AJNR. American journal of neuroradiology最新文献

{"title":"Deep Learning-Based Prediction of PET Amyloid Status Using MRI.","authors":"Donghoon Kim, Jon André Ottesen, Ashwin Kumar, Brandon C Ho, Elsa Bismuth, Christina B Young, Elizabeth Mormino, Greg Zaharchuk","doi":"10.3174/ajnr.A8899","DOIUrl":"https://doi.org/10.3174/ajnr.A8899","url":null,"abstract":"<p><strong>Background and purpose: </strong>Identifying amyloid-beta (Aβ)-positive patients is essential for Alzheimer's disease (AD) clinical trials and disease-modifying treatments but currently requires PET or cerebrospinal fluid sampling. Previous MRI-based deep learning models, using only T1-weighted (T1w) images, have shown moderate performance.</p><p><strong>Materials and methods: </strong>Multi-contrast MRI and PET-based quantitative Aβ deposition were retrospectively obtained from three public datasets: ADNI, OASIS3, and A4. Aβ positivity was defined using each dataset's recommended centiloid threshold. Two EfficientNet models were trained to predict amyloid positivity: one using only T1w images and another incorporating both T1w and T2-FLAIR. Model performance was assessed using an internal held-out test set, evaluating AUC, accuracy, sensitivity, and specificity. External validation was conducted using an independent cohort from Stanford Alzheimer's Disease Research Center. DeLong's and McNemar's tests were used to compare AUC and accuracy, respectively.</p><p><strong>Results: </strong>A total of 4,056 exams (mean [SD] age: 71.6 [6.3] years; 55% female; 55% amyloid-positive) were used for network development, and 149 exams were used for external testing (mean [SD] age: 72.1 [9.6] years; 58% female; 56% amyloid-positive). The multi-contrast model outperformed the single-modality model in the internal held-out test set (AUC: 0.67, 95% CI: 0.65-0.70, <i>P</i> < 0.001; accuracy: 0.63, 95% CI: 0.62-0.65, <i>P</i> < 0.001) compared to the T1w-only model (AUC: 0.61; accuracy: 0.59). Among cognitive subgroups, the highest performance (AUC: 0.71) was observed in mild cognitive impairment. The multi-contrast model also demonstrated consistent performance in the external test set (AUC: 0.65, 95% CI: 0.60-0.71, <i>P</i> = 0.014; accuracy: 0.62, 95% CI: 0.58- 0.65, <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>The use of multi-contrast MRI, specifically incorporating T2-FLAIR in addition to T1w images, significantly improved the predictive accuracy of PET-determined amyloid status from MRI scans using a deep learning approach.</p><p><strong>Abbreviations: </strong>Aβ＝ amyloid-beta; AD＝ Alzheimer's disease; AUC＝ area under the receiver operating characteristic curve; CN＝ cognitively normal; MCI＝ mild cognitive impairment; T1w = T1-wegithed; T2-FLAIR = T2-weighted fluid attenuated inversion recovery; FBP＝¹⁸F-florbetapir; FBB＝¹⁸F-florbetaben; SUVR＝ standard uptake value ratio.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DTI-Derived Evaluation of Glymphatic System Function in Veterans with Chronic Multisymptom Illness.","authors":"Yu Zhang, Matthew S Moore, Yashar Rahimpour, J David Clark, Peter J Bayley, J Wesson Ashford, Ansgar J Furst","doi":"10.3174/ajnr.A8901","DOIUrl":"https://doi.org/10.3174/ajnr.A8901","url":null,"abstract":"<p><strong>Background and purpose: </strong>Chronic Multisymptom Illness includes symptoms of fatigue, pain, sleep difficulties, as well as neurological, respiratory, and gastrointestinal problems and is particularly common in veterans from the 1990-91 Gulf War and the Afghanistan and Iraq Wars. Glymphatic system function may play an important role in the etiopathology of Chronic Multisymptom Illness but has not been addressed. DTI-derived analysis along the perivascular space provides a promising proxy for glymphatic system function by evaluating the status of perivascular space fluid flow. The objective of this study was to compare this DTI-derived glymphatic index in veterans with CMI and healthy controls, and to reveal possible correlations between this index and the severity of CMI symptoms.</p><p><strong>Materials and methods: </strong>DTI-derived indices were extracted from imaging data of 203 veterans who met clinical diagnostic criteria for Chronic Multisymptom Illness, and 224 age-matched healthy control subjects from multiple public research databases. Severity of Chronic Multisymptom Illness, sleep difficulty, pain intensity, and the degree of chronic fatigue were based on self-report measures. MRI scanner and site variations were harmonized. Statistical analyses were performed adjusting for demographic confounding factors.