AJNR. American journal of neuroradiology最新文献

{"title":"Thrombectomy Alone or Alongside Intravenous Thrombolysis in Managing Acute Ischemic Stroke Caused by Basilar Artery Occlusion: A Multicenter Observational Study.","authors":"Mo Yang, Yue-Zhou Cao, Peng-Hua Lv, Yasuo Ding, Zhensheng Liu, Zhenyu Jia, Lin-Bo Zhao, Chuan Xu, Hai-Bin Shi, Sheng Liu","doi":"10.3174/ajnr.A8520","DOIUrl":"10.3174/ajnr.A8520","url":null,"abstract":"<p><strong>Background and purpose: </strong>It remains unclear whether the combination of endovascular treatment (EVT) with intravenous thrombolysis (IVT) results in a more favorable functional outcome than EVT alone in managing cases of acute ischemic stroke (AIS) caused by basilar artery occlusion (BAO). Thus, this study aimed to compare the outcomes of 2 approaches-direct endovascular treatment (DEVT) and bridging therapy (IVT plus EVT)-in patients with acute BAO presenting within 4.5 hours of stroke onset.</p><p><strong>Materials and methods: </strong>This multicenter retrospective cohort study included 153 patients with acute BAO presenting within 4.5 hours of stroke onset. Of these patients, 65 (42.5%) and 88 (57.5%) underwent DEVT and bridging therapy, respectively. The primary outcome was defined as good functional outcome (mRS, 0-3) at 90 days. Additionally, preoperative clinical features, thrombectomy attempts, successful reperfusion rates, incidences of symptomatic intracranial hemorrhage (sICH), and mortality were compared between the 2 groups.</p><p><strong>Results: </strong>At 90 days, the rate of good functional outcome was comparable between the DEVT (44.6%) and bridging-therapy (39.8%) groups (adjusted odds ratio [aOR], 1.12; 95% CI, 0.55-2.31; <i>P</i> = .753). The bridging-therapy group exhibited a lower percentage of patients requiring ≥3 attempts of stent retrieval (aOR, 0.39; 95% CI, 0.16-0.93; <i>P</i> = .034). Preoperative clinical features, rate of successful reperfusion, sICH, and mortality were similar between the 2 groups.</p><p><strong>Conclusions: </strong>In patients with BAO-induced AIS, DEVT demonstrates a comparable functional outcome to bridging therapy within 4.5 hours of symptom onset, but IVT reduces the number of thrombectomy attempts.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334167","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-Based Reconstruction for Accelerated Cervical Spine MRI: Utility in the Evaluation of Myelopathy and Degenerative Diseases.","authors":"So Jung Koo, Roh-Eul Yoo, Kyu Sung Choi, Kyung Hoon Lee, Han Byeol Lee, Dong-Joo Shin, Hyunsuk Yoo, Seung Hong Choi","doi":"10.3174/ajnr.A8567","DOIUrl":"https://doi.org/10.3174/ajnr.A8567","url":null,"abstract":"<p><strong>Background and purpose: </strong>Deep learning (DL)-based reconstruction enables improving the quality of MR images acquired with a short scan time. We aimed to prospectively compare the image quality and diagnostic performance in evaluating cervical degenerative spine diseases and myelopathy between conventional cervical MRI and accelerated cervical MRI with a commercially available vendor-neutral DL-based reconstruction.</p><p><strong>Materials and methods: </strong>Fifty patients with degenerative cervical spine disease or myelopathy underwent both conventional cervical MRI and accelerated cervical MRI by using a DL-based reconstruction operating within the DICOM domain. The images were evaluated both quantitatively, based on SNR and contrast-to-noise ratio (CNR), and qualitatively, by using a 5-point scoring system for the overall image quality and clarity of anatomic structures on sagittal T1WI, sagittal contrast-enhanced (CE) T1WI, and axial/sagittal T2WI. Four radiologists assessed the sensitivity and specificity of the 2 protocols for detecting degenerative diseases and myelopathy.</p><p><strong>Results: </strong>The DL-based protocol reduced MRI acquisition time by 47%-48% compared with the conventional protocol. DL-reconstructed images demonstrated a higher SNR on sagittal T1WI (<i>P</i> = .046) and a higher CNR on sagittal T2WI (<i>P</i> = .03) than conventional images. The SNR on sagittal T2WI and the CNR on sagittal T1WI did not significantly differ (<i>P</i> > .05). DL-reconstructed images had better overall image quality on sagittal T1WI (<i>P</i> < .001), sagittal T2WI (Dixon in-phase or TSE) (<i>P</i> < .001), and sagittal T2WI (Dixon water-only) (<i>P</i> = .013) and similar image quality on axial T2WI and sagittal CE T1WI (<i>P</i> > .05). DL-reconstructed images had better clarity of anatomic structures (<i>P</i> values were < .001 for all structures, except for the neural foramen [<i>P</i> = .024]). DL-reconstructed images had a higher sensitivity for detecting neural foraminal stenosis (<i>P</i> = .005) and similar sensitivities for diagnosing other degenerative spinal diseases and myelopathy (<i>P</i> > .05). The specificities for diagnosing degenerative spinal diseases and myelopathy did not differ between the 2 images (<i>P</i> > .05).