AJNR. American journal of neuroradiology最新文献

{"title":"Spontaneous Intracranial Hypotension in Children: A Multi-Institutional Review of Spinal CSF Leaks Localized on Advanced Myelography.","authors":"Ajay A Madhavan, Peter G Kranz, Lalani Carlton Jones, Edward S Ahn, Timothy J Amrhein, Waleed Brinjikji, Andrew Callen, Jeremy K Cutsforth-Gregory, Mark D Mamlouk, V Michelle Silvera, Julie B Guerin","doi":"10.3174/ajnr.A8430","DOIUrl":"10.3174/ajnr.A8430","url":null,"abstract":"<p><p>Spontaneous intracranial hypotension is an increasingly recognized syndrome caused by a spinal CSF leak, with most reported cases occurring in adults. The use of specialized or advanced myelography to localize spinal CSF leaks has evolved substantially in recent years, particularly since the initial description of CSF-venous fistulas in 2014. To our knowledge, no prior series have evaluated the use of specialized myelographic techniques to localize CSF leaks in children with spontaneous intracranial hypotension, likely because the disease is rare in this patient population. This issue may be compounded by a hesitation to perform invasive procedures in children. In this clinical report, we conducted a multi-institutional review of pediatric patients with spontaneous spinal CSF leaks localized using advanced myelographic techniques, such as prone and decubitus digital subtraction and CT myelography, as well as dynamic CT myelography. We report the clinical features of these patients, as well as imaging findings, types of leaks discovered, and method of treatment. We found that the primary types of spontaneous spinal CSF leaks that occur in adults, including dural tears and CSF fistulas, can be seen in children, too. Furthermore, we show that specialized myelographic techniques can successfully localize these leaks and facilitate effective targeted treatment.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402242","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":"A review of intracranial aneurysm imaging modalities, from CT to state-of-the-art MR.","authors":"Sammy Allaw, Kameel Khabaz, Tyler C Given, Dominic M Montas, Roberto J Alcazar-Felix, Abhinav Srinath, Tareq Kass-Hout, Timothy J Carroll, Michael C Hurley, Sean P Polster","doi":"10.3174/ajnr.A8549","DOIUrl":"https://doi.org/10.3174/ajnr.A8549","url":null,"abstract":"<p><p>Traditional guidance for intracranial aneurysm (IA) management is dichotomized by rupture status. Fundamental to ruptured aneurysm management is the detection and treatment of subarachnoid hemorrhage, along with securing the aneurysm by the safest technique. On the other hand, unruptured aneurysms first require a careful assessment of natural history versus treatment risk, including an imaging assessment of aneurysm size, location, and morphology, along with additional evidence-based risk factors such as smoking, hypertension, and family history. Unfortunately, a large proportion of ruptured aneurysms are in the lower risk size category (<7mm), putting a premium on discovering a more refined non-invasive biomarker to detect and stratify aneurysm instability prior to rupture. In this review of aneurysm work-up, we cover the gamut of established imaging modalities (e.g., CT, CTA, DSA, FLAIR, 3D-TOF-MRA, CE-MRA) as well as more novel MR techniques (MR-VWI, DCE-MRI, CFD). Additionally, we evaluate the current landscape of AI software and their integration into diagnostic and risk stratification pipelines for IAs. These advanced MR techniques, increasingly complemented with AI models, offer a paradigm shift by evaluating factors beyond size and morphology, including vessel wall inflammation, permeability, and hemodynamics. Additionally, we provide our institution's scan parameters for many of these modalities as reference. Ultimately, this review provides an organized, up-to-date summary on the array of available modalities/sequences for IA imaging to help build protocols focused on IA characterization.ABBREVIATIONS: IA = intracranial aneurysm; LP = lumbar puncture; UIA = unruptured intracranial aneurysm; VWI = vessel wall imaging; 3DRA = 3D Rotational Angiography.