AJNR. American journal of neuroradiology最新文献

{"title":"¹⁸F-FDG PET/MR-Based Individual Metabolic Network Analysis for Prognosis Assessment in Temporal and Extratemporal Lobe Refractory Epilepsy.","authors":"Siqi Zhang, Weizhao Lu, Chenyang Yao, Jingjuan Wang, Bixiao Cui, Jie Lu","doi":"10.3174/ajnr.A9027","DOIUrl":"https://doi.org/10.3174/ajnr.A9027","url":null,"abstract":"<p><strong>Background and purpose: </strong>This study aimed to employ the Individual-Specific Metabolic Network (ISMN) for prognosis assessment in refractory temporal and extratemporal lobe epilepsy (TLE/ETLE), analyzing homogeneity and heterogeneity among patients based on glucose metabolism patterns from 18F-FDG PET/MR and exploring their association with surgical outcomes.</p><p><strong>Materials and methods: </strong>Clinical and 18F-FDG PET/MR data were retrospectively reviewed from patients with refractory epilepsy who underwent surgical resection. Healthy controls served as references for network construction. Patients were categorized into TLE and ETLE based on the epileptogenic zone determined by surgery and pathology. ISMN nodal and edge characteristics were compared between patients and controls, as well as between TLE and ETLE. Associations between network properties and clinical variables were examined. A linear classifier using nodal and edge features predicted surgical outcomes.</p><p><strong>Results: </strong>18F-FDG PET/MR images were collected from TLE (n = 39), ETLE (n = 33), and healthy controls (n = 68), subdivided into reference (n = 46) and control (n = 22) groups. TLE and ETLE showed increased node degrees in the right angular and inferior temporal gyri but reduced edge connectivity between the right anterior ventral temporal region and temporal pole. ETLE exhibited broader, more fluctuating ISMN alterations with stronger clinical correlations. ISMN features strongly predicted postoperative outcomes, with edge features influencing TLE, while node features were key in ETLE.</p><p><strong>Conclusions: </strong>ISMN analysis highlights metabolic network contributions to refractory epilepsy prognosis, uncovering distinct and shared pathophysiological mechanisms in TLE and ETLE to guide personalized therapy.</p><p><strong>Abbreviations: </strong>TLE＝ temporal lobe epilepsy; ETLE＝ extratemporal lobe epilepsy; AEDs＝ anti-epileptic drugs; SEEG＝ stereoelectroencephalography; ISMN＝ individual-specific network; SUVR＝ standardized uptake value ratio.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202524","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":"ACR TI-RADS Risk Score Escalation Observed in Benign Thyroid Nodules Following Radiofrequency Ablation.","authors":"Tess J Battiola, Richard H Wiggins, Devaprabu Abraham","doi":"10.3174/ajnr.A9028","DOIUrl":"https://doi.org/10.3174/ajnr.A9028","url":null,"abstract":"<p><strong>Background and purpose: </strong>Radiofrequency ablation (RFA) has emerged as an effective non-surgical treatment for symptomatic benign thyroid nodules and toxic adenomas. While post-RFA ultrasonographic changes are expected, they may inadvertently evoke alarm and prompt unnecessary interventions when risk stratification models such as the American College of Radiology Thyroid Imaging Reporting & Data System (ACR TI-RADS) are applied. This study aims to quantify the ultrasound imaging changes using TIRADS scoring of thyroid nodules before and after RFA, and we highlight that these changes should not be used as a basis for clinical action.</p><p><strong>Materials and methods: </strong>This retrospective study analyzed patients who underwent RFA for symptomatic thyroid nodules at a quaternary care academic medical center between May 2021 and May 2024. All nodules were assessed using the ACR TI-RADS calculator and underwent fine-needle aspiration (FNA) biopsy prior to treatment. Following RFA, ultrasonography was conducted at 3-month intervals and TI-RADS scores were reassessed. The primary endpoint was the change in TI-RADS classification following RFA.