</p><p><strong>Conclusions: </strong>The accelerated cervical MRI reconstructed with a vendor-neutral DL-based reconstruction algorithm did not compromise image quality and had higher or similar diagnostic performance for diagnosing cervical degenerative spine diseases and myelopathy compared with the conventional protocol.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733546","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":"Morphometric Evaluation of the Facial and Vestibulocochlear Nerves Using MR Imaging in Patients with Menière Disease.","authors":"Wilhelm H Flatz, Annika Henneberger-Kunz, Regina Schinner, Ullrich Müller-Lisse, Maximilian Reiser, Birgit Ertl-Wagner","doi":"10.3174/ajnr.A8537","DOIUrl":"10.3174/ajnr.A8537","url":null,"abstract":"<p><strong>Background and purpose: </strong>Menière disease (MD) is a condition of unknown etiology, involving genetic predisposition, autoimmune processes, viral infections, cellular apoptosis, and oxidative stress. This study aimed to investigate potential differences in cranial nerves VII and VIII in patients with MD using hydrops MRI (FLAIR) for morphometric evaluations.</p><p><strong>Materials and methods: </strong>Sequences acquired were 3T MRI, CISS, and 3D FLAIR. We evaluated the morphometrics of cranial nerves VII and VIII from the cerebellopontine angle to the internal auditory canal fundus, comparing the nonaffected and affected sides. Furthermore, we examined the findings in relation to symptom duration and evaluated the feasibility of FLAIR in the morphometry of the cranial nerves.</p><p><strong>Results: </strong>A total of 53 patients with MD with unilateral symptoms were included. After statistical analysis, no significant differences were found regarding morphometric changes in the affected side compared with the nonaffected side of cranial nerves VII and VIII. There was also no significant difference between the morphometric evaluations of patients with different symptom durations. The morphometric evaluation using hydrops MRI sequences (FLAIR) showed no significant difference compared with established morphometric highly T2-weighted imaging (CISS).</p><p><strong>Conclusions: </strong>Our data found no differences in nerve morphometry between clinically nonaffected and affected sides in patients with unilateral MD, nor any correlation with symptom duration. This finding contrasts with previous ones of correlations between clinical features and endolymphatic hydrops. A disease process starting before clinical symptom onset could be a possible explanation. Morphometric evaluation of brain nerves using hydrops MRI sequences is practical and provides similar results compared with T2-weighted imaging, improving patient comfort and reducing MRI scan times.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482793","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":"Long-term (12 months) Outcomes of Endovascular Thrombectomy for Large Stroke: A Meta-Analysis of SELECT2, TESLA, TENSION, and LASTE trials.","authors":"Ali Mortezaei, Muhammed Amir Essibayi, Ahmed Abdelsalam, Joshua Hanna, Redi Rahmani, David J Altschul, Robert M Starke","doi":"10.3174/ajnr.A8749","DOIUrl":"https://doi.org/10.3174/ajnr.A8749","url":null,"abstract":"<p><strong>Background: </strong>Endovascular thrombectomy (EVT) has demonstrated benefits over standard medical care (MC) in randomized controlled trials (RCTs) for patients with large vessel occlusion (LVO) and large infarct territory at 90 days. However, conflicting evidence exists regarding long-term safety and efficacy of EVT in these populations.</p><p><strong>Purpose: </strong>To evaluate the clinical benefits of EVT in patients with large-core infarction through meta-analysis of high-quality RCT evidence with up to one-year follow-up.</p><p><strong>Data sources: </strong>PubMed/MEDLINE, Web of Science, and Scopus databases.</p><p><strong>Study selection: </strong>RCTs involving patients with confirmed LVO and Alberta Stroke Program Early CT Score (ASPECTS) of ≤5, comparing EVT plus MC versus MC alone, with long-term outcome data.</p><p><strong>Data analysis: </strong>Meta-analysis of long-term functional and safety outcomes with subgroup analysis comparing long-term (≤1 year) versus short-term (≤90 days) data on functional outcomes, imaging modalities, and presentation window. Leave-one-out sensitivity analysis was performed to resolve heterogeneity.