AJNR. American journal of neuroradiology最新文献

{"title":"Optimizing CTP in Posterior Circulation Infarction (POCI): A Comprehensive Analysis of CTP Postprocessing Algorithms for POCI.","authors":"Leon S Edwards, Cecilia Cappelen-Smith, Dennis Cordato, Andrew Bivard, Leonid Churilov, Longting Lin, Chushuang Chen, Carlos Garcia-Esperon, Mark W Parsons","doi":"10.3174/ajnr.A8833","DOIUrl":"10.3174/ajnr.A8833","url":null,"abstract":"<p><strong>Background and purpose: </strong>CTP software packages utilize various mathematical techniques to transform source data into clinically useful maps. These techniques have not been validated for posterior circulation infarction (POCI). Studies of anterior circulation stroke have shown that algorithm differences significantly influence the accuracy and best tissue parameters and thresholds of output maps. We examined the influence of the processing algorithm on CTP accuracy and best tissue parameters and thresholds in acute POCI.</p><p><strong>Materials and methods: </strong>Data were analyzed from patients diagnosed with a POCI enrolled in the International Stroke Perfusion Imaging Registry (INSPIRE). Fifty-eight patients with baseline multimodal CT with occlusion of a large posterior circulation artery and follow-up diffusion-weighted MRI at 24-48 hours were included. CTP parametric maps were generated by using 5 algorithms, including singular value deconvolution, singular value deconvolution with delay and dispersion correction (SVDd), partial deconvolution, the stroke stenosis, and maximum slope models. Receiver operating curve (ROC) analysis and linear regression were used for voxel-based analysis and volume-based analysis, respectively.</p><p><strong>Results: </strong>Partial deconvolution by using the MTT parameter was the optimal technique for characterizing ischemic-penumbra (AUC 95% CI: 0.73 [0.64-0.81]) and infarct core (AUC 95% CI: 0.70 [0.63-0.73]). The optimal MTT threshold was >165% and >180% for core and penumbra, respectively. By volume analysis, the maximum slope and SVDd by using MTT were the best algorithms for the estimation of penumbra and core, respectively. Estimates of core volume were weak (all R² ≤0.02). Processing algorithm-influenced model accuracy (AUC range: 0.70-0.73 [core], 0.67-0.72 [penumbra]) and optimal tissue parameter and threshold. MTT was the most consistent optimal parameter across algorithms. The optimal MTT threshold by algorithm varied from >120% to >200% for core and 155% to 195% for penumbra.</p><p><strong>Conclusions: </strong>CTP has diagnostic utility in POCI. There were notable differences in optimal parameter and threshold by algorithm. Clinicians should be aware of the specific characteristics of the algorithm used in their CTP software and apply caution when comparing output maps between vendors.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059505","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":"7T MRI Automated Software Segmentation of the Hippocampus for Epilepsy: Prospective Performance Evaluation.","authors":"Brian J Burkett, Andrew J Fagan, Krystal M Kirby, Zaki Ahmed, Benjamin H Brinkmann, Daniel J Blezek, David B Burkholder, Karl N Krecke, Steven A Messina, Robert J Witte, Kirk M Welker","doi":"10.3174/ajnr.A8862","DOIUrl":"https://doi.org/10.3174/ajnr.A8862","url":null,"abstract":"<p><strong>Background and purpose: </strong>7T MRI is a promising clinical technology for epilepsy imaging. Quantification of hippocampus volume on MRI is a clinically useful biomarker in epilepsy. Applying automated hippocampus volume measurement tools to 7T MRI is needed to optimize the use of clinical ultra-high-field strength epilepsy imaging. The objective of this study is a performance evaluation of automated hippocampal volume measurement software at 7T MRI in both normal participants and those with seizure disorders.