</p><p><strong>Results: </strong>A total of 28 nodules from 25 patients were monitored after RFA for a median follow-up duration of 419 days. The majority (92.9%) were benign (Bethesda II) on FNA. The mean volume reduction ratio (VRR) was 66.7% (range 33.0% to 91.6%), with therapeutic success (VRR > 50%) achieved in 86% of patients. Post-RFA risk stratification increased following RFA, with the mean TI-RADS score increasing from 3.04 to 4.25 (p-value < 0.001), predominantly driven by increased hypo-echogenicity and new echogenic foci/calcifications.</p><p><strong>Conclusions: </strong>Thyroid nodules frequently undergo post RFA structural changes which result in misleading upstaging on the ACR TIRADS stratification system. These changes are expected and require cautious interpretation to avoid overdiagnosis, patient anxiety, and mismanagement.</p><p><strong>Abbreviations: </strong>RFA = radiofrequency ablation; ACR TI-RADS = American College of Radiology Thyroid Imaging Reporting & Data System; FNA = fine-needle aspiration; VRR = volume reduction ratio.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202482","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":"Temporomandibular joint (TMJ) lesions with intracranial extension: illustrative cases from a systematic review of the literature and our institution.","authors":"Hayley McKee, Taryn Rohringer, Andrew Z Yang, Yash Patel, Laila Alshafai, Emma Blanchette, Christine M Glastonbury, Pascal J Mosimann, Jürgen Germann, Shivaprakash Hiremath, Alexandre Boutet","doi":"10.3174/ajnr.A9025","DOIUrl":"https://doi.org/10.3174/ajnr.A9025","url":null,"abstract":"<p><strong>Background: </strong>Intracranially extending temporomandibular joint (TMJ) lesions may be radiologically misinterpreted as primary intracranial or skull base pathologies, leading to diagnostic delays or inappropriate management.</p><p><strong>Purpose: </strong>This systematic review aimed to characterize the clinical and imaging features of such TMJ lesions and evaluate the impact of radiologic misclassification. We also aimed to develop a diagnostic framework for when to consider an intracranially extending TMJ lesion, based on clinical and radiologic features.</p><p><strong>Data sources: </strong>A comprehensive search of MEDLINE, SCOPUS, and Embase, conducted in accordance with PRISMA guidelines, yielded 2,255 records.</p><p><strong>Study selection: </strong>After screening with a pre-determined inclusion and exclusion criteria, 128 studies involving 152 patients were included in the final analysis.</p><p><strong>Data analysis: </strong>Statistical analyses were performed using STATA software. We also identified 3 patient cases through our institutional neuroradiology practice who were clinically and radiologically assessed for intracranially extending TMJ lesions.</p><p><strong>Data synthesis: </strong>Patients had symptoms for an average of 34 months prior to diagnosis (47% female, mean age 50 years). The most common pathologies were pigmented villonodular synovitis/tenosynovial giant cell tumor (43%) and synovial chondromatosis (24%). Neurological symptoms were reported in 48% of cases, most frequently hearing loss (70%). Nearly one-third (33%) of cases with an imaging differential did not list a TMJ pathology (18/55). In cases with accurate imaging diagnosis, 90% had both CT and MRI performed. Most lesions were non-enhancing (CT 83%, MRI 75%) and demonstrated no adjacent brain edema (96%). In two cases, a TMJ ganglion cyst and pseudogout were misdiagnosed as intracranial tumors, resulting in unnecessary intervention, including repeat craniotomy and radiotherapy.</p><p><strong>Limitations: </strong>Inherent biases of case report literature, including variability in the reporting of the imaging and clinical features, management and follow-up.</p><p><strong>Conclusions: </strong>TMJ lesions with intracranial extension often present with non-specific symptoms and can mimic extra-axial tumors, leading to misdiagnosis on imaging. Recognition of hallmark imaging features, including lack of parenchymal invasion and distinct imaging patterns, may help improve radiologic accuracy and prevent overtreatment. We propose a diagnostic framework outlining when to suspect intracranially extending TMJ lesions based on clinical and imaging features, and how to avoid common diagnostic pitfalls.