AJNR. American journal of neuroradiology最新文献

{"title":"Relationship of Mechanism of Injury to Asymptomatic Cervical Spine Fractures in the Elderly.","authors":"Christopher Lawrence, Mahla Radmard, Armin Tafazolimoghadam, Akua A Amoah, Dhairya A Lakhani, Javad Azadi, Arjun Chanmugam, David M Yousem","doi":"10.3174/ajnr.A8542","DOIUrl":"https://doi.org/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 computed tomography 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 computed tomography 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, 240/13925 (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.ABBREVIATIONS: CCR = The Canadian Cervical Spine Rule; CSCT = cervical spine computed tomography; ED = emergency department; EMR = electronic medical record; MVC = motor vehicle collision.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","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":"Patient and Provider Characteristics Associated with Receipt of Image-guided Interventions for Low Back Pain.","authors":"Ghazaleh Safazadeh, Ruth C Carlos, Lubdha M Shah, Gregory J Stoddard, Rebecca Steed, Troy A Hutchins, Miriam E Peckham","doi":"10.3174/ajnr.A8502","DOIUrl":"10.3174/ajnr.A8502","url":null,"abstract":"<p><strong>Background and purpose: </strong>Low back pain commonly causes disability, often managed with conservative image-guided interventions before surgery. Research has documented racial disparities with these and other non-pharmacologic treatments. We posited that individual chart reviews may provide insight into the disparity of care types through documented patient/provider discussions and their effect on treatment plans.</p><p><strong>Materials and methods: </strong>This retrospective analysis involved adults newly diagnosed with low back pain within a large Utah healthcare system. The primary outcome was the association of provider and patient variables with the frequency of image-guided interventions received within one year of low back pain diagnosis between White/non-Hispanic and underrepresented minority cohorts. Secondary outcomes were receipt of additional treatment types (physical therapy and lumbar surgery), time to any treatment, time to image-guided intervention, and discussion/receipt of therapy between cohorts within one year of diagnosis.</p><p><strong>Results: </strong>Among 812 subjects (41% underrepresented minority and 59% White/non-Hispanic), more White/non-Hispanic patients had at least one image-guided intervention within 12 months compared to underrepresented minority patients (7.2% vs. 12.5%, p = .001), despite underrepresented minorities having higher presenting pain scores (64.5% vs. 49.3%; pain intensity > 5, p = .001). Underrepresented minority patients more often saw generalists (71.7% vs. 52.6%, p < .001) and advanced practice clinician providers (33.6% vs. 25.6%, p < .02) compared to the White/non-Hispanic cohort. Both cohorts were referred to a specialist at the same rate (17.7% vs. 19.8%, p = .20); however, referral completion was noted less often (60.4% vs. 77.7%, p = .02) and took longer to complete in underrepresented minority patients (54 vs. 27.5; mean day, p = .003).</p><p><strong>Conclusions: </strong>Underrepresented minority patients had more severe low back pain on presentation but received image-guided interventions less often than White/non-Hispanic patients. Our in-depth chart analysis supports the lack of referral completion and evaluation from a spine specialist provider as the main deterrent to the receipt of image-guided interventions in this cohort. While there may be systematic provider barriers, such as absence of a decision-making discussion, data do not support provider bias as a contributing factor to differences in receipt of image-guided interventions.</p><p><strong>Abbreviations: </strong>IGI = image-guided intervention; LBP = low back pain; URM = underrepresented minority; WNH = White/non-Hispanic; ICC = intraclass correlation coefficient.