</p><p><strong>Materials and methods: </strong>7T MRI examinations were prospectively acquired in 50 participants. A subset of participants also underwent 3T MRI examinations, and a subset underwent 2 separate 7T acquisitions. Automated segmentation of the hippocampus was performed with 2 commonly used software packages (FreeSurfer and NeuroQuant) at 3T and 7T, with hippocampal volumes calculated for segmentations without any visually unacceptable errors as determined by radiologist review. Hippocampal volumes were also measured from manual segmentations, and the intraclass correlation coefficient (ICC) was used to compare data with automated segmentation volumes.</p><p><strong>Results: </strong>Visually unacceptable automated hippocampus segmentation errors occurred more frequently at 7T than at 3T with NeuroQuant (11.0% versus 7.14%) and FreeSurfer (12.5% versus 0%). Computerized volume measurements at 7T correlated poorly with manual segmentation for both software programs (ICC <0.4). Hippocampal volume estimate correlation between matched 7T and 3T MRI in the same participant was fair (ICC = 0.4-0.59) to good (0.6-0.75) for software and manual segmentation. For repeated 7T MRI examinations in the same participant, hippocampus segmentation reproducibility was excellent (0.75) for automated software but poor (< 0.4) for manual segmentation.</p><p><strong>Conclusions: </strong>Computerized volume measurement of the hippocampus at 7T correlates poorly with volumes obtained through manual segmentation and suboptimally with matched 3T examination measurements, but is highly reproducible at 7T within the same participant. Segmentation errors are more common with 7T examinations, and further development of a hippocampal segmentation method specific to 7T MRI is needed to fully realize the benefits of 7T MRI for imaging patients with epilepsy.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260273","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":"Reliability of pseudocontinuous arterial spin labeling in ischemic stroke and comparison with other perfusion techniques: systematic review and meta-analysis.","authors":"Jéssica Borges Kroth, Suzete N F Guarda, Danny J Wang, Maria G M Martin, Adriana B Conforto","doi":"10.3174/ajnr.A9031","DOIUrl":"https://doi.org/10.3174/ajnr.A9031","url":null,"abstract":"<p><strong>Background: </strong>Pseudocontinuous arterial spin labeling (pCASL) is a non-invasive, gadolinium-free MRI technique for assessing brain perfusion.</p><p><strong>Purpose: </strong>To evaluate the test-retest reliability of pCASL-CBF measurements in ischemic stroke (IS) and compare pCASL metrics with those from DSC, CTP, and PET.</p><p><strong>Data sources: </strong>Systematic searches were conducted in MEDLINE, EMBASE, and LILACS. Risk of bias and methodological quality were evaluated using QUADAS-2 and QAREL tools.</p><p><strong>Study selection: </strong>11 studies, encompassing 383 participants with IS were included.</p><p><strong>Data analysis: </strong>Random-effects meta-analysis with inverse variance method and heterogeneity assessed using I² statistics.</p><p><strong>Data synthesis: </strong>No PET studies were identified. Only one low-quality, high-risk-of-bias study assessed test-retest reliability, finding no significant differences in repeated absolute CBF measurements over time and excellent reliability across regions. Most studies comparing pCASL with DSC, and all comparing pCASL with CTP, had a low risk of bias. In the hyperacute phase of IS, pCASL and DSC showed no significant differences in infarct core relative CBF (95% CI: -0.11 to 0.13; I² = 0%) or hypoperfusion volumes (95% CI: -0.28 to 0.68; I² = 69%). Evidence on the comparability of pCASL with other DSC or CTP metrics was limited.</p><p><strong>Limitations: </strong>The small number of included studies prevented a meta-analysis for the primary outcome and limited conclusions for secondary outcomes.</p><p><strong>Conclusions: </strong>Robust conclusions about the test-retest reliability of pCASL or the comparability of metrics obtained with this technique and DSC, CTP, or PET in different phases following ischemic stroke could not be drawn.