AJNR. American journal of neuroradiology最新文献

{"title":"Histologically Validated Ex Vivo Characterization of Intraplaque Hemorrhage and Lipid Components Using Quantitative Susceptibility Mapping.","authors":"Ayano Ishiyama, Hideki Ishimaru, Shinji Okano, Yohei Ikebe, Tsuyoshi Izumo, Yoichi Morofuji, Minoru Morikawa, Reiko Ideguchi, Ryo Toya","doi":"10.3174/ajnr.A9335","DOIUrl":"10.3174/ajnr.A9335","url":null,"abstract":"<p><strong>Background and purpose: </strong>Accurate characterization of carotid plaque components is essential for stroke risk assessment. Intraplaque hemorrhage (IPH) is a well-established marker of plaque vulnerability, whereas lipid-rich necrotic cores (LRNCs) often show overlapping signal characteristics with IPH on conventional MRI. The purpose of this study was to compare quantitative susceptibility mapping (QSM) with conventional MRI in differentiating IPH and lipid components in carotid plaques using ex vivo histologic validation.</p><p><strong>Materials and methods: </strong>Twenty-four carotid plaque specimens obtained by en bloc excision during carotid endarterectomy between October 2017 and August 2021 were examined. All specimens underwent ex vivo MRI at 3T, including T1WI, T2WI, and TOF-equivalent FLASH, as well as QSM reconstructed from multiecho FLASH phase data. After MRI, specimens were serially sectioned and stained using H&E and immunohistochemical techniques. ROIs corresponding to histologically confirmed IPH and lipid components were delineated on MRI by consensus of 2 radiologists. On conventional MRI, signal intensities were measured in corresponding histologic regions, and contrast-to-noise ratios (CNRs) were calculated relative to surrounding agarose gel. On QSM, absolute magnetic susceptibility values were measured in the same regions. The difference between plaque tissue and the surrounding agarose gel was defined as the relative susceptibility value (rSV), which was used for statistical analysis. CNRs and rSVs among plaque components were compared using the Kruskal-Wallis test, followed by the Steel-Dwass test for pair-wise comparisons.</p><p><strong>Results: </strong>Seventy-nine matched cross-sectional slices were analyzed, yielding 24 IPH, 61 LRNCs, and 13 foam-cell aggregates (FAs). No significant difference in CNR was observed between IPH and LRNC on T1WI or FLASH. Histopathologic analysis demonstrated that many LRNCs exhibited erythrocyte-derived remnants consistent with prior hemorrhagic events. FAs showed lower CNRs than IPH on T1WI and FLASH (<i>P</i> < .05). On T2WI, IPH showed lower CNRs than LRNCs or FAs (<i>P</i> < .05). On QSM, IPH demonstrated higher rSVs than LRNCs or FAs (<i>P</i> < .01).</p><p><strong>Conclusions: </strong>Histologic validation demonstrates that many LRNCs contain erythrocyte remnants, which may contribute to their overlapping signal characteristics with IPH on conventional MRI. QSM captures erythrocyte-derived susceptibility effects within plaques and provides complementary susceptibility-based information not available from conventional MRI.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639807","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":"Novel Neuroimaging Biomarker of Cortical Gray/White Border Integrity in Blast-Related Mild Traumatic Brain Injury.","authors":"V Carlota Andreu Arasa, Francesca C Fortenbaugh, Aubrey A Knoff, Catherine B Fortier, William P Milberg, David H Salat","doi":"10.3174/ajnr.A9347","DOIUrl":"10.3174/ajnr.A9347","url":null,"abstract":"<p><strong>Background and purpose: </strong>Recent studies suggest that blast or mid-impact neurotrauma are characterized by scar-border forming astrogliosis at the gray-white matter junction. Individuals with mild traumatic brain injury (mTBI) and blast trauma have increased neuroinflammation and impairment of axonal remyelination on postmortem histopathology. However, there are currently only limited methodologies to use in the assessment of the cortical gray/white interface using in vivo neuroimaging. The purpose was to investigate the gray-white matter contrast (GWC) at the gray-white matter junction that may be linked to neuroinflammation/astrogliosis in the setting of blast exposure and/or mTBI, through 3D T1-weighted MPRAGE images.