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194042","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":"Precision Diffusion-Weighted Imaging of Head and Neck Squamous Cell Carcinoma.","authors":"Gloria J Guzmán Pérez-Carrillo, Wenshang Wang, Jingxia Liu, Rachel Reed, Shuang Wu, Maryam Rahmani, Michael Boss, Dariya Malyarenko, Amita Shukla-Dave, Matt Parsons, Trevor Andrews, Hongyu An","doi":"10.3174/ajnr.A9026","DOIUrl":"https://doi.org/10.3174/ajnr.A9026","url":null,"abstract":"<p><strong>Background and purpose: </strong>Head and neck squamous cell carcinoma (HNSCC) represents a significant global health burden, with over 890,000 new cases annually and approximately 450,000 related deaths worldwide. Our study aims to optimize diffusion-weighted imaging (DWI) sequences for the head and neck and determine reproducibility metrics values for ADC, allowing clinicians to distinguish between genuine physiological changes and measurement errors.</p><p><strong>Materials and methods: </strong>We optimized the head and neck DWI protocol using QIBA-recommended parameters, high 2000 b-value, Zoom-IT technology, and a Polyvinylpyrrolidone (PVP) phantom calibration. Twenty-six biopsy-proven HNSCC patients underwent pre-treatment \"coffee-break\" test-retest DWI scans on a Siemens 3T Vida MRI scanner. ADC values were extracted from 46/51 segmented tumor regions (either tumor mass or metastatic lymphadenopathy), and reproducibility measures were assessed using the within-subject coefficient of variation (wCV), repeatability coefficient (RC), and intraclass correlation coefficient (ICC). Bland-Altman plots and correlation analyses were used to evaluate measurement precision. Both manual segmentation by two expert neuroradiologists and semiautomated methods of segmentation were utilized.</p><p><strong>Results: </strong>Out of 51 identified tumor masses, 46 were included in the final analysis. The Bland-Altman plot revealed minimal bias in ADC values between test-retest scans. The calculated 5.2-5.4% wCV resulted in a repeatability coefficient of 14.4%. The ICC between test and retest measurements was 0.8-0.83, indicating good test-retest reliability. The DICE score between the two expert readers for all parameters indicated excellent agreement between segmentations performed by different readers, with values of 0.991 for the test measurement and 0.976 for the retest measurement.</p><p><strong>Conclusions: </strong>Our findings support the use of an optimized DWI protocol for accurate and reproducible ADC quantification in HNSCC, which is comparable to or better than the percent repeatability coefficient derived from QIBA Profiles for breast, liver, and prostate, although it is inferior to those for the brain. Further QIB Stage 2-type Profile research is necessary to refine imaging parameters, improve reproducibility markers, and establish DWI as a clinical standard for evaluating HNSCC tumor recurrence.</p><p><strong>Abbreviations: </strong>BOT=base of tongue. HNC=head and neck cancer. HNSCC= head and neck squamous cell carcinoma. ICC=Intraclass correlation coefficient. QIBA=Qualitative Initiative Biomarker Alliance. QuiC=Quantitative Imaging Committee. LoA= Limits of agreement. RC=repeatability coefficient. SCC=Squamous cell carcinoma. QIB=quantitative imaging biomarkers. wCV=within-lesion coefficient of variation.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194048","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 Findings in Carbonic Anhydrase VA Deficiency: A Case Series Highlighting Diagnostic and Prognostic Patterns in a Potentially Reversible Mitochondrial Dysfunction.","authors":"Diego C Fragoso, Eiman Al-Ajmi, Agustin M Cardenas, Pilar Quijada-Fraile, Asthik Biswas, Sniya Sudhakar, Felice D'Arco, Kshitij Mankad, Khalid Al-Thihli, Olaf Bodamer, Anne O'Donnell-Luria, Edward Yang, Lance Rodan, Fathiya Al-Murshedi, Cesar Augusto P F Alves","doi":"10.3174/ajnr.A8948","DOIUrl":"https://doi.org/10.3174/ajnr.A8948","url":null,"abstract":"<p><strong>Background and purpose: </strong>Imaging characteristics of the secondary urea cycle disorder caused by carbonic anhydrase VA (CA-VA) deficiency remain poorly understood. This study aimed to evaluate the neuroimaging features associated with CA-VA deficiency through a collaborative multicenter investigation.