AJNR. American journal of neuroradiology最新文献

{"title":"CT-Based Intrathrombus and Perithrombus Radiomics for Prediction of Prognosis after Endovascular Thrombectomy: A Retrospective Study across 2 Centers.","authors":"Minda Li, Jingxuan Jiang, Hongmei Gu, Su Hu, Jingli Wang, Chunhong Hu","doi":"10.3174/ajnr.A8522","DOIUrl":"10.3174/ajnr.A8522","url":null,"abstract":"<p><strong>Background and purpose: </strong>Complications from endovascular thrombectomy (EVT) can negatively affect clinical outcomes, making the development of a more precise and objective prediction model essential. This research aimed to assess the effectiveness of radiomics features derived from presurgical CT scans in predicting the prognosis post-EVT in patients with acute ischemic stroke.</p><p><strong>Materials and methods: </strong>This investigation included 336 patients with acute ischemic stroke from 2 medical centers from March 2018 to March 2024. The participants were split into a training cohort of 161 patients and a validation cohort of 175 patients. Patient outcomes were rated with the mRS: 0-2 for good, 3-6 for poor. A total of 428 radiomics features were derived from intrathrombus and perithrombus regions in noncontrast CT and CTA images. Feature selection was conducted using a least absolute shrinkage and selection operator regression model. The efficacy of 8 different supervised learning models was assessed using the area under the curve (AUC) of the receiver operating characteristic curve.</p><p><strong>Results: </strong>Among all models tested in the validation cohort, the logistic regression algorithm for the combined model achieved the highest AUC (0.87; 95% CI, 0.81-0.92), outperforming other algorithms. The combined use of radiomics features from both the intrathrombus and perithrombus regions significantly enhanced diagnostic accuracy over models using features from a single region (0.81 versus 0.70, 0.77), highlighting the benefit of integrating data from both regions for improved prediction.</p><p><strong>Conclusions: </strong>The findings suggest that a combined radiomics model based on CT serves as a potent approach to assessing the prognosis following EVT. The logistic regression model, in particular, proved to be both effective and stable, offering critical insights for the management of stroke.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"681-688"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376413","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":"Pituitary Gland Duplication Syndrome: An International Imaging Analysis.","authors":"Ulrike Löbel, Martin Catala, Felice D'Arco, Maarten H Lequin, Rosa Pasquariello, Pilvi Ilves, Dagmar Loorits, Annika Tähepõld, Giulio Pezzetti, Ian Craven, Mariasavina Severino, Andrea Rossi","doi":"10.3174/ajnr.A8534","DOIUrl":"10.3174/ajnr.A8534","url":null,"abstract":"<p><strong>Background and purpose: </strong>Duplication of the pituitary gland is a rare developmental anomaly. Multiple associated craniofacial malformations have previously been reported with the largest series to date consisting of 5 patients. In this multi-institutional series of 10 patients, we present a detailed review of the imaging features and discuss a possible overarching pathogenesis that would explain most of the detected malformations.</p><p><strong>Materials and methods: </strong>Inclusion criteria for this retrospective imaging review were the presence of a pituitary stalk and gland duplication and the characteristic appearance of the hypothalamic ventral midline. In addition to the clinical presentation, we recorded the imaging findings of 10 patients (9 girls) through onsite and online reviews. Genetic analysis was available for 6 patients.</p><p><strong>Results: </strong>The duplicated pituitary stalk and gland showed normal imaging appearances in all patients. Mammillary bodies were clearly identified lateral to the characteristic prominence of the hypothalamic ventral midline. Strands of tissue extending to the anterior dura (\"limited ventral myeloschisis\") were noted at the medulla oblongata in 10, and at the cervical spinal cord in 7 patients. The medulla oblongata showed a \"butterfly\" appearance on axial images in 9 patients. Ten patients had cervical segmentation anomalies (\"zipperlike\"), 9 had anterior-posterior brainstem patterning defects (small pons, elongated medulla), and corpus callosum measurements were abnormal in all patients. Three patients each presented with diencephalic-mesencephalic junction abnormalities and 4 with an anterior mesencephalic \"cap.\" An oropharyngeal teratoma was present in 4 patients. Genetics was normal in 3 of the 6 patients studied; the remainder were found to have mutations in <i>EFNB1</i> and a gene variant of <i>GIT1</i>, 2 copies of 7 and 8 exon of <i>SMN1</i> gene, and 2.126 megabase duplication at bands q11.1 and q11.2 of 1 chromosome 15, respectively.