</p><p><strong>Abbreviations: </strong>pCASL＝pseudocontinuous arterial spin labeling; IS: ischemic stroke; QUADAS-2＝Quality Assessment of Diagnostic Accuracy Studies-2; QAREL＝ Quality Appraisal for Reliability Studies.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260260","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":"Locating Spinal Leaks in Spontaneous Intracranial Hypotension: How Many Dynamic Myelographies Does It Take?","authors":"Saujanya Rajbhandari, Thomas Petutschnigg, Levin Häni, Danial Nasiri, Johannes Goldberg, Christoph Schankin, Adrian Scutelnic, Philipe Breiding, Lorenz Grunder, David Brustman, Andreas Raabe, Jan Gralla, Sara Pilgram-Pastor, Johannes Kaesmacher, Katharina Wolf, Jürgen Beck, Ralph T Schär, Eike Piechowiak, Tomas Dobrocky","doi":"10.3174/ajnr.A9032","DOIUrl":"https://doi.org/10.3174/ajnr.A9032","url":null,"abstract":"<p><strong>Background and purpose: </strong>Localizing a cerebrospinal fluid (CSF) leak in spontaneous intracranial hypotension (SIH) patients is of utmost importance when pursuing a targeted therapy. The study aimed to evaluate the accuracy of dynamic myelography techniques in localizing spinal CSF leaks and report the number of examinations required, stratified by leak type and spinal level.</p><p><strong>Materials and methods: </strong>Consecutive SIH patients with a spinal longitudinal extradural CSF collection (SLEC) investigated at our department from January 2013 to February 2025 were screened. All included patients underwent a dynamic myelography work-up to localize the level of spinal CSF leak using conventional dynamic myelography (CDM), and/or dynamic computed tomography myelography (DCTM).</p><p><strong>Results: </strong>In total, 198 SLEC positive SIH patients (mean age: 50 ± 12 years; 67% female, 133/198) were included. In total, 147 patients had a ventral (74%), 49 patients had lateral (25%), and two patients had a primary dorsal (1%) leak. The spinal CSF leak was localized with the first, second, third or fourth dynamic myelography in 97 (49%), 70 (35%), 16 (8%), 11 patients (6%), respectively. The median number of myelography exams (CDM + DCTM) per patient to localize a CSF leak was 2 (IQR 1-2; range 1-8); 1 (IQR 1-2; range 1-5) for ventral, 2 (IQR 1-2; range 1-6) for lateral and 6 (IQR 5-7; range 4-8) for dorsal leaks. In total, 160 patients (81%) were referred for microsurgical closure. The dural leak was identified intraoperatively on the indicated vertebral level in 153 patients (96%), in 2 patients (1.3%) spontaneous sealing occurred, in 5 patients (3%) wrong-level surgery occurred.</p><p><strong>Conclusions: </strong>Dynamic myelography exams accurately and reliably localize spinal CSF leaks in SIH patients with SLEC. In about half of the patients, the level of the leak can be localized with the first CDM. In case of a repeat dynamic myelography, the technique and patient positioning can be adopted according to the results of the previous exam. Primary dorsal leaks are rare, but due to the low level of suspicion, pose a diagnostic challenge.</p><p><strong>Abbreviations: </strong>CSF: Cerebrospinal Fluid; CDM: Conventional Dynamic Myelography; DSM: Digital Subtraction Myelography; DAP: Dose-Area Product; DLP: Dose-Length Product; DCTM: Dynamic Computed Tomography Myelography; EBP: Epidural Blood Patch; ICHD: International Classification Of Headache Disorders; IQR: Interquartile Range; PMCT: Post-Myelo CT; SLEC: Spinal Longitudinal Extradural CSF Collection; SIH: Spontaneous Intracranial Hypotension; SD: Standard Deviation; WLS: wrong-level surgery.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260238","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":"Cerebellar subpial hemorrhage - an underestimated location of fetal intracranial hemorrhage.","authors":"Amit Haboosheh, Nicole Amberg, Christine Haberler, David Mirsky, Sarah Glatter, Dieter Bettelheim, Daniela Prayer, Gregor Kasprian","doi":"10.3174/ajnr.A9019","DOIUrl":"10.3174/ajnr.A9019","url":null,"abstract":"<p><strong>Background and purpose: </strong>Subpial hemorrhage (SPH) is a rare form of intracranial hemorrhage, typically observed in neonates. It differs from subarachnoid and subdural hemorrhages in both anatomical location and underlying pathophysiology. The primary aim of this study was to describe the distinct fetal MRI features of cerebellar SPH.