</p><p><strong>Materials and methods: </strong>A retrospective, longitudinal study with confirmed CA5A variants at five large centers was performed. MR studies were qualitatively reviewed according to a standardized reporting form at initial and follow-up MRI.</p><p><strong>Results: </strong>A total of nine patients with CA-VA deficiency were included, six of whom were female. The median age at symptom onset was 3 days (interquartile range [IQR]: 2.5-48.5 days), and the median interval between symptom onset and brain MRI was 7 days. Seven patients (77%) experienced a single metabolic crisis so far. A favorable clinical outcome, defined as the absence of significant neurological impairment was observed in five patients (55.5%), while four (44.4%) exhibited moderate to severe neurological longterm impairment. All patients demonstrated brain imaging abnormalities. In the favorable-outcome group, imaging findings demonstrated a urea cycle disorder-like pattern, with selective involvement of the cortical and juxtacortical regions of the insular/peri-insular area, the sylvian/peri-sylvian fissures, and the perirolandic cortex. In contrast, the unfavorable-outcome group exhibited either more extensive involvement of the aforementioned regions-extending to the thalamus, basal ganglia, and brainstem. Follow-up MRI was available for three patients: two of them showed near-complete resolution of brain abnormalities (favorable outcome group), while one displayed relatively extensive chronic gliotic changes (unfavorable outcome group).</p><p><strong>Conclusions: </strong>MRI plays a key role in the early diagnosis of CA-VA deficiency, as brain abnormalities are expected and often exhibit features suggestive of an underlying urea cycle disorder. Furthermore, neuroimaging may serve as a valuable prognostic marker, directly impacting clinical decision-making, management, and follow-up strategies.</p><p><strong>Abbreviations: </strong>CA-VA＝ Carbonic Anhydrase VA; CA-VB＝ Carbonic Anhydrase VB; FOG＝ Favorable-outcome group; UOG＝ Unfavorable-outcome group; UCD＝ Urea cycle disorders.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193987","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":"Predicting Vasospasm and Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: The Role of Vessel Wall MRI.","authors":"Mehmet Aksakal, Dandan Chang, Mona Kharaji, Charles Watt, Michael R Levitt, Daniel S Hippe, Chengcheng Zhu, Mahmud Mossa-Basha","doi":"10.3174/ajnr.A9024","DOIUrl":"https://doi.org/10.3174/ajnr.A9024","url":null,"abstract":"<p><strong>Background and purpose: </strong>Aneurysmal subarachnoid hemorrhage is a life-threatening condition associated with angiographic vasospasm, delayed cerebral ischemia, and other complications that may lead to significant morbidity and mortality. Our study evaluated associations of vessel wall enhancement on intracranial vessel wall MRI with rupture status, and predictive value of vessel wall enhancement, conventional imaging, and clinical features for angiographic vasospasm, delayed cerebral ischemia, which encompasses delayed infarction and symptomatic vasospasm.</p><p><strong>Materials and methods: </strong>A retrospective cohort study included patients who underwent endovascular treatment for ruptured or unruptured intracranial aneurysms with immediate post-intervention vessel wall MRI between November 2015 and August 2022. Logistic regression models were used to assess the relationship of vessel wall enhancement with SAH, angiographic vasospasm, and a composite of delayed cerebral ischemia, delayed infarction, and symptomatic vasospasm after adjustment for clinical and traditional imaging factors. We used adjusted vessel wall enhancement segments as a qualitative variable, defined as the proportion of enhanced vessel segments relative to the total number of evaluable segments per patient.