</p><p><strong>Data synthesis: </strong>Four RCTs comprising 1229 patients (49% female) were included. EVT demonstrated significant superiority over MC in functional independence (mRS0-2) (RR 3.91, 95% CI 2.7-5.66; P<0.001), mortality (RR 0.84, 95% CI 0.75-0.95; P=0.005), overall survival (mRS0-5) (RR 1.17, 95% CI 1.05-1.31; P=0.005), and quality of life (SMD 0.55, 95% CI 0.32-0.8; P<0.001) with up to one-year follow-up. No significant differences in complication rates were observed except for higher extra-cerebral thromboembolic events in the EVT group (RR 7.94, 95% CI 1.01-62.2; P=0.048).</p><p><strong>Limitations: </strong>Study limited to RCT data with potential variations in thrombectomy techniques and patient selection criteria across trials.</p><p><strong>Conclusions: </strong>In patients with ischemic stroke due to LVO with established large core infarct, EVT plus MC showed significant long-term benefits in functional outcomes, survival, and quality of life compared to MC alone.</p><p><strong>Abbreviations: </strong>EVT = endovascular thrombectomy; MC = medical care; LVO = large vessel occlusion; ASPECTS = Alberta Stroke Program Early CT Score; RCTs = randomized controlled trials; RR = risk ratio; CI = confidence interval; SMD = standardized mean difference; mRS = modified Rankin Scale; sICH = symptomatic intracranial hemorrhage; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; HR = hazard ratio; ROB2 = Risk of Bias 2; NIHSS = National Institutes of Health Stroke Scale.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733550","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":"Enhancing Clarity in Dynamic Myelography Reporting: Results of a Survey of Patients and Referring Providers Evaluating a Standardized Reporting System in the Myelographic Workup of Patients with Suspected Spontaneous Intracranial Hypotension.","authors":"Andrew L Callen, Samantha L Pisani Petrucci, Debayan Bhaumik, Peter Lennarson, Marius Birlea, Jennifer MacKenzie, Jodi Ettenberg, Lalani Carlton Jones","doi":"10.3174/ajnr.A8751","DOIUrl":"10.3174/ajnr.A8751","url":null,"abstract":"<p><strong>Background and purpose: </strong>Dynamic myelography is a critical diagnostic tool for identifying cerebrospinal fluid (CSF) leaks, yet the current lack of standardized reporting can lead to variability in both clinical decision-making and patient understanding. To address these issues, we developed the Spontaneous Intracranial Hypotension Reporting and Data System (SIH-RADS), a standardized scoring system designed to categorize findings on dynamic myelography based on the degree of diagnostic certainty. We then administered a survey to patients and referring providers in order to evaluate the perceived value, clarity, and impact of SIH-RADS on patient and provider experiences as an adjunct to traditional reporting methods for dynamic myelography.</p><p><strong>Materials and methods: </strong>The SIH-RADS scoring system was developed as a collaborative effort between patients and physicians, with six categories ranging from \"Definite Positive with Precise Localization\" (SIH-RADS 5) to \"Technical Failure\" (SIH-RADS 0). Surveys were distributed to three groups: (1) patients who had undergone myelography at our institution for suspected SIH, (2) anonymous patients via private spinal CSF leak groups on social media who had previously undergone myelography, and (3) referring providers who order myelograms for SIH evaluation. Survey questions assessed understanding of traditional reports, clarity of the SIH-RADS system, its impact on decision-making, and preferences for future reporting. Statistical comparisons between local and anonymous patient responses were performed using chi-square tests for categorical variables and t-tests for continuous variables. The observational study STROBE Checklist was utilized, with the proposed methodology followed.</p><p><strong>Results: </strong>A total of 125 patients (78 local patients, 47 anonymous patients) and 13 providers participated in the survey. Among patients, 77% expressed a preference for SIH-RADS over traditional reporting methods, and 58% believed it would improve their understanding of myelography results. Among providers, 92% favored adopting SIH-RADS for future reports, with 85% rating it as very or extremely useful for guiding clinical decisions. 92% of providers reported that the standardized system would enhance communication with patients. Qualitative feedback emphasized the benefits of clearer categorization and actionable recommendations, while also highlighting opportunities to refine patient-facing language and address ambiguities in intermediate scores.