AJNR. American journal of neuroradiology最新文献

{"title":"The Inferior Cerebellar Peduncle Sign: A Novel Imaging Marker for Differentiating Multiple System Atrophy Cerebellar Type from Spinocerebellar Ataxia.","authors":"Chae Y Lim, Yujin Seo, Beomseok Sohn, Minjung Seong, Sung T Kim, Sungjun Hong, Jinyoung Youn, Eung Y Kim","doi":"10.3174/ajnr.A8623","DOIUrl":"10.3174/ajnr.A8623","url":null,"abstract":"<p><strong>Background and purpose: </strong>The hot cross bun (HCB) sign is a hallmark feature of multiple system atrophy with predominant cerebellar ataxia (MSA-C), typically observed in advanced stages of the disease; however, it can also present in other conditions such as spinocerebellar ataxia (SCA), making the differentiation challenging. The middle cerebellar peduncle (MCP) sign may be observed in various medical conditions and in healthy individuals. We hypothesized that the inferior cerebellar peduncle (ICP), known to be affected in MSA-C, may exhibit hyperintensity on FLAIR imaging, potentially aiding in differentiating MSA-C from SCA.</p><p><strong>Materials and methods: </strong>Medical records of 153 patients with probable MSA-C and 72 genetically confirmed SCAs from a single institution were reviewed retrospectively between January 2012 and June 2023. MRI was performed using 3T scanners. The ICP sign was deemed positive when the bilateral ICP signal intensity exceeded that of the medulla oblongata on axial FLAIR images. MCP and HCB signs were also evaluated. Two independent neuroradiologists evaluated all MRIs, and interobserver agreement was assessed using κ statistics. Univariable and multivariable logistic regression analyses identified predictive features, and diagnostic performance was assessed.</p><p><strong>Results: </strong>The ICP sign was more prevalent in patients with MSA-C (65%) compared with those with SCA (6.9%; <i>P</i> < .001). The HCB and MCP signs were more frequent in patients with MSA-C (<i>n</i> = 110 and <i>n</i> = 134) than in those with SCA (<i>n</i> = 19 and <i>n</i> = 30; <i>P</i> < .001). The ICP sign demonstrated the highest specificity (95%) for predicting MSA-C, with an area under the curve (AUC) = 0.82, respectively. The MCP sign exhibited superior sensitivity (87%) but lower specificity and AUC compared with the ICP sign. Combining the ICP and MCP signs improved the AUC to 0.86. Integrating clinical features (age, sex, and disease duration) with imaging features yielded excellent diagnostic performance, with an AUC = 0.98.</p><p><strong>Conclusions: </strong>The ICP sign on FLAIR imaging has high specificity in distinguishing MSA-C from SCA. Integrating clinical and imaging features further enhances diagnostic accuracy, potentially improving the differential diagnosis in clinical settings of cerebellar ataxia.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1223-1230"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824825","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":"Optimizing Image Quality in Cerebral 3D Rotational Angiography: A Study on the Impact of Voxel Size.","authors":"Seongsik Han, Byung Jun Kim, Pae Sun Suh, Hye Hyeon Moon, So-Yeon Kim, Jong-Tae Yoon, Boseong Kwon, Deok Hee Lee, Yunsun Song","doi":"10.3174/ajnr.A8672","DOIUrl":"10.3174/ajnr.A8672","url":null,"abstract":"<p><strong>Background and purpose: </strong>3D rotational angiography (3DRA) is a crucial diagnostic tool for assessing neurovascular diseases. Despite its superior spatial resolution, challenges arise in visualizing minute vasculatures. This study investigates the impact of voxel size on the spatial resolution and noise of cerebral 3DRA.</p><p><strong>Materials and methods: </strong>3DRA data from January 2022 to May 2022 were retrospectively analyzed, including a total of 10 patients with 50 small vessels (<1.0 mm in diameter) analyzed (5 vessels per patient). Using the Artis Q biplane angiography machine, 3DRA data sets were acquired and reconstructed at various voxel sizes ranging from 0.05 mm to 0.30 mm. Quantitative assessment included measurement of vessel visibility (maximum grayscale intensity within the vessel), vessel sharpness (slope of grayscale intensity calculated between 20% and 80% of maximum intensity), and background noise (standard deviation within a nonvascular region). Qualitative assessments-sharpness, noise, and overall image quality-were evaluated by 3 neuroradiologists.