Clinical Neuroradiology最新文献

{"title":"Reframing Medium-Vessel Occlusion Thrombectomy in Acute Ischemic Stroke: Device-Vessel Matching and Patient Selection as Keys to Clinical Benefit.","authors":"Matija Zupan, René Chapot, Senta Frol","doi":"10.1007/s00062-026-01667-z","DOIUrl":"https://doi.org/10.1007/s00062-026-01667-z","url":null,"abstract":"","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845088","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 Cone-Beam CT for Follow-up of Intracranial Aneurysms Treated with the Woven EndoBridge Device.","authors":"Yosuke Tajima, Masaaki Kubota, Hajime Yokota, Jun Koizumi, Katsuya Hayashi, Yoshinori Higuchi","doi":"10.1007/s00062-025-01576-7","DOIUrl":"10.1007/s00062-025-01576-7","url":null,"abstract":"<p><strong>Purpose: </strong>The Woven EndoBridge (WEB) device is an established endovascular treatment method for wide-neck intracranial aneurysms. Digital subtraction angiography (DSA) is the reference standard for posttreatment evaluation; however, its invasive nature limits its repeated use. This study aimed to compare the diagnostic accuracy and reproducibility of intravenous cone-beam computed tomography (IVCBCT) and DSA in the follow-up of aneurysms treated with the WEB device.</p><p><strong>Methods: </strong>This prospective single-center study included 16 patients with unruptured intracranial aneurysms who were treated with the WEB device. All patients underwent both DSA and IVCBCT at the 6‑month follow-up, performed on the same day. Aneurysm occlusion status was independently evaluated by two experienced neuroradiologists using the 8‑point modified Bicêtre Occlusion Scale Score (BOSS). Intermodality and interobserver agreement were assessed using Cohen's kappa statistics.</p><p><strong>Results: </strong>Complete agreement between IVCBCT and DSA was observed in all 16 cases (κ = 1.0 for both raters). Interobserver agreement for IVCBCT grading was also excellent (κ = 0.86). The BOSS distribution for IVCBCT was as follows: grade 0 or 0' in eight cases (50.0%), grade 1 in five cases (31.3%), grade 2 in two cases (12.5%), and grade 3 in one case (6.2%). IVCBCT demonstrated consistent diagnostic performance across various occlusion grades.</p><p><strong>Conclusion: </strong>IVCBCT offers a reliable, noninvasive alternative to DSA for the follow-up of WEB-treated aneurysms, providing excellent diagnostic concordance and reproducibility.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"195-201"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337960","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":"Detection of Microvascular Failure After Thrombectomy Directly in the Angio-Suite Using Parametric Color Coding.","authors":"Ludwig Singer, Maximilian Sprügel, Jeannette Becker, Hannes Lücking, Stefan T Gerner, Stefan Schwab, Arnd Dörfler, Tobias Engelhorn","doi":"10.1007/s00062-025-01557-w","DOIUrl":"10.1007/s00062-025-01557-w","url":null,"abstract":"<p><strong>Purpose: </strong>The \"no-reflow phenomenon\" refers to persisting microvascular failure despite complete macrovascular reperfusion. We investigated whether parametric color coding (PCC) analysis of the DSA-series after successful mechanical thrombectomy could predict microvascular dysfunction.</p><p><strong>Methods: </strong>We retrospectively analyzed the STAMINA database for patients admitted to a single tertiary care center over a 5-year period with MCA-Occlusion (M1 or M2 branch), large penumbra, TICI 3 and infarct volume exceeding 15 ml on follow-up CT-presumed to reflect microvascular failure. These 55 patients were compared to 55 controls with infarcts < 15 ml on follow-up CT. As proof of concept, we included 42 non-stroke patients undergoing elective treatment of unruptured intracranial aneurysms. Using iFlow-PCC software, we calculated critical flow parameters, including cerebral circulation time (CirT), relative cortical time to peak (rTTP), and microvascular transit time (mTT).