-01697-7","DOIUrl":"https://doi.org/10.1007/s00062-026-01697-7","url":null,"abstract":"<p><strong>Purpose: </strong>Swarm Learning has been introduced as a decentralized alternative to Central Learning. We aimed to evaluate whether Swarm Learning (SL) is equivalent to Central Learning (CL) for training AI models to detect middle cerebral artery (MCA) occlusions on CT angiography (CTA).</p><p><strong>Methods: </strong>This retrospective study included CTAs of patients suspected of ischemic stroke and negative controls from two institutions and three scanners between October 2010 and March 2024. After manual segmentation of occluded vessels by two raters, two AI algorithms (MedNeXt‑S, Swin UNETR) were trained using CL and SL. Sensitivity, specificity, positive/negative predictive values (PPV, NPV), accuracy, and AUC were calculated. Significance testing was performed using the exact McNemar test and comparisons of relative predictive values. For external validation, CTAs from a fourth scanner from a third institution were used.</p><p><strong>Results: </strong>470 CTAs of 470 patients (mean age, 72.6 years ±14.3; 247 women) were included, with 356 (75.7%) MCA-occlusions. Training used 375-377 CTAs (79.8-80.2%), with 93-95 (19.8-20.2%) for internal validation. For internal validation, averaged accuracy ranged from 87.23-92.54%, sensitivity from 91.13-93.56%, specificity from 64.82-95.92%, PPV from 90.27-98.44%, and NPV from 73.39-78.66%. For external validation, 101 CTAs of 101 patients (mean age 70.9 years ±16.8; 56 women) were included, with 27 CTAs (26.7%) showing MCA occlusion. Neither internal nor external validation showed significant differences between SL and CL.</p><p><strong>Conclusion: </strong>AI models trained with SL showed no significant differences compared with CL and may represent a sustainable, and data-safe alternative.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406552","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 New Tumor Predisposition Syndromes with Neuro-Oncological Relevance-A Comprehensive Review for Neuroradiologists.","authors":"Reinhold Nafe, Luciana Porto, Anke Barnbrock, Elke Hattingen","doi":"10.1007/s00062-026-01677-x","DOIUrl":"https://doi.org/10.1007/s00062-026-01677-x","url":null,"abstract":"<p><p>The 5th edition of the WHO Classification of Tumors of the Central Nervous System (CNS) introduced new additional tumor predisposition syndromes (TPS) that were not included in the 2016 version of the WHO Classification. It is essential for neuroradiologists to be familiar with these novel TPS entities, as accurate imaging interpretation and clinical evaluation often depend on recognising patterns of peripheral and central nervous system findings. Such identification should lead to genetic testing to confirm the suspected TPS diagnosis. Generally, neuroradiological features of brain tumors arising in these TPS are not distinctly different from those observed in sporadic forms of the same tumors. Even in uncommon cases such as meningiomas with aggressive behaviour, often seen in BAP1 syndrome, imaging and clinical evaluations can only suggest TPS; a definite diagnosis cannot be made from phenotype and imaging alone. This review discusses all new TPS in detail and presents their phenotypic spectrum known today. Knowledge of the genetic aspects of each TPS provides additional support to neuroradiologists due to the certainty of the clear distinguishability of TPS. For example, in conditions such as DICER1 syndrome and Fanconi anaemia, the diversity of genetic mutations contributes directly to the broad spectrum of phenotypic manifestations. As a result, genetic knowledge is essential not only for diagnosis but also for appreciating the complexity and heterogeneity of these syndromes in clinical practice. Finally, this discussion includes other TPS that, while not yet classified as distinct entities in the current edition of the WHO Classification of Tumors of the CNS, remain relevant to the field of neuro-oncology.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297166","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 Research for the Use of 7 T Magnetic Resonance Imaging for Spinal Pathologies: a Scoping Review.","authors":"Nathan Nguyen, Alexa R Lauinger, Anant Naik, Robert Liu, Yagiz Yolcu, Paul M Arnold","doi":"10.1007/s00062-026-01669-x","DOIUrl":"https://doi.org/10.1007/s00062-026-01669-x","url":null,"abstract":"<p><strong>Purpose: </strong>Magnetic resonance imaging (MRI) at 7 T (7T) offers higher signal-to-noise ratio and improved spatial resolution compared to lower magnetic field strengths such as 1.5T and 3T, which may improve lesion detection and anatomical visualization for spinal cord pathology. This review summarizes current techniques and achievements in 7T spinal imaging and outlines associated technical barriers and future directions.