AJNR. American journal of neuroradiology最新文献

{"title":"7 Tesla Time-of-Flight MRA in Adolescents.","authors":"Sergio Valencia, Fedel Machado-Rivas, Maria Camila Cortes-Albornoz, Samuel Cd Cartmell, Harry Griffin, Darren B Orbach, Vanessa Rameh, Alfred Pokmeng See, Simon K Warfield, Onur Afacan, Camilo Jaimes","doi":"10.3174/ajnr.A8908","DOIUrl":"https://doi.org/10.3174/ajnr.A8908","url":null,"abstract":"<p><strong>Background and purpose: </strong>The increased signal-to-noise ratio (SNR) at 7 Tesla (7T) enables higher spatial resolution for neurovascular imaging, yet its application in pediatric magnetic resonance angiography (MRA) remains underexplored. This study systematically evaluates the advantages of 7T time-of-flight (TOF) MRA compared to 3T in pediatric patients, hypothesizing that 7T would provide superior vessel contrast and increased vascular volume, given the use of smaller voxels, as well as higher SNR, despite these smaller voxels.</p><p><strong>Materials and methods: </strong>This HIPAA-compliant, IRB-approved retrospective study included pediatric patients (<19 years) who underwent 7T TOF MRA. Controls consisted of either same-subject 3T MRAs within 6 months (when available) or age-and sex-matched 3T MRA subjects. Imaging parameters were optimized for spatial resolution at 7T to achieve 0.3-0.4 mm isotropic voxels. Quantitative analysis included contrast ratio (CR) and SNR measurements for the ICA, M1 to M4 arterial segments, and lenticulostriate perforating arteries. Vascular volume was assessed using 3D segmentation. Semiquantitative vessel conspicuity ratings and motion artifact scoring were performed by blinded neuroradiologists.</p><p><strong>Results: </strong>Fifteen patients (10 with 7T MRA, 5 with matched 3T controls) and 20 MRAs were analyzed. CR was significantly higher at 7T for perforators, M3, and M4 branches (P < 0.05), with the greatest improvement in M4 branches. Vascular volume was 147% greater at 7T (P = 0.018), reflecting improved small vessel depiction and segmentation. Semiquantitative analysis showed significantly better vessel conspicuity at 7T for M4 branches and lenticulostriate perforators (P < 0.01). Motion artifact scores were similar between field strengths (P = 0.118).</p><p><strong>Conclusions: </strong>7T TOF MRA significantly enhances vascular contrast and improves visualization of small arteries compared to 3T, making it a valuable tool for pediatric cerebrovascular imaging.</p><p><strong>Abbreviations: </strong>CR＝ Contrast Ratio; LSA＝ Lenticulostriate Perforating Arteries.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546526","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":"Fusion of FDG and FMZ PET Reduces False-Positives in Predicting Epileptogenic Zone.","authors":"Bingyang Cai, Shize Jiang, Hui Huang, Jiwei Li, Siyu Yuan, Ya Cui, Weiqi Bao, Jie Hu, Jie Luo, Liang Chen","doi":"10.3174/ajnr.A8647","DOIUrl":"10.3174/ajnr.A8647","url":null,"abstract":"<p><strong>Background and purpose: </strong>Epilepsy, a globally prevalent neurologic disorder, necessitates precise identification of the epileptogenic zone (EZ) for effective surgical management. While the individual utilities of FDG-PET and flumazenil (FMZ)-PET have been demonstrated, their combined efficacy in localizing the epileptogenic zone remains underexplored. We aim to improve the noninvasive prediction of EZ in temporal lobe epilepsy (TLE) by combining FDG-PET and FMZ-PET with statistical feature extraction and machine learning.</p><p><strong>Materials and methods: </strong>This study included 20 drug-resistant patients with unilateral TLE (14 mesial TLE, 6 lateral TLE) and 2 control groups (<i>n</i> = 29 for FDG, <i>n</i> = 20 for FMZ). EZ of each patient was confirmed by postsurgical pathology and 1-year follow-up, while propagation zone (PZ) and noninvolved zone (NIZ) were derived from the epileptogenicity index based on presurgical stereo-encephalography (SEEG) monitoring. Whole brain PET scans were obtained with dual tracers [¹⁸F]FDG and [¹⁸F]FMZ on separate days, from which standard uptake value ratio (SUVR) was calculated by global mean scaling. Low-order statistical parameters of SUVRs and t-maps derived against control groups were extracted. Additionally, fused FDG and FMZ features were created by using arithmetic operations. Spearman correlation was used to investigate the associations between FDG and FMZ, while multiple linear regression analyses were used to explore the interaction effects of imaging features in predicting epileptogenicity. Crafted imaging features were used to train logistic regression models to predict EZ, whose performance was evaluated by using 10-fold cross-validation at ROI level, and leave-1-patient-out cross-validation at patient level.</p><p><strong>Results: </strong>FDG SUVR significantly decreased in EZ and PZ compared with NIZ, while FMZ SUVR in EZ significantly differed from PZ. Interaction effects were found between FDG and FMZ in their prediction of epileptogenicity. Fusion of FDG and FMZ provided the best prediction model with an area under the curve (AUC) of 0.86 [0.84-0.87] for EZ versus NIZ and an AUC of 0.79 [0.77-0.81] for EZ versus PZ, eliminating 100% false-positives in 50% of patients, and ≥80% FPs in 90% of patients at patient level.