</p><p><strong>Results: </strong>Among 128 patients (79 ruptured, 49 unruptured), adjusted vessel wall enhancement was significantly higher among patients with ruptured than unruptured aneurysms (OR=1.62, 95%CI=1.39-1.99, p<0.001). In the rupture cohort, adjusted vessel wall enhancement was the only independent predictor of angiographic vasospasm (OR=1.12, 95%CI=1.03-1.23, p=0.01). In contrast, the modified Fisher grade and hypertension were independent predictors of delayed cerebral ischemia (p<0.05), whereas adjusted vessel wall enhancement was not.</p><p><strong>Conclusions: </strong>Qualitative adjusted vessel wall enhancement is associated with SAH and is a reliable, independent predictor of angiographic vasospasm, but is not predictive of delayed cerebral ischemia. Given the multifactorial nature of SAH-related complications, integrating vessel wall enhancement with conventional imaging and clinical factors may improve risk stratification and predictive assessment.</p><p><strong>Abbreviations: </strong>aSAH= Aneurysmal Subarachnoid Hemorrhage. ASVWE= Adjusted Segmental Vessel Wall Enhancement. DCI= Delayed Cerebral Ischemia. DI= Delayed Infarction. IA= Intracranial Aneurysm. IVWM= Intracranial Vessel Wall MRI. mFisher= Modified Fisher Grade. OR=Odds Ratio. VWE= Vessel Wall Enhancement.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194067","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":"Leptomeningeal vascularity in Gadopiclenol Enhanced Pediatric Brain MRI.","authors":"Sergio Valencia, Harry Griffin, Maria C Cortes-Albornoz, Suely Fazio-Ferraciolli, Michael S Gee, Jad S Husseini, Fedel Machado-Rivas, Samuel Cartmell, Camilo Jaimes","doi":"10.3174/ajnr.A9020","DOIUrl":"https://doi.org/10.3174/ajnr.A9020","url":null,"abstract":"<p><strong>Background and purpose: </strong>Gadolinium-based contrast agents (GBCAs) are essential in pediatric neuroimaging, enabling visualization of pathology that disrupts the blood-brain barrier. Gadopiclenol is a new macrocyclic GBCA with higher T1 relaxivity, permitting a 50% dose reduction while maintaining diagnostic quality. However, it is unknown whether this higher relaxivity alters background extra-axial vascular enhancement. We hypothesized that gadopiclenol, despite its lower dose, would increase background enhancement on post-contrast pediatric brain MRI compared to gadoterate meglumine (Gd-DOTA).</p><p><strong>Materials and methods: </strong>In this retrospective observational study, 302 contrast-enhanced brain MRI studies in patients aged 2-18 years were reviewed: 151 with gadopiclenol (0.05 mmol/kg) and 151 with Gd-DOTA (0.1 mmol/kg). Post-contrast sequences included 3D T1 spin echo (SE), 3D T1 gradient echo (SPGR), 2D T1 turbo spin echo (TSE), and 2D FLAIR. Two neuroradiologists established binary enhancement categories based on sulcal enhancement thresholds (high vs. low). One reader assigned scores for all studies; a second reader evaluated a subset for interobserver agreement. Logistic regression assessed the association between contrast agent and high enhancement, adjusting for age, sex, anesthesia, and scanner field strength.</p><p><strong>Results: </strong>Gadopiclenol was independently associated with significantly greater odds of high extra-axial enhancement on all T1-weighted sequences: 3D T1 SE (OR = 10.2, p < 0.001), 3D T1 SPGR (OR = 10.7, p < 0.001), and 2D T1 TSE (OR = 14.0, p < 0.001). Anesthesia was also an independent predictor of high enhancement on 3D SE and SPGR. On 2D FLAIR, contrast agent had no effect; instead, younger age was associated with high enhancement (p = 0.022), with an age-anesthesia interaction suggesting attenuation of this effect under sedation. Interobserver agreement was moderate to substantial (κ = 0.530-0.632).</p><p><strong>Conclusions: </strong>Gadopiclenol increases background extra-axial enhancement on T1-weighted post-contrast sequences in pediatric brain MRI, likely reflecting its higher relaxivity. Radiologists should be aware of this effect to avoid misinterpretation as leptomeningeal pathology. Post-contrast FLAIR remains unaffected and continues to serve as a reliable sequence for detecting true meningeal disease.