</p><p><strong>Methods and materials: </strong>This retrospective multi-center study included twenty-four fetuses, aged between 20+5 and 34+0 weeks of gestation, from three institutions. Postmortem 3T MRI and neuropathological workup were available for four cases and one post-natal MRI.</p><p><strong>Results: </strong>SPH was located infratentorially along the cerebellum and vermis in all 24 cases. SPH was observed as either unilateral, bilateral, or multifocal, with several distinct morphological patterns, crescentic or spherical/punctate shapes along the cerebellar surface. Postmortem MRI in one case confirmed the prenatal MRI findings, and neuropathological analysis confirmed SPH extending from the pia-arachnoid through the molecular layer, and hemosiderin-containing macrophages within the external granular layer associated with reduced and disrupted Bergmann glial processes in areas adjacent to SPH.</p><p><strong>Conclusion: </strong>Fetal cerebellar SPH are characterized by crescentic foci of signal abnormality that appear \"attached\" to the cerebellar surface. Cerebellar SPH constitutes a distinct entity that may be detected on prenatal imaging, either in isolation or in association with fetal germinal matrix-intraventricular hemorrhage (GM-IVH).</p><p><strong>Abbreviations: </strong>SPH = Subpial hemorrhage, US = Ultrasound, GM-IVH = Germinal matrix -Intraventricular hemorrhage, IVH = Intraventricular hemorrhage, DWM = Dandy Walker malformation, FGR = Fetal growth restriction, TTTS = Twin-Twin Transfusion Syndrome, SSFSE = Single-shot fast spin-echo, EGL = External granule layer.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182519","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":"Disparities in Access to Specialized Care for Spontaneous Intracranial Hypotension.","authors":"Maria P Puello, Premal Trivedi, Kathryn Kerrigan, Andrea Walters, Debayan Bhaumik, Peter Lennarson, Andrew L Callen","doi":"10.3174/ajnr.A9036","DOIUrl":"https://doi.org/10.3174/ajnr.A9036","url":null,"abstract":"<p><strong>Background and purpose: </strong>Patients with spontaneous intracranial hypotension (SIH) often face substantial delays in diagnosis and treatment. Barriers to accessing specialized care for SIH remain poorly understood, particularly with regard to potential demographic and/or socioeconomic disparities. The purpose of this study is to evaluate whether patients seen in a specialized CSF leak clinic differ demographically or socioeconomically from those presenting to the emergency department (ED) with headache who receive neuroimaging.</p><p><strong>Materials and methods: </strong>We retrospectively compared all patients evaluated in the University of Colorado CSF Leak Program in March 2025 to patients presenting to the ED at our institution during the same month with a primary complaint of headache who underwent neuroimaging. Demographic and socioeconomic variables were extracted from the electronic medical record and compared between groups using the chi-square test, t-tests, or the Mann-Whitney U test, as appropriate.</p><p><strong>Results: </strong>A total of 95 patients from the CSF leak clinic and 130 patients from the ED headache clinic were included in this study. Patients seen in the CSF leak clinic were significantly more likely to be female (76.8% vs. 57.7%, χ2=8.9, p=0.003), white (89.5% vs. 47.7%, χ2=45.5, p <0.001), have private insurance (72.6% vs. 41.5%, χ2=27.91, p <0.001), and report English as their primary language (96.8% vs. 75.4%, χ2=21.3, p <0.001). The median driving distance to the hospital was substantially longer in the CSF clinic cohort (23 miles, IQR 12-70 vs. 7 miles, IQR 6-12; Mann-Whitney U = 9562, p <0.001). ZIP code-based household income did not differ significantly between groups ($98,000 vs. $91,000; t = 1.20, p = 0.11).