</p><p><strong>Conclusions: </strong>A structured reporting system improves the perceived clarity, utility, and communication of dynamic myelography findings among both patients and providers.</p><p><strong>Abbreviations: </strong>CSF = cerebrospinal fluid; SIH = spontaneous intracranial hypotension; CVF = CSF venous fistula.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733548","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":"3D MR Neurography of craniocervical nerves: comparing DESS and post-contrast STIR with deeplearning-based reconstruction at 1.5T.","authors":"Falko Ensle, Fabio Zecca, Bjarne Kerber, Maelene Lohezic, Yan Wen, Jonas Kroschke, Karolina Pawlus, Roman Guggenberger","doi":"10.3174/ajnr.A8750","DOIUrl":"https://doi.org/10.3174/ajnr.A8750","url":null,"abstract":"<p><strong>Background and purpose: </strong>3D MR neurography is a useful diagnostic tool in head and neck disorders, but neurographic imaging remains challenging in this region. Optimal sequences for nerve visualization have not yet been established and may also differ between nerves. While deep learning reconstruction can enhance nerve depiction, particularly at 1.5T, studies in the head and neck are lacking. The purpose of this study was to compare DESS and post-contrast STIR sequences in deep-learning -reconstructed 3D MR neurography of the extraforaminal cranial and spinal nerves at 1.5T.</p><p><strong>Materials and methods: </strong>Eighteen consecutive exams of 18 patients undergoing head-and-neck MRI at 1.5T were retrospectively included (mean age: 51 ± 14 years, 11 female). 3D DESS and post-contrast 3D STIR sequences were obtained as part of the standard protocol, and reconstructed with a prototype deep learning algorithm. Two blinded readers qualitatively evaluated visualization of the inferior alveolar, lingual, facial, hypoglossal, greater occipital, lesser occipital and greater auricular nerves, as well as overall image quality, vascular suppression and artifacts. Additionally, apparent signal-to-noise ratio (aSNR) and contrast-to-noise ratios (aCNR) of the inferior alveolar and greater occipital nerve were measured. Visual ratings and quantitative measurements, respectively, were compared between sequences using Wilcoxon signed-rank test.</p><p><strong>Results: </strong>DESS demonstrated significantly improved visualization of the lesser occipital nerve, greater auricular nerve and proximal greater occipital nerve (p < 0.015). Post-contrast STIR showed significantly enhanced visualization of the lingual nerve, hypoglossal nerve and distal inferior alveolar nerve (p < 0.001). The facial nerve, proximal inferior alveolar nerve and distal greater occipital nerve did not demonstrate significant differences in visualization between sequences (p > 0.08). There was also no significant difference for overall image quality and artifacts. Post-contrast STIR achieved superior vascular suppression, reaching statistical significance for one reader (p = 0.039). Quantitatively, there was no significant difference between sequences (p > 0.05).</p><p><strong>Conclusions: </strong>Our findings suggest that 3D DESS generally provides improved visualization of spinal nerves, while post-contrast 3D STIR facilitates enhanced delineation of extraforaminal cranial nerves.</p><p><strong>Abbreviations: </strong>DESS = Dual-echo steady-state; DL = Deep learning; FN = Facial nerve; GAN = Greater auricular nerve; GON = Greater occipital nerve; HN = Hypoglossal nerve; IAN = Inferior alveolar nerve; LN = Lingual nerve; LON = Lesser occipital nerve; MRN = Magnetic resonance neurography.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733543","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":"Evaluation of stapes image quality with ultra-high-resolution CT in comparison to cone-beam CT and high-resolution CT in cadaveric heads.","authors":"U Puel, S Boukhzer, M Doyen, G Hossu, F Boubaker, F Groubatch, A Blum, P A Gondim Teixeira, M Eliezer, C Parietti-Winkler, R Gillet","doi":"10.3174/ajnr.A8748","DOIUrl":"https://doi.org/10.3174/ajnr.A8748","url":null,"abstract":"<p><strong>Background and purpose: </strong>The purpose of this study was to evaluate the ability of high-resolution (HR), ultra-high-resolution (UHR) with and without deep learning reconstruction (DLR), and cone-beam (CB) CT scanners to image the stapes using micro-CT as a reference.</p><p><strong>Materials and methods: </strong>11 temporal bone specimens were imaged using all imaging modalities. Subjective image analysis was performed by grading image quality on a Likert scale, and objective image analysis was performed by taking various measurements of the stapes superstructure and footplate. Image noise and radiation dose were also recorded.