</p><p><strong>Results: </strong>A total of 50 vessels were analyzed quantitatively. Both the maximum intensity and slope of grayscale intensity at vessel walls decreased with increasing voxel size. There was a significant 2.94% increase in vessel intensity for every 0.05 mm decrease in voxel size (<i>P</i> < .001). Background noise significantly decreased as the voxel size increased (<i>P</i> < .001). Qualitatively, as the voxel size decreased, the sharpness of the image improved, and the amount of noise decreased. The overall image quality generally improved with decreasing voxel size. A good interrater agreement was observed among the neuroradiologists (κ = 0.601).</p><p><strong>Conclusions: </strong>Voxel size significantly influences 3DRA image quality. Smaller voxel sizes enhance spatial resolution and overall image clarity despite increased noise and reduced field of view. Strategic application of smaller voxel sizes is crucial for detailed vascular assessments, such as aneurysm morphology and fine vascular structures.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1173-1179"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129749","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":"Contrast-Enhanced CISS/FIESTA Imaging for Increased Conspicuity of Pituitary Microadenomas in Cushing Disease.","authors":"Ian T Mark, Jamie Van Gompel, Maria Peris Celda, Eric Stinson, Irina Bancos, Lucinda Gruber, Jason Little, Derek R Johnson, Steven A Messina","doi":"10.3174/ajnr.A8596","DOIUrl":"10.3174/ajnr.A8596","url":null,"abstract":"<p><strong>Background and purpose: </strong>Pituitary microadenomas can be challenging to see on MRI, particularly when they are small. The detection of microadenomas commonly relies on contrast-enhanced sequences, highlighting the adenoma that demonstrates hypoenhancement relative to the native pituitary gland on T1-weighted sequences. Detecting adenomas in patients with Cushing disease is crucial because surgery is the standard of care treatment. Accurate preoperative lesion localization is directly associated with improved outcomes. The purpose of our study was to determine the utility of contrast-enhanced CISS/FIESTA with cycling (FIESTA-C) for identifying pituitary microadenomas in patients with Cushing disease.</p><p><strong>Materials and methods: </strong>This cross-sectional study retrospectively reviewed pituitary MR images in patients with Cushing disease who had postcontrast CISS/FIESTA-C. Images were evaluated for lesion conspicuity (well-defined margins), as well as the signal intensity (SI) of the adenoma and native pituitary gland. The normalized SI difference was calculated by subtracting the lesion SI from the pituitary SI and dividing by the pituitary SI. Patient age, sex, and diagnosis based on intraoperative findings, pathology results, and postoperative adrenal insufficiency were recorded.</p><p><strong>Results: </strong>Seventeen patients (15 women) were included in this study. Sixteen (94%) adenomas were discrete on CISS/FIESTA-C compared with 11 (65%) on T1-weighted imaging. The mean adenoma normalized SI difference with CISS/FIESTA-C was 0.512 (SD, 0.12), relative to 0.242 (SD, 0.15) on T1-weighted imaging (<i>P</i> < .001).</p><p><strong>Conclusions: </strong>In comparison with MR T1-weighted images, contrast-enhanced CISS/FIESTA-C imaging detects a higher number of pituitary microadenomas with superior conspicuity. Because up to 50% of patients with Cushing disease present without a pituitary lesion detected on MRI, postcontrast CISS/FIESTA-C may be especially valuable as an additional sequence in this population.