</p><p><strong>Conclusions: </strong>Patients accessing specialized care for SIH at a tertiary referral center are more likely to be white, English-speaking, and privately insured compared to patients presenting to the ED with headache, despite coming from farther geographic distances. These findings suggest significant disparities in access to specialty care for SIH, highlighting the need for targeted outreach, streamlined referral pathways, and broader diagnostic awareness in general practice and emergency settings.</p><p><strong>Abbreviations: </strong>SIH＝ Spontaneous intracranial hypotension.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254087","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":"Motion-Informed 3D Deep Learning Reconstruction in Patients with Cognitive Impairment.","authors":"Shohei Fujita, Daniel Polak, Dominik Nickel, Daniel N Splitthoff, Yantu Huang, Nelson Gil, Sittaya Buathong, Chen-Hua Chiang, Wei-Ching Lo, Bryan Clifford, Stephen F Cauley, John Conklin, Susie Y Huang","doi":"10.3174/ajnr.A8977","DOIUrl":"https://doi.org/10.3174/ajnr.A8977","url":null,"abstract":"<p><strong>Background and purpose: </strong>Motion artifacts remain a key limitation in brain MRI, particularly during 3D acquisitions in cognitively impaired patients. Most deep learning (DL) reconstruction techniques improve signal-to-noise ratio but lack explicit mechanisms to correct for motion. This study aims to validate a DL reconstruction method that integrates retrospective motion correction into the reconstruction pipeline for 3D T1-weighted brain MRI.</p><p><strong>Materials and methods: </strong>This prospective, intra-individual comparison study included a controlled-motion cohort of healthy volunteers and a clinical cohort of patients undergoing evaluation for memory loss. Each cohort was scanned at distinct imaging sites between October 2022 and August 2023 in staggered periods. All participants underwent 4-fold under-sampled 3D magnetization-prepared rapid gradient-echo imaging with integrated Scout Accelerated Motion Estimation and Reduction (SAMER) acquisition. Image volumes were reconstructed using standard-of-care methods and the proposed DL approach. Quantitative morphometric accuracy was assessed by comparing brain segmentation results of instructed-motion scans to motion-free reference scans in the healthy volunteers. Image quality was rated by two board-certified neuroradiologists using a five-point Likert scale. Statistical analysis included Wilcoxon tests and intraclass correlation coefficients.</p><p><strong>Results: </strong>A total of 41 participants (15 women [37%]; mean age, 58 years) and 154 image volumes were evaluated. The DL-based method with integrated motion correction significantly reduced segmentation error under moderate and severe motion (12.4% to 3.5% and 44.2% to 12.5%, respectively; P < .001). Visual ratings showed improved scores across all criteria compared with standard reconstructions (overall image quality, 4.26 ± 0.72 vs. 3.59 ± 0.82; P < .001). In 47% of cases, motion artifact severity was improved following DL-based processing. Inter-reader agreement ranged from moderate to substantial.</p><p><strong>Conclusions: </strong>Motion-informed DL reconstruction improved both morphometric accuracy and perceived image quality in 3D T1-weighted brain MRI. This technique may enhance diagnostic utility and reduce scan failure rates in motion-prone patients with cognitive impairment.</p><p><strong>Abbreviations: </strong>AD = Alzheimer's disease; DL = deep learning; ICC = intra-class correlation coefficient; SAMER = scout accelerated motion estimation and reduction.