</p><p><strong>Results: </strong>Both healthy controls and veterans showed significantly reduced glymphatic indices associated with increased age. Compared to controls, veterans showed bilaterally lower indices (Cohen's d = -.47; p < .001) after adjusting for age, sex, and education. Across the entire sample of veterans, negative correlations were observed between glymphatic indices and pain intensities (r = -.17; p = .01), sleep disturbances (r = -.17; p = .02), degree of fatigue (r = -.20; p = .006), severity of Chronic Multisymptom Illness (r = -.17; p = .02), and the indices were positively correlated with medullar volumes (r = -.19; p = .007). Note, these results showing significant outcomes for a group of patients do not guarantee the same outcome for individual patients.</p><p><strong>Conclusions: </strong>This study suggests that impaired glymphatic functions are strongly associated with Chronic Multisymptom Illness. These findings improve our understanding of the pathological mechanism underlying Chronic Multisymptom Illness and point to DTI-based metrics as a potential biomarker for disease severity in this condition.</p><p><strong>Abbreviations: </strong>CMI＝ Chronic multisymptom illness; GWI＝ Gulf War Illness; PVS＝ perivascular space; DTI-ALPS＝ DTI-analysis along the perivascular space; HC＝ healthy control; TBI＝ traumatic brain injury; PTSD＝ post-traumatic stress disorder; PSQI＝ Pittsburgh sleep quality index; BPI＝ brief pain inventory; CFS＝ chronic fatigue syndrome.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Safety and Efficacy of Balloon Mounted Stents and Self Expanding Stents in Rescue Stenting for Large Vessel Occlusion: Secondary analysis of the RESCUE-ICAS Registry.","authors":"Sami Al Kasab, Adam T Mierzwa, Imad Samman Tahhan, Shadi Yaghi, Mouhammad Jumaa, Violiza Inoa, Francesco Capasso, Michael Nahhas, Robert M Starke, Isabel Fragata, Matthew T Bender, Krisztina Moldovan, Ilko Maier, Jonathan A Grossberg, Pascal Jabbour, Marios Psychogios, Edgar A Samaniego, Jan-Karl Burkhardt, David Altschul, Justin Mascitelli, Mohamad Ezzeldin, Ramesh Grandhi, Adam de Havenon, Thanh N Nguyen, Ameer E Hassan","doi":"10.3174/ajnr.A8895","DOIUrl":"10.3174/ajnr.A8895","url":null,"abstract":"<p><strong>Background and purpose: </strong>Patients with intracranial stenosis-related large vessel occlusion (ICAS-LVO) may experience better outcomes with stenting compared to standalone mechanical thrombectomy. This study evaluates the safety and clinical outcomes of self-expanding stents (SES) versus balloon-mounted stents (BMS) in ICAS-LVO patients treated with mechanical thrombectomy and stenting.</p><p><strong>Materials and methods: </strong>This secondary analysis of the RESCUE-ICAS registry, a multicenter observational study, included ICASLVO patients from 25 stroke centers who underwent stenting. Patients were stratified by stent type (SES or BMS). The primary endpoint was 90-day modified Rankin Scale (mRS) 0-2. Secondary outcomes included successful reperfusion, recurrent stroke, and infarct volume. Symptomatic intracranial hemorrhage was the primary safety outcome. Inverse probability weighting adjusted for confounders.</p><p><strong>Results: </strong>Among 194 patients, 111 received SES, of whom 61 (55%) underwent pre-stenting angioplasty. After adjustment, no significant difference was observed between SES and BMS in 90-day mRS 0-2 (OR 1.10, 95% CI 0.62-1.96, p=0.75), successful reperfusion (mTICI ≥2B), or final infarct volume. SES was associated with higher odds of moderate stenosis (>50%) at follow-up (OR 3.7, 95% CI 1.15-11.98, p=0.02) and recurrent stroke (13.5% vs. 1.2%, p=0.001), particularly in patients without pre-stenting angioplasty (14% vs. 1%).</p><p><strong>Conclusions: </strong>SES and BMS demonstrated comparable safety and clinical outcomes in ICAS-LVO patients. However, SES was linked to higher rates of restenosis and recurrent strokes, potentially influenced by the absence of pre-stenting angioplasty. Further research is needed to refine stenting strategies in this population.</p><p><strong>Abbreviations: </strong>BMS = balloon mounted stents, ICAS = intracranial atherosclerotic stenosis, IPW = Inverse probability weighted, MT = mechanical thrombectomy, LVO = Large vessel occlusion, RS = rescue stenting, RESCUE-ICAS = Registry of Emergent Large Vessel Occlusion due to Intracranial Stenosis, SES = self-expanding stents (SES).