</p><p><strong>Conclusions: </strong>Combined FDG and FMZ offer a promising avenue for noninvasive localization of the epileptogenic zone in TLE, potentially refining surgical planning.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1493-1500"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967374","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":"1501-1509"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","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":"Quantitative Shape Irregularity and Density Heterogeneity of Preoperative Hematoma Can Predict Rebleeding following Minimally Invasive Catheter Evacuation for Intracerebral Hemorrhage.","authors":"Kaijiang Kang, Zeqiang Ji, Yang Du, Guangshuo Li, Jing Yan, Zeyu Ding, Yiming Shi, Yanfang Liu, Jianwei Wu, Xingquan Zhao","doi":"10.3174/ajnr.A8680","DOIUrl":"10.3174/ajnr.A8680","url":null,"abstract":"<p><strong>Background and purpose: </strong>Postoperative rebleeding is a critical factor associated with poor outcomes in patients with intracerebral hemorrhage (ICH) who undergo minimally invasive catheter evacuation (MICE) followed by thrombolysis. This study aimed to explore the association between quantitative shape irregularity and density heterogeneity of preoperative hematoma and rebleeding after MICE.</p><p><strong>Materials and methods: </strong>We analyzed patients with ICH who underwent MICE between February 2021 and January 2024. The surface regularity index (SRI) and density coefficient of variation (DCV) of the hematomas were obtained based on preoperative CT by using 3D Slicer software. Postoperative rebleeding was defined as a hematoma increase of >6 mL or >33% compared with the previous CT. The predictive value of shape irregularity (reflected by SRI) and density heterogeneity (reflected by DCV) for postoperative rebleeding were comprehensively analyzed.</p><p><strong>Results: </strong>In total, 240 patients were included, of whom 45 (18.8%) experienced postoperative rebleeding. Patients with postoperative rebleeding exhibited lower SRI (37.2 versus 51.4, <i>P</i> = .001) and higher DCV (13.8% versus 11.7%, <i>P</i> < .001) after adjusting for preoperative hematoma volume, surface area, standard deviation of hematoma density, intraventricular hemorrhage (IVH), hematoma expansion (HE), time period from onset to surgery, and catheter misplacement. The combination of SRI, DCV, IVH, and HE demonstrated optimal discrimination in predicting postoperative rebleeding, with an area under the curve (AUC) and 95% CI of 0.880 (0.824-0.935).</p><p><strong>Conclusions: </strong>Hematoma shape irregularity and density heterogeneity are risk factors for rebleeding after MICE for ICH. SRI and DCV can be used to identify individuals at high risk of postoperative rebleeding.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1360-1366"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287444","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":"Reentry Technique for Rescue Recanalization of Carotid Near-Total Occlusion after Subintimal Penetration.","authors":"Dang Khoi Tran, Huu-Thao Nguyen, Chih-Wei Huang, Kai-Chen Chung, Yuang Seng Tsuei","doi":"10.3174/ajnr.A8860","DOIUrl":"10.3174/ajnr.A8860","url":null,"abstract":"","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1403"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334624","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":"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":"1446-1452"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","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":"Neuroimaging Spectrum of Erdheim-Chester Disease: An Image-Based Review.","authors":"Pranjal Rai, Hayden J Swartz, Neetu Soni, John C Benson, Amit Agarwal, Steven A Messina, Paul J Farnsworth, Carrie M Carr, Girish Bathla","doi":"10.3174/ajnr.A8599","DOIUrl":"10.3174/ajnr.A8599","url":null,"abstract":"<p><p>Erdheim-Chester disease (ECD) is a rare, multisystem histiocytic disorder characterized by its variable clinical presentations. CNS involvement is observed in approximately one-half of patients with ECD (up to 76% in some series) and often carries a poorer prognosis. While CNS involvement may remain asymptomatic, others may experience a range of neurologic symptoms, including cognitive decline, neuropsychiatric disturbances, motor deficits, cranial or peripheral neuropathies, and endocrine abnormalities. Neuroimaging findings in CNS-ECD are diverse, including neurodegeneration manifesting as cerebral or cerebellar volume loss; solitary or multifocal variably enhancing intraparenchymal lesions along the neuroaxis; meningeal infiltration; and involvement of the hypothalamo-pituitary axis, perivascular sheathing, or basal ganglia lesions. Other well-documented sites of involvement include the craniofacial region, orbits, and spine. Awareness of these findings is relevant, not only because of the nonspecific nature of these findings, but also because of the high proportion of CNS involvement in ECD and the higher mortality associated with CNS involvement. This review provides an in-depth overview of the various manifestations of CNS involvement in ECD and their imaging features, along with a brief overview of the differential considerations, which include other histiocytic and nonhistiocytic processes.