AJNR. American journal of neuroradiology最新文献

{"title":"CT Perfusion Map Generation from Multi-phase CT Angiography Using Generative adversarial model for Acute Ischemic Stroke.","authors":"Yuxin Cai, Jianhai Zhang, Ganesh Arvind, Bo Hu, Menon Bijoy, Shengcai Chen, Wu Qiu","doi":"10.3174/ajnr.A8857","DOIUrl":"https://doi.org/10.3174/ajnr.A8857","url":null,"abstract":"<p><strong>Background and purpose: </strong>Multiphase CT Angiography (mCTA) has shown potential as a diagnostic tool for acute ischemic stroke (AIS), as it captures dynamic changes in cerebral vasculature. However, mCTA has limitations in assessing brain tissue perfusion, which reduces its clinical interpretability. To address this limitation, we aim to develop a generative adversarial network (GAN) that generates CT Perfusion (CTP)-like maps from mCTA. This approach aims to improve the interpretability of mCTA.</p><p><strong>Materials and methods: </strong>A total of 714 cases with NCCT, CTP, mCTA, and follow-up NCCT/MR were analyzed across internal and external datasets. A GAN was trained to generate multi-parametric CTP maps (Tmax, CBF, CBV). The model's performance was evaluated using SSIM, PSNR, and FID compared to actual CTP maps. Clinical utility was assessed by predicting infarct core and penumbra using threshold-based segmentation and evaluating metrics such as Dice coefficient, AUC of dichotomized infarct volume of < 70cc and mismatch ratio following DEFUSE 3 criteria, compared to the ground truth of actual CTP prediction.</p><p><strong>Results: </strong>The GAN achieved SSIM 0.647-0.662, PSNR 20.6-20.9, and FID 16.6-17.0 on internal data, surpassing both CycleGAN [11] (SSIM: 0.608-0.642, PSNR: 18.2-19.2, FID: 27.6-32.5) and Pix2Pix [10] (SSIM: 0.630-0.645, PSNR: 19.5-19.7, FID: 19.4-20.8) across all metrics. Predicted penumbra and infarct core showed Dice coefficients of 0.672 and 0.468, with strong correlations (penumbra: 0.921, core: 0.902) and AUCs of 0.854 (95% CI: 0.819-0.888)(mismatch ratio) and 0.850(95% CI: 0.817-0.884) (dichotomized infarct core). External data validation yielded Dice coefficients of 0.481 (penumbra) and 0.301 (core) with AUCs of 0.720(95% CI: 0.589- 0.808) (mismatch ratio) and 0.703(95% CI: 0.528-0.794)(dichotomized infarct core).</p><p><strong>Conclusions: </strong>The GAN effectively generated CTP-like maps from mCTA, improving interpretability and demonstrating promising diagnostic performance, particularly for resource-limited settings.</p><p><strong>Abbreviations: </strong>mCTA = Multiphase CT angiography, CTP = CT perfusion, CBF = Cerebral blood flow, CBV = Cerebral blood volume, GAN = Generative adversarial network, FID = Fréchet inception distance, AUC = Area under the receiver operating characteristic curve, AIS = acute ischemic stroke.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182567","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":"Factors Associated with Major Re-Recanalization following Second Coiling for Recanalized Aneurysms: A Multicenter Experience over 20 Years during Long-Term Follow-up.","authors":"Michiyasu Fuga, Toshihiro Ishibashi, Issei Kan, Ken Aoki, Rintaro Tachi, Koreaki Irie, Naoki Kato, Shunsuke Hataoka, Gota Nagayama, Tohru Sano, Toshihide Tanaka, Yuichi Murayama","doi":"10.3174/ajnr.A8671","DOIUrl":"https://doi.org/10.3174/ajnr.A8671","url":null,"abstract":"<p><strong>Background and purpose: </strong>Second coiling for recanalized aneurysms can mitigate the risk of delayed rupture, though re-recanalization may still occur. However, factors associated with re-recanalization after second coiling for recanalized aneurysms have yet to be adequately investigated. The present study explored a large, multicenter data set accumulated over 20 years to identify factors associated with major re-recanalization after second coiling for recanalized aneurysms.