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303161","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":"Spinal CSF Leaks: The Neuroradiologist Transforming Care.","authors":"Mark D Mamlouk, Andrew L Callen, Ajay A Madhavan, Niklas Lützen, Lalani Carlton Jones, Ian T Mark, Waleed Brinjikji, John C Benson, Jared T Verdoorn, D K Kim, Timothy J Amrhein, Linda Gray, William P Dillon, Marcel M Maya, Thien J Huynh, Vinil N Shah, Tomas Dobrocky, Eike I Piechowiak, Joseph Levi Chazen, Michael D Malinzak, Jessica L Houk, Peter G Kranz","doi":"10.3174/ajnr.A8484","DOIUrl":"10.3174/ajnr.A8484","url":null,"abstract":"<p><p>Spinal CSF leak care has evolved during the past several years due to pivotal advances in its diagnosis and treatment. To the reader of the <i>American Journal of Neuroradiology</i> (<i>AJNR</i>), it has been impossible to miss the exponential increase in groundbreaking research on spinal CSF leaks and spontaneous intracranial hypotension (SIH). While many clinical specialties have contributed to these successes, the neuroradiologist has been instrumental in driving this transformation due to innovations in noninvasive imaging, novel myelographic techniques, and image-guided therapies. In this editorial, we will delve into the exciting advancements in spinal CSF leak diagnosis and treatment and celebrate the vital role of the neuroradiologist at the forefront of this revolution, with particular attention paid to CSF leak-related work published in the <i>AJNR</i>.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115812","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":"Neuroimaging Correlates with Clinical Severity in Wilson Disease: A Multiparametric Quantitative Brain MRI.","authors":"Xiao-Zhong Jing, Gai-Ying Li, Yu-Peng Wu, Xiang-Zhen Yuan, Jia-Lin Chen, Shu-Hong Wang, Xiao-Ping Wang, Jian-Qi Li","doi":"10.3174/ajnr.A8479","DOIUrl":"https://doi.org/10.3174/ajnr.A8479","url":null,"abstract":"<p><strong>Background and purpose: </strong>Previous studies have reported metal accumulation and microstructure changes in deep gray nuclei (DGN) in Wilson disease (WD). However, there are limited studies that investigate whether there is metal accumulation and microstructure changes in DGN of patients with WD with normal-appearing routine MRI. This study aimed to evaluate multiparametric changes in DGN of WD and whether the findings correlate with clinical severity in patients with WD.</p><p><strong>Materials and methods: </strong>The study enrolled 28 patients with WD (19 with neurologic symptoms) and 25 controls. Fractional anisotropy (FA), mean diffusivity (MD), and magnetic susceptibility in globus pallidus, pontine tegmentum, dentate nucleus, red nucleus, head of caudate nucleus, putamen, substantia nigra, and thalamus were extracted. Correlations between imaging data and the Unified Wilson's Disease Rating Scale (UWDRS) neurologic subitems were explored.</p><p><strong>Results: </strong>FA, MD, and susceptibility values were higher in multiple DGN of patients with WD than controls (<i>P</i> < .05). Patients with WD without abnormal signals in DGN on routine MRI also had higher FA, MD, and susceptibility values than controls (<i>P</i> < .017). We found that UWDRS neurologic subscores correlated with FA and susceptibility values of DGN (<i>P</i> < .05). In addition, we also found that FA and susceptibility values in specific structures correlated with specific neurologic symptoms of WD (ie, tremor, parkinsonism, dysarthria, dystonia, and ataxia) (<i>P</i> < .05).</p><p><strong>Conclusions: </strong>Patients with WD have increased FA, MD, and susceptibility values even before the lesion is morphologically apparent on routine MRI. The increased FA and susceptibility values correlate with clinical severity of WD.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482794","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":"https://doi.org/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 using <i>n-</i>BCA with dual balloon protection, a single center retrospective record review was performed on eight consecutive patients who underwent preoperative tumor embolization via the MHT for posterior fossa meningiomas between 2020 and 2024.</p><p><strong>Results: </strong>All patients successfully embolized the MHT using <i>n-</i>BCA. Complete obliteration was achieved in five 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 seven of eight cases. The mean estimated blood loss during surgical resection was 186 mL (range, 39-392 mL). The mean operative time was 431 min (range, 317-767 min).</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><p><strong>Abbreviations: </strong>MHT=meningohypophyseal trunk; ILT=inferolateral trunk; CPA=Cerebellopontine angle; BGC=balloon guide catheter; PVA=polyvinyl alcohol; GTR=Gross Total Resection; CN=Cranial nerve.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","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}