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1300-1308"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142694074","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":"1412-1420"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","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":"Prevalence and Characteristics of Microspurs in Patients with Spontaneous Intracranial Hypotension Compared with the General Population.","authors":"Danial Nasiri, Levin Häni, Johannes Goldberg, Thomas Petutschnigg, Tomas Dobrocky, Ralph T Schär, Christoph Schankin, Andreas Raabe, Jürgen Beck, Eike Immo Piechowiak, Christopher Marvin Jesse","doi":"10.3174/ajnr.A8644","DOIUrl":"10.3174/ajnr.A8644","url":null,"abstract":"<p><strong>Background and purpose: </strong>In patients diagnosed with spontaneous intracranial hypotension (SIH), microspurs are considered the culprit lesion in most ventral dural leaks (type I). The imaging characteristics of discogenic spurs, and their prevalence in the general population has not been reported in the literature.</p><p><strong>Materials and methods: </strong>This observational case-control study was conducted comparing the prevalence and characteristics of discogenic microspurs between patients with SIH with a type I leak treated at a tertiary hospital between 2013 and 2023 and an age- and sex-matched cohort of trauma patients.</p><p><strong>Results: </strong>Each group consisted of 85 patients (mean age 51.6 ± 11.9 years), 74% (58/85 patients) were women. The prevalence of discogenic microspurs in the control group and SIH group was 31.8% and 90.6%, respectively. The mean length of the culprit microspur responsible for a dural leak was larger compared with the mean length of all coincidental microspurs from both the SIH and the control group not causing a dural leak (2.6 mm versus 1.6 mm, <i>P</i> < .001). Our multivariate logistic regression revealed that an increasing length of a microspur (OR, 1.942, CI 1.35-2.80, <i>P</i> < .001) and a narrower diameter of the spinal canal (OR, 0.85, CI 0.76-0.96, <i>P</i> = .008) were predictive for a dural tear.</p><p><strong>Conclusions: </strong>A discogenic microspur is a common incidental finding and may be found in almost one-third of the general population. The length of the culprit microspur and the diameter of the spinal canal are distinct morphologic characteristics for type I associated CSF leaks.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1486-1492"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960165","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":"Peritumoral Hyperintense Signal on Postcontrast FLAIR Images Surrounding Vestibular Schwannomas following Stereotactic Radiosurgery.","authors":"Sandy T Nguyen, John C Benson, Girish Bathla, Paul J Farnsworth, Matthew L Carlson, Michael J Link, John I Lane","doi":"10.3174/ajnr.A8657","DOIUrl":"10.3174/ajnr.A8657","url":null,"abstract":"<p><strong>Background and purpose: </strong>Prior investigations have noted the presence of peritumoral hyperintense signal (a \"halo\") around vestibular schwannomas on postcontrast 3D T2 FLAIR images. This study evaluated this phenomenon in a cohort of patients undergoing stereotactic radiosurgery.</p><p><strong>Materials and methods: </strong>A retrospective review was completed of consecutive patients with presumed vestibular schwannomas undergoing stereotactic radiosurgery. Tumor size, location, presence or absence of a peritumoral halo, and halo thickness were recorded. Images were reviewed for presence and size of peritumoral hyperintense signal on postcontrast 3D T2 FLAIR images before and after treatment.</p><p><strong>Results: </strong>Twenty-six patients were included in this study, 14 of whom were women (54.0%). Average age was 62 ± 12 years. Before treatment, a postcontrast 3D T2 FLAIR hyperintense peritumoral halo was seen in 85% of patients, averaging 0.8 ± 0.4 mm in thickness. There was a higher incidence of peritumoral halo in posttreatment patients (96%) than pretreatment patients (85%) (<i>P</i> = .017) with a mean follow-up period of 1.2 years (SD 0.35) from November 12, 2019, to September 5, 2023. The average halo thickness was also larger in posttreatment patients (average =1.4 ± 0.4 mm) compared with pretreatment patients (0.8 ± 0.4 mm) (<i>P</i> < .001). Average tumoral size did not significantly change following treatment (<i>P</i> = .10).</p><p><strong>Conclusions: </strong>Vestibular schwannomas treated with stereotactic radiosurgery are more likely to have a peritumoral halo on postcontrast 3D T2 FLAIR images, with larger halo size as compared with pretreatment studies. Further study with a larger tumor cohort and longer follow-up will be necessary to determine if these findings are predictive of subsequent tumor shrinkage.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1453-1457"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980993","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}