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed 188 consecutive aneurysms in 185 patients who underwent second coiling for saccular recanalized aneurysms at 3 institutions from January 2003 to December 2023. Patients were classified into 2 groups: with major re-recanalization (R group) and without major re-recanalization (NR group). To identify factors associated with major re-recanalization, clinical, anatomic, and procedural characteristics were compared between the 2 groups by multivariate logistic regression analysis and stepwise selection.</p><p><strong>Results: </strong>During follow-up (mean, 62.3 ± 51.2 months), 72 (38.3%) of the 188 recanalized aneurysms showed major re-recanalization. In univariate analysis, compared with the NR group, the R group showed significantly larger aneurysm size, neck size, and aneurysm volume at first coiling and lower rates of stent-assisted coiling, use of an intermediate catheter (IMC), and complete occlusion at second coiling. Stepwise multivariate logistic regression analysis revealed neck size at first coiling (OR 1.18; 95% CI: 1.04-1.33) as an independent risk factor and stent-assisted coiling (OR 0.34; 95% CI: 0.15-0.79), use of an IMC (OR 0.35; 95% CI: 0.16-0.80), and complete occlusion at second coiling (OR 0.16; 95% CI: 0.033-0.70) as independent protective factors for major re-recanalization.</p><p><strong>Conclusions: </strong>The main risk factor for major re-recanalization after second coiling of recanalized aneurysms was neck size at first coiling, and protective factors included stent-assisted coiling, use of an IMC, and complete occlusion at second coiling. Second coiling for recanalized aneurysms may reduce the risk of major re-recanalization by using a stent or IMC and achieving complete occlusion.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183013","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":"Decubitus Myelography for Spinal Extradural Arachnoid Cyst-Better Classified as a Lateral Dural CSF Leak?","authors":"Mark D Mamlouk, Anthony R Zamary, Niklas Lützen, Jürgen Beck, Adriana Gutierrez, Mark F Sedrak","doi":"10.3174/ajnr.A8856","DOIUrl":"https://doi.org/10.3174/ajnr.A8856","url":null,"abstract":"<p><p>Spinal extradural arachnoid cysts are rare lesions that may result in compressive myelopathy. Their etiology is unclear, but they are thought to represent extradural collections due to a one-way dural defect from the subarachnoid space to the cyst. To date, identifying this dural defect on MRI and myelography have had limited and variable success. Surgery is the standard treatment for these cysts; however, there is debate whether total cyst removal is necessary versus dural repair alone. In this technical report, we show how dynamic decubitus CT and digital subtraction myelography can identify the dural defect and precisely guide the surgical approach. We also discuss many similarities between spinal extradural arachnoid cysts and lateral dural tear CSF leaks observed in patients with spontaneous intracranial hypotension and suggest they may represent a spectrum of CSF leaks.ABBREVIATIONS: SIH ＝ spontaneous intracranial hypotension; CTM ＝ CT myelography; DSM = digital subtraction myelography.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183661","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":"Low- and Intermediate-Grade Lateral Sinus Dural Arteriovenous Fistulas: Factors Affecting the Outcome of Endovascular Treatment over 18-Year Experience in a High-Volume Neurovascular Center.","authors":"Guoli Duan, Yuhang Zhang, Yang Wang, Zhe Li, Chenghao Shang, Rundong Chen, Rui Zhao, Pengfei Yang, Dongwei Dai, Yibin Fang, Qinghai Huang, Bo Hong, Yi Xu, Qiang Li, Jianmin Liu","doi":"10.3174/ajnr.A8622","DOIUrl":"10.3174/ajnr.A8622","url":null,"abstract":"<p><strong>Background and purpose: </strong>Lateral sinus dural arteriovenous fistulas (LS-DAVFs) carry a higher rate of recurrence after endovascular treatment (EVT). Our objective was to investigate the independent predictors of recurrence and unfavorable functional outcomes of low-and intermediate-grade LS-DAVFs after EVT.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed our database of prospectively collected information for all patients with low- and intermediate-grade LS-DAVFs who underwent EVT from May 2004 to December 2021. Patient demographics, angiographics, treatment, and outcomes were analyzed to identify independent predictors of recurrence and unfavorable outcomes.