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-Field (64 mT) Portable MRI for Rapid Point-of-Care Diagnosis of Dissemination in Space in Patients Presenting with Optic Neuritis.","authors":"Timothy Reynold Lim, Suradech Suthiphosuwan, Jonathan Micieli, Reza Vosoughi, Raphael Schneider, Amy W Lin, Yingming Amy Chen, Alexandra Muccilli, James J Marriott, Daniel Selchen, Shobhit Mathur, Jiwon Oh, Aditya Bharatha","doi":"10.3174/ajnr.A8395","DOIUrl":"10.3174/ajnr.A8395","url":null,"abstract":"<p><strong>Background and purpose: </strong>Low-field 64 mT portable brain MRI has recently shown diagnostic promise for MS. This study aimed to evaluate the utility of portable MRI (pMRI) in assessing dissemination in space (DIS) in patients presenting with optic neuritis and determine whether deploying pMRI in the MS clinic can shorten the time from symptom onset to MRI.</p><p><strong>Materials and methods: </strong>Newly diagnosed patients with optic neuritis referred to a tertiary academic MS center from July 2022 to January 2024 underwent both point-of-care pMRI and subsequent 3T conventional MRI (cMRI). Images were evaluated for periventricular (PV), juxtacortical (JC), and infratentorial (IT) lesions. DIS was determined on brain MRI per 2017 McDonald criteria. Test characteristics were computed by using cMRI as the reference. Interrater and intermodality agreement between pMRI and cMRI were evaluated by using the Cohen κ. Time from symptom onset to pMRI and cMRI during the study period was compared with the preceding 1.5 years before pMRI implementation by using Kruskal-Wallis with post hoc Dunn tests.</p><p><strong>Results: </strong>Twenty patients (median age: 32.5 years [interquartile range {IQR}, 28-40]; 80% women) were included, of whom 9 (45%) and 5 (25%) had DIS on cMRI and pMRI, respectively. Median time interval between pMRI and cMRI was 7 days (IQR, 3.5-12.5). Interrater agreement was very good for PV (95%, κ = 0.89), and good for JC and IT lesions (90%, κ = 0.69 for both). Intermodality agreement was good for PV (90%, κ = 0.80) and JC (85%, κ = 0.63), and moderate for IT lesions (75%, κ = 0.42) and DIS (80%, κ = 0.58). pMRI had a sensitivity of 56% and specificity of 100% for DIS. The median time from symptom onset to pMRI was significantly shorter (8.5 days [IQR 7-12]) compared with the interval to cMRI before pMRI deployment (21 days [IQR 8-49], <i>n</i> = 50) and after pMRI deployment (15 days [IQR 12-29], <i>n</i> = 30) (both <i>P</i> < .01). Time from symptom onset to cMRI in those periods was not significantly different (<i>P </i>= .29).</p><p><strong>Conclusions: </strong>In patients with optic neuritis, pMRI exhibited moderate concordance, moderate sensitivity, and high specificity for DIS compared with cMRI. Its integration into the MS clinic reduced the time from symptom onset to MRI. Further studies are warranted to evaluate the role of pMRI in expediting early MS diagnosis and as an imaging tool in resource-limited settings.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461254","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":"Enzyme Replacement Therapy for CLN2 Disease: MRI Volumetry Shows Significantly Slower Volume Loss Compared with a Natural History Cohort.","authors":"Pritika Gaur, Paul Gissen, Asthik Biswas, Kshitij Mankad, Sniya Sudhakar, Felice D'Arco, Angela Schulz, Jens Fiehler, Jan Sedlacik, Ulrike Löbel","doi":"10.3174/ajnr.A8408","DOIUrl":"10.3174/ajnr.A8408","url":null,"abstract":"<p><strong>Background and purpose: </strong>Neuronal ceroid lipofuscinoses are a group of neurodegenerative disorders. Recently, enzyme replacement therapy (ERT) was approved for neuronal ceroid lipofuscinosis type 2 (CLN2), a subtype of neuronal ceroid lipofuscinoses. The aim of this study was to quantify brain volume loss in CLN2 disease in patients on ERT in comparison with a natural history cohort using MRI.