</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI Interpretation Errors in Adult Patients with Medically Refractory Epilepsy.","authors":"Aoife M Haughey, Nadav Gasner, Timo Krings","doi":"10.3174/ajnr.A8681","DOIUrl":"10.3174/ajnr.A8681","url":null,"abstract":"<p><strong>Background and purpose: </strong>The aim is to determine the most common MRI interpretation errors in patients with medically refractory epilepsy (MRE) according to our experience in a tertiary academic center with a large volume epilepsy program, to raise awareness of the \"blind spots\" in imaging patients with MRE, and to highlight the importance of combining clinical and electroencephalographic information to obtain the most accurate diagnosis.</p><p><strong>Materials and methods: </strong>This is a retrospective observational study. All patients with MRE who underwent MRI brain (on 3T, with dedicated epilepsy protocol), and who were discussed at the weekly interdisciplinary epilepsy conference in our center between January 2008 and July 2023 were included. The initial MRI interpretation and final MRI interpretation results were reviewed.</p><p><strong>Results: </strong>A total of 886 patients with MRE were included. Three hundred patients were MRI-negative (33.86%), diagnoses were missed in 95 patients (10.7%), a second diagnosis was missed in patients with dual pathologies in 42 patients (4.74%), findings were misinterpreted in 4 patients (0.45%), an overcall was made in 2 patients (0.2%), and in 5 patients the correct diagnosis was discussed but erroneously deemed absent on initial interpretation (0.56%), resulting in a total of 148 discrepant MRI reports. Mesial temporal sclerosis comprised the most common pathology encountered overall, followed by encephalomalacia related to prior insult, enlarged amygdala (EA), malformations of cortical development, cavernoma, and ulegyria. The relative proportion of missed focal cortical dysplasia, encephalocele, and EA accounted for the most common misses/misdiagnoses.</p><p><strong>Conclusions: </strong>Evaluation of patients with MRE requires excellent interdisciplinary care. Input from all members of the interdisciplinary team is essential for accurate interpretation of MRI in patients with MRE for the neuroradiologist. We hope to inform radiologists of commonly overlooked pathologies in MRI brain interpretation for patients with epilepsy. In doing so, we want to maximize the yield of initial MRI interpretation in these patients.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Invasion Volume of the Primary Nasopharyngeal Carcinoma Predicts Treatment Outcome.","authors":"Qi Yong H Ai, Ho Sang Leung, Frankie K F Mo, Lun M Wong, Linfang Lan, Edwin P Hui, Brigette B Y Ma, Ann D King","doi":"10.3174/ajnr.A8678","DOIUrl":"https://doi.org/10.3174/ajnr.A8678","url":null,"abstract":"<p><strong>Background and purpose: </strong>Quantification of deep invasion of the primary tumor is a predictor of outcome in oral cancer, but its predictive value in nasopharyngeal carcinoma (NPC) is unknown. This study aimed to investigate deep invasion of the primary NPC by using volumetric measurements on MRI for the prediction of outcome.</p><p><strong>Materials and methods: </strong>Retrospective review was conducted of 822 MRIs from patients with newly diagnosed nonmetastatic NPC with volumetric analysis of the primary tumor to obtain total primary tumor volume (PTV), deep invasion volume (DIV), and ratio of deep to the total primary tumor volume (DIVr). Optimal predictors were identified by the multivariable Cox regression and c-index correlating with disease-free survival (DFS), distant metastases-free survival (DMFS), and overall survival (OS).</p><p><strong>Results: </strong>High DIVr, DIV, and PTV significantly correlated with poor DFS, DMFS, and OS (all <i>P</i> < .01); DIVr being the optimal measurement (hazard ratio = 3.234 for DFS, 3.409 for DMFS, and 3.184 for OS). Compared with the eighth edition American Joint Committee on Cancer (AJCC) T-category, DIVr showed modest improvement in c-indexes for predicting DFS (0.602 versus 0.620, <i>P</i> = .03) and DMFS (0.597 versus 0.626, <i>P</i> < .01), but not OS (<i>P</i> = .15). The use of a DIVr-based T-category had similar survival prognostication to the eighth edition AJCC T-category although there was improved prediction in DMFS.</p><p><strong>Conclusions: </strong>DIVr is a better predictor of outcome in NPC than PTV or DIV, with slightly superior performance to the eighth edition AJCC T-category especially for DMFS.