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1255-1259"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689925","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 as a Powerful Tool to Detect Small- and Medium-Size Vessel CNS Vasculitis.","authors":"Angelika Hoffmann, William Almiri, Pasquale Mordasini, Alexandrine Bähler, David J Seiffge, Martina B Göldlin, Eugen Jäger, Ioan-Paul Muresan, Lisa Christ, Mirjam R Heldner, Roland Wiest, Piotr Radojewski","doi":"10.3174/ajnr.A8627","DOIUrl":"10.3174/ajnr.A8627","url":null,"abstract":"<p><p>Imaging can help to diagnose CNS vasculitis. Yet so far, no imaging studies of CNS vasculitis at 7T are available. We share our experience of vessel wall imaging (VWI) at 7T in patients with suspected vasculitis. All included patients (<i>n</i>=45) underwent a clinically approved 7T MRI comprising high-resolution arterial TOF angiography as well as high-resolution VWI with T1 sampling perfection with application-optimized contrast using different flip angle evolution (SPACE) and T1 SE acquired pre- and postcontrast. Twenty-three patients showed negative and 22 patients showed positive VWI at 7T. Ten of 22 7T VWI-positive cases were suggestive of vasculitis with 9 patients showing VWI of large- and medium-size vessels and 1 patient VWI of small vessels. Small-vessel vasculitis was only depicted with 7T VWI, but not 3T VWI. Our work demonstrates that diagnosing CNS vasculitis, especially small-vessel vasculitis, is feasible at 7T and highlights the potential of high-field VWI encouraging further studies in this field.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1283-1286"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856947","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":"Cognitive Control Network and Language Reorganization in Patients with Brain Tumors.","authors":"Luca Pasquini, Antonio Napolitano, Leonardo Spitoni, Maurizio Schmid, Francesco Dellepiane, Mehrnaz Jenabi, Kyung Peck, Andrei Holodny","doi":"10.3174/ajnr.A8638","DOIUrl":"10.3174/ajnr.A8638","url":null,"abstract":"<p><strong>Background and purpose: </strong>The interaction between language and other cognitive networks in patients harboring brain tumors is poorly understood. We studied the modification of the cognitive control network (CCN) induced by brain tumors and its participation in language reorganization. We hypothesized that patients with brain tumors and reorganized language would show a modification of the CCN compared with patients who remain left dominant.</p><p><strong>Materials and methods: </strong>Patients were selected with the criteria: newly diagnosed, pathologically-confirmed left-hemispheric tumor; single lesions; right-handedness; task-based and resting-state fMRI; no artifacts. Age-matched healthy controls (HC) were recruited from open-source databases. Language laterality was calculated by using task-based fMRI. We obtained the CCN through ad hoc independent component analysis on resting-state fMRI. Differences in CCN between patients and HC were characterized by cosine similarity (CS) and earth mover's distance (EMD). Changes related to language reorganization and patients' speech were assessed with the <i>t</i> test (<i>P</i> < .05). Results were corrected for multiple comparisons.</p><p><strong>Results: </strong>One hundred forty-two right-handed patients (35 low-grade and 88 high-grade gliomas; 19 metastases) and 184 HC were included. Two independent components of the CCN were obtained. The <i>t</i> test confirmed significant effects of lateralization on the CCN (<i>P</i> = .004). Modification of CCN was associated with fewer speech deficits 1 week after surgery (<i>P</i> = .005).</p><p><strong>Conclusions: </strong>This study provides evidence that modifications of CCN occur in the setting of language reorganization. Patients exhibiting these modifications perform better at speech evaluation after surgery, suggesting a role of cognitive control in compensating for speech deficits when language reorganizes.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1238-1248"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901073","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":"Evaluating the Role of Imaging Markers in Predicting Stroke Risk and Guiding Management After Vertebral Artery Injury: A Retrospective Study.","authors":"Jessica Vankawala, Zixin Yi, Manisha Koneru, Joshua Santucci, Charles Morse, Joseph Ifrach, Zein Al-Atrache, Nicole M Fox, Anna Goldenberg-Sandau, Jane Khalife, Daniel A Tonetti, Tudor G Jovin, Corey M Mossop, Hamza A Shaikh","doi":"10.3174/ajnr.A8866","DOIUrl":"https://doi.org/10.3174/ajnr.A8866","url":null,"abstract":"<p><strong>Background and purpose: </strong>Traumatic vertebral artery injury is a severe consequence of head and neck trauma occurring when a disturbance to vessel wall architecture causes vessel dissection. These injuries