</p><p><strong>Materials and methods: </strong>Post-9/11 veterans (<i>n</i>=723) from the Translational Research Center for TBI and Stress Disorders completed MRI. Participants were grouped into 4 categories: participants with a history of blast-related mTBI (blast-mTBI), participants with a history of mTBI due to other mechanical forces (blunt-mTBI), participants with a history of close blast exposure but no mTBI, and those without a history of lifetime mTBI or close blast exposure. MRI data processing for morphometry and cortical surface mapping was done using FreeSurfer image analysis. Signal intensities in gray and white matter along the cortical and white matter interface were used to calculate mean GWC value.</p><p><strong>Results: </strong>Veterans in the blast-mTBI group showed diffuse patterns of increased GWC relative to the other groups, particularly in the frontotemporal lobes. This effect was driven primarily by a greater number of high GWC regions in the blast-mTBI group compared with the no-neurotrauma and blunt-mTBI groups.</p><p><strong>Conclusions: </strong>There was diffuse increased GWC on MR in the blast-mTBI group compared with the no-neurotrauma, close blast exposure, and blunt-mTBI groups. These findings may be linked to astrogliosis and neuroinflammation in patients with blast-mTBI. Histopathologic correlation with imaging findings will be necessary to better understand these effects.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative Perihematomal Imaging Analysis for the Prediction of Intracerebral Hematoma Expansion.","authors":"Yuval Wiesel, Michael Findler, Jonathan Naftali, Asaf Honig, Rani Barnea, Eitan Auriel","doi":"10.3174/ajnr.A9334","DOIUrl":"10.3174/ajnr.A9334","url":null,"abstract":"<p><strong>Background and purpose: </strong>Hematoma expansion (HE) is a major cause of early neurologic deterioration and poor outcome in spontaneous intracerebral hemorrhage. The perihematomal region (PHR), a potential site of secondary vascular injury, remains poorly characterized. We evaluated whether quantitative PHR features provide predictive information for HE beyond hematoma features and insight into HE dynamics.</p><p><strong>Materials and methods: </strong>In this retrospective 2-center study, 149 patients with acute intracerebral hemorrhage underwent baseline CT within 24 hours of symptom onset and follow-up CT within 72 hours. HE was defined as >6 mL or >33% hematoma growth on follow-up CT. Hematoma regions and PHRs were segmented using relative (half and full radius) and absolute (2, 5, and 10 mm) definitions. Radiomic features were extracted and modeled using multivariable logistic regression. Clinical predictors were added to create combined clinical radiomic models, and performance was evaluated on an independent test set.</p><p><strong>Results: </strong>HE occurred in 29% (44/149) of patients. The hematoma only radiomic model showed modest discrimination (area under the receiver operating characteristic curve [AUROC] = 0.71; 95% CI, 0.62-0.80). Incorporating PHR features improved performance, with the absolute 5-mm PHR model achieving the highest discrimination (AUROC = 0.91; 95% CI, 0.86-0.95). Adding clinical predictors further enhanced performance (AUROC = 0.94; 95% CI, 0.90-0.97). Key PHR features associated with HE included reduced sphericity, increased texture coarseness, and clustered heterogeneity.</p><p><strong>Conclusions: </strong>Quantitative PHR characterization was strongly associated with HE and provided incremental value beyond hematoma derived radiomics, with further improvement when combined with clinical predictors. This contrast-free approach may support objective risk stratification, guide targeted interventions, and reduce expansion related morbidity.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640124","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":"Clinical Presentation, Misdiagnosis, and Imaging Findings of Anterior Disc Herniations.","authors":"Ola A E Mohamed, Sevda Alipour Khabir, Parnian Habibi, Carrie M Carr, Ethan A Thonn, Ben Johnson-Tesch, Steven A Messina, Ian T Mark","doi":"10.3174/ajnr.A9379","DOIUrl":"10.3174/ajnr.A9379","url":null,"abstract":"<p><p>Anterior and anterolateral lumbar disc herniations are uncommon and usually do not present with classic radicular symptoms. This contributes to a broader and sometimes misleading differential diagnosis based on the initial presentation. When identified on cross-sectional imaging performed for nonspinal indications, displaced disc material can be mistaken for a retroperitoneal mass, potentially prompting additional imaging or invasive evaluation. We report 6 cases of anterior and anterolateral disc herniations identified on CT and MRI, including some patients presenting with abdominal or flank pain. Imaging demonstrated anterior disc extrusion, some with marked inflammatory changes. In some cases, the initial diagnosis included retroperitoneal neoplasm or an inflammatory process. Recognizing this imaging pattern and its clinical context may help accurate diagnosis, avoid unnecessary procedures, and guide appropriate management.