</p><p><strong>Results: </strong>One hundred and seventeen patients with 117 low- and intermediate-grade LS-DAVFs who underwent EVT were included in this study. The mean age of the patients was 53.0 ± 17.5 years. Immediately complete obliteration was achieved in 103/117 (88%) patients after EVT. Clinical follow-up was available for all 117 patients, with an unfavorable outcome rate of 5.1%. Angiographic follow-up was available in 91 patients (78%). Recurrence occurred in 16 (18%) patients and 8 (6.8%) received retreatment. Contralateral sinus severe stenosis or occlusion was an independent high-risk factor for the unfavorable outcome (OR = 11.7; 95% CI: 1.9-70.9, <i>P</i> < .01) and recurrence (OR = 63.8; 95% CI: 10.3-396.5, <i>P</i> < .01) for low- and intermediate-grade LS-DAVFs at follow-up.</p><p><strong>Conclusions: </strong>Contralateral sinus severe stenosis or occlusion represents a stronger independent risk factor associated with recurrence and unfavorable outcomes in patients with low- and intermediate-grade LS-DAVFs when the involved ipsilateral sinus was occluded after EVT. For patients with LS-DAVFs, the patency of the contralateral sinus should be considered when making therapeutic decisions.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822974","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":"Time is Spine: A Novel Radiology Reporting System for Optimizing Spine Oncology Decision-Making and Reducing Time to Treatment.","authors":"Colbey W Freeman, Raghav Mattay, Charles E Kahn, Laurie Loevner, Anish A Butala, Neil R Malhotra, Alvand Hassankhani","doi":"10.3174/ajnr.A8845","DOIUrl":"https://doi.org/10.3174/ajnr.A8845","url":null,"abstract":"<p><strong>Background and purpose: </strong>Patients with spinal metastases are at risk of instability and cord compression, requiring prompt diagnosis and timely intervention. Effective communication between radiologists and treatment teams is critical to ensure timely treatment. To address this, we developed a novel dictation macro incorporating spine oncology imaging findings and a linked automated notification system to accelerate spine oncology referrals and enhance care delivery.</p><p><strong>Materials and methods: </strong>A spine MRI dictation macro was developed incorporating MRI-relevant elements of the Spine Imaging Neoplastic Score and an expanded Epidural Spinal Cord Compression scale into a Spine Oncology Imaging Score (SOIS). Finalized reports containing the macro triggered an automated email notification to a multidisciplinary spine oncology treatment team. Neuroradiologists were educated on the macro, but its use was optional. Time between MRIs to follow-up spine oncology clinic visits and subsequent treatment were compared for outpatients with and without the macro in a Cox proportional hazards model.</p><p><strong>Results: </strong>Between April 2021 and February 2023, 274 outpatients with spinal metastasis had MRI reports with the macro. Among these, 213 (77.7%) had follow-up visits related to the MRI findings and 154 (56.2%) received treatment. During this same period, 152 outpatients had MRI reports did not utilize this macro and 117 (77.0%) had follow-up visits and 58 (38.2%) received treatment. After controlling for SOIS, age, visit department, and treatment type, use of the macro was associated with earlier spine oncology visits (p=0.004) and treatment (p=0.03).</p><p><strong>Conclusions: </strong>The implementation of a structured spine oncology macro combined with an automated notification system to a specialized spine oncology team significantly reduced time to consultation and treatment in patients with spinal metastases. This suggests that incorporating structured reporting tools with critical elements like SOIS, coupled with an efficient notification system, can enhance clinical workflow and expedite decision making in oncology care.