come with a host of complications, including debilitating neurological damage, although patients are often asymptomatic upon presentation. Still, the screening recommendations, treatment strategies, and predicted outcomes of traumatic vertebral artery injury remain largely undefined. Therefore, it is imperative to investigate the risk of life-threatening sequelae occurring secondary to vertebral artery injury to minimize patient morbidity. This study aimed to explore the Biffl grade as an imaging marker for prognosticating acute stroke risk and guiding appropriate management strategies. We hypothesize that an increase in Biffl grade will directly correlate with an increase in post-injury stroke risk in a stepwise fashion.</p><p><strong>Materials and methods: </strong>A database of patients admitted to a level 1 trauma center with CTA-diagnosed vertebral artery injury was retrospectively reviewed. The primary outcome was the risk of an acute ischemic stroke event within 14 days of injury. Univariable and multivariable logistic regression analyses were performed to explore the association between Biffl grade and stroke risk while controlling for clinically significant covariables.</p><p><strong>Results: </strong>Of 219 patients, the median age was 60 years. Within the acute period, 22 (10.0%) of traumatic vertebral artery injury patients had an acute stroke. In the multivariable regression, only Biffl Grade 2 (p=0.01) and 4 (p=0.04) were significantly associated with a higher risk of stroke. This risk did not increase in a stepwise fashion as Biffl grade increased. The predicted probability of a stroke event exceeds 20% for Biffl grade 2 and 5 injuries, and the probability of stroke decreases in patients managed with antithrombotic medication regardless of injury severity.</p><p><strong>Conclusions: </strong>The risk of post-injury ischemic stroke does not consistently correlate with injury severity as assessed per the Biffl grade. Thus, Biffl grade alone is likely not an adequate prognostic factor to predict the risk of ischemic stroke in traumatic vertebral artery injury patients or for guiding optimal treatment for such patients with increased risk for stroke.</p><p><strong>Abbreviations: </strong>TVAI = traumatic vertebral artery injury; IQR = interquartile range; GCS = Glasgow Coma Scale; DAPT = Dual Antiplatelet Therapy.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217830","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":"Normal Facial Nerve Enhancement on Volumetric Interpolated Breath-Hold Examination MRI Sequence.","authors":"Nanjiba Nawaz, Amit B Desai, Alok A Bhatt","doi":"10.3174/ajnr.A8592","DOIUrl":"10.3174/ajnr.A8592","url":null,"abstract":"<p><strong>Background and purpose: </strong>Enhancement of the facial nerve can be seen on MRI due to its rich arteriovenous plexus. Classically, enhancement of the facial nerve beyond the geniculate ganglion has been described as a normal finding, while enhancement of the canalicular and labyrinthine segments is considered abnormal. We hypothesize facial nerve enhancement of the canalicular and labyrinthine segments is a normal finding on the postcontrast T1-weighted, fat-saturated volumetric interpolated breath-hold examination (VIBE) sequence on both 1.5T and 3T MRI scanners.</p><p><strong>Materials and methods: </strong>Fifty patients without facial nerve symptoms undergoing MRI by using the internal auditory canal protocol were identified at our institution, 25 cases on a 1.5T scanner and 25 cases on a 3T scanner; a total of 100 facial nerves. Presence or absence of enhancement of the facial nerve segments on the postcontrast T1-weighted, fat-saturated VIBE sequence were independently analyzed by 2 neuroradiologists.</p><p><strong>Results: </strong>On 1.5T, of 50 facial nerves evaluated, percentage of nerves with enhancement at each segment was as follows: 80% canalicular, 92% labyrinthine, 100% tympanic, 100% mastoid, and 80% intraparotid. On 3T, of 50 facial nerves evaluated, percentage of nerves with enhancement at each segment was as follows: 60% canalicular, 84% labyrinthine, 98% tympanic, 100% mastoid, and 93% intraparotid.