</p><p><strong>Results: </strong>Microvascular transit time (mTT) was significantly prolonged in the suspected microvascular failure group (3.22 ± 0.85 s) compared to the recanalization control group (2.79 ± 0.64 s; p = 0.003) and the non-stroke interventional control group (2.54 ± 0.90 s, p = 0.0003). The group with suspected microvascular failure exhibited a median modified Rankin Score at 3 months (mRS 3M: 4, IQR: 3-5) and a higher number of poor outcomes (mRS 5-6; n = 16) compared to the control group with similar strokes (median mRS 3M: 2, IQR: 1-4; mRS 5-6: n = 4).</p><p><strong>Conclusion: </strong>Prolonged microvascular transit time (mTT) can predict microvascular failure after thrombectomy. Angiographic flow analysis, performed directly in the angio-suite allows early identification of patients who may benefit from additional therapy like intra-arterial thrombolysis.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"67-75"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876412","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":"Thalamic Arteriovenous Malformations: Clinical Presentation, Angio-Architecture and Therapeutic Management: Retrospective Analysis of a Single Center Experience in 22 Patients.","authors":"Pierre-Marie Chiaroni, Mariette Delaître, Eimad Shotar, Bertrand Mathon, Nader-Antoine Sourour, Julien Allard, Kevin Premat, Mahmoud Elhorany, Anne-Laure Boch, Pierre-Yves Borius, Stéphanie Lenck, Vincent Degos, Alexandre Carpentier, Frédéric Clarençon","doi":"10.1007/s00062-025-01558-9","DOIUrl":"10.1007/s00062-025-01558-9","url":null,"abstract":"<p><strong>Purpose: </strong>Assess the prevalence of thalamic AVM (tAVMs), their revealing conditions and angio-architectural features, as well as their therapeutic management.</p><p><strong>Methods: </strong>Monocentric retrospective study (1998 to 2018) involving 748 consecutive patients with a brain AVM managed at the Pitié-Salpêtrière Hospital, from which tAVMs were retrieved. Revealing condition of the tAVMs was recorded. tAVMs' angio-architecture was systematically reviewed on angiographic examinations. The safety and effectiveness of treatments (conservative management and exclusion treatment) were evaluated based on clinical and angiographic criteria.</p><p><strong>Results: </strong>Twenty-two consecutive patients (9 males, mean age: 32 ± 14 years) with a tAVM were included (prevalence: 2.9%). tAVMs were revealed by a bleeding event in 86.4% of cases. The posterolateral choroidal artery was the most frequently observed arterial feeder in our series (71.4%). Associated aneurysm (nidal and/or pedicular) was observed in 36.4% of patients. The tAVMs' mean volume was 6.45 ± 12.8 ml. Venous drainage was in the deep venous system only in most cases (81%). Four patients received conservative management, 12 patients were treated by radiosurgery and 12 by embolization, with 6 patients (27.2%) who received both embolization and radiosurgery. Complete nidal occlusion was achieved in 33.3% of the patients who underwent angiographic follow-up. Two embolized patients (16.7%) suffered severe embolization-related complications, and 4 patients treated with radiosurgery (33.3%) suffered severe procedure related complication, all of which resolved without significant sequela.</p><p><strong>Conclusion: </strong>Our results underline the safety of exclusion treatments by embolization and/or radiosurgery of tAVMs. Efficacy in terms of angiographic exclusion still needs to be demonstrated at long-term due to limited imaging follow-up.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"103-118"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976169","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 Bail out Technique to Manage Cervical Artery Dissections During Neurointerventions.","authors":"Petra Cimflova, Eike I Piechowiak, Tomas Dobrocky, Jan Gralla","doi":"10.1007/s00062-025-01553-0","DOIUrl":"10.1007/s00062-025-01553-0","url":null,"abstract":"","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"243-245"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823036","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":"Follow-up Optical Coherence Tomography Evaluation of Endothelialization in Drug-eluting Stents for Symptomatic Vertebral Artery Stenosis: a Report of Nine Cases.","authors":"Bo Lei, Li Chen, Wenzhang Luo, Ying Chen, Honggang Wu, Jiachuan Wu, Shu Chen, Niandong Zheng, Daobao Zhang","doi":"10.1007/s00062-025-01582-9","DOIUrl":"10.1007/s00062-025-01582-9","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to assess the endothelialization of drug-eluting stents (DES) 3 months after implantation for the treatment of symptomatic vertebral artery stenosis using endovascular optical coherence tomography (OCT).