{"title":"Arterial Spin-Labeling Perfusion Lightbulb Sign: An Imaging Biomarker of Pediatric Posterior Fossa Hemangioblastoma.","authors":"Onur Simsek, Nakul Sheth, Amirreza Manteghinejad, Mix Wannasarnmetha, Timothy P Roberts, Aashim Bhatia","doi":"10.3174/ajnr.A8391","DOIUrl":"10.3174/ajnr.A8391","url":null,"abstract":"<p><strong>Background and purpose: </strong>Hemangioblastoma is a rare vascular tumor that occurs within the central nervous system in children. Differentiating hemangioblastoma from other posterior fossa tumors can be challenging on imaging, and preoperative diagnosis can change the neurosurgical approach. We hypothesize that a \"lightbulb sign\" on the arterial spin-labeling (ASL) sequence (diffuse homogeneous intense hyperperfusion within the solid component of the tumor) will provide additional imaging finding to differentiate hemangioblastoma from other posterior fossa tumors.</p><p><strong>Materials and methods: </strong>In this retrospective comparative observational study, we only included pathology-proved cases of hemangioblastoma, while the control group consisted of other randomly selected pathology-proved posterior fossa tumors from January 2022 to January 2024. Two blinded neuroradiologists analyzed all applicable MRI sequences, including ASL sequence if available. ASL was analyzed for the lightbulb sign. Disagreements between the radiologists were resolved by a third pediatric neuroradiologist. χ² and Fisher exact test were used to analyze the data.</p><p><strong>Results: </strong>Ninety-five patients were enrolled in the study; 57 (60%) were boys. The median age at diagnosis was 8 years old (interquartile range: 3-14). Of the enrolled patients, 8 had hemangioblastoma, and 87 had other posterior fossa tumors, including medulloblastoma (<i>n</i> = 31), pilocytic astrocytoma (<i>n</i> = 23), posterior fossa ependymoma type A (<i>n</i> = 16), and other tumors (<i>n</i> = 17). The comparison of hemangioblastoma versus nonhemangioblastoma showed that peripheral edema (<i>P </i>= .02) and T2-flow void (<i>P </i>= .02) favor hemangioblastoma, whereas reduced diffusion (low ADC) (<i>P </i>= .002) and ventricular system extension (<i>P </i>= .001) favor nonhemangioblastoma tumors. Forty-two cases also had ASL perfusion sequences. While high perfusion favors hemangioblastoma (<i>P </i>= .03), the lightbulb sign shows a complete distinction because all the ASL series of hemangioblastoma cases (<i>n</i> = 4) showed the lightbulb sign, whereas none of the nonhemangioblastoma cases (<i>n</i> = 38) showed the sign (<i>P</i> < .001).</p><p><strong>Conclusions: </strong>Lightbulb-like intense and homogeneous hyperperfusion patterns on ASL are helpful in diagnosing posterior fossa hemangioblastoma in children.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447776","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":"Additional Diagnostic Value of Cone Beam CT Myelography Performed After Digital Subtraction Myelography for Detecting CSF-venous Fistulas.","authors":"Ajay A Madhavan, Niklas Lutzen, Jeremy K Cutsforth-Gregory, Wouter I Schievink, Michelle L Kodet, Ian T Mark, Pearse P Morris, Steven A Messina, John T Wald, Waleed Brinjikji","doi":"10.3174/ajnr.A8535","DOIUrl":"https://doi.org/10.3174/ajnr.A8535","url":null,"abstract":"<p><strong>Background and purpose: </strong>CSF-venous fistulas are a common cause of spontaneous intracranial hypotension. The diagnosis and precise localization of these fistulas hinges on specialized myelographic techniques, which mainly include decubitus digital subtraction myelography and decubitus CT myelography (using either energy integrating or photon counting detector CT). A previous case series showed that cone beam CT myelography, performed as an adjunctive tool with digital subtraction myelography, increased the detection of CSF-venous fistulas. Here, we sought to determine the additive yield of cone beam CT myelography for CSF-venous fistula detection in a consecutive series of patients with spontaneous intracranial hypotension who underwent concurrent decubitus digital subtraction myelography and cone beam CT myelography.