</p><p><strong>Conclusions: </strong>Enhancement of the canalicular and labyrinthine segments of the facial nerve is a normal finding on the postcontrast, T1-weighted, fat-saturated VIBE sequence. Careful attention to clinical history and asymmetry should be considered before calling abnormality of the facial nerve.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1268-1271"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142694078","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":"Effects of Psilocybin on Mouse Brain Microstructure.","authors":"Paloma C Frautschi, Ajay P Singh, Nicholas A Stowe, Sean M Grady, Zarmeen Zahid, Matthew I Banks, John-Paul J Yu","doi":"10.3174/ajnr.A8634","DOIUrl":"10.3174/ajnr.A8634","url":null,"abstract":"<p><strong>Background and purpose: </strong>There is surging interest in the therapeutic potential of psychedelic compounds like psilocybin in the treatment of psychiatric illnesses like major depressive disorder (MDD). Recent studies point to the rapid antidepressant effect of psilocybin; however, the biologic mechanisms underlying these differences remain unknown. This study determines the feasibility of using diffusion MRI to characterize and define the potential spatiotemporal microstructural differences in the brain following psilocybin treatment in C57BL/6J male mice.</p><p><strong>Materials and methods: </strong>Eleven- to 15-week-old C57BL/6J male mice were randomly assigned to receive psilocybin, 6-fluoro-N, N-diethyltryptamine, or saline and ex vivo imaged 24 hours (<i>n</i>=18) and 72 hours (<i>n</i>=18) posttreatment. A 1-way ANOVA with multiple comparison testing (Bonferroni correction) assessed diffusion metric differences (tractography, DTI, neurite orientation dispersion and density imaging) between the 3 groups and was performed in the following regions of interest: amygdala, striatum, hippocampus, thalamus, primary visual cortex area, frontal association cortex, and medial prefrontal cortex at 24 hours and 72 hours postdrug administration.</p><p><strong>Results: </strong>Psilocybin-treated mice demonstrated structural connectivity differences at 72 hours in the frontal association cortex (compared with saline, mean tract length increases, <i>P</i> = .03). Psilocybin also induced microstructural differences at 24 hours postinjection in the primary visual cortex (compared with saline, mean diffusivity [MD] increases, <i>P</i> = .02) and 72 hours postinjection in the striatum (compared with saline; MD increases, <i>P</i> = .02, neurite density index [NDI] decreases, <i>P</i> = .02) and hippocampus (compared with saline; MD increases, <i>P</i> = .04, NDI decreases, <i>P</i> = .02).</p><p><strong>Conclusions: </strong>Diffusion microstructure imaging and white matter tractography are sensitive methods to detect and characterize the neural substrates and microstructural differences accompanying psilocybin treatment. These findings suggest the potential role for diffusion microstructure imaging to quantify the bioeffects of psychedelics like psilocybin on the brain, monitor treatment response, and identify salient clinical end points in an emerging therapeutic option for patients with MDD.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1216-1222"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069676","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":"Gender Differences in Medicare Practice and Payment of Neuroradiologists.","authors":"Ajay Malhotra, Chris Lee, Mihir Khunte, Dheeman Futela, Raj Moily, Seyedmehdi Payabvash, Dheeraj Gandhi, Max Wintermark","doi":"10.3174/ajnr.A8633","DOIUrl":"https://doi.org/10.3174/ajnr.A8633","url":null,"abstract":"<p><strong>Background and purpose: </strong>Female neuroradiologists in clinical practice are outnumbered by their male counterparts. However, it is unknown whether there are differences in practice patterns and Medicare billing and payment between female and male neuroradiologists. Our aim was to compare representation, practice range, clinical productivity, and Medicare payments for female and male neuroradiologists.</p><p><strong>Materials and methods: </strong>A retrospective cross-sectional study of Medicare provider and service data was conducted. Male and female neuroradiologists who received Medicare payments from 2017 to 2021 and the services rendered were analyzed. Primary outcome was gender representation, mean payments received from Medicare, charges submitted, and codes billed. <i>T</i> tests and Mann-Whitney <i>U</i> tests were used to determine differences in payment and practice volume between male and female radiologists.