AJNR. American journal of neuroradiology最新文献

{"title":"Direct Localization of the VIM/DRTT Using Quantitative Susceptibility Mapping in Essential Tremor: A Pilot MRI Study.","authors":"Sohae Chung, Ha Neul Song, Varun R Subramaniam, Pippa Storey, Seon-Hi Shin, Timothy M Shepherd, Yvonne W Lui, Yi Wang, Alon Mogilner, Brian H Kopell, Ki Seung Choi","doi":"10.3174/ajnr.A8934","DOIUrl":"https://doi.org/10.3174/ajnr.A8934","url":null,"abstract":"<p><strong>Background and purpose: </strong>Accurate localization of the ventral intermediate nucleus (VIM) within the dentatorubrothalamic tract (DRTT) is critical for effective neurosurgical treatment of essential tremor (ET). This study evaluated the feasibility and anatomical specificity of quantitative susceptibility mapping (QSM) for direct VIM/DRTT visualization, comparing it with conventional diffusion tractography-based reconstructions.</p><p><strong>Materials and methods: </strong>Twenty-seven participants (10 healthy controls, 17 ET patients) were enrolled across two institutions and imaged on 3T MRI systems. QSM-defined VIM/DRTT regions were manually segmented based on characteristic hypointense susceptibility contrast. Whole-brain diffusion tractography was performed to reconstruct the DRTT, pyramidal tract (PT), and medial lemniscus (ML) tracts. Spatial overlap between QSM-and tractography-defined VIM/DRTT regions was calculated, as well as overlap with neighboring PT and ML tracts to assess specificity.</p><p><strong>Results: </strong>Two participants were excluded due to insufficient VIM/DRTT streamlines in tractography reconstruction. In healthy controls, QSM-and tractography-defined VIM/DRTT showed high spatial correspondence (left: 87.6 ± 5.1%; right: 85.3 ± 6.5%). ET patients exhibited slightly lower overlap (mean range: 71.5 - 85.1%). Overlap with neighboring PT and ML tracts was minimal (<3.3%), confirming high anatomical specificity of QSM-derived VIM/DRTT regions.</p><p><strong>Conclusions: </strong>QSM enables direct visualization of the VIM/DRTT with high spatial agreement to conventional tractography-based approaches while demonstrating minimal overlap with adjacent tracts. These findings support QSM as a complementary or standalone imaging modality for improved, patient-specific neurosurgical targeting in ET.</p><p><strong>Abbreviations: </strong>DBS = deep brain stimulation; DRTT = dentatorubrothalamic tract; ET = essential tremor; ML = medial lemniscus; MRgFUS = MR-guided focused ultrasound; VIM = ventral intermediate nucleus; PT = pyramidal tract; QSM = quantitative susceptibility mapping; WM = white matter.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669067","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":"Postnatal Development of the Vestibular Aqueduct Trajectory on CT: Establishing Age-Specific Norms to Distinguish Normal from Arrested (Hypoplastic) Development.","authors":"Amy F Juliano, Priyanka K Naik, Laura V Romo, Nathan Huey, Kuei-You Lin, David Bächinger, Caroline D Robson, Andreas H Eckhard","doi":"10.3174/ajnr.A8933","DOIUrl":"https://doi.org/10.3174/ajnr.A8933","url":null,"abstract":"<p><strong>Background and purpose: </strong>Although the otic capsule is fully formed at birth, the vestibular aqueduct (VA) continues to mature postnatally. Failure of this maturation-VA hypoplasia-identifies a subgroup of Menière's disease (MD) patients and can be detected on CT by measuring the VA's angular trajectory (ATVA). However, the age at which ATVA stabilizes and hypoplasia can be reliably diagnosed remains unclear. We therefore defined the normal timeline of ATVA development to establish age-specific CT norms for distinguishing physiologic VA development from fetal/hypoplastic arrest.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed temporal bone and head CTs in 159 children (318 ears) aged 0-16 years without otologic abnormality. Two head & neck radiologists measured ATVA and retrolabyrinthine bone (RL) thickness-previously established surrogates of VA hypoplasia-on axial reformatted images. Inter-reader reliability was assessed by intraclass correlation coefficient (ICC). We modeled ATVA versus age using generalized additive mixed models. First-derivative analysis of the age spline identified when ATVA change plateaued. Eighty-and 95% prediction intervals determined ages at which ATVA reliably fell below clinical thresholds (140°, 130°, 120°).