</p><p><strong>Conclusions: </strong>Duplication of the pituitary gland presents as well-defined craniofacial and cervical spine malformation phenotype. Axial mesoderm duplication generating an excess of Sonic Hedgehog may be the primary embryologic driver leading to this condition.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"808-814"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407335","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":"Light-Chain Deposition Diseases of the CNS: Review of Pathogenesis, Imaging Features, and Radiographic Mimics.","authors":"Pranjal Rai, Neetu Soni, Girish Bathla, Karuna Raj, Amit Desai, Vivek Gupta, Amit Agarwal","doi":"10.3174/ajnr.A8390","DOIUrl":"10.3174/ajnr.A8390","url":null,"abstract":"<p><p>Light-chain deposition disease (LCDD) is a rare CNS disorder characterized by the extracellular accumulation of monoclonal immunoglobulin light chains in various organs. LCDD typically arises secondary to an underlying plasma cell dyscrasia, such as monoclonal gammopathy of undetermined significance or multiple myeloma. However, rare cases can occur in the absence of a demonstrable plasma cell disorder. The kidneys, liver, lungs, and heart are the most affected organs. Intracerebral LCDD, particularly without an underlying plasma cell neoplasm, represents an exceedingly uncommon entity with limited documented cases in the literature. This review article explores the pathogenesis, histopathologic features, and characteristic neuroimaging findings of intracerebral LCDD. We emphasize the diverse imaging presentations of this disease, which can closely resemble other neurologic pathologies. Recognizing these potential mimics is crucial for avoiding misdiagnosis, especially in the absence of a known underlying plasma cell disorder. This article aims to provide a comprehensive overview from a neuroradiologic perspective, facilitating the recognition and differentiation of this challenging entity.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"659-665"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447778","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":"Laser Interstitial Thermal Therapy for Intra-Axial Brain Tumors: Everything the Neuroradiologist Should Know.","authors":"Anneliese F Rademacher, Hassan A Fadel, Jacob A Pawloski, Mia Ma, Ken N Nkongchu, Ian Y Lee, Arafat Y Ali","doi":"10.3174/ajnr.A8427","DOIUrl":"10.3174/ajnr.A8427","url":null,"abstract":"<p><p>Laser interstitial thermal therapy (LITT) is a minimally invasive cytoreductive treatment option for patients with intracranial tumors. Utilizing real-time MR thermometry, LITT delivers tailored, targeted, and permanent cytotoxic thermal injury to intra-axial pathology. As a minimally invasive and nonionizing treatment option proved to be an effective, less morbid, and more efficient alternative to surgery, the utility of LITT has rapidly expanded. Along with this growth comes the need for neurosurgeons and neuroradiologists to accurately assess the radiographic outcomes of LITT in a standardized, dependable, and longitudinal fashion. We present a comprehensive overview of the indications and mechanisms of action of LITT for intra-axial brain tumors as well as guidance on thorough pre-, intra-, and postoperative imaging assessments. Using detailed case examples describing the contemporary uses of LITT, we hope to provide a foundational understanding of LITT that will inform imaging assessment and guide accurate multi disciplinary tumor board discussion.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"666-674"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689929","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":"Advancing Neuroradiology through Innovation and Member Engagement.","authors":"","doi":"10.3174/ajnr.A8708","DOIUrl":"https://doi.org/10.3174/ajnr.A8708","url":null,"abstract":"","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":"46 4","pages":"645"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775102","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":"Relationship of Mechanism of Injury to Asymptomatic Cervical Spine Fractures in the Elderly.","authors":"Christopher Lawrence, Mahla Radmard, Armin Tafazolimoghadam, Akua Afrah Amoah, Dhairya A Lakhani, Javad Azadi, Arjun Chanmugam, David M Yousem","doi":"10.3174/ajnr.A8542","DOIUrl":"10.3174/ajnr.A8542","url":null,"abstract":"<p><p>The Canadian Cervical Spine Rule, a clinical decision-making tool for patients post-trauma, is often interpreted as recommending cervical spine CT in patients ≥65 years old, who sustain a dangerous mechanism of injury, and/or have extremity paresthesias. We retrospectively reviewed 6 years' of emergency department cervical spine CT reports to determine fracture rates in patients ≥65, symptomatic or not, who did and did not have a dangerous mechanism. Of those ≥65 years old, 240 of 13,925 (1.72%) patients had cervical spine fractures. The fracture rate in asymptomatic patients ≥65 was 0.27%. The fracture rate in asymptomatic patients ≥65, who did not have a dangerous mechanism of injury was 0.15%. The rate of unstable fractures requiring surgery was 0.007%. The findings suggest that the algorithm to scan asymptomatic patients ≥65, and/or those ≥65 without a dangerous injury mechanism, should be revisited for appropriateness and overall value.