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254026","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":"The Role of MRA as a Preliminary Diagnostic Tool in Diagnosing and Localizing Spinal Dural Arteriovenous Fistula.","authors":"Efrat Saraf Lavi, Julieta Aristizabal, Dileep R Yavagal, Robert M Starke, Adham M Khalafallah, Allan D Levi, Richard J T Gornia","doi":"10.3174/ajnr.A8830","DOIUrl":"10.3174/ajnr.A8830","url":null,"abstract":"<p><strong>Background and purpose: </strong>Despite advances in imaging techniques, spinal dural arteriovenous fistulas (SDAVFs) may be misdiagnosed, leading to delays in treatment and in some cases irreversible neurologic damage. Spinal DSA has been considered the standard in diagnosing SDAVFs; however, it is operator-dependent and often technically difficult, which can result in false-negative results. MRI/MRA has been established as a sensitive and specific imaging technique in diagnosing SDAVF and in identifying the correct level of the fistula. We present our experience with diagnosing SDAVF by using MRI/MRA and propose MRA as a complementary imaging technique to DSA in diagnosing and localizing SDAVF.</p><p><strong>Materials and methods: </strong>Once institutional review board approval was granted, data were retrospectively collected from records of 30 patients with surgically proved cases of type I SDAVFs at a large tertiary academic center. This search included records from 2010-2024. Eligibility criteria included any patient with a surgically proved SDAVF, or patients treated by embolization for SDAVF in whom preoperative MRI and DSA had been obtained. Of these patients, 15 had preoperative spinal MRA. The demographic variables collected included patient age, sex, prior spine surgery history, symptomatology, and outcomes.</p><p><strong>Results: </strong>In all 30 patients, an SDAVF was suggested on routine MRI. In 7 cases, DSA was negative. In all 15 patients who had MRA before treatment at our institution, the MRA was positive for SDAVFs. In 3 cases the MRA was done after DSA at our institution failed to identify the SDAVFs and the patient was taken to surgery based on the MRA results alone. In 4 patients with outside institution negative DSAs, MRAs at our institution were positive and subsequently had positive DSA.</p><p><strong>Conclusions: </strong>Our findings suggest that MRA is a highly sensitive tool for detecting SDAVF and should be used before DSA, to decrease the likelihood of false-negative DSAs. A limited spinal DSA may also be considered in cases in which MRA clearly identifies the fistula level.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053418","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":"Are Deep White Matter Hyperintensities Associated with Amyloid-Related Imaging Abnormalities in Patients with Alzheimer Disease Treated with Lecanemab?","authors":"Saurabh Rohatgi, Shenghua Zhu, Esteban Calle Cadavid, Jeremy N Ford, Benjamin M Kozak, Odette Ganem Chagui, Maryam Vejdani-Jahromi, Harry R Griffin, Hana Farzaneh, Raymond Y Huang, Jarrel C Seah, Nima Omid-Fard, Teresa Gomez-Isla, John R Dickson, Liliana Ramírez Gómez, Javier M Romero","doi":"10.3174/ajnr.A8822","DOIUrl":"https://doi.org/10.3174/ajnr.A8822","url":null,"abstract":"<p><strong>Background and purpose: </strong>Amyloid-related imaging abnormalities (ARIA) are common complications of antiamyloid immunotherapy for Alzheimer disease (AD). Identifying imaging biomarkers that predict ARIA risk may help guide treatment decisions. This study investigates the relationship between deep white matter hyperintensities (DWMH), perivascular spaces (PVS), and ARIA incidence in patients with AD treated with lecanemab.</p><p><strong>Materials and methods: </strong>This retrospective cohort study included 27 ARIA-positive patients identified between November 2023 and November 2024, and 27 age- and sex-matched ARIA-negative controls. Baseline MRI was assessed for DWMH burden (Fazekas score) and PVS grades in the basal ganglia and centrum semiovale. Simple logistic regression was performed to evaluate associations between imaging markers and ARIA risk.</p><p><strong>Results: </strong>ARIA-positive patients had significantly higher Fazekas scores compared with ARIA-negative patients (1.37 versus 1.0; <i>P</i> = .0262), indicating a greater DWMH burden. PVS grades in the basal ganglia were numerically higher in ARIA-positive patients (1.81 versus 1.56, <i>P</i> = .0733) but did not reach statistical significance. Simple logistic regression identified the Fazekas score as a significant predictor of ARIA (OR: 2.812; 95% CI, 1.076-8.438; <i>P</i> = .0343). The area under the receiver operating characteristic curve for the model was 0.640 (95% CI, 0.492-0.788; <i>P</i> = .078).