</p><p><strong>Methods: </strong>A scoping review in accordance with PRISMA extension for scoping reviews guidelines was performed utilizing PubMed, Scopus, and Web of Science. Only studies related to 7T MRI of human subjects were included, after removing unrelated studies and those of non-human subjects.</p><p><strong>Results: </strong>Twenty-nine studies were included. Current literature supports 7T's superior resolution and signal-to-noise ratio in comparison to 1.5T and 3T MRI. These studies reported improved lesion detection and staging in multiple sclerosis (MS), spinal cord injury (SCI), and amyotrophic lateral sclerosis (ALS); however, the implications of results are limited by small sample sizes, technical heterogeneity, and inconsistent outcome measures. Additionally, the use of 7T spinal imaging remains limited by radiofrequency coil design, susceptibility artifacts, physiological noise, lack of FDA-clearance for spinal indications, and an absence of standardized imaging protocols. Future research aims to address these limitations.</p><p><strong>Conclusion: </strong>Spinal cord imaging at 7T is challenging due to technical constraints and higher susceptibility to artifacts as a result of physiological noise (respiration, swallowing, and bulk movement). However, early studies' results using 7T imaging support improved ability, compared to 3T, to provide enhanced visualization of fine anatomical structures, such as nerve roots, and to improve spinal cord lesion detection.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201036","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":"Feasibility of Using Angioscopy to Visualize the Internal Vessel Wall of the Internal Carotid Artery.","authors":"Roland Schwab, Nike Zschenderlein, Axel Boese, Stefan Klebingat, Daniel Behme","doi":"10.1007/s00062-025-01587-4","DOIUrl":"10.1007/s00062-025-01587-4","url":null,"abstract":"<p><strong>Background: </strong>Digital subtraction angiography lacks the ability to visualise intimal surface changes. Angioscopy, in contrast, enables direct imaging of the endoluminal surface, revealing luminal alterations, as established in cardiovascular imaging. Its application in the internal carotid artery (ICA) could allow assessment of pathological changes and the visualization of implant structures such as stents or flow diverters, including their apposition to the vessel wall. This study evaluates the feasibility of using a thin fibre-optic endoscope for angioscopy in the ICA anatomy.</p><p><strong>Methods: </strong>Five 3D DSA image sets of the ICA with varying anatomies were selected. Tube-based vessel models were fabricated to replicate the corresponding vascular segments, incorporating a measurement scale and, optionally, a stent or a flow diverter. The advancement of a fibre-optic endoscope and the related influence on vessel deformation were assessed in each model. Spatial and colour resolution were evaluated by applying coloured markings to the inner tube surface to simulate vessel wall discolouration. The visibility of structural details, including flow diverter meshes and stent struts, was assessed based on image contrast and sharpness within the angioscope's defined field of view.</p><p><strong>Results: </strong>The endoscope was successfully advanced to the distal end in all models. Increased vascular curvature required greater mechanical force for navigation and positioning, leading to observable straightening of the vessel model. In all cases, endoscopic imaging produced clear visualizations of vessel wall markings and implant structures. Stent struts and flow diverter meshes were distinguishable, as were discolorations simulating pathological changes.</p><p><strong>Conclusion: </strong>Angioscopy of the ICA is technically feasible and enables endoluminal visualization, including implant structures. Feasibility was strongly dependent on vessel curvature and required substantial increases in delivery force in highly tortuous anatomies.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"359-367"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490654","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":"Neuroimaging in Non-fatal Strangulation: a Retrospective Analysis of Injury Patterns, Clinical Features and Diagnostic Utility.","authors":"Katja Döring, Zaid Abdel-Muhdy, Athanasia Warnecke, Michael Klintschar, Heinrich Lanfermann, Stefan Bleich, Johanna Seifert","doi":"10.1007/s00062-025-01597-2","DOIUrl":"10.1007/s00062-025-01597-2","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the incidence and patterns of injuries after non-fatal self-inflicted (SIS) and non-self-inflicted strangulation (NSIS) and evaluate diagnostic utility of computed tomography (CT) and magnetic resonance imaging (MRI).</p><p><strong>Methods: </strong>Single-center retrospective analysis (2013-2024) of patients undergoing CT and/or MRI following SIS/NSIS. Demographics, psychiatric comorbidity, strangulation mechanism, clinical symptoms and imaging findings were analyzed. Imaging was assessed for strangulation-associated injuries (e.g., fractures of the hyoid-larynx-complex [HLC], soft tissue hematoma [STH], blunt cervicovascular injury [BCVI]). Descriptive statistics were performed to detect risk factors for strangulation-associated injuries.