</p><p><strong>Materials and methods: </strong>Nineteen (14 female, 5 male) patients with CLN2 disease at 1 UK center were studied using serial 3D T1-weighted MRI (follow-up time, 1-9 years). Brain segmentation was performed using FreeSurfer. Volume measurements for supratentorial gray and white matter, deep gray matter (basal ganglia/thalami), the lateral ventricles, and cerebellar gray and white matter were recorded. The volume change with time was analyzed using a linear mixed-effects model excluding scans before treatment onset. Comparison was made with a published natural history cohort of 12 patients (8 female, 4 male), which was re-analyzed using the same method.</p><p><strong>Results: </strong>Brain volume loss of all segmented brain regions was much slower in treated patients compared with the natural history cohort. For example, supratentorial gray matter volume in treated patients decreased by a mean of 3% (SD, 0.74%) (<i>P</i> < .001) annually compared with an annual volume loss of a mean of 16.8% (SD, 1.5%) (<i>P</i> < .001) in the natural history cohort.</p><p><strong>Conclusions: </strong>Our treatment cohort showed a significantly slower rate of brain parenchymal volume loss compared with a natural history cohort in several anatomic regions. Our results complement prior clinical data that found a positive response to ERT. We demonstrate that automated MRI volumetry is a sensitive tool to monitor treatment response in children with CLN2 disease.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560535","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":"Optimal Endovascular Therapy Technique for Isolated Intracranial Atherothrombotic Stroke-Related Large-Vessel Occlusion in the Acute-to-Subacute Stage.","authors":"Mikiya Beppu, Kazutaka Uchida, Nobuyuki Sakai, Hiroshi Yamagami, Kazunori Toyoda, Yuji Matsumaru, Yasushi Matsumoto, Kenichi Todo, Mikito Hayakawa, Seigo Shindo, Shinzo Ota, Masafumi Morimoto, Masataka Takeuchi, Hirotoshi Imamura, Hiroyuki Ikeda, Kanta Tanaka, Hideyuki Ishihara, Hiroto Kakita, Takanori Sano, Hayato Araki, Tatsufumi Nomura, Fumihiro Sakakibara, Manabu Shirakawa, Shinichi Yoshimura","doi":"10.3174/ajnr.A8399","DOIUrl":"10.3174/ajnr.A8399","url":null,"abstract":"<p><strong>Background and purpose: </strong>Reocclusion after treatment is a concern in endovascular therapy for isolated intracranial atherothrombotic stroke-related large-vessel occlusion (AT-LVO). However, the optimal endovascular therapy technique for AT-LVO has not yet been investigated. This study evaluated the optimal endovascular therapy technique for AT-LVO in a real-world setting.</p><p><strong>Materials and methods: </strong>We conducted a historical, multicenter registry study at 51 centers that enrolled patients with AT-LVO. We divided the patients into 3 groups based on the endovascular therapy technique: mechanical thrombectomy alone, percutaneous transluminal angioplasty (PTA), and stent deployment. Mechanical thrombectomy alone was classified into the mechanical thrombectomy-only group; PTA and mechanical thrombectomy-PTA, into the PTA group; and mechanical thrombectomy-stent deployment, mechanical thrombectomy-PTA-stent deployment, PTA-stent deployment, and stent deployment-only into the stent group. The primary outcome was incidence of reocclusion of the treated vessels within 90 days of endovascular therapy completion.</p><p><strong>Results: </strong>We enrolled 770 patients and analyzed 509 patients. The rates in the mechanical thrombectomy-only, PTA, and stent deployment groups were 40.7%, 44.4%, and 14.9%, respectively. Incidence rate of residual stenosis >70% of final angiography was significantly higher in the mechanical thrombectomy-only group than in the PTA and stent deployment groups (mechanical thrombectomy-only versus PTA versus stent deployment: 34.5% versus 26.3% versus 13.2%, <i>P</i> = .002). Reocclusion rate was significantly lower in the PTA group than in the mechanical thrombectomy-only group (adjusted hazard ratio, 0.48; 95% CI, 0.29-0.80). Of the patients, 83.5% experienced reocclusion within 10 days after endovascular therapy. Alarmingly, a substantial subset (approximately 62.0%) of patients experienced reocclusion within 2 days of endovascular therapy. Incidence of mRS scores of 0-2 ninety days after endovascular therapy was not significantly different among the 3 groups. Incidences of symptomatic intracranial hemorrhage, any other intracranial hemorrhage, and death were not significantly different.