</p><p><strong>Materials and methods: </strong>We retrospectively searched our institutional database for all consecutive patients who underwent decubitus digital subtraction myelography with adjunctive cone beam CT myelography between 8/5/2021 and 8/5/2024. We excluded any patients harboring extradural CSF on spine imaging, not meeting International Classification of Headache Disorders (3^rd edition) criteria for spontaneous intracranial hypotension, or not having undergone technically successful cone beam CT myelography in combination with digital subtraction myelography. All myelographic images were independently reviewed by two neuroradiologists. We calculated the diagnostic yield of both myelographic tests for localizing a CSF-venous fistula.</p><p><strong>Results: </strong>We identified 100 patients who underwent decubitus digital subtraction myelography with adjunctive cone beam CT. We excluded 15 patients based on above criteria. 59/85 patients had a single definitive CSF-venous fistula. Among positive cases, the fistula was visible on digital subtraction myelography in 38/59 patients and visible on cone beam CT myelography in 59/59 patients. In 26/85 patients, no definitive fistula was identified on either modality.</p><p><strong>Conclusions: </strong>Cone beam CT myelography increased the diagnostic yield for CSF-venous fistula detection and may be a useful addition to digital subtraction myelography.</p><p><strong>Abbreviations: </strong>CB-CTM = cone beam CT myelography; CVF = CSF-venous fistula; DSM = digital subtraction myelography; EID-CTM = energy integrating detector CT myelography; PCD CTM = photon counting detector CT myelography; SIH = spontaneous intracranial hypotension.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482790","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":"Neuroradiologic, clinic and genetic characterization of cerebellar heterotopia: a pediatric multicentric study.","authors":"Ludovica Pasca, Filippo Arrigoni, Romina Romaniello, Maria Savina Severino, Davide Politano, Fulvio D'Abrusco, Jessica Garau, Valentina De Giorgis, Adriana Carpani, Sabrina Signorini, Simona Orcesi, Felice D'Arco, Enrico Alfei, Elisa Cattaneo, Elisa Rognone, Sara Uccella, Maria Teresa Divizia, Paolo Infantino, Enza Maria Valente, Renato Borgatti, Anna Pichiecchio","doi":"10.3174/ajnr.A8450","DOIUrl":"https://doi.org/10.3174/ajnr.A8450","url":null,"abstract":"<p><p><i>Background and purpose:</i>Cerebellar heterotopia (CH) is a neuroradiological abnormality poorly reported and investigated in the literature. It can be observed as an isolated finding, but it has been mainly reported in the context of cerebellar dysgenesis and in syndromic conditions. The aim of this study is to provide a comprehensive neuroradiological, clinical, and genetic characterization of a cohort of pediatric patients with cerebellar heterotopia.<i>Materials and methods:</i>Patients with a diagnosis of CH were systematically selected from the neuroimaging databases of the four Italian Centers participating in this retrospective study. For each patient, information regarding demographic, clinical, genetic and neuroradiological data were collected.<i>Results:</i>Thirty-two pediatric patients were recruited and subdivided into two groups: patients with isolated CH and/or cerebellar malformations (n= 18) and patients with CH associated with cerebral malformations (n=14). Isolated CH consistently showed a peripheral subcortical localization in the inferior portion of cerebellar hemispheres, with either unilateral or bilateral distribution. Ten patients belonging to the second group had a diagnosis of CHARGE syndrome, and their nodules of CH were mainly but not exclusively bilateral, symmetric, located in the peripheral subcortical zone and in the inferior portion of the cerebellar hemispheres; the remaining 4 patients of the second group, showed either bilateral or unilateral CH, located in both peripheral cortex and deep white matter and in the superior and inferior portions of cerebellum. Patients with isolated CH showed high prevalence of language development delay; neurodevelopmental disorders were the most represented clinical diagnoses. Recurring features were behavioral problems and motor difficulties. A conclusive genetic diagnosis was found in 18/32 patients.