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791672","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":"Concordance and Association of Kidokoro MRI Scores at 32 and 40 Weeks Postmenstrual Age with Neurodevelopmental Outcomes in Very Preterm Infants.","authors":"Linda Bonezzi, Tommaso Biagioni, Simona Fiori, Carly Luke, Joanne M George, Paul B Colditz, Jurgen Fripp, Robert S Ware, Kerstin Pannek, Roslyn N Boyd","doi":"10.3174/ajnr.A9350","DOIUrl":"10.3174/ajnr.A9350","url":null,"abstract":"<p><strong>Background and purpose: </strong>Early identification of neurodevelopmental risk in very preterm infants is critical for timely intervention. The Kidokoro MRI scoring system offers a semiquantitative approach to evaluating brain abnormalities. This study aimed to assess the agreement of Kidokoro scores obtained in the same infants at 32 and 40 weeks postmenstrual age, and their association to cognitive, language, and motor outcomes at 24 months corrected age.</p><p><strong>Materials and methods: </strong>A cohort of 187 very preterm infants (median 28⁺⁵ weeks gestational age; 55% boys) underwent structural MRI at 2 time points: early (median 32⁺² weeks) and term-equivalent age (TEA; median 40⁺⁵ weeks), using 3T scanners. Scans were scored independently using a modified version of the Kidokoro system. Bland-Altman analysis assessed agreement between early and TEA scores. Neurodevelopmental outcomes were assessed at 24 months using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Multivariable linear regression models evaluated the predictive value of MRI scores, adjusting for sex, gestational age, birth weight centile, and socioeconomic status.</p><p><strong>Results: </strong>Early MRI scores were consistently higher than TEA scores (mean difference: 1.9; 95% CI, 1.6-2.2), with WM scores showing the largest discrepancy (mean difference: 1.68; 95% CI, 1.46-1.90), primarily due to the myelination delay item. Excluding this item reduced the difference to 0.32 (95% CI, -0.01 to 0.64). Early and TEA Kidokoro Global Brain Abnormality Score (GBAS) were negatively associated with Bayley-III cognitive and motor, but not language scores. Higher GBAS were associated with lower cognitive (early: β = -0.67 [95% CI, -1.23 to -0.11], partial <i>R</i> ² = 0.03; TEA: β = -0.60 [95% CI, -1.15 to -0.06], partial <i>R</i> ² = 0.03) and motor scores (early: β = -1.04 [95% CI, -1.67 to -0.41], partial <i>R</i> ² = 0.06; TEA: β = -1.18 [95% CI, -1.78 to -0.58], partial <i>R</i> ² = 0.08). Reduction in GBAS from early to TEA correlated with higher motor scores (β = 1.02 [95% CI, 0.03-2.02], partial <i>R</i> ² = 0.02). WM abnormalities were linked to poorer motor outcomes at both time points.</p><p><strong>Conclusions: </strong>Kidokoro scores at early and term-equivalent time points are associated with neurodevelopmental outcomes at 24 months. Global abnormalities and WM scored at either time points, or their longitudinal changes are significantly linked to motor outcomes. Refinement of the scoring system for the early assessment may enhance clinical utility.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694170","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":"Dual-Lumen Balloon Assisted Onyx Embolization of Middle Meningeal Artery for Chronic Subdural Hematoma.","authors":"Abraham Madjidov, Varun Naragum, Dennis Oh, Kamal Kalia, Huanwen Chen, Jay Gutta, Dheeraj Gandhi","doi":"10.3174/ajnr.A9678","DOIUrl":"https://doi.org/10.3174/ajnr.A9678","url":null,"abstract":"<p><strong>Background and purpose: </strong>Middle meningeal artery embolization (MMAE) with liquid embolic agents (LEAs) is increasingly used to manage chronic subdural hematoma (CSDH). Conventional microcatheters require distal wedge positioning of the microcatheter tip or proximal plug formation to prevent reflux and achieve effective distal penetration. Dual-lumen balloon microcatheters limit reflux and enable controlled LEA injection, which may improve procedural efficiency. The evidence base for dual-lumen balloons in CSDH is limited.