</p><p><strong>Results: </strong>Inter-reader agreement was excellent (ICC = 0.92 ATVA; 0.88, RL thickness). Mean ATVA declined from 135° (±7.5°) in infants to 98° (±6.0°) in adolescents. By 80% prediction interval, the ATVA upper limit fell below 140° by ∼1.8 years, 130° by ∼3.1 years, and 120° by ∼10.4 years. The 95% interval excluded ATVA ≥140° by ∼3.0 years and ≥130° by ∼10.3 years, but not >120° before age 16 years. No ears above age 8 years fell in the fetal category (≥140°), and none above age 12 years in the intermediate category (121°-139°). First-derivative analysis showed ATVA change plateaued at ∼5.0 years. RL thickness ≥1.2 mm universally corresponded to mature ATVA (≤120°).</p><p><strong>Conclusions: </strong>ATVA transitions from fetal (≥140°) to mature (≤120°) trajectory over the first decade, stabilizing by ∼5 years. ATVA >120° before ∼10 years reflects normal development; after ∼12 years, it indicates adult-persistent hypoplasia. RL thickness ≥1.2 mm serves as a practical surrogate for mature VA orientation. These benchmarks empower radiologists to differentiate normal maturation from MD-associated VA hypoplasia, enabling early risk stratification and management.</p><p><strong>Abbreviations: </strong>VA = vestibular aqueduct; ATVA = angular trajectory of the vestibular aqueduct; RL = retrolabyrinthine bone; MD = Menière's disease; ED = endolymphatic duct; ES = endolymphatic sac.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669068","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":"Impact of Image Latency and Frame Rate on Simulated Remote Robotic-Assisted Neurovascular Procedures.","authors":"Arturo Consoli, Guillaume Charbonnier, Thais Baena Moura, Khaled Gaber, Alexander O'Neill, Thomas R Marotta, Julian Spears, Eileen Liu, Nicole Mariantonia Cancelliere, Vitor Mendes Pereira","doi":"10.3174/ajnr.A8722","DOIUrl":"https://doi.org/10.3174/ajnr.A8722","url":null,"abstract":"<p><strong>Background and purpose: </strong>The implementation of remote procedures represents the ultimate goal of the robotic development in the neurovascular field. Studies from remote cardiac interventions established a maximum latency threshold of 400 ms, however, no data are available for neurovascular procedures. The aim of this study was to define the maximum acceptable latency and minimum refreshment frame rate (RFR) for neuroendovascular procedures in a simulated remote setting.</p><p><strong>Materials and methods: </strong>Using a virtual simulator and an endovascular robotic arm, 7 operators performed 8 simulated aneurysm and stroke treatment interventions (4 manually and 4 robotic-assisted), during which video display of the intervention was randomly altered with different latencies (100, 250, 450, 600, 800 ms) and RFR (10, 15, 25, 30 frames per second [fps]). Operators rated the acceptability of each latency and RFR by using a modified acceptability score (mAS) and an independent observer recorded the number of dangerous uncontrolled movement (DUMs).</p><p><strong>Results: </strong>Maximum acceptable latency (defined as a minimum mAS of 85%) was defined at 100 ms for manually performed procedures and at 250 ms by using robotic-assistance, whereas minimum acceptable RFR was defined at 15 fps. A total of 55 intracranial DUMs were recorded, most of which occurred at latencies ≥450 ms (49/51) and with RFRs of 10 fps (4/4). Time intervals were shorter for manual procedures, although not significantly, and for experienced operators.</p><p><strong>Conclusions: </strong>Latency during simulated neurovascular interventions influences operator performance, judgment, and confidence and maximum thresholds (250 ms) seem to be lower than those previously reported from remote cardiac interventions. In this experimental setting, RFR seemed to have a lower impact in terms of acceptance rates. Latency and RFR represent relevant parameters to define and monitor in remote environments to maximize safety.