</p><p><strong>Abbreviations: </strong>SINS ＝ Spine Instability Neoplastic Score; ESCC ＝ Epidural Spinal Cord Compression; SOaR² = Spine Surgery, Medical Oncology, and Radiation Oncology/Radiology); SOIS = Spine Oncology Imaging Score; SQL = Structured Query Language; IQR = interquartile range; CMS = Centers for Medicare & Medicaid Services.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132040","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":"Adjunctive Flat-panel CT-based Reperfusion Grading after Endovascular Therapy: Enhanced Detection of Residual Distal Vessel Occlusion.","authors":"Sung Hyun Baik, Cheolkyu Jung, Jun Yup Kim, Do Yeon Kim, Nakhoon Kim, Beom Joon Kim, Jihoon Kang, Hee-Joon Bae","doi":"10.3174/ajnr.A8844","DOIUrl":"https://doi.org/10.3174/ajnr.A8844","url":null,"abstract":"<p><strong>Background and purpose: </strong>The detection of residual distal vessel occlusion is crucial for the evolution of endovascular therapy outcomes. This study evaluated whether distal occlusion tracker signs on immediate postprocedural flat-panel CT could assist in the detection of residual distal vessel occlusion in patients with acute ischemic stroke due to large vessel occlusion after thrombectomy.</p><p><strong>Materials and methods: </strong>A single-center retrospective analysis was conducted on patients with anterior circulation large-vessel occlusion who achieved successful reperfusion, defined as a modified TICI score of ≥2b, following endovascular therapy and underwent immediate postprocedural flat-panel CT and perfusion MRI. Two reviewers, blinded to the clinical data and perfusion findings, independently assessed the presence, number, and location of distal occlusion tracker signs on flat-panel CT and the final reperfusion state on cerebral DSA. Distal occlusion tracker signs were defined as dot-like, round, or tubular hyperdensities along the course of the distal intracranial arteries on immediate postprocedural flat-panel CT. Two datasets were compared: (I) using DSA alone, and (II) using DSA combined with flat-panel CT. A core laboratory determined the TICI grading and residual distal occlusion using both DSA and postprocedural perfusion MRI as reference standards.</p><p><strong>Results: </strong>The distal occlusion tracker sign was present in 65/156 patients (41.7%), with excellent inter-rater agreement (weighted kappa = 0.91; 95%CI, 0.85-0.96). Distal occlusion tracker signs demonstrated a sensitivity and specificity of 81.5 and 96.2%, respectively. The diagnostic accuracy in detecting residual distal occlusion was greater with the addition of flat-panel CT findings to DSA than with DSA alone (the area under the curve increased from 0.884 to 0.955, P=0.009). Reperfusion grading overestimation decreased from 17.9% with DSA alone to 3.8% with the addition of flat-panel CT to DSA.</p><p><strong>Conclusions: </strong>Distal occlusion tracker signs are common findings on immediate postprocedural flat-panel CT, indicating residual distal vessel occlusion. The addition of flat-panel CT findings to DSA may enhance the detection of residual distal vessel occlusion after endovascular therapy.</p><p><strong>Abbreviations: </strong>EVT = endovascular therapy; DVO = distal vessel occlusion; FPCT = flat-panel computed tomography; DOT = distal occlusion tracker; FPCT+DSA__TICI = TICI grading performed using FPCT and DSA; DSA__TICI = TICI grading performed using DSA alone; Core__TICI = TICI grading performed by the Core laboratory.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133389","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":"Glymphatic Function as a Moderator in White Matter Injury and Cognitive Impairment: A Community-Dwelling Cohort Study.","authors":"Junjun Wang, Ying Zhou, Kemeng Zhang, Wang Ran, Wansi Zhong, Haidi Jin, Huan Zhou, Yifei Li, Jianzhong Sun, Min Lou","doi":"10.3174/ajnr.A8846","DOIUrl":"https://doi.org/10.3174/ajnr.A8846","url":null,"abstract":"<p><strong>Background and purpose: </strong>White matter injury (WMI) is associated with cognitive dysfunction in aging population; however, a clinicoradiological discrepancy often arises between WMI and cognition function in clinical practice. Emerging evidence suggests that the glymphatic system plays a crucial role in clearing metabolic waste and maintaining cognitive function. We hypothesize that glymphatic dysfunction may contribute to this discrepancy by moderating the impact of WMI on cognition.