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Learning MRI Models for the Differential Diagnosis of Tumefactive Demyelination versus <i>IDH</i> Wild-Type Glioblastoma.","authors":"Gian Marco Conte, Mana Moassefi, Paul A Decker, Matthew L Kosel, Christina B McCarthy, Jessica A Sagen, Yalda Nikanpour, Mahboubeh Fereidan-Esfahani, Michael W Ruff, Fiorella S Guido, Heather K Pump, Terry C Burns, Robert B Jenkins, Bradley J Erickson, Daniel H Lachance, W Oliver Tobin, Jeanette E Eckel-Passow","doi":"10.3174/ajnr.A8645","DOIUrl":"10.3174/ajnr.A8645","url":null,"abstract":"<p><strong>Background and purpose: </strong>Diagnosis of tumefactive demyelination can be challenging. The diagnosis of indeterminate brain lesions on MRI often requires tissue confirmation via brain biopsy. Noninvasive methods for accurate diagnosis of tumor and nontumor etiologies allows for tailored therapy, optimal tumor control, and a reduced risk of iatrogenic morbidity and mortality. Tumefactive demyelination has imaging features that mimic <i>isocitrate dehydrogenase</i> wild-type glioblastoma (<i>IDH</i>wt GBM). We hypothesized that deep learning applied to postcontrast T1-weighted (T1C) and T2-weighted (T2) MRI can discriminate tumefactive demyelination from <i>IDH</i>wt GBM.</p><p><strong>Materials and methods: </strong>Patients with tumefactive demyelination (<i>n</i> = 144) and <i>IDH</i>wt GBM (<i>n</i> = 455) were identified by clinical registries. A 3D DenseNet121 architecture was used to develop models to differentiate tumefactive demyelination and <i>IDH</i>wt GBM by using both T1C and T2 MRI, as well as only T1C and only T2 images. A 3-stage design was used: 1) model development and internal validation via 5-fold cross validation by using a sex-, age-, and MRI technology-matched set of tumefactive demyelination and <i>IDH</i>wt GBM, 2) validation of model specificity on independent <i>IDH</i>wt GBM, and 3) prospective validation on tumefactive demyelination and <i>IDH</i>wt GBM. Stratified area under the receiver operating curves (AUROCs) were used to evaluate model performance stratified by sex, age at diagnosis, MRI scanner strength, and MRI acquisition.</p><p><strong>Results: </strong>The deep learning model developed by using both T1C and T2 images had a prospective validation AUROC of 88% (95% CI: 0.82-0.95). In the prospective validation stage, a model score threshold of 0.28 resulted in 91% sensitivity of correctly classifying tumefactive demyelination and 80% specificity (correctly classifying <i>IDH</i>wt GBM). Stratified AUROCs demonstrated that model performance may be improved if thresholds were chosen stratified by age and MRI acquisition.</p><p><strong>Conclusions: </strong>MRI can provide the basis for applying deep learning models to aid in the differential diagnosis of brain lesions. Further validation is needed to evaluate how well the model generalizes across institutions, patient populations, and technology, and to evaluate optimal thresholds for classification. Next steps also should incorporate additional tumor etiologies such as CNS lymphoma and brain metastases.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Effectiveness of a Novel Integrated Angiography System for Continuous Guidance and Flushing in Diagnostic Cerebral Catheter Angiography: A Randomized Controlled Trial.","authors":"Boseong Kwon, Jong-Tae Yoon, Yun Hyeok Choi, Soo Jeong, Byung Jun Kim, Joon Ho Choi, Sun Moon Hwang, Deok Hee Lee, Yunsun Song","doi":"10.3174/ajnr.A8700","DOIUrl":"10.3174/ajnr.A8700","url":null,"abstract":"<p><strong>Background and purpose: </strong>The guided angiography system, an integrated angiography system, enables continuous guidance and flushing during diagnostic procedures. A guidewire provides guidance by remaining inside the catheter during contrast injection into tortuous vessels. While its feasibility was demonstrated in a retrospective study, this randomized controlled trial aims to evaluate its safety and effectiveness.</p><p><strong>Materials and methods: </strong>This single-center, single-blind, randomized controlled trial was conducted from September 2021 to June 2022. Patients with unruptured intracranial aneurysms were enrolled and randomly assigned to either the guided or the conventional group. Primary outcomes were procedural time and serious adverse events. Secondary outcomes included catheterization success, adverse events, fluoroscopy time, fluoroscopy dose, and image quality.