</p><p><strong>Results: </strong>106 patients (55.7% female; mean age 40.2 years) and 124 events of strangulation with subsequent neuroimaging were included (CT: 96.8%, MRI: 3.2%). SIS comprised 80.6% of cases, mostly ligature strangulation (68.0%), followed by near-hanging (29.0%). NSIS accounted for 18.5% of cases. Eleven patients sustained strangulation-associated injuries, primarily HLC fractures and STH (6 cases each), but no BCVI. Older age (odds ratio: 1.04; 95% confidence interval: 1.01-1.07; p = 0.021) showed a weak association and male sex (6.32, 1.31-30.59, p = 0.022), near-hanging (12.36, 3.19-47.81, p < 0.001) and intubation (8.65, 2.04-36.78, p < 0.001) a moderate association with strangulation-associated injuries. We identified a distinct patient subgroup with recurrent SIS, characterized by predominant female sex, younger age and psychiatric disorders presenting with emotional instability. Injuries were not detected in any of these cases.</p><p><strong>Conclusion: </strong>Severe strangulation-associated injuries are rare. CT should be used selectively, particularly in alert patients lacking relevant clinical findings. MRI may be preferable in younger patients and for forensic evaluation, particularly in NSIS.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"473-484"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710151","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":"Research Reality in Neuroradiology: a Survey Analysis at German University Hospitals.","authors":"Béatrice Maxime von Tresckow, Katharina Schregel, Sarah Schlaeger, Daniel P O Kaiser, Roland Schwab, Daniel Weiss, David Zopfs, Elke Hattingen, Ansgar Berlis, Peter Schramm, Katharina J Wenger","doi":"10.1007/s00062-025-01608-2","DOIUrl":"10.1007/s00062-025-01608-2","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to provide a representative overview of the current research conditions in neuroradiology at German hospitals.</p><p><strong>Methods: </strong>In 2024, the German Society of Neuroradiology (DGNR) conducted an anonymous online survey targeting neuroradiology researchers working at German hospitals. Participants were recruited via targeted e-mail-outreach and professional social media channels. Data were collected using the Easyfeedback platform. A total of 60 individuals participated, of whom 33 completed the full 33-item questionnaire. Data were analyzed descriptively.</p><p><strong>Results: </strong>Among respondents who completed the survey, 50% reported being satisfied or very satisfied with their current research conditions. Respondents from non-independent departments expressed more dissatisfaction than those of independent institutes. Major challenges for researchers included insufficient research time, lack of funding, and limited infrastructure. Scientific work was most frequently conducted alongside clinical duties or during personal time, while only a minority of respondents reported receiving continuousely protected research time. Intramural university funding represented the most common funding source. Any type of structured research program was available at approximately half of the institutions. Mentoring opportunities within these programs were reported by a majority of respondents, with generally positive evaluations and corresponding higher satisfaction with research conditions.</p><p><strong>Conclusion: </strong>Structural independence, expanding protected research time, improving funding opportunities, and promoting structured research and mentoring programs appear essential to ensure sustainable academic development and innovation in the field.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"595-609"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146068226","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":"Brain Atrophy and White Matter Changes Grading Agreement on NCCT and MRI in Ischemic Stroke.","authors":"William Betzner, Nishita Singh, Ibrahim Alhabli, Mohammed Almekhlafi, Fouzi Bala, Faysal Benali, Kaden Lam, Cody Doolan, Joseph Carere, Luciana Catanese, Tolu Sajobi, Aleksander Tkach, Richard Swartz, Bijoy K Menon, Aravind Ganesh","doi":"10.1007/s00062-026-01636-6","DOIUrl":"10.1007/s00062-026-01636-6","url":null,"abstract":"<p><strong>Purpose: </strong>Brain frailty measures like atrophy and white matter changes (WMC) are becoming increasingly relevant in stroke outcome prediction but are conventionally thought to be best seen on MRI compared to CT. We assessed agreement between baseline CT vs follow-up MRI ratings for brain atrophy and WMC; and compared their discriminative ability for 90-day functional outcomes in acute ischemic stroke.