</p><p><strong>Conclusions: </strong>Incidence rate of reocclusion was significantly lower in the PTA group than in the mechanical thrombectomy-only group. We found no meaningful difference in reocclusion rates between the stent deployment and mechanical thrombectomy-only groups. In Japan, glycoprotein IIb/IIIa inhibitors are not reimbursed. Therefore, PTA might be the preferred choice for AT-LVOs due to the higher reocclusion risk with mechanical thrombectomy-only. Reocclusion was likely to occur within 10 days, particularly within 2 days post-endovascular therapy.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141478150","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":"Stroke thrombectomy for large infarcts with limited penumbra: Systematic review and meta-analysis of randomized trials.","authors":"Huanwen Chen, Seemant Chaturvedi, Dheeraj Gandhi, Marco Colasurdo","doi":"10.3174/ajnr.A8553","DOIUrl":"https://doi.org/10.3174/ajnr.A8553","url":null,"abstract":"<p><strong>Background and purpose: </strong>Recent randomized trials have suggested that endovascular thrombectomy (EVT) is superior to medical management (MM) for stroke patients with large infarcts. However, whether or how perfusion metrics should be used to guide optimal patient selection for treatment is largely unknown.</p><p><strong>Materials and methods: </strong>This was a meta-analysis of randomized controlled trials reporting the effectiveness of EVT for large infarcts stratified by perfusion mismatch profiles. Patients with mismatch ratio 1.2-1.8 or penumbra volume 10-15cc (intermediate mismatch) or mismatch ratio <1.2 or volume <10cc (low mismatch) were included. Odds of 90-day modified Rankin scale (mRS) 0 to 3 (good) and 5 to 6 (poor) were calculated and effect sizes were pooled using Mantel-Haenszel fixed-effects models.</p><p><strong>Results: </strong>Two trials - SELECT2 and ANGEL-ASPECT - were included; 140 intermediate mismatch (75 EVT and 65 MM) and 60 low mismatch patients (23 EVT and 37 MM) were identified. EVT was significantly associated with higher odds of mRS 0 to 3 for intermediate mismatch (pooled OR 2.77 [95%CI 1.11-6.89], p=0.028; Figure 1), but not low mismatch (pooled OR 1.47 [95%CI 0.444.94], p=0.54; Figure 1). Similarly, in terms of 90-day poor outcomes (mRS 5 or 6), EVT for intermediate mismatch patients was significantly associated with lower odds (OR 0.49 [95%CI 0.24 to 0.99], p=0.046; Figure 2), while EVT for the low mismatch cohort was not (OR 0.66 [95%CI 0.22 to 1.96], p=0.45; Figure 2). There was no significant inter-study heterogeneity observed across study estimates.</p><p><strong>Conclusions: </strong>For patients with large infarcts, EVT appears to be likely beneficial for patients with perfusion mismatch ratio and volume of at least 1.2 and 10cc, but not for those with mismatch ratio <1.2 or volume <10cc. These data generally support the continued use of perfusion imaging to select patients with large infarcts for EVT if it is available at the treating institution. Future studies and trials should consider investigating the efficacy and safety of EVT for patients with large infarcts and low mismatch profiles.</p><p><strong>Abbreviations: </strong>EVT = endovascular thrombectomy; MM = medical management; OR = odds ratio; CI = confidence interval.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514459","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":"Automated quantification of cerebral microbleeds in susceptibility-weighted MRI: association with vascular risk factors, white matter hyperintensity burden, and cognitive function.","authors":"Ji Su Ko, Yangsean Choi, Eun Seon Jeong, Hyun-Jung Kim, Grace Yoojin Lee, Ji Eun Park, Namkug Kim, Ho Sung Kim","doi":"10.3174/ajnr.A8552","DOIUrl":"https://doi.org/10.3174/ajnr.A8552","url":null,"abstract":"<p><strong>Background and purpose: </strong>To train and validate a deep learning (DL)-based segmentation model for cerebral microbleeds (CMB) on susceptibility-weighted MRI; and to find associations between CMB, cognitive impairment, and vascular risk factors.