</p><p><strong>Results: </strong>The global image quality scores were all worse than micro-CT (<i>P</i> ≤ 0.01). UHR-CT with and without DLR had the second-best global image quality scores (<i>P</i> > 0.99), which were both better than CB-CT (<i>P</i> = 0.01 for both). CB-CT had a better global image quality score than HR-CT (<i>P</i> = 0.01). Most of the measurements differed between HR-CT and micro-CT (<i>P</i> ≤ 0.02), but not between UHR-CT with and without DLR, CB-CT, and micro-CT (<i>P</i> > 0.06). The air noise value of UHR-CT with DLR was not different from CB-CT (<i>P</i> = 0.49), but HR-CT and UHR-CT without DLR exhibited higher values than UHR-CT with DLR (<i>P</i> ≤ 0.001). HR-CT and UHR-CT with and without DLR yielded the same effective radiation dose values of 1.23 ± 0.11 (1.13-1.35) mSv, which was four times higher than that of CB-CT (0.35 ± 0 mSv, <i>P</i> ≤ 0.01).</p><p><strong>Conclusion: </strong>UHR-CT with and without DLR offers comparable objective image analysis to CB-CT while providing superior subjective image quality. However, this is achieved at the cost of a higher radiation dose. Both CB-CT and UHR-CT with and without DLR are more effective than HR-CT in objective and subjective image analysis.</p><p><strong>Abbreviations: </strong>CB: Cone beam; CT: Computed tomography; DLR: Deep learning reconstruction; HR: High-resolution; UHR: Ultra-high resolution.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702437","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":"Involvement Beyond Peripheral Nerves in Pure Neuritic Leprosy: An MR Imaging Study.","authors":"Sanjeev Kumar Bhoi, Suprava Naik, Yuvraj Lahre, Menka Jha, Suvendu Purkait, Priyanka Samal, Gautom Kumar Saharia, V R Sree Charan, Pritimayee Behera","doi":"10.3174/ajnr.A8562","DOIUrl":"https://doi.org/10.3174/ajnr.A8562","url":null,"abstract":"<p><strong>Background and purpose: </strong>Pure neuritic leprosy (PNL) is an uncommon form of leprosy involving peripheral nerves alone. Some isolated case reports and observational studies have shown imaging changes in the CNS in patients with leprosy. This prospective observational study evaluates the involvement of the nervous system beyond peripheral nerve among patients with PNL with MR imaging.</p><p><strong>Materials and methods: </strong>We screened patients presenting with features of neuropathy and/or thickened nerves. Patients were subjected to detailed clinical examination, routine tests along with nerve conduction study, and biopsy of peripheral nerve, usually the sural nerve. MRI of brachial and lumbar plexus, dorsal root ganglia, spinal cord, and brain were evaluated in patients with histopathologically confirmed Hansen neuritis.</p><p><strong>Results: </strong>Of 86 patients screened for PNL, 52 were positive on nerve biopsy. Most patients were men (86.53%) and the mean age was 45.72 ± 15.25 years. Asymmetrical polyneuropathy was the most common nerve conduction study pattern in 55.76% (29/52) patients. We found abnormal imaging findings in 21 (40.38%) patients. Ganglionitis was the most common finding seen in 14 (26.92%) patients followed by plexitis (15.38%) and myelitis (11.53%). Patients with MRI lesions were younger and were found to have more functional impairment and raised CSF protein.</p><p><strong>Conclusions: </strong>In PNL, many patients have subclinical involvement of dorsal root ganglion, brachial plexus, lumbar plexus, and spinal cord. Exact pathophysiology of CNS involvement is not clear; however, imaging of the above-mentioned regions may help in early diagnosis and prevent complications. These MRI findings in PNL are important considerations when assessing patients with peripheral neuropathy.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671973","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":"Stent Angioplasty for the Treatment of Cerebral Vasospasm: A Systematic Review and Meta-Analysis.","authors":"Jonathan Cortese, Esref Alperen Bayraktar, Sherief Ghozy, Armin Zarrintan, Cem Bilgin, Waleed Brinjikji, Ramanathan Kadirvel, Pervinder Bhogal, David F Kallmes","doi":"10.3174/ajnr.A8617","DOIUrl":"https://doi.org/10.3174/ajnr.A8617","url":null,"abstract":"<p><strong>Background: </strong>Several case series and prospective cohorts have reported the use of stent retrievers (SR) and specifically designed expanding stents (ES) to perform in situ mechanical stent angioplasty to treat cerebral vasospasm in subarachnoid vasospasm.</p><p><strong>Purpose: </strong>The aim of this study was to review and conduct a meta-analysis to evaluate the safety and efficacy of this novel technique.