</p><p><strong>Methods: </strong>In this post-hoc, observational analysis of baseline CT and follow-up MRI data from the Alteplase compared to Tenecteplase (AcT) randomised-controlled trial, experts assessed brain atrophy, periventricular and deep WMC using established visual-rating scales. Binary agreement (none-mild vs. moderate-severe) and agreement across the full scores between atrophy and WMC measures on CT and MRI were calculated using Gwet's agreement coefficient (AC1). Logistic regression estimated discrimination for 90-day modified Rankin Scale (mRS) 0-1. Agreement of AUCs for CT and MRI models were compared using DeLong's test.</p><p><strong>Results: </strong>Among 1577 AcT participants, 491(31.1%) had interpretable CT and MRI. Binary agreement was substantial for periventricular (AC1 = 0.70) and total WMC (AC1 = 0.68) scores, Koedam scale (AC1 = 0.76) and frontal atrophy (AC1 = 0.80). Almost perfect agreement (AC1:0.81-0.97) was found for deep WMC (AC1 = 0.85), and the other atrophy scores (AC1 = 0.81-0.97). There was no significant difference between NCCT or MRI in discriminating 90-day mRS 0-1 for any measures.</p><p><strong>Conclusions: </strong>CT ratings of brain atrophy and WMC by experts have substantial to almost-perfect agreement compared to MRI. Both achieve similar discrimination of 90-day functional outcomes. This implies the reasonable use of CT scans in evaluating brain frailty measures in clinical practice and stroke trials.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"721-729"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147311798","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":"Intravenous Thrombolysis in Distal Medium Middle Cerebral Artery Occlusion Patients with Unsuccessful Mechanical Reperfusion.","authors":"Hamza Adel Salim, Benjamin Pulli, Vivek Yedavalli, Dhairya Lakhani, Orabi Hajjeh, Basel Musmar, Nimer Adeeb, Fathi Milhem, Davide Simonato, Yan-Lin Li, Muhammed Amir Essibayi, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kühn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Leonard L Yeo, Benjamin Y Q Tan, Robert W Regenhardt, Aymeric Rouchaud, Jens Fiehler, Sunil Sheth, Ajit S Puri, Christian Dyzmann, Marco Colasurdo, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Mohamad Abdalkader, Piers Klein, Takahiro Ota, Ashkan Mowla, Kareem El Naamani, Pascal Jabbour, Arundhati Biswas, Frédéric Clarençon, James E Siegler, Thanh N Nguyen, Ricardo Varela, Amanda Baker, David Altschul, Nestor R Gonzalez, Markus A Möhlenbruch, Vincent Costalat, Benjamin Gory, Christian Paul Stracke, Constantin Hecker, Gaultier Marnat, Hamza Shaikh, Christoph J Griessenauer, David S Liebeskind, Alessandro Pedicelli, Andrea M Alexandre, Tobias D Faizy, Illario Tancredi, Erwah Kalsoum, Boris Lubicz, Vitor Mendes Pereira, Aman B Patel, Maurizio Fuschi, Max Wintermark, Jeremy J Heit, Adrien Guenego, Adam A Dmytriw","doi":"10.1007/s00062-025-01583-8","DOIUrl":"10.1007/s00062-025-01583-8","url":null,"abstract":"<p><strong>Background: </strong>The efficacy and safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT) for distal, medium vessel occlusions (DMVO) is not well established. This study investigates whether IVT impacts outcomes in DMVO patients, particularly in those with unsuccessful or partial recanalization after MT.</p><p><strong>Methods: </strong>We conducted a retrospective, multicenter study using data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry. The study population included AIS patients with DMVO in the M2, M3, and M4 segments of the MCA, treated with or without IVT followed by MT and a final modified Thrombolysis in Cerebral Infarction (mTICI) score of 0, 1, or 2a. The primary outcome was functional independence, assessed by the 90-day modified Rankin Scale (mRS) of 0-1 or 0-2.</p><p><strong>Results: </strong>The study comprised 210 patients with final mTICI 0 to 2a, with 130 undergoing MT alone and 80 receiving IVT followed by MT. Logistic regression analysis revealed no significant differences in clinical outcomes between groups. The odds ratios (ORs) for achieving a 90-day mRS of 0-1 and 0-2 were 1.55 (95% CI 0.62 to 3.87; p = 0.34) and 1.55 (95% CI 0.72 to 3.37; p = 0.26), respectively. The odds of symptomatic intracerebral hemorrhage (sICH) were similar between groups (OR 0.64, 95% CI 0.28 to 1.47; p = 0.29), as were the odds of intracranial hemorrhage (ICH) of any type (OR 1.39, 95% CI 0.71 to 2.73; p = 0.34).</p><p><strong>Conclusions: </strong>In AIS patients with DMVO and unsuccessful or partial recanalization after MT, IVT did not significantly improve clinical outcomes. Additionally, IVT did not increase the risk of hemorrhagic complications. These findings suggest that while IVT preceding MT is safe in this context, it may not improve outcomes for patients with unsuccessful MT.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"387-399"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145606854","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}