</p><p><strong>Conclusions: </strong>Higher DWMH burden, as quantified by the Fazekas score, is significantly associated with ARIA risk in patients with AD treated with lecanemab. These findings suggest that DWMH may serve as a potential imaging biomarker for ARIA risk stratification. Larger studies incorporating additional vascular biomarkers, including cerebral amyloid angiopathy markers, are warranted to refine risk prediction models.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214135","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":"Plaque-Reporting and Data System Related to Cerebrovascular Event Risk with Mild/Moderate Stenosis: A Chinese Atherosclerosis Risk Evaluation II Study.","authors":"Maoxue Wang, Yin Guo, Daniel S Hippe, Xihai Zhao, Chun Yuan, Luca Saba, Bing Zhang, Mahmud Mossa-Basha","doi":"10.3174/ajnr.A8819","DOIUrl":"10.3174/ajnr.A8819","url":null,"abstract":"<p><strong>Background and purpose: </strong>Plaque-Reporting and Data System (Plaque-RADS) provides a standardized approach for evaluating carotid plaque morphology and composition. The aim of this study was to evaluate carotid Plaque-RADS and its relationship to clinical risk factors and ipsilateral cerebrovascular symptoms, in a prospectively-acquired multicenter, vessel wall MRI data set.</p><p><strong>Materials and methods: </strong>Symptomatic patients were recruited from the Chinese Atherosclerosis Risk Evaluation, NCT02017756 (CARE-II) study. This cross-sectional study included patients with recent stroke or TIA and atherosclerotic plaques in at least 1 carotid artery. Lipid-rich necrotic core, ulceration, intraplaque hemorrhage, a thick or thin fibrous cap, fibrous cap rupture, and intraluminal thrombi were identified from multiple-contrast vessel wall imaging and were used to determine carotid Plaque-RADS. In addition, ancillary features including calcification and plaque burden via the maximum normalized wall index (max-NWI) were collected. The degree of stenosis was classified as mild (<30%), moderate (30%-69%), and severe (70%-99%). Generalized estimating equation-based logistic regression was performed to assess the relationship between the Plaque-RADS score and cerebrovascular events.</p><p><strong>Results: </strong>A total of 433 patients (62 [SD, 9.97] years, 302 men [69.7%]) with 866 carotid arteries were included in this study. Symptomatic carotid arteries had a higher stenosis degree (11.8% [SD, 24.7%] versus 8.6% [SD, 18.8%]; <i>P</i> = .01), Plaque-RADS score (≥3: 33.9% versus 28.4%; <i>P</i> = .02), and max-NWI (0.53 [SD, 0.14] versus 0.51 [SD, 0.13]; <i>P</i> = .002) compared with the asymptomatic side. Plaque RADS was significantly associated with cerebrovascular events (OR = 1.11 per 1-level increase; 95% CI, 1.01-1.24; <i>P</i> = .04). In patients with mild/moderate bilateral carotid artery stenosis, plaque RADS ≥3 was significantly associated with symptomatic events (OR = 1.30; 95% CI, 1.01-1.68; <i>P</i> = .04). Higher Plaque-RADS on the symptomatic side was related to advanced age (OR = 1.27 per 10-year increase; 95% CI, 1.03-1.56; <i>P</i> = .03), male sex (OR = 1.90; 95% CI, 1.05-3.43; <i>P</i> = .03), and smoking history (OR = 1.99; 95% CI, 1.20-3.31; <i>P</i> = .007).</p><p><strong>Conclusions: </strong>Male patients of advanced age with a smoking history were associated with an increased risk of higher Plaque-RADS scores. Plaque-RADS demonstrated the ability to stratify patients experiencing cerebrovascular events, even in cases with mild-to-moderate stenosis. However, this association lost statistical significance after adjusting for stenosis or max-NWI.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044693","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}