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661252","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":"Diagnostic Performance of Ultrasound in Neck Node NI-RADS Category 2.","authors":"Richard Dagher, Alexander Khalaf, Susana Calle, Samir A Dagher, Komal B Shah, Amy Juliano, Ashley H Aiken, Kim O Learned","doi":"10.3174/ajnr.A8717","DOIUrl":"10.3174/ajnr.A8717","url":null,"abstract":"<p><strong>Background and purpose: </strong>The Neck Imaging Reporting and Data System (NI-RADS) scoring system standardized imaging surveillance of head and neck (H&N) cancer with risk classification. A nodal NI-RADS score of 2 on contrast-enhanced CT (CECT) of the neck indicates low suspicion for recurrence/persistent disease, and close follow-up or addition of PET is recommended. The unclear follow-up imaging findings and/or mild FDG uptake raise the patient's anxiety about potential delay in diagnosis and intervention while adding high imaging costs. Therefore, at our institution, diagnostic ultrasound (US)/US-guided fine-needle aspiration (US-FNA) is incorporated into our paradigm. We aim to evaluate US performance in nodal NI-RADS 2 on CECT as an alternative valuable tool in surveillance imaging guidelines.</p><p><strong>Materials and methods: </strong>We conducted a retrospective database search (2019-2024) for patients with primary H&N cancer (excluding thyroid cancer and melanoma), a single index neck node NI-RADS 2 on surveillance neck CECT, and a neck US/US-FNA performed within 3 months afterward for evaluation of the NI-RADS 2 node. We categorized US/US-FNA results as positive or negative and reviewed clinical and imaging follow-up, management, and nodal disease status up to 1 year following US. The incidence of nodal recurrence and US diagnostic performance were evaluated.</p><p><strong>Results: </strong>Of 90 patients, 36 (40%) had normal diagnostic US with no FNA performed and were thus considered negative, and 54 patients (60%) had abnormal US and hence concurrent US-FNA. Eighteen (33.3%) US-FNAs were positive for tumor: 27 with normal lymphoid tissue and 9 with indeterminate cytology (no viable malignant cells, acellular or atypia) were considered negative (66.7%). All positive US-FNAs resulted in management changes. Two patients with normal diagnostic US, 1 with negative FNA, and 1 with indeterminate FNA developed recurrence in these nodes within 1 year. The incidence of US-detected malignancy was 20% in patients with a nodal NI-RADS 2, surpassing the published rate of 14.3%. The sensitivity, accuracy, and negative predictive value of US/US-FNA in detecting tumor recurrence/persistence in nodal NI-RADS 2 are 81.8%, 95.6%, and 94.4%, respectively.</p><p><strong>Conclusions: </strong>Ultrasound demonstrated good diagnostic performance in the detection of nodal recurrence in patients with NI-RADS 2 on CECT. Its role as an alternative tool in surveillance should be considered.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Spontaneous Intracranial Hypotension Probabilistic Brain MRI Scoring Systems in Normal Patients.","authors":"Crystal H Kang, Ajay A Madhavan, John C Benson, Ian T Mark, Benjamin A Johnson-Tesch, Robert J McDonald, Jared T Verdoorn","doi":"10.3174/ajnr.A8713","DOIUrl":"10.3174/ajnr.A8713","url":null,"abstract":"<p><strong>Background and purpose: </strong>Probabilistic brain MRI scoring systems have been introduced to stratify the likelihood of identifying a CSF leak at myelography in spontaneous intracranial hypotension (SIH). The Bern scoring system by Dobrocky and colleagues is now well recognized, with a scoring system by Benson and colleagues introduced more recently (referred to as the Mayo score in this study). Neither of these scoring systems have been thoroughly evaluated in patients without SIH. The goal of this study was to evaluate these scoring systems in patients without SIH to understand the specificity of these MRI findings.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed normal brain MRIs performed in patients without clinically suspected SIH. Each examination was reviewed by 1 of 4 board-certified neuroradiologists with extensive experience in SIH, and all criteria of both scoring systems were evaluated and recorded.</p><p><strong>Results: </strong>Ninety patients were included. Bern score was low probability in 78% and intermediate probability in 22%. Mayo score was low probability in 100%. Relatively high rates of positivity were seen in 3 specific Bern score parameters, including prepontine cistern effacement 5.0 mm or less (53%), decreased mammilopontine distance 6.5 mm or less (40%), and suprasellar cistern effacement 4.0 mm or less (28%). All intermediate probability Bern scores were due to suprasellar cistern effacement plus either or both prepontine cistern effacement and decreased mammilopontine distance. All other parameters of both scoring systems were either never or very rarely positive.