</p><p><strong>Materials and methods: </strong>We conducted a retrospective review of community-dwelling residents in our center who underwent multimodal MRI scan and neuropsychological testing from April 2017 to December 2021. WMI, as indicated by white matter hyperintensities (WMHs) and normal-appearing white matter (NAWM) microstructural injury, along with cerebral blood flow (CBF), were quantified by multimodal MRI. Cognition was assessed by mini-mental state examination (MMSE). Glymphatic function was evaluated using diffusion tensor imaging along the perivascular space (DTI-ALPS). Moderation analyses were performed to explore the potential role of glymphatic function.</p><p><strong>Results: </strong>A total of 947 participants were included in the final analysis. A higher WMHs burden was found to be associated with lower MMSE scores in the low DTI-ALPS group (r = -0.261, <i>p</i> <0.001), but the correlation was not significant in the high DTI-ALPS group (r = -0.082, <i>p</i> = 0.07). After adjusting for confounding factors, DTI-ALPS moderated the relationship between WMHs burden and MMSE score (β = 1.792, <i>p</i> = 0.02), and the moderating effect was significant in participants aged ≤60 years old (β = 2.573, <i>p</i> = 0.04), without lacunes (β = 2.576, <i>p</i> = 0.01) or without cerebral microbleeds (β = 3.008, <i>p</i> = 0.004). Longitudinal analysis demonstrated that DTIALPS also moderated the relationship between WMHs burden and cognitive decline (β = -3.771, <i>p</i> =0.001). Furthermore, DTI-ALPS moderated the relationship between NAWM microstructural injury and MMSE score (β = -20.201, <i>p</i> =0.01), but no moderating effect was detected between CBF and MMSE score (<i>p</i> > 0.05).</p><p><strong>Conclusions: </strong>Glymphatic system plays a moderate role in the association between WMI and cognitive impairment, highlighting its potential importance in WMI-related cognitive impairment. Further studies are needed to explore the relative mechanisms.</p><p><strong>Abbreviations: </strong>ASL = Arterial spin labeling; CMBs = Cerebral microbleeds; DTI-ALPS = Diffusion tensor imaging along the perivascular space; ESWAN = Enhanced T2 star weighted angiography; FA = Fractional anisotropy; ICV = Intracranial volume; MMSE = Mini-mental state examination; NAWM = Normal-appearing white matter; WMHs = White matter hyperintensities; WMI = White matter injury.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133391","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":"Digital Subtraction Myelography for the Detection of Type 1 Spinal CSF Leaks: Evaluation of Temporal Characteristics and Diagnostic Value.","authors":"Niklas Lützen, Florian Volz, Amir El Rahal, Katharina Wolf, Laura Krismer, Jürgen Beck, Horst Urbach, Charlotte Zander","doi":"10.3174/ajnr.A8847","DOIUrl":"https://doi.org/10.3174/ajnr.A8847","url":null,"abstract":"<p><strong>Background and purpose: </strong>Ventral dural tears (type 1 leaks) are reported to be the most common cause of spontaneous intracranial hypotension (SIH) and may require high dynamic myelography for detection. The aim of this cross-sectional study was to evaluate the temporal characteristics and diagnostic value of digital subtraction myelography (DSM) in type 1 leaks.</p><p><strong>Materials and methods: </strong>Between April 2022 and August 2024, 104 consecutive patients with type 1 leaks were retrospectively identified. Institutional diagnostic standard included DSM as first-line examination; where deviating, patients were excluded. A previously described positioning technique of patients was used, enabling examination even in the challenging cervicothoracic junction of the spine. We evaluated the time for the contrast agent to first appear in the epidural space after reaching the level of the leak intrathecally, and the overall diagnostic yield of DSM.