</p><p><strong>Data sources: </strong>A systematic review and meta-analysis was conducted according to established protocols. Searches were conducted in PubMed, Scopus, Web of Science, and EMBASE databases up to June 2024, including variations of \"stent,\" \"expanding device,\" \"vasospasm,\" \"subarachnoid hemorrhage.\" Original studies reporting treatment outcomes for vasospasm by using SR/ES in more than 5 patients were included.</p><p><strong>Study selection: </strong>Pooled data from 8 studies, comprising 156 patients and 428 targeted vessels treated with stent angioplasty for vasospasm were analyzed.</p><p><strong>Data analysis: </strong>We evaluated rates of angiographic success, complications, recurrence, and neurologic improvement. Meta-analysis was performed by using a random-effects model.</p><p><strong>Data synthesis: </strong>The angiographic success rate was 81.8% (95% CI: 70.6-89.3). Subgroup analysis showed a success rate of 86.5% (95% CI: 62.6-96.1) with ES and 80.5% (95%CI: 62.6-93.1) with SR. Overall complication rate was 1.1% (95% CI: 0.0-3.6), due to clot formation or hemorrhage. Recurrence of vasospasm was noted in 12.8% (95% CI: 5.2-28.1) while neurologic improvement was seen in 65.9% (95% CI: 51.1-78.1) of the cases. Finally, it should be noted that all included studies used stent angioplasty in combination with intra-arterial vasodilators.</p><p><strong>Limitations: </strong>Our meta-analysis is limited by selection and reporting biases, as well as high heterogeneity. Moreover, the overall low quality of available evidence is the main limitation of our results.</p><p><strong>Conclusions: </strong>Combination of stent angioplasty and intra-arterial vasodilators was found to have high rates of angiographic success and low incidences of adverse events. Randomized controlled trials are needed to confirm their efficacy and safety compared with medical and balloon angioplasty treatments.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671981","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":"Subacute Stent Deformities as an Underlying Reason for Vessel Stenosis after Flow Diversion with the p64 Stent: Review and Discussion of Biologic Mechanisms and Consequences.","authors":"G Vladev, A Sirakov, S Matanov, K Sirakova, K Ninov, S Sirakov","doi":"10.3174/ajnr.A8564","DOIUrl":"https://doi.org/10.3174/ajnr.A8564","url":null,"abstract":"<p><strong>Background and purpose: </strong>Flow-diverter stents are a potent and efficient tool in the instrumentarium of neurointerventional radiologists for the treatment of intracranial aneurysms. With their implementation, some adverse effects and complications such as hemorrhagic and ischemic ones, have been seen as a potential downfall of the method. In-stent stenosis is one such complication, which until now has not received enormous attention due to its seemingly benign characteristic. In our study we propose a different point of view on this matter and aim to establish a potential mechanism for its development: a subacute postprocedural stent deformation, due to segmental vessel constriction as a reaction to the implant.</p><p><strong>Materials and methods: </strong>We enrolled 48 patients between the ages of 31 and 71 (8 men) with aneurysms on the distal portions of the ICA, all of whom were treated with the p64 flow-diverter stent, to assess the incidence of this phenomenon, as well as establish a correlation between it and subsequent clinical symptoms. A protocol for short-term follow-up, consisting only of a high-dose fluoroscopy image of the implant (conducted on the 14th postprocedural day) was implemented to assess the state of the implant before endothelization was to be expected.</p><p><strong>Results: </strong>Stent deformities were seen in 58% of cases. One patient with an observed stent deformity presented with several episodes of acute contralateral 1-sided weakness of the limbs. Seventy-one percent of those patients presented with a mild/moderate unilateral headache postprocedurally. A correlation between the deformity and a subsequent narrowing of the parent vessel diameter was established on follow-ups. Notable in-stent stenosis was reported in 35% of all cases.</p><p><strong>Conclusions: </strong>Cases with subacute stent deformities are presented in a nonnegligible percent of flow-diversion therapies with the p64 stent. A statistically significant association between the observed deformation and subsequent in-stent stenosis was observed on follow-up.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672036","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}