</p><p><strong>Methods: </strong>Between March and May 2024, OCT was performed on patients 3 months (90 ± 7 days) after undergoing surgery for stent implantation at the vertebral artery ostium in our center.</p><p><strong>Results: </strong>Nine DES were implanted in nine patients. The mean follow-up period was 95.6 ± 12.6 days. OCT findings showed the vertebral artery lumen with fully endothelialized stent struts covered by neointima in all nine patients 3 months after implantation, indicating complete endothelialization.</p><p><strong>Conclusions: </strong>Complete endothelialization of vertebral artery DES occurred 3 months after implantation, providing a theoretical basis for potentially reducing the duration of DAPT 3 months. Further clinical studies are essential to validate these findings.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"233-238"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453296","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":"Automated Protocol Suggestions for Cranial MRI Examinations Using Locally Fine-tuned BERT Models.","authors":"Christian Boschenriedter, Christian Rubbert, Marius Vach, Julian Caspers","doi":"10.1007/s00062-025-01554-z","DOIUrl":"10.1007/s00062-025-01554-z","url":null,"abstract":"<p><p>Selection of appropriate imaging sequences protocols for cranial magnetic resonance imaging (MRI) is crucial to address the medical question and adequately support patient care. Inappropriate protocol selection can compromise diagnostic accuracy, extend scan duration, and increase the risk of misdiagnosis. Typically, radiologists determine scanning protocols based on their expertise, a process that can be time-consuming and subject to variability. Language models offer the potential to streamline this process. This study investigates the capability of bidirectional encoder representations from transformers (BERT)-based models to suggest appropriate MRI protocols based on referral information.A total of 410 anonymized electronic referrals for cranial MRI from a local order-entry system were categorized into nine protocol classes by an experienced neuroradiologist. A locally hosted instance of four different, pre-trained BERT-based classifiers (BERT, ModernBERT, GottBERT, and medBERT.de) were trained to classify protocols based on referral entries, including preliminary diagnoses, prior treatment history, and clinical questions. Each model was additionally fine-tuned for local language on a large dataset of electronic referrals.The model based on medBERT.de with local language fine-tuning was the best-performing model and correctly predicted 81% of all protocols, achieving a macro-F1 score of 0.71, macro-precision and macro-recall values of 0.73 and 0.71, respectively. Moreover, we were able to show that local language fine-tuning led to performance improvements across all models.These results demonstrate the potential of language models to predict MRI protocols, even with limited training data. This approach could accelerate and standardize radiological protocol selection, offering significant benefits for clinical workflows.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"59-66"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876411","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":"Spontaneous Intracranial Hypotension and CSF-Venous Fistulae: from Diagnostic Imaging to Interventional Management.","authors":"Emanuele Orru, Neil V Patel, Jonathan Pace, Timo Krings","doi":"10.1007/s00062-025-01573-w","DOIUrl":"10.1007/s00062-025-01573-w","url":null,"abstract":"<p><p>Over the past decade, major advances have transformed the understanding and management of cerebrospinal fluid (CSF) leaks leading to spontaneous intracranial hypotension (SIH). Among the most impactful developments has been the identification and characterization of CSF-venous fistulae (CVF), a distinct and still underrecognized cause of SIH. This discovery has prompted a paradigm shift in both diagnostic