</p><p><strong>Results: </strong>100/104 patients (49 women) were included. Mean age was 49 years (SD ± 11.9 years), mean BMI 24.8 (SD ± 4.29), and median Bern SIH score 4 (IQR 5). Type 1 leaks most commonly occurred at the T1/2 and T2/3 level (each 20/100), range C6/7-L1/2. The mean time for the contrast to be visible in the epidural space was on average 1.5 seconds (range 0-9 seconds) with 1 frame-persecond acquisition being sufficient for all but one patient. DSM as first-line investigation made the diagnosis in 76/100 patients, confirmed in all patients undergoing surgery (74/76). 24/100 patients required one or more subsequent dynamic CT-myelography (dCTM) for definite diagnosis another day, with 21/24 leaks confirmed at surgery. Bern SIH Score was significantly lower in dCTM compared to DSM group (3.25 vs 5; p=0.009), whereas age (p=0.548) and BMI (p=0.185) were not found to have an impact.</p><p><strong>Conclusions: </strong>DSM demonstrated a high diagnostic yield for type 1 leaks when used as a first-line investigation. We have confirmed the high-flow characteristics of these leaks, suggesting that DSM's high temporal resolution is ideally suited for their detection, with 1 frame-per-second being overall sufficient. A lower Bern SIH score could favor patients for primary use of dCTM, however, further research may clarify why DSM occasionally misses diagnoses.</p><p><strong>Abbreviations: </strong>SIH=spontaneous intracranial hypotension, DSM=digital subtraction myelography, dCTM=dynamic CT myelography.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133390","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":"[¹⁸F]-FDG Uptake as a Marker of Residual Anaplastic and Poorly Differentiated Thyroid Carcinoma following <i>BRAF</i>-Targeted Therapy.","authors":"Samir A Dagher, Kim O Learned, Richard Dagher, Jennifer Rui Wang, Xiao Zhao, S Mohsen Hosseini, Anastasios Maniakas, Maria E Cabanillas, Naifa L Busaidy, Ramona Dadu, Priyanka Iyer, Mark E Zafereo, Alexander M Khalaf","doi":"10.3174/ajnr.A8588","DOIUrl":"10.3174/ajnr.A8588","url":null,"abstract":"<p><strong>Background and purpose: </strong>Neoadjuvant <i>BRAF</i>-directed therapy and immunotherapy followed by surgery improves survival in patients with <i>BRAF</i> ^V600E-mutant anaplastic thyroid carcinoma (ATC), more so in those who have complete ATC pathologic response. This study assesses the ability of FDG-PET to noninvasively detect residual high-risk pathologies including ATC and poorly differentiated thyroid carcinoma (PDTC) in the preoperative setting.</p><p><strong>Materials and methods: </strong>This retrospective, single-center study included consecutive <i>BRAF</i> ^V600E-mutant patients with ATC treated with at least 30 days of neoadjuvant <i>BRAF</i>-directed therapy and who underwent FDG-PET/CT within 30 days before surgery. The highest pathologic grade observed for every head and neck lesion resected was recorded. Each lesion on preoperative PET/CT was retrospectively characterized. The primary end point was to contrast the standardized uptake normalized by lean body mass (SULmax) for lesions with residual high-risk (ATC, PDTC) versus low-risk pathologies (papillary thyroid carcinoma, negative). An optimal SULmax threshold was then identified by using a receiver operating characteristic analysis, and the ability of this threshold to noninvasively and preoperatively risk-stratify patients by overall survival was then evaluated with a Kaplan-Meier plot.</p><p><strong>Results: </strong>Thirty patients (mean age 66.5 ± 9.0; 17 men) were included in this study, with 94 surgically sampled lesions. Of these lesions, 57 (60.6%) were low-risk (39 negative, 18 papillary thyroid carcinoma) and 37 (39.4%) were high-risk (29 ATC, 8 PDTC). FDG uptake was higher for high-risk compared with low-risk pathologies: median SULmax 5.01 (interquartile range [IQR] 2.81-10.95) versus 1.29 (IQR 1.06-3.1) (<i>P</i> < .001, Mann-Whitney <i>U</i> test). The sensitivity, specificity, and accuracy for detecting high-risk pathologies at the optimal threshold of SULmax ≥2.75 were 0.784 [95% CI, 0.628-0.886], 0.702 [95% CI, 0.573-0.805], and 0.734 [95% CI, 0.637-0.813], respectively. Patients with at least 1 high-risk lesion identified with the aforementioned cutoff had a worse prognosis compared with patients without high-risk lesions in the head and neck: median overall survival for the former group was 259 days and was not attained for the latter (<i>P</i> = .038, log-rank test).