</p><p><strong>Abbreviations: </strong>GBCA＝ gadolinium-based contrast agent; SE＝ spin echo; SPGR＝ spoiled gradient echo; TSE＝ turbo spin echo.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182325","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-reported symptom relief from percutaneous benign thyroid nodule radiofrequency ablation in routine clinical care.","authors":"Michelle Mai, Vincent M Levesque, Ellen Marqusee, Matthew I Kim, Jeffrey P Guenette","doi":"10.3174/ajnr.A9022","DOIUrl":"https://doi.org/10.3174/ajnr.A9022","url":null,"abstract":"<p><strong>Background and purpose: </strong>We investigated patient-reported symptom relief from percutaneous ultrasound-guided radiofrequency ablation of benign thyroid nodules in routine clinical care, given that prior studies have reported efficacy based on size reduction and specific symptom scores but not patient-reported effectiveness.</p><p><strong>Materials and methods: </strong>This retrospective cohort study included all consecutive adults treated 5/12/2021-8/7/2024 with ultrasound-guided radiofrequency ablation for symptomatic benign thyroid nodules at a quaternary care hospital. Procedures were performed by a single board certified neuroradiologist utilizing a trans-isthmus moving shot technique. Patient-reported symptom relief (symptoms resolved yes/no) was assessed at 6-month routine clinical follow-up. Descriptive statistics were performed. Pre-ablation nodule size associations with symptom resolution were assessed with Wilcoxon tests.</p><p><strong>Results: </strong>49 patients (mean age 56.6±13.1 years; 45 females) had average pre-ablation nodule volume of 30.6±31.0 mL, higher than 20.1±22.4 mL reported in a recent meta-analysis of efficacy studies. Common pre-ablation symptoms were cosmetic deformity (37/49, 77.1%), dysphagia (28/49, 58.3%), and dysphonia (15/49, 30.6%). Thirty-six patients (73.0%) completed at least one follow-up visit. Post-ablation symptom resolution was 78.0% (28/36, 95%CI 61.9%-88.3%) among those with follow-up, higher than the 64.4% reported in the single study included in the meta-analysis that assessed subjective symptom relief. Relative mean volume reduction was 52.3±27.4% in those with follow-up and was associated with symptom resolution (59% reduction with symptom resolution vs. 30% without, p=0.035). One patient experienced a minor bleeding complication.</p><p><strong>Conclusions: </strong>Patient-reported symptom relief from percutaneous ultrasound-guided thermal ablation of benign thyroid nodules in our clinic has resulted in approximately 80% clinically-relevant effectiveness based on patient-reported symptom relief, with a slightly lower volume reduction rate compared to those reported in efficacy studies. Our clinic patients had larger nodule volumes than typical in published studies and many patients opted to forgo post-treatment follow-up. This likely led to underestimation of our effectiveness and volume reduction measurements.</p><p><strong>Abbreviations: </strong>RFA＝ radiofrequency ablation; BTN＝ benign thyroid nodule; VAS＝ visual analog scale; VRR＝ volume reduction ratio; TSH = thyroid stimulating hormone; LA＝ laser ablation; MWA＝ microwave ablation.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182285","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":"CT-Based Timeline for Closure of Sphenoid Body Synchondroses and Foramina in Children.","authors":"Carmen R Cerron-Vela, Amirreza Manteghinejad, Marcus Meneses, Luis Octavio Tierradentro-Garcia, Austin Moats, Savvas Andronikou","doi":"10.3174/ajnr.A9021","DOIUrl":"https://doi.org/10.3174/ajnr.A9021","url":null,"abstract":"<p><strong>Background and purpose: </strong>The sphenoid bone is formed from multiple ossification centers. Its body develops through the fusion of the presphenoid and postsphenoid cartilages separated by the inter-sphenoidal synchondrosis. Variations in ossification can lead to persistent craniopharyngeal duct remnants, potentially associated with pituitary dysfunction or tumors. We aimed to determine the timeline of closure of these synchondroses and associated foramina in children without skull base abnormalities on CT scans.