<i>Conclusions:</i>We found distinctive neuroradiological patterns of CH. Genetic results raise the possibility of a correlation between cerebellar morphological and functional developmental disruption, underscoring the importance of CH detection and reporting to orient the diagnostic path.Abbreviations <b>CH</b> Cerebellar heterotopia; <b>MRI</b> Magnetic resonance imaging; <b>CC</b> Corpus callosum; <b>ASD</b> autism spectrum disorder; <b>IVH</b> inferior vermian hypoplasia.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482795","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":"Morphometric evaluation of facial and vestibulocochlear nerves using magnetic resonance imaging in patients with Menière's disease.","authors":"Wilhelm H Flatz, Annika Henneberger-Kunz, Regina Schinner, Ullrich Müller-Lisse, Maximilian Reiser, Birgit Ertl-Wagner","doi":"10.3174/ajnr.A8537","DOIUrl":"https://doi.org/10.3174/ajnr.A8537","url":null,"abstract":"<p><strong>Background and purpose: </strong>Menière's disease (MD) is a condition of unknown etiology, involving genetic predisposition, autoimmune processes, viral infections, cellular apoptosis, and oxidative stress. This study aimed to investigate potential differences in the VII^th and VIII^th cranial nerves in MD patients using Hydrops-MRI (FLAIR) for morphometric evaluations.</p><p><strong>Materials and methods: </strong>Using a 3T MRI scanner, constructive-interference-in-steady-state (CISS) and 3D-FLAIR-inversionrecovery (FLAIR) sequences were acquired. We evaluated the morphometrics of the VII^th and VIII^th cranial nerves from the cerebellopontine angle to the internal auditory canal fundus, comparing the non-affected and affected sides. Furthermore, we examined the findings in relation to symptom duration and evaluated feasibility of FLAIR-imaging in morphometry of cranial nerves.</p><p><strong>Results: </strong>A total of 53 MD patients with unilateral symptoms were included. After statistical analysis, no significant differences were found regarding morphometric changes in the affected side compared to the non-affected side of the VII^th and VIII^th cranial nerves. There was also no significant difference between morphometric evaluations of patients with different symptom durations. The morphometric evaluation using Hydrops-MRI-Sequences (FLAIR) showed no significant difference compared to established morphometric highly T2-weighted imaging (CISS).</p><p><strong>Conclusions: </strong>Our data found no differences in nerve morphometry between clinically non-affected and affected sides in unilateral MD patients, nor any correlation with symptom duration. This contrasts with previous findings of correlations between clinical features and endolymphatic hydrops. A disease process starting before clinical symptom onset could be a possible explanation. Morphometric evaluation of brain nerves using Hydrops-MRI-Sequences is practical and provides similar results to T2-weighted imaging, improving patient comfort and reducing MRI scan time.</p><p><strong>Abbreviations: </strong>CN = cochlear nerve; CPA = cerebellopontine angle; CSA = cross-sectional area; FN = facial nerve; IAC = internal auditory canal; IVN = inferior vestibular nerve; LD = long diameter; MD = Menière's disease; SD = short diameter; SVN = superior vestibular nerve.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482793","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, Rossella Pasquariello, Pilvi Ilves, Dagmar Loorits, Annika Tähepõld, Giulio Pezzetti, Ian Craven, Mariasavina Severino, Andrea Rossi","doi":"10.3174/ajnr.A8534","DOIUrl":"https://doi.org/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 five patients. In this multi-institutional series of ten 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 ten patients (9 female) through onsite and online reviews. Genetic analysis was available for six 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 (\"zipper\"-like), 9 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 four patients. Genetics was normal in three of the six patients studied; the remainder were found to have mutations in <i>EFNB1</i> and a gene variant of <i>GIT1</i>, two copies of 7. And 8. exon of <i>SMN1</i> gene, and 2.126 megabase duplication at bands q11.1 and q11.2 of one 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 embryological driver leading to this condition.</p><p><strong>Abbreviations: </strong>CFNS＝ Craniofrontonasal Syndrome; DPG＝ Duplication of the Pituitary Gland; SHH＝ Sonic Hedgehog.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-11","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}