</p><p><strong>Materials and methods: </strong>Participants in this single-institution retrospective study underwent brain MRI to evaluate cognitive impairment between January-September 2023. For training the DL model, the nnU-Net framework was used without modifications. The DL model's performance was evaluated on independent internal and external validation datasets. Linear regression analysis was used to find associations between log-transformed CMB numbers, cognitive function (mini-mental status examination [MMSE]), white matter hyperintensity (WMH) burden, and clinical vascular risk factors (age, sex, hypertension, diabetes, lipid profiles, and body mass index).</p><p><strong>Results: </strong>Training of the DL model (n = 287) resulted in a robust segmentation performance with an average dice score of 0.73 (95% CI, 0.67-0.79) in an internal validation set, (n = 67) and modest performance in an external validation set (dice score = 0.46, 95% CI, 0.33-0.59, n = 68). In a temporally independent clinical dataset (n = 448), older age, hypertension, and WMH burden were significantly associated with CMB numbers in all distributions (total, lobar, deep, and cerebellar; all <i>P</i> <.01). MMSE was significantly associated with hyperlipidemia (β = 1.88, 95% CI, 0.96-2.81, <i>P</i> <.001), WMH burden (β = -0.17 per 1% WMH burden, 95% CI, -0.27-0.08, P <.001), and total CMB number (β = -0.01 per 1 CMB, 95% CI, -0.02-0.001, <i>P</i> = .04) after adjusting for age and sex.</p><p><strong>Conclusions: </strong>The DL model showed a robust segmentation performance for CMB. In all distributions, CMB had significant positive associations with WMH burden. Increased WMH burden and CMB numbers were associated with decreased cognitive function.</p><p><strong>Abbreviations: </strong>CMB = cerebral microbleed; DL = deep learning, DSC = dice similarity coefficient; MMSE = mini-mental status examination; SVD = small vessel disease; SWI = susceptibility-weighted image; WMH = white matter hyperintensity.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514456","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":"Repeatability and Reproducibility of pseudo-Continuous Arterial Spin Labeling Measured Brain Perfusion in Healthy Volunteers and Glioblastoma Patients.","authors":"Limin Zhou, Durga Udayakumar, Yiming Wang, Marco C Pinho, Benjamin C Wagner, Michael Youssef, Joseph A Maldjian, Ananth J Madhuranthakam","doi":"10.3174/ajnr.A8551","DOIUrl":"https://doi.org/10.3174/ajnr.A8551","url":null,"abstract":"<p><strong>Background and purpose: </strong>Arterial spin labeled (ASL) MRI has gained recognition as a quantitative perfusion imaging method for managing patients with brain tumors. Limited studies have so far investigated the reproducibility of ASL-derived perfusion in patients with brain tumors. This study aims to evaluate intrasession repeatability and intersession reproducibility of perfusion measurements using 3D pseudo-continuous ASL (pCASL) with Cartesian TSE (TSE-CASPR) in healthy volunteers (HV) and glioblastoma (GBM) patients at 3 Tesla and compare against 3D pCASL with GRASE.</p><p><strong>Materials and methods: </strong>This prospective study (NCT03922984) was approved by the institutional review board and written informed consent was obtained from all subjects. HV underwent repeated pCASL evaluations 2-4 weeks apart between November 2021 and October 2022. GBM patients were recruited for longitudinal MRI from September 2019 to February 2023. Intrasession repeatability (HV and GBM) and intersession reproducibility (HV only) of pCASL were assessed using linear regression, Bland-Altman analyses, intraclass correlation coefficient (ICC) with 95% confidence interval (CI), and within-subject coefficients of variation (wsCV).