and therapeutic strategies. Novel imaging techniques-including lateral decubitus CT myelography and digital subtraction myelography-have markedly improved detection rates, while targeted interventions such as transvenous embolization have emerged as safe and effective treatment options. In this review, we first outline the general pathophysiology and imaging principles related to SIH and CSF leaks, followed by a focused and comprehensive analysis of the current evidence managing CVFs. We discuss their diagnostic challenges, therapeutic approaches, and evolving clinical implications, aiming to provide a thorough update for diagnostic and interventional neuroradiologists involved in the care of patients with SIH.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"3-17"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240268","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":"Angioplasty and Stenting of Persistent Primitive Trigeminal Artery Stenosis in Acute Ischemic Stroke.","authors":"Parth A Patel, Luis Rueda, Mitchell Oei, Dan-Victor Giurgiutiu","doi":"10.1007/s00062-025-01561-0","DOIUrl":"10.1007/s00062-025-01561-0","url":null,"abstract":"","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"247-250"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976199","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":"Health Economic Impact of Incomplete Reperfusion Patterns After Endovascular Thrombectomy in Acute Ischemic Stroke.","authors":"Alexander Stebner, Petra Cimflova, Salome L Bosshart, Wolfgang G Kunz, Pervinder Bhogal, Michael Hill, Mayank Goyal, Johanna M Ospel","doi":"10.1007/s00062-025-01524-5","DOIUrl":"10.1007/s00062-025-01524-5","url":null,"abstract":"<p><strong>Background and purpose: </strong>Incomplete reperfusion in endovascular thrombectomy (EVT) impacts patients' outcomes. Different incomplete reperfusion patterns may benefit from targeted therapeutic strategies, e.g. EVT-accessible incomplete reperfusion patterns could improve by performing additional EVT attempts, while EVT-non-accessible incomplete patterns might benefit from pharmacological therapies. The health-economic implications of these therapies are uncertain. This study aims to assess the potential economic benefits of improving incomplete reperfusion patterns after EVT.</p><p><strong>Materials and methods: </strong>Retrospective Data analysis from the ESCAPE-NA1 trial, which included patients with large vessel occlusion strokes undergoing EVT. Reperfusion patterns were classified as near-/complete (eTICI 2c3), EVT-accessible incomplete (eTICI 2b), or EVT-non-accessible incomplete (eTICI 2b) and we compared multiple attempts to achieve eTICI 2c3 vs. first-pass eTICI 2c3. A Markov-Model was built to compare lifetime costs and quality adjusted life-years (QALY) for each reperfusion pattern over a lifetime horizon, considering both healthcare and societal perspectives.</p><p><strong>Results: </strong>A total of 1105 of patients were enrolled in the ESCAPE-NA1 trial of which 949 with eTICI 2b, 2c and 3 were further analyized (mean age 70.7 ± 13.6 [SD]; 463 female). Near-Complete reperfusion (eTICI 2c3) was achieved in 506/1105 patients (45.8%). Incomplete reperfusion patterns (eTICI 2b) were found in 450/1105 (40.7%) patients. Angiography imaging could be further investigated in 443/450 (98.4%) cases with 147/443(33.2%) EVT-accessible and 296/443(66.8%) EVT-non-accessible incomplete reperfusion patterns. Compared to EVT-accessible and EVT-non-accssible incomplete reperfusion, achieving complete (eTICI 2c3) reperfusion resulted in lower costs and an additional 1.14/0.45 QALYs, making it the dominant strategy from a health-economic perspective. In the complete reperfusion (eTICI 2c3) group, cumulative lifetime QALYs were similar with 5.25 for single-pass eTICI 2c3 and 5.19 for multi-pass eTICI 2c3.</p><p><strong>Conclusions: </strong>Improving incomplete reperfusion patterns after EVT has considerable potential health economic benefits, both in the presence and absence of a target occlusion that is amenable to EVT.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"93-102"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976149","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}