</p><p><strong>Conclusions: </strong>All intermediate probability Bern scores were due to decreased CSF cistern measurements, which had relatively high positivity rates in our non-SIH patient cohort. Due to substantial overlap with normal patients, these measurements are not specific indicators of \"brain sag,\" a hallmark imaging finding for SIH, and are not specific for SIH when the only \"positive\" brain MRI finding(s). The Mayo score is likely more specific for SIH with low probability scores in all patients in our cohort.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469916","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":"Corticospinal Tract Displacement: A Novel Imaging Marker for Arm Recovery in Patients with Acute Hypertensive Intracerebral Hemorrhage.","authors":"Sean I Savitz, Seth B Boren, Clark W Sitton, Khader M Hasan, Emily A Stevens, Robert Suchting, Ching-Jen Chen, Jaroslaw Aronowski, Muhammad E Haque","doi":"10.3174/ajnr.A8729","DOIUrl":"https://doi.org/10.3174/ajnr.A8729","url":null,"abstract":"<p><strong>Background and purpose: </strong>Brain parenchymal mass effect after acute intracerebral hemorrhage (ICH) causes neurologic deficits by displacing and or damaging the corticospinal tract (CST). The impact of corticospinal tract displacement (CSTD) on arm recovery and the influence of hematoma reversal on recovery are not well understood. We conducted a serial MRI study to explore these relationships.</p><p><strong>Materials and methods: </strong>Eighteen patients with spontaneous subcortical ICH were scanned on days 2 (baseline) and 90 (90 days) of onset. We used 3D-anatomic and 2D-DTI MRI, segmenting hematoma volume (HV), perihematomal edema (PHE), and the posterior limbs of the internal capsule (PLIC) volume labeled as native space. Presegmented PLIC volumes labeled as standard PLIC were obtained by using DTI-atlas. All segmented volumes were registered on a standard T1-weighted image followed by inverse-matrix transformation. Centroid-coordinates in native and standard PLIC were determined and a change in Euclidean distance was used to assess CSTD. Additionally, we measured changes in corticospinal tract volume due to lesion load (LLCSTV). ICH severity and upper extremity impairment were assessed by using NIHSS and Fugl-Meyer Upper Extremity (FM-UE) scores. A generalized linear mixed-model was applied to analyze CSTD and volume changes. A Bayesian inference was used to determine the posterior probability (PP). The CSTD, LLCSTV, and HV were correlated with NIHSS and FM-UE scores.</p><p><strong>Results: </strong>We enrolled 11 men and 7 women, with a mean age of 54.8 (standard deviation = 11.8). Analyses found strong support for temporal change in hematoma volume (14.8 ± 23.7 to 4.46 ± 4.99 mL) 75.5% decrease in log HV (<i>b</i> = -1.41, PP > 99.9%), a 64.3% decrease in NIHSS (<i>b</i> = -7.95, PP > 99.9%), and a 111.8% increase (25.9 ± 22.0 to 41.0 ± 22.1 mL) in FM-UE (<i>b </i>=<i> </i>20.2, PP = 99.8%). The average ipsilesional (absolute = 10.1 ± 4.5 to 5.78 ± 2.26 mm) log CSTD decreased by 44.9% (<i>b</i> = -0.59, PP = 99.9%). The LLCSTV (27.8 ± 3.8 to 31.4 ± 2.8 mL) increased by 12.9% (<i>b </i>=<i> </i>3.69, PP > 99.9%). Both ipsilesional log CSTD (<i>b</i> = -0.011, PP > 99.2%) and CST volume (<i>b</i> = 0.06, PP >99.8%), were strongly associated with arm recovery (FM-UE) substantiated by a strong association with stroke severity (NIHSS).</p><p><strong>Conclusions: </strong>We present a quantitative surrogate imaging marker of CSTD and its association with arm recovery after ICH.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661251","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":"Impact of Previous Glycemic Control on High-Resolution MRI Plaque Characteristics and Stroke Mechanisms in Patients with Middle Cerebral Artery Atherosclerosis.","authors":"Qin Huang, Wei Liu, Lei Liu, Shuo Zhang, Yantong Yang, Xianjin Zhu, Zunjing Liu","doi":"10.3174/ajnr.A8721","DOIUrl":"https://doi.org/10.3174/ajnr.A8721","url":null,"abstract":"<p><strong>Background and purpose: </strong>Although diabetes mellitus (DM) is a consistently documented risk factor for the plaque vulnerability, the effect of diabetes mellitus and glycemic control on the characteristics of intracranial plaques and stroke mechanism has yet to be explored. This study aimed to explore whether prestroke glycemic control is linked to plaque instability and could result in varying types and mechanisms of stroke.