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"820-822"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482796","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":"Hypersensitivity Reactions to Fibrin Glue during Epidural Blood Patching.","authors":"Jennifer L Smith, Myoung J Kim, Linda Gray, Michael D Malinzak, Samantha Morrison, Amy P Stallings, Alaattin Erkanli, Peter G Kranz, Timothy J Amrhein","doi":"10.3174/ajnr.A8568","DOIUrl":"10.3174/ajnr.A8568","url":null,"abstract":"<p><strong>Background and purpose: </strong>Fibrin glue is increasingly incorporated as a component in epidural blood patching (EBP) for the treatment of spinal CSF leaks. Hypersensitivity reactions are a potential complication of its use but are not well studied in the setting of EBP. The purpose of this study was to determine the incidence of hypersensitivity reactions to fibrin glue during EBP and to identify any predisposing factors associated with increased patient risk.</p><p><strong>Materials and methods: </strong>A single-center retrospective cohort study with nested case-control design included patients who received fibrin glue EBP for the treatment of iatrogenic CSF leaks or spontaneous intracranial hypotension over 13 years. Patient demographics and multiple procedure-specific variables were collected. Cases were identified from the total cohort as those with hypersensitive reactions and matched with controls in a 1:3 ratio. The incidence of hypersensitivity reactions in the total cohort was calculated. Logistic regression models were fit to test for associations between variables and the development of a hypersensitivity reaction.</p><p><strong>Results: </strong>A total of 3065 CT-guided EBPs with fibrin glue were identified in 1574 individual patients. The incidence of hypersensitivity reactions was 0.49% per procedure and 0.95% per patient and never occurred during the first EBP with fibrin glue. Case-control analysis found higher odds for hypersensitivity reactions in patients with a lower BMI (OR 0.82 [0.71-0.96], <i>P</i> = .003), younger age (OR 0.95 [0.91-0.99], <i>P</i> = .011), and during procedures with inadvertent intravenous injections (OR 5.44 [1.34-22.01], <i>P</i> = .014).</p><p><strong>Conclusions: </strong>We found a 0.49% incidence of hypersensitivity reactions during EBP with fibrin glue, none occurring during the first exposure. Younger age, lower BMI, and inadvertent intravenous injection during the procedure were associated with a higher likelihood of reactions. This study provides data useful for counseling patients on procedural risk and identifies variables for physicians to be aware of to help prevent life-threatening reactions to fibrin glue during EBP.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"840-845"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics of Branchial Cleft Anomalies.","authors":"Neil Rowlands, Catherine Russo, Kevin Liu, Anthony Yassall, Tendy Chiang, Mai-Lan Ho","doi":"10.3174/ajnr.A8604","DOIUrl":"10.3174/ajnr.A8604","url":null,"abstract":"<p><strong>Background and purpose: </strong>Branchial cleft anomalies (BCA) are a group of relatively common congenital pediatric neck masses, which exhibit wide variability in clinical presentation and treatment approaches. This study attempts to fill this gap by evaluating BCA clinical, radiographic, and treatment features in a large cross-sectional cohort.</p><p><strong>Materials and methods: </strong>We performed a retrospective cross-sectional study of patients with BCA presenting to a single pediatric quaternary care center between 2017 and 2023. The radiology information system was queried for the term \"branchial,\" with diagnostic confirmation based on radiology and medical records review including patient demographics, clinical presentation and symptoms, genetic testing, interventions, and pathology. Relevant statistical tests were performed.</p><p><strong>Results: </strong>We retrospectively identified 302 unique patients with 412 imaging examinations that included the term \"branchial\" in the radiology information system between 2017 and 2023. The final cohort included 167 patients with a total of 246 imaging examinations. Among patients with BCA, median age at presentation was 3.3 years (range 0-22.9). Leading clinical presentations included a neck mass (88%, 147) and skin drainage (29%, 29). BCA classification was first in 37% (61), second in 44% (73), third in 4% (7), and fourth in 15% (26). Interventions included incision and drainage in 70% (121) and complete excision in 54% (91). Among patients with resected BCA, 22% (20/91) experienced at least 1 recurrence.