</p><p><strong>Results: </strong>Twenty HV (9 men, age: 25.1±1.7 years, range 23-30 years) and 21 GBM patients (15 men; age: 59.8±14.3 years, range 28-81 years) were enrolled. Within imaging session, 3D pCASL measured perfusion with TSE-CASPR and GRASE respectively achieved high R² values (0.88-0.95; 0.93-0.96), minimal biases (-0.46 to 0.81; -0.08 to 0.35 mL/100g/min), high ICC [95% CI] (0.96-0.98 [0.94-0.98]; 0.96-0.98 [0.92-0.99]), and low wsCV (6.64%-9.07%; 5.20%-8.16%) in HV (N=20) and GBM patients (N=21). Across imaging session, 3D pCASL in HV (N=20) achieved high R² values (0.71; 0.82), minimal biases (-1.2; -0.90 mL/100g/min), high ICC [95% CI] values (0.85 [0.81-0.89]; 0.90 [0.87-0.93]), and low wsCV values (13.82%; 9.98%).</p><p><strong>Conclusions: </strong>Our study demonstrated excellent intrasession repeatability of 3D pCASL measured cerebral perfusion in HV and GBM patients and good to excellent intersession reproducibility in HV. 3D pCASL with GRASE performed slightly better than 3D pCASL with TSE-CASPR in HV; however, in GBM patients, 3D pCASL with TSE-CASPR showed better performance in tumor regions with nearly twofold higher SNR. ASL measured perfusion could serve as a non-contrast quantitative imaging biomarker to facilitate the management of GBM patients.</p><p><strong>Abbreviations: </strong>ASL = arterial spin labeling; pCASL = pseudo-continuous arterial spin labeling; GBM = glioblastoma; CBF = cerebral blood flow; CASPR = Cartesian acquisition with spiral profile reordering; GRASE = gradient and spin echo; NAGM = normal-appearing gray matter.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514458","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":"Assessing the Diagnostic Value of Brain White Matter Hyperintensities and Clinical Symptoms in Predicting the Detection of CSF Venous Fistula in Patients with Suspected Spontaneous Intracranial Hypotension.","authors":"Samantha L Pisani Petrucci, Nadya Andonov, Peter Lennarson, Marius Birlea, Chantal O'Brien, Danielle Wilhour, Abigail Anderson, Jeffrey L Bennett, Andrew L Callen","doi":"10.3174/ajnr.A8548","DOIUrl":"https://doi.org/10.3174/ajnr.A8548","url":null,"abstract":"<p><strong>Background and purpose: </strong>Spontaneous intracranial hypotension (SIH) due to CSF venous fistula (CVF) is increasingly recognized as a secondary cause of headaches, with symptoms often overlapping with primary headache syndromes such as migraine. While brain MRI studies have focused on features indicative of SIH, findings that support an alternate headache etiology, such as the bifrontal white matter hyperintensities (WMH) often seen in migraines, have not been explored in this context. This study assesses 1) the quantity and distribution of WMH and 2) the presenting clinical features in patients with and without CVF found on dynamic decubitus CT myelography (dCTM).</p><p><strong>Materials and methods: </strong>72 consecutive patients underwent clinical workup for SIH due to suspected CVF, including pre-procedural brain and spine MRI followed by dCTM. Brain imaging features were analyzed, including Bern score, quantitative WMH burden, and WMH distribution. Demographics and clinical symptoms present at the time of presentation were recorded. Imaging features were compared between groups with and without CVF using parametric or nonparametric comparisons according to variable normality. Multivariate logistic regression explored the relationships between imaging features, clinical symptoms, and the presence of CVF.</p><p><strong>Results: </strong>The cohort included 40 patients with (CVF+) and 32 patients without (CVF-), with no significant age or sex differences. CVF+ patients had significantly higher Bern scores and significantly fewer WMH. There were significant differences in the frequencies of WMH patterns between groups, with a migrainous pattern observed most frequently in CVF-patients. Logistic regression combining Bern score, WMH burden, and WMH pattern demonstrated a better fit for predicting CVF than using Bern score or WMH features alone. Fourteen clinical symptoms showed the greatest differences between CVF+ and CVF-groups. Logistic regression demonstrated a positive association between CVF detection and a pressure/throbbing headache quality, and negative associations for neck pain, facial pain, phonophobia, and anhedonia/depression.