</p><p><strong>Results: </strong>From 2017 to 2021, there were a total of 2701 neuroradiologists, of whom 526 (19.5%) were female, with a higher proportion of women in academic than nonacademic neuroradiology practice (23.3% versus 15.6%, respectively). On average, female neuroradiologists charged less (mean, standard error [SE], $642,489 [$14,756] versus $738,416 [$7800]; <i>P</i> < .001) and were paid less by Medicare (mean [SE], $92,834 [$1877] versus $113,495 [$1044]; <i>P</i> < .001) compared with their male counterparts. By contrast, female neuroradiologists had a higher payment-per-service ratio (mean [SE], 0.232 [0.001] versus 0.208 [0.0003]; <i>P</i> < .001). Women billed fewer median total services (1802; interquartile range [IQR], 925-4726] versus 2461 [IQR, 1268-5781]; <i>P</i> < .001), served fewer median beneficiaries (1232 [IQR, 705-1963] versus 1697 [IQR, 990-2682]; <i>P</i> < .001), and billed fewer median unique codes (19 [IQR, 13-26] versus 23 [IQR, 17-33]; <i>P</i> < .001). Temporal analysis of data across the 5-year study period showed that men consistently received higher payments than women, though the difference in mean Medicare charge (<i>P</i> = .03), mean Medicare payment (<i>P</i> = .04), and median number of services provided (<i>P</i> = .04) between the 2 cohorts is decreasing.</p><p><strong>Conclusions: </strong>Female neuroradiologists were underrepresented, charged less, and received less overall payment compared with their male counterparts. Female neuroradiologists provided a smaller range and number of services, and a greater proportion of female neuroradiologists billed for higher-paying services. Further studies are needed to assess differences in part-time work and subspecialty representation to determine their impact.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":"46 6","pages":"1093-1099"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217831","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":"Role of Hypoperfusion Intensity Ratio in Vessel Occlusions: A Review on Safety and Clinical Outcomes.","authors":"Sana Rehman, Arsalan Nadeem, Arbab Burhan Uddin Kasi, Ali Husnain, Summaiyya Waseem, Sohail Kumar, Syed Muhammad Owais, Nasreen Banu, Dhairya A Lakhani, Hamza A Salim, Risheng Xu, Vaibhav S Vagal, Yasmin N Aziz, Argye E Hillis, Victor C Urrutia, Rafael H Llinas, Elisabeth B Marsh, Richard Leigh, Hanzhang Lu, Adam A Dmytriw, Adrien Guenego, Gregory W Albers, Jeremy J Heit, Tobias D Faizy, Vivek S Yedavalli","doi":"10.3174/ajnr.A8557","DOIUrl":"10.3174/ajnr.A8557","url":null,"abstract":"<p><p>The hypoperfusion intensity ratio (HIR) is a quantitative metric used in vascular occlusion imaging to evaluate the extent of brain tissue at risk due to hypoperfusion. Defined as the ratio of tissue volume with a time-to-maximum (Tmax) of >10 seconds to that of >6 seconds, HIR assists in differentiating between the salvageable penumbra and the irreversibly injured core infarct. This review explores the role of HIR in assessing clinical outcomes and guiding treatment strategies, including mechanical thrombectomy and thrombolytic therapy, for patients with large-vessel occlusions (LVOs). Evidence suggests that higher HIR values are associated with worse clinical outcomes, indicating more severe tissue damage and reduced potential for salvage through reperfusion. Additionally, HIR demonstrates predictive accuracy regarding infarct growth, collateral flow, and the risk of reperfusion hemorrhage. It has shown superiority over traditional metrics, such as core infarct volume, in predicting functional outcomes. HIR offers valuable insights for risk stratification and treatment planning in patients with LVOs and distal medium vessel occlusions. Incorporating HIR into clinical practice enhances patient care by improving decision-making processes, promoting timely interventions, and optimizing postintervention management to minimize complications and improve recovery outcomes.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"1069-1081"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549479","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}