</p><p><strong>Materials and methods: </strong>This retrospective study analyzed CT scans of children aged 0-6 years from a tertiary pediatric hospital (2018-2022). Scans with abnormalities or skull anomalies were excluded. Two pediatric radiologists assessed synchondroses and foramina, classifying them as patent or fused. Sample size was determined using AUC analysis. Statistical methods included descriptive analysis, interrater reliability (Cohen's Kappa, ICC), Mann-Whitney U test, and cut point analysis with bootstrapping to determine closure times.</p><p><strong>Results: </strong>We analyzed 160 scans (94 males, 58.8%; 66 females, 41.2%) with a median age of 1.4 years (IQR: 0.3-3.7). Interrater reliability was strong (κ > 0.80) for most structures, moderate for detecting intra-pre-sphenoid synchondrosis and pneumatization, and weak for intra-post-sphenoidal synchondrosis. Cut-point analysis demonstrated that the inter-sphenoid synchondrosis fused first at 4 months, followed by the intra-pre-sphenoid synchondrosis, the anterior and posterior foramen, with pneumatization occurring last at 24.8 months; all with an area under the curve > 80%. Pairwise threshold differentiation showed pneumatization followed the closure of inter-sphenoid synchondrosis, intra-pre-sphenoid synchondrosis, and anterior foramen by 22.8, 22.7, and 17.4 weeks, respectively.</p><p><strong>Conclusions: </strong>The sphenoid body synchondroses and foramina show a predictable closure timeline within the first year of life, while pneumatization commences after the second year. Understanding this timeline provides radiologists with a reference standard for interpreting CT examinations that include the skull base (e.g., head, maxillofacial, temporal bone CTs) in children under two years of age, supporting more confident interpretation and potentially reducing overcalling and related follow-up imaging.</p><p><strong>Abbreviations: </strong>AUC＝Area Under the Curve; CI＝Confidence Interval; IQR = Interquartile Range.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182306","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":"Feasibility of MR-Guided PET Reconstruction in Detection of Focal Cortical Dysplasia.","authors":"Erik H Middlebrooks, Chen Lin, Robert A Pooley, Matthew G Spangler-Bickell, Alex Smith, Daniel Litwiller, Vishal Patel, Yu Cai, Vivek Gupta, Neetu Soni","doi":"10.3174/ajnr.A9023","DOIUrl":"https://doi.org/10.3174/ajnr.A9023","url":null,"abstract":"<p><p>Focal cortical dysplasia (FCD) is one of the most prevalent and difficult to detect structural etiologies of epilepsy. Recent advancements in MRI technology have enhanced detectability of FCD, yet many remain undiagnosed by MRI. FDG-PET may increase detection rates when utilized alongside MRI, yet PET continues to be underutilized beyond temporal lobe epilepsy, likely due to challenges in identifying subtle cortical lesions. Hybrid PET/MR systems present an opportunity to improve image quality and lesion detection, but benefits of hybrid PET/MR in epilepsy beyond workflow advantages are not well established. This feasibility study assesses the potential of a prototype MR-guided PET reconstruction that integrates event-by-event motion correction, enhanced point spread function modeling, regularization techniques, and MR-guided reconstruction algorithm. We demonstrate enhancements in cortical definition and increased conspicuity of FCD in FDG-PET. The combined reconstruction approach provides a distinct advantage for PET/MR, thereby helping to realize the full potential of hybrid PET/MR systems.ABBREVIATIONS: FCD = focal cortical dysplasia; FWHM = full width at half maximum; OSEM = ordered subset expectation maximization; BSREM = block sequential regularized expectation maximization.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182287","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}