</p><p><strong>Conclusions: </strong>BCA have diverse clinical manifestations for which imaging aids in localization, classification, and interventional planning.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"815-819"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733544","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":"Thrombectomy Alone or Alongside Intravenous Thrombolysis in Managing Acute Ischemic Stroke Caused by Basilar Artery Occlusion: A Multicenter Observational Study.","authors":"Mo Yang, Yue-Zhou Cao, Peng-Hua Lv, Yasuo Ding, Zhensheng Liu, Zhenyu Jia, Lin-Bo Zhao, Chuan Xu, Hai-Bin Shi, Sheng Liu","doi":"10.3174/ajnr.A8520","DOIUrl":"10.3174/ajnr.A8520","url":null,"abstract":"<p><strong>Background and purpose: </strong>It remains unclear whether the combination of endovascular treatment (EVT) with intravenous thrombolysis (IVT) results in a more favorable functional outcome than EVT alone in managing cases of acute ischemic stroke (AIS) caused by basilar artery occlusion (BAO). Thus, this study aimed to compare the outcomes of 2 approaches-direct endovascular treatment (DEVT) and bridging therapy (IVT plus EVT)-in patients with acute BAO presenting within 4.5 hours of stroke onset.</p><p><strong>Materials and methods: </strong>This multicenter retrospective cohort study included 153 patients with acute BAO presenting within 4.5 hours of stroke onset. Of these patients, 65 (42.5%) and 88 (57.5%) underwent DEVT and bridging therapy, respectively. The primary outcome was defined as good functional outcome (mRS, 0-3) at 90 days. Additionally, preoperative clinical features, thrombectomy attempts, successful reperfusion rates, incidences of symptomatic intracranial hemorrhage (sICH), and mortality were compared between the 2 groups.</p><p><strong>Results: </strong>At 90 days, the rate of good functional outcome was comparable between the DEVT (44.6%) and bridging-therapy (39.8%) groups (adjusted odds ratio [aOR], 1.12; 95% CI, 0.55-2.31; <i>P</i> = .753). The bridging-therapy group exhibited a lower percentage of patients requiring ≥3 attempts of stent retrieval (aOR, 0.39; 95% CI, 0.16-0.93; <i>P</i> = .034). Preoperative clinical features, rate of successful reperfusion, sICH, and mortality were similar between the 2 groups.</p><p><strong>Conclusions: </strong>In patients with BAO-induced AIS, DEVT demonstrates a comparable functional outcome to bridging therapy within 4.5 hours of symptom onset, but IVT reduces the number of thrombectomy attempts.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"706-711"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Embolization of Posterior Fossa Meningiomas Supplied with Meningohypophyseal Trunk by Using <i>n</i>-BCA and Dual Balloon Protection.","authors":"Jota Tega, Koichiro Takemoto, Takayuki Koga, Dai Kawano, Shintaro Yoshinaga, Hideaki Tanaka, Kei Yamashiro, Toshiyuki Enomoto, Hironori Fukumoto, Yoshinobu Horio, Hiromasa Kobayashi, Takashi Morishita, Mitsutoshi Iwaasa, Hiroshi Abe","doi":"10.3174/ajnr.A8536","DOIUrl":"10.3174/ajnr.A8536","url":null,"abstract":"<p><strong>Background and purpose: </strong>Efficacy of tumor embolization for posterior fossa meningioma is controversial due to the lack of adequate embolization for dangerous feeders. Of these, a meningohypophyseal trunk (MHT) has high therapeutic value despite the high risks associated with embolization.</p><p><strong>Materials and methods: </strong>To analyze the utility of preoperative MHT embolization for posterior fossa meningiomas by using <i>n-</i>BCA with dual balloon protection, a single-center retrospective record review was performed on 8 consecutive patients who underwent preoperative tumor embolization via the MHT for posterior fossa meningiomas between 2020 and 2024.</p><p><strong>Results: </strong>In all cases the MHT was successfully embolized by using <i>n-</i>BCA. Complete obliteration was achieved in 5 cases, which is related to the tentorial artery alone as the feeding vessel. None of the patients had cerebral infarction associated with distal embolization. One patient experienced worsening of preoperatively observed abducens nerve palsy due to cranial nerve ischemia. Gross total resection was achieved in 7 of 8 cases. The mean estimated blood loss during surgical resection was 186 mL (range, 39-392 mL). The mean operative time was 431 minutes (range, 317-767 minutes).</p><p><strong>Conclusions: </strong>The MHT embolization of posterior fossa meningiomas by using <i>n</i>-BCA is technically feasible with a high success rate and an acceptable complication rate.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"720-724"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482792","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}