</p><p><strong>Materials and methods: </strong>This single-center retrospective study included consecutive adults with CSDH treated from December 2021 to September 2025. The Scepter XC dual-lumen balloon microcatheter was used to arrest antegrade flow and control Onyx-18 delivery, first distal to the anterior branch origin and then from the MMA trunk into the posterior branch. Outcomes included >50% hematoma thickness reduction and complete resolution on computed tomography (CT), recurrence, retreatment, complications, hospital stay, and procedure time.</p><p><strong>Results: </strong>152 patients were identified; 33 (21.7%) underwent concomitant surgery and 108 (71.1%) standalone MMAE. Median follow-up was 3 months. This technique achieved >50% hematoma thickness reduction in 90.4% and complete resolution in 70.6% at 3 months or last follow-up. There were no serious adverse events definitely associated with the dual-lumen balloon technique. Overall postprocedural complications occurred in 4 patients (2.6%): transient facial palsy in 2 (1.3%), transient diplopia in 1 (0.7%), and bilateral watershed territory cerebral infarctions without long-term neurological deficits in 1 (0.7%). Median hospital stay was 2 days (IQR 1-4), and median procedure duration was 31.5 minutes (IQR 24.3-48.8). None of the patients who completed follow-up experienced CSDH recurrence or required retreatment.</p><p><strong>Conclusions: </strong>Scepter XC-assisted Onyx-18 MMAE was technically feasible and associated with high rates of CSDH resorption and resolution, with a safety profile similar to other MMAE techniques and no serious adverse events directly attributable to dual-lumen balloon microcatheter use.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186789","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":"Short-Duration [¹⁸F]florbetapir PET Reconstructions: Centiloid Agreement and Temporal-Window Analysis.","authors":"Yusuke Kawasaki, Kota Yokoyama, Hirofumi Yamada, Masaaki Kawanishi, Keisuke Takino, Nobuo Sanjo, Yoichiro Nishida, Jun Oyama, Junichi Tsuchiya, Masaki Ohyagi, Masahito Yamada, Sonoko Misawa, Ukihide Tateishi","doi":"10.3174/ajnr.A9675","DOIUrl":"https://doi.org/10.3174/ajnr.A9675","url":null,"abstract":"<p><strong>Background and purpose: </strong>Shorter [¹⁸F]florbetapir PET acquisitions could improve workflow, but the effects of reconstruction duration and temporal-window position on Centiloid values are not well characterized. We evaluated quantitative agreement across short-duration reconstructions, temporal-window effects, and visual agreement.</p><p><strong>Materials and methods: </strong>This retrospective study included a primary cohort of 32 patients with early 1-, 2-, and 5-min reconstructions and a 10-min reference. A temporal-window cohort of 22 patients underwent early and late 5-min analysis. A validation cohort of 37 examinations underwent early, centered, and late 1- and 5-min reconstructions and a 10-min reference. Two readers independently classified early 1-min, early 5-min, and 10-min images across three separate reading sessions. Centiloid agreement was assessed using paired differences, Bland-Altman limits of agreement, and categorical agreement.</p><p><strong>Results: </strong>In the primary cohort, mean differences from the 10-min reference were -3.70, -2.97, and -1.65 CL for early 1-, 2-, and 5-min reconstructions, respectively. In the temporal-window cohort, late 5-min values averaged 2.86 CL higher than early values. The validation cohort reproduced both findings: early-to-late shifts were +5.53 CL at 1 min and +3.07 CL at 5 min. In the reader study, agreement with 10 min was 70.3%-86.5% at 1 min and 94.6%-100% at 5 min; interreader κ was 0.49, 0.77, and 0.89 at 1, 5, and 10 min, respectively.</p><p><strong>Conclusions: </strong>Early short-duration reconstructions yielded systematically lower Centiloid values, while later temporal windows yielded higher values at fixed duration. Visual agreement with 10 min was high at 5 min but lower at 1 min. Reconstruction duration and frame timing should be standardized before abbreviated protocols are considered substitutes for standard 10-min imaging.