</p><p><strong>Conclusions: </strong>Preoperative FDG-PET noninvasively identifies lesions with residual high-risk pathologies following neoadjuvant <i>BRAF</i>-directed targeted therapy and immunotherapy for <i>BRAF</i>-mutated ATC. FDG-PET avidity may serve as an early prognostic marker that correlates with residual high-risk pathology in <i>BRAF</i>-mutated ATC after neoadjuvant therapy.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689923","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 Efficacy of the Neuroform Atlas Stent for Treatment of Intracranial Aneurysms: A Systematic Review, Meta-Analysis, and Meta-Regression.","authors":"Umar Akram, Shahzaib Ahmed, Zain Ali Nadeem, Mona Shahriari, Hamza Ashraf, Haider Ashfaq, Eeshal Fatima, Ahmed Raza, Aimen Nadeem, Zuha Majid, Arsalan Nadeem, Tayyab Ahmed, Ammara Akram, Sana Rehman, Abeer Sarwar, Janet Mei, Francis Deng, Licia Pacheco-Luna, Nathan Hyson, Vivek S Yedavalli","doi":"10.3174/ajnr.A8593","DOIUrl":"10.3174/ajnr.A8593","url":null,"abstract":"<p><strong>Background: </strong>Intracranial aneurysms (IAs) are the major cause of subarachnoid hemorrhage. Stent-assisted coiling, especially with the Neuroform Atlas stent (NAS), has proved more effective than coiling alone for treating these aneurysms.</p><p><strong>Purpose: </strong>To perform a systematic review and meta-analysis to investigate the efficacy and safety of the NAS in treating IAs.</p><p><strong>Data sources: </strong>A comprehensive literature search was conducted on PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and clinicaltrials.gov from inception until June 2024.</p><p><strong>Study selection: </strong>We included studies on ruptured and unruptured IAs treated with the NAS, covering experimental, observational, and case series across all age groups. The aneurysm occlusion rate was assessed by using the Raymond-Roy classification (RROC). The mRS and adverse events related to stent use were also recorded.</p><p><strong>Data analysis: </strong>The statistical analysis was conducted on R Version 4.3.2 by using the packages \"meta\" and \"metasens.\" We reported our results as proportions with their corresponding CIs. Meta-regression, leave-one-out, and sensitivity analyses were conducted to confirm the robustness of our results.</p><p><strong>Data synthesis: </strong>A total of 42 studies including 2434 participants with a mean age of 51 to 73 years were included. Among angiographic outcomes, the final RROC 1/RROC 2 was achieved in 95% of the patients, final RROC 1 in 82%, RROC 2 in 12%, and RROC 3 in 5% of the patients. Additionally, 93% of the patients showed mRS grade 0, 5% showed mRS grade 1, 3% showed mRS grade 2, 2% showed mRS grade 3, 0% showed mRS grade 4, 0% showed mRS grade 5, and 1% showed mRS grade 6. All adverse events had a ≤5% rate.</p><p><strong>Limitations: </strong>Due to limited cause-specific data, we were unable to analyze mortality specific to the stent placement and complications. Despite the large number of studies included, comparative studies were still observed to be scarce.</p><p><strong>Conclusions: </strong>Although the generalizability of our findings is limited, this study demonstrates that the NAS is highly effective for treating IAs, with high occlusion rates and a low incidence of adverse events. The stent's performance, supported by comprehensive analysis, highlights its safety and efficacy in managing both ruptured and unruptured aneurysms.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142694080","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}