</p><p><strong>Conclusions: </strong>These findings suggest a negative association between CVF detection, increased burden of WMH, and a migrainous WMH pattern. Symptom analysis describes distinct clinical phenotypes, challenging orthostatic headache as a defining characteristic. These results support a comprehensive assessment of imaging and clinical presentations in the workup of suspected SIH.</p><p><strong>Abbreviations: </strong>SIH = spontaneous intracranial hypotension; CVF = CSF venous fistula; WMH = white matter hyperintensities; dCTM = dynamic CT myelography; dDSM = dynamic digital subtraction myelography; PPV = positive predictive value; NPV = negative predictive value Received month day, year; accepted after revision month day, year.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514455","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":"Comprehensive segmentation of gray matter structures on T1-weighted brain MRI: A Comparative Study of CNN, CNN hybrid-transformer or -Mamba architectures.","authors":"Yujia Wei, Jaidip Manikrao Jagtap, Yashbir Singh, Bardia Khosravi, Jason Cai, Jeffrey L Gunter, Bradley J Erickson","doi":"10.3174/ajnr.A8544","DOIUrl":"https://doi.org/10.3174/ajnr.A8544","url":null,"abstract":"<p><strong>Background and purpose: </strong>Recent advances in deep learning have shown promising results in medical image analysis and segmentation. However, most brain MRI segmentation models are limited by the size of their datasets and/or the number of structures they can identify. This study evaluates the performance of six advanced deep learning models in segmenting 122 brain structures from T1-weighted MRI scans, aiming to identify the most effective model for clinical and research applications.</p><p><strong>Materials and methods: </strong>1,510 T1-weighted MRIs were used to compare six deep-learning models for the segmentation of 122 distinct gray matter structures: nnU-Net, SegResNet, SwinUNETR, UNETR, U-Mamba_BOT and U-Mamba_ Enc. Each model was rigorously tested for accuracy using the Dice Similarity Coefficient (DSC) and the 95th percentile Hausdorff Distance (HD95). Additionally, the volume of each structure was calculated and compared between normal control (NC) and Alzheimer's Disease (AD) patients.</p><p><strong>Results: </strong>U-Mamba_Bot achieved the highest performance with a median DSC of 0.9112 [IQR:0.8957, 0.9250]. nnU-Net achieved a median DSC of 0.9027 [IQR: 0.8847, 0.9205] and had the highest HD95 of 1.392[IQR: 1.174, 2.029]. The value of each HD95 (<3mm) indicates its superior capability in capturing detailed brain structures accurately. Following segmentation, volume calculations were performed, and the resultant volumes of normal controls and AD patients were compared. The volume changes observed in thirteen brain substructures were all consistent with those reported in existing literature, reinforcing the reliability of the segmentation outputs.</p><p><strong>Conclusions: </strong>This study underscores the efficacy of U-Mamba_Bot as a robust tool for detailed brain structure segmentation in T1-weighted MRI scans. The congruence of our volumetric analysis with the literature further validates the potential of advanced deep-learning models to enhance the understanding of neurodegenerative diseases such as AD. Future research should consider larger datasets to validate these findings further and explore the applicability of these models in other neurological conditions.</p><p><strong>Abbreviations: </strong>AD = Alzheimer's Disease; ADNI = Alzheimer's Disease Neuroimaging Initiative; DSC = Dice Similarity Coefficient; HD95 = the 95th Percentile Hausdorff Distance; IQR = Interquartile Range; NC = Normal Control; SSMs = State-space Sequence Models.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482791","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}