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169453","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":"Moyamoya-Type Collaterals in ACTA2 p. Arg179 Related Arteriopathy: Challenging the Paradigm of Absent Neovascularization-A Longitudinal DSA Study.","authors":"Jawid Madjidyar, Anna Kyselyova, Zsolt Kulcsar, Tilman Schubert, Patrick Thurner, Nadia Khan","doi":"10.3174/ajnr.A9674","DOIUrl":"https://doi.org/10.3174/ajnr.A9674","url":null,"abstract":"<p><strong>Background and purpose: </strong>ACTA2 p. Arg179 variants can cause a distinctive cerebrovascular arteriopathy historically described lacking classic moyamoya basal collaterals. Limited data on collateral architecture and surgical outcomes have led to uncertainty regarding revascularization strategies. The purpose of this study is to provide a systematic longitudinal DSA assessment of collateral patterns and postoperative findings in pediatric ACTA2-associated cerebrovascular disease.</p><p><strong>Material and methods: </strong>Ten pediatric patients with genetically confirmed ACTA2 mutations underwent DSA imaging. Eight consecutive patients with neurological instability and confirmed hemodynamic compromise underwent surgical revascularization (indirect or combined direct-indirect). Two patients with stable neurological status were managed conservatively. Paired DSA (7 patients) and magnetic resonance angiography (5 patients) were performed at baseline and follow-up of the operated cohort. Collaterals were classified as classic moyamoya-type, distal moyamoya-type, leptomeningeal, or duropial. Postoperative revascularization was graded using Matsushima classification.</p><p><strong>Results: </strong>Mean baseline vessel calibers demonstrated marked proximal ectasia (petrous ICA 8.4 ± 2.8 mm vs. normative 3.8 ± 0.4) transitioning to distal stenosis (supraclinoid ICA 2.6 ± 0.7 mm vs. normative 3.3 ± 0.3). Classic moyamoya-type collaterals were present in 2 patients at baseline and in 5 patients at follow-up. Postoperative Matsushima grading demonstrated Grade A/B in 6 patients, with surgical collateralization remaining patent and sufficient up to 14 years.</p><p><strong>Conclusions: </strong>ACTA2 p. Arg179 related cerebral arteriopathy demonstrates moyamoya-type collaterals challenging the historical paradigm of absent collateralization. Robust surgical neovascularization comparable to idiopathic moyamoya may support revascularization in symptomatic pediatric patients with confirmed hemodynamic compromise.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167690","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":"Advanced Practice Providers in Spinal CSF Leak Programs: A Multi-Institutional Study of Current Roles and Perceived Impact on Patient Care.","authors":"Ajay A Madhavan, Michelle L Kodet, Peter G Kranz, Timothy J Amrhein, Mark D Mamlouk, Andrew Callen, Gayle Salama, J Levi Chazen, Vinil Shah, Wouter I Schievink, Rachelle Tache, Ian T Mark, Anousheh Sayah, Miriam E Peckam, Lubdha Shah, Amish H Doshi, Ian Carroll, E Hope Weant","doi":"10.3174/ajnr.A9679","DOIUrl":"https://doi.org/10.3174/ajnr.A9679","url":null,"abstract":"<p><strong>Background and purpose: </strong>Advanced practice providers (APPs), including nurse practitioners and physician assistants, are increasingly integrated into radiology practices. However, their utilization and clinical responsibilities in dedicated spinal CSF leak programs have not been characterized. Using a multicenter survey, we investigated APP training, clinical responsibilities, perceived impact, and challenges of APP integration at US spinal CSF leak programs.</p><p><strong>Materials and methods: </strong>A survey was distributed to physicians at US institutions with dedicated spinal CSF leak programs and APP involvement. Candidate institutions were identified through the International Society for Spinal CSF Leak and American Society of Spine Radiology. Survey questions addressed program characteristics, APP training and structure, clinical responsibilities, perceived impact, and challenges. Responses were summarized descriptively.