</p><p><strong>Results: </strong>A total of 200 participants (mean age, 59 [SD, 10 years], 71% women) were randomized into the guided (<i>n</i> = 100) and the conventional (<i>n</i> = 100) groups. The guided group demonstrated shorter procedural times compared with the conventional group (18.3 [SD, 9.2] versus 21.3 [SD, 8.1] minutes, <i>P</i> < .001). There were no serious adverse events in either group, and adverse events were similar. Catheterization success rates were similar between the guided and conventional groups (93.9% versus 96.8%, <i>P</i> = .226). However, the guided angiography system backed up more catheterization failures from the conventional angiography system, but not vice versa (57.1% versus 11.1%, <i>P</i> = .003). Among catheterization successes, the guided group achieved shorter fluoroscopy time (7.0 versus 7.7 minutes, <i>P</i> = .033) and lower fluoroscopy dose (466.8 versus 566.5 μGy·m², <i>P</i> = .015). Regarding imaging quality, clinical acceptability was comparable between the guided and conventional groups (95.3% versus 95.5%, <i>P</i> = .781).</p><p><strong>Conclusions: </strong>The guided angiography system offers a simple and effective alternative for diagnostic cerebral conventional angiography, with reduced radiation exposure and a favorable safety profile.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altered Functional Connectivity and Amyloid Deposition in Posttraumatic Stress Disorder-Associated Cognitive Impairment.","authors":"Richard Dagher, Parisa Arjmand, Daniel A Stevens, Max Wintermark, Haris I Sair, Vivek Yedavalli, Licia P Luna","doi":"10.3174/ajnr.A8694","DOIUrl":"10.3174/ajnr.A8694","url":null,"abstract":"<p><strong>Background and purpose: </strong>Posttraumatic stress disorder (PTSD) has been linked to an increased risk of cognitive impairment and dementia, with neuroinflammation, metabolic dysfunction, and neuropathologic markers such as β-amyloid and τ implicated as potential mechanisms. However, the roles of altered functional connectivity and amyloid deposition as biomarkers in the progression of cognitive impairment among patients with PTSD remain unclear, with limited and often conflicting evidence from existing neuroimaging studies. This study examines these neuroimaging markers in patients with PTSD with and without cognitive impairment to better understand the neurobiologic pathways contributing to cognitive decline in PTSD.</p><p><strong>Materials and methods: </strong>Data were obtained from the Alzheimer's Disease Neuroimaging Initiative (ADNI) and Department of Defense (DOD) databases. A cohort of 178 age-matched male subjects was divided into 4 groups: posttraumatic stress disorder with cognitive impairment (PTSD-CI); posttraumatic stress disorder and cognitively normal (PTSD-CN); non-posttraumatic stress disorder with cognitive impairment (NPTSD-CI); and non-posttraumatic stress disorder and cognitively normal (NPTSD-CN). All subjects underwent resting-state functional MRI and amyloid PET imaging, with PTSD diagnosis and cognitive impairment (CI) confirmed through clinical assessments. Functional connectivity was analyzed by using the CONN Toolbox, and amyloid burden was quantified via standardized uptake value ratios. Analyses controlled for demographic and genetic factors, including age, education, <i>apolipoprotein E4</i> status, and depression.</p><p><strong>Results: </strong>Compared with the NPTSD-CN group, the PTSD-CI group showed significantly increased amyloid uptake in the temporal and parietal lobes, with corresponding functional connectivity increase between the bilateral temporal lobes and parietal operculum. In contrast, PTSD-CN patients exhibited no significant amyloid increase but showed increased connectivity between the salience network, postcentral gyri, and sensorimotor areas, and decreased connectivity between the sensorimotor network and anterior cingulate cortex. These distinct patterns suggest differing neurobiologic profiles between PTSD-CI and PTSD-CN patients.</p><p><strong>Conclusions: </strong>The findings suggest that elevated amyloid and altered connectivity patterns are associated with cognitive impairment in PTSD, particularly in the temporal and parietal regions. In contrast, PTSD without cognitive decline was associated with functional connectivity changes in salience and sensorimotor networks but no increased amyloid deposition. This study underscores the importance of neuroimaging biomarkers in understanding PTSD-related cognitive decline and suggests avenues for further investigation into the mechanistic pathways involved.