</p><p><strong>Materials and methods: </strong>We retrospectively included 107 patients with infarction attributed to atherosclerotic stenosis of the M1 segment of the MCA within 4 weeks of symptom onset, all of whom underwent high-resolution MR imaging. Patients were categorized into 4 groups based on their history of diabetes mellitus (DM) and their prestroke glycemic control: non-diabetes mellitus, glycosylated hemoglobin (HbA1c) <7.0%, HbA1c 7.0-8.9%, and HbA1c ≥ 9.0%. The morphology and composition of intracranial atherosclerotic plaques were evaluated by HR-MRI. The degree of plaque enhancement was measured by the plaque-to-pituitary stalk contrast ratio based on signal intensity values on postcontrast T1 images. The infarct pattern and stroke mechanisms were analyzed through diffusion-weighted imaging.</p><p><strong>Results: </strong>Among the enrolled 107 patients with stroke, 49 (45.79%) had DM. The remodeling index, wall index, and the degree of stenosis did not differ between the 4 groups. Poor glycemic control was associated with a higher prevalence of large cortical/cortical-deep patterns (25.9% in non-DM, 35.7% in HbA1c <7.0%, 39.1% in HbA1c 7.0-8.9%, and 41.7% in HbA1c ≥ 9.0% group). Compared with non-DM group, the proportion of artery-to-artery embolism and mixed mechanisms tends to increase along with increased HbA1c levels. The higher prevalence of intraplaque hemorrhage (40.8% versus 19.0%, <i>P</i> = .01), discontinuity of plaque surface (34.7% versus 12.7%, <i>P</i> = .01), and complicated plaque (defined as plaques with surface defects or hemorrhage) (55.1% versus 22.4%, <i>P</i> < .001) was significantly observed in diabetic patients more so than non-DM patients. HbA1c ≥ 9.0% was independently associated with an increased degree of plaque enhancement (coefficient: 0.35, <i>P</i> < .001).</p><p><strong>Conclusions: </strong>Poor glycemic control is independently linked to heightened plaque enhancement and a higher prevalence of complicated plaque. More large cortical/cortical-deep patterns were found, which may be associated with a small increase in artery-to-artery embolism and mixed mechanisms in such patients.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661253","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":"Efficacy of the Basilar Artery on Computed Tomography Angiography Score in Predicting Functional Outcomes after Thrombectomy for Basilar Arterial Occlusion: A Frequentist and Bayesian Meta-analysis.","authors":"Ho-Chang Huang, Hui-An Lin, Jyun-Jhe Wang, Sheng-Feng Lin","doi":"10.3174/ajnr.A8706","DOIUrl":"10.3174/ajnr.A8706","url":null,"abstract":"<p><strong>Background: </strong>The Basilar Artery on Computed Tomography Angiography (BATMAN) score is a 10-point grading system assessing arterial opacification and thrombus burden in the posterior circulation. It predicts outcomes in endovascular thrombectomy, with lower scores reflecting poor opacification.</p><p><strong>Purpose: </strong>This systematic review and meta-analysis evaluated the efficacy of the BATMAN score in predicting 90-day functional outcomes after thrombectomy.</p><p><strong>Data sources: </strong>We systematically searched PubMed, EMBASE, Scopus, and Cochrane Library and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for relevant English and Chinese articles published between January 1, 2017, and December 1, 2024.</p><p><strong>Study selection: </strong>The inclusion criteria were as follows: including patients who had undergone endovascular therapy (EVT) for posterior circulation acute ischemic stroke; assessing the BATMAN score through angiographic examinations, such as CTA, DSA, and MRA before EVT; and assessing functional outcomes on day 90 by using the mRS. We excluded duplicate articles, conference summaries, review articles, articles lacking original data, and articles for which the full text was unavailable.</p><p><strong>Data analysis: </strong>We determined the standardized mean difference in BATMAN scores between patients with favorable and unfavorable outcomes. Binormal receiver operating characteristic curve analysis determined the BATMAN score's diagnostic performance and the optimal threshold. The Bayesian approach validated the mean between-group difference in the BATMAN scores.</p><p><strong>Data synthesis: </strong>A higher BATMAN score was significantly associated with a favorable functional outcome (standardized mean difference in Cohen <i>d</i>: 0.82; 95% CI: 0.56-1.08). Binormal receiver operating characteristic curve analysis revealed an optimal BATMAN score threshold of ≥6, indicating a sensitivity of 76.1%, a specificity of 52.0%, and an area under the curve value of 0.71 (95% CI: 0.69-0.73). The Bayesian estimate of the mean between-group difference in BATMAN score was 1.52 (95% highest posterior attenuation: 1.41-1.62).