</p><p><strong>Results: </strong>Twelve institutions completed the survey. Eight (67%) reported caring for more than 250 spinal CSF leak patients annually. APPs included nurse practitioners at 4 centers (33%), physician assistants at 3 (25%), and both at 5 (42%); 7 centers (58%) had APPs dedicated exclusively to spinal CSF leak care. APP training was primarily informal and on-the-job at all institutions. Common primary APP responsibilities included obtaining outside imaging, patient intake and symptom review, procedure and sedation orders, informed consent, post-procedural follow-up, pain management, and treatment of rebound intracranial hypertension. Shared APP and physician responsibilities commonly included outside record review, determining evaluation urgency, preliminary imaging review, sedation assessment, and multidisciplinary coordination. Procedural responsibilities such as lumbar puncture, intrathecal contrast administration, myelography planning, and CSF leak treatment were primarily performed by physicians in most programs. At least 75% of respondents strongly agreed that APP participation improved continuity of care, patient communication/accessibility, clinic efficiency, patient satisfaction, physician administrative burden, and multidisciplinary coordination. Common barriers included funding/support, billing/reimbursement, and limited procedural privileges.</p><p><strong>Conclusions: </strong>APPs are widely integrated into dedicated spinal CSF leak programs, with substantial involvement in pre-procedural evaluation, care coordination, and post-procedural management, while advanced myelography and CSF leak treatment remain predominantly physician-directed. APP participation was perceived to improve patient care and clinical workflow. These findings provide a framework for APP integration into specialized spinal CSF leak programs.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172087","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":"2024-2025 Academic Neuroradiology Workforce and Practice Survey: Faculty FTE and Effort, Recruitment and Retirement Benchmarks.","authors":"Max Wintermark, Rahul Bhala, Ari Blitz, Scott Faro, Ajay Malhotra, Julie Bykowski, Tabassum Kennedy","doi":"10.3174/ajnr.A9677","DOIUrl":"https://doi.org/10.3174/ajnr.A9677","url":null,"abstract":"<p><strong>Purpose: </strong>Rising RVU targets and clinical workloads in academic neuroradiology raise concerns about diagnostic accuracy, patient safety, faculty burnout, and erosion of education/research missions. This national survey of division chiefs characterized current practice patterns, effort models, moonlighting, operational factors, compensation, protected time, grant support, and perceptions of sustainable productivity.</p><p><strong>Materials and methods: </strong>Web-based survey of academic neuroradiology division chiefs (American Society of Neuroradiology directory), with up to three reminders. 51 responses were collected anonymously and analyzed descriptively in Microsoft Excel. Questions covered workforce, clinical effort models, workload exceedance drivers, moonlighting, leadership protected time, and grant support.</p><p><strong>Results: </strong>Divisions had median 11 FTE (25th-75th: 7-17.25); faculty were mostly full-time (median 90% at 1.0 FTE). Retirement risk was low short-term (median 0% in 2 years, 10% in 5 years); median 2 hires/year. Median clinical effort was 74% cFTE. Effort models split between shift-based (47%) and RVU-target (45%; typically, 40th-70th percentile AAARAD); volume caps used in only 8%. Targets were frequently exceeded, mainly due to moonlighting/financial incentives (49%) and voluntary work (32%). Moonlighting was offered in 52% of divisions (median 50% participation), yielding typical additional income of $26K-$100K/year. Protected effort medians: 20% (division chiefs), 10% (fellowship directors). Grant support was commensurate with funding in most divisions; 62% received \"cap gap\" support for federal grants.</p><p><strong>Conclusion: </strong>Academic neuroradiology faces intense clinical demands, and relies heavily on voluntary and incentivized faculty moonlighting. These findings highlight the need for accurate productivity benchmarks, operational improvements, and stronger institutional protections to sustain quality, safety, faculty satisfaction, and the academic mission.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170421","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}