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple Synchronous CSF-Venous Fistulas in Spontaneous Intracranial Hypotension: A Multi-Institutional Case Series.","authors":"Ajay A Madhavan, Timothy J Amrhein, Michelle L Kodet, Niklas Lutzen, Michael D Malinzak, Jeremy K Cutsforth-Gregory, Ian T Mark, Ivan Garza, Eike I Piechowiak, Lalani Carlton Jones","doi":"10.3174/ajnr.A8900","DOIUrl":"https://doi.org/10.3174/ajnr.A8900","url":null,"abstract":"<p><p>CSF-venous fistulas are a common cause of spontaneous intracranial hypotension. Due to the more routine use of decubitus myelography and advancements in various imaging techniques, recognition of CSF-venous fistulas has increased in recent years. Most commonly, patients harbor only one fistula at the time of myelography (although additional de novo fistulas can arise after treatment). Occasionally, two synchronous CSF-venous fistulas may be seen on a single myelogram. The co-existence of more than two CSF-venous fistulas, however, is quite rare and has only been previously described in two instances. Here, we present a multi-institutional series of sixteen patients with three or more concurrently discovered CSF-venous fistulas, representing the largest cohort of such patients to date. We describe their clinical features, imaging findings, treatment approaches, and outcomes.ABBREVIATIONS: CVF = CSF-venous fistula; CB-CTM = cone beam CT myelogram; DSM = digital subtraction myelography; EID = energy integrating detector; SIH = spontaneous intracranial hypotension; PCD = photon counting detector.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Radiologist Recommendations for Temporal Bone CT to Assess Superior Semicircular Canal Dehiscence on Temporal Bone MRI.","authors":"Pejman Rabiei, Jisoo Kim, Amir A Satani, C Eduardo Corrales, Ronilda Lacson, Ramin Khorasani, Jeffrey P Guenette","doi":"10.3174/ajnr.A8691","DOIUrl":"10.3174/ajnr.A8691","url":null,"abstract":"<p><strong>Background and purpose: </strong>Superior semicircular canal dehiscence (SSCD) can be detected on temporal bone MR images. Radiologists often recommend confirmation with temporal bone CT because of reported lower MRI positive predictive value. The value of these recommendations is unclear, given that CT overestimates dehiscence due to volume averaging and that only a small proportion of patients with dehiscence on CT suffer from dehiscence syndrome. We thus evaluated final diagnoses and outcomes in patients who adhered to the recommended additional CT.</p><p><strong>Materials and methods: </strong>This retrospective cohort observational study, performed at a multi-institution health care system, included consecutive temporal bone MRI reports from June 1, 2021, through May 31, 2022, with a recommendation for additional temporal bone CT. We recorded whether CT was performed, dehiscence present on CT, symptoms, final diagnosis, treatment decisions, and outcomes. Actionability elements (complete containing imaging technique, timeframe, and rationale; unambiguous; unconditional; without multiplicity; and without alternate language) of the recommendations were extracted from a prior data set. Descriptive statistics were performed. A binomial generalized linear model was used to test the correlation of ambiguous recommendation language with recommendation adherence.</p><p><strong>Results: </strong>There were 5109 temporal bone MRI examinations performed and interpreted by 34 radiologists. One hundred eighty-seven of the 5109 reports (3.7%) included a recommendation for additional temporal bone CT including 101/5109 (2.0%) specifically for suspected SSCD. While 22% (22/101) of these recommended examinations were performed, only 32% of these (7/22) confirmed dehiscence. Ultimately, only 1 patient was diagnosed with dehiscence syndrome and was managed conservatively. No recommendations for additional imaging (0/101) met actionable criteria and 76.2% (77/101) were ambiguous. Ambiguous recommendations had 0.54 lower, but not statistically significant, odds of being performed (95% CI: 0.19-1.6, <i>P</i> = .25).</p><p><strong>Conclusions: </strong>Radiologist recommendations for temporal bone CT in the setting of questionable SSCD findings on MRI appear to have negligible clinical value. Thus, it is likely most appropriate to report possible SSCD in the MRI report impression without recommending further imaging.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}