</p><p><strong>Limitations: </strong>All of the included studies were observational in design and varied in terms of sample size. Nonetheless, our comprehensive statistical approach, with both frequentist and Bayesian approaches, might have overcome the limitations associated with sample size discrepancies.</p><p><strong>Conclusions: </strong>Our findings suggest the BATMAN score of ≥6 predicts post-thrombectomy favorable functional outcomes in patients with posterior circulation acute ischemic stroke.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460635","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":"Sex-Specific Association between Anatomic Variants of the Circle of Willis and Intracranial Aneurysms in Individuals with a Familial Predisposition.","authors":"Marloes H A Nanninga, Denise A M van Strien, Birgitta K Velthuis, Mireille R E Velthuis, Iris N Vos, Phebe J Groenheide, Ynte M Ruigrok, Irene C van der Schaaf","doi":"10.3174/ajnr.A8690","DOIUrl":"10.3174/ajnr.A8690","url":null,"abstract":"<p><strong>Background and purpose: </strong>First-degree relatives of patients with aneurysmal subarachnoid hemorrhage (aSAH) face elevated risks for intracranial aneurysm development and aSAH, which both occur more often in women. Anatomic variants of the circle of Willis (CoW) affect its hemodynamics and are associated with unruptured intracranial aneurysms (UIAs). It is unknown if these findings apply to patients with a familial predisposition for these conditions and if they are sex-specific. We, therefore, assessed if anatomic CoW variants are associated with intracranial aneurysms identified at screening in individuals with a familial predisposition and if these associations are sex-specific.</p><p><strong>Materials and methods: </strong>Individuals with and without intracranial aneurysms, identified at MRA time-of-flight screening, were compared. CoW arterial diameters were measured to identify anatomic variants and categorized into 6 types for both the anterior and posterior parts. Logistic regression was used for comparison, adjusted for age, hypertension, and the cohorts the individuals were part of, and stratified for sex-specific subgroups.</p><p><strong>Results: </strong>Of all 1291 included individuals, 94 (7.3%) had aneurysms. A normal anterior variant was less common among individuals with aneurysms (OR 0.59, 95% CI: 0.37-0.93). This effect was only observed in women (OR 0.45, 95% CI: 0.25-0.80) and not in men (OR 1.39, 95% CI: 0.57-3.35). The variant with anterior communicating artery hypoplasia or absence was more common in individuals with aneurysms (OR 1.61, 95% CI: 1.03-2.54). This effect was observed in both women (OR 1.62, 95% CI: 0.95-2.75) and men (OR 1.37, 95% CI: 0.55-3.41). No differences were found for variants of the posterior part of the CoW.</p><p><strong>Conclusions: </strong>Women with intracranial aneurysms identified at screening less frequently had a normal anterior part of the CoW compared with those without aneurysms. Additionally, individuals with aneurysms more often had anterior communicating artery hypoplasia or absence, which association was not sex-specific. These anatomic variations may enhance the effectiveness of screening for intracranial aneurysms.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257506","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":"Technical Aspects of Dynamic CT Myelography: Optimizing Patient Positioning for the Detection of CSF Leaks.","authors":"Samantha L Pisani Petrucci, Debayan Bhaumik, Andrew L Callen","doi":"10.3174/ajnr.A8903","DOIUrl":"https://doi.org/10.3174/ajnr.A8903","url":null,"abstract":"<p><p>Successful localization of CSF leaks on dynamic CT myelography requires a refined technical approach. In this video article, methods are presented to select and optimize patient position, as well as highlight potential pitfalls and strategies to augment utility in the setting of a difficult examination. Careful understanding and refinement of patient positioning in dynamic CT myelography ensures the performance of high-fidelity examinations with maximal diagnostic yield, decreasing the need for repeat studies and lumbar punctures.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661254","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}