AJNR. American journal of neuroradiology最新文献

{"title":"Visualization of Nerve Pathology and Correlation with Clinical Severity in Bell's Palsy Using 3D Double-Echo Steady-State with Water Excitation Sequence.","authors":"Hiroyuki Fujii, Tomohiro Kikuchi, Nana Fujii, Emiko Chiba, Sota Masuoka, Akihiro Nakamata, Kohei Hamamoto, Mitsuru Matsuki, Harushi Mori","doi":"10.3174/ajnr.A8919","DOIUrl":"10.3174/ajnr.A8919","url":null,"abstract":"<p><strong>Background and purpose: </strong>Bell's palsy (BP) is the most common cause of facial nerve (FN) palsy. This study aimed to investigate the diagnostic ability of the 3D Double-Echo Steady-State with Water Excitation (3D-DESS-WE) sequence to visualize pathological changes in the FN of BP patients.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 30 BP patients who underwent 3T MRI including 3D-DESS-WE within 30 days of onset and 60 sex-and age±2-matched controls. Qualitative evaluation of FN signal intensity (SI_FN) and thickness (TH_FN) was performed using a 3-point scale. Quantitative metrics included SI_FN and TH_FN measurements and affected-to-unaffected ratios (SR_A/U and TR_A/U) in the BP group, and right-to-left ratios in controls. Interobserver agreement, group comparisons, correlations with clinical severity (Yanagihara score), and diagnostic performance were assessed. In a subset of 17 matched pairs, the diagnostic performance of contrast-enhanced T1WI (CE-T1WI) was assessed, and its agreement with 3D-DESS-WE-based qualitative assessment was evaluated.</p><p><strong>Results: </strong>Qualitative scores for SI_FN and TH_FN were significantly higher in the BP group than in controls (<i>P</i> < .001), with high interobserver agreement (κ = 0.810, 0.788, respectively). When dichotomized (score 0 vs. 1-2), qualitative assessments showed good diagnostic performance with sensitivity and specificity of 0.87 and 0.82 for SI_FN, and 0.90 and 0.80 for TH_FN, respectively. Neither qualitative score correlated significantly with clinical severity. Agreement between 3D-DESS-WE-based and CE-T1WI-based qualitative assessments was substantial to almost perfect (κ = 0.766-0.882). In quantitative analysis, both SI_FN and TH_FN were significantly higher on the affected side in the BP group (<i>P</i> < .001), whereas no significant lateral differences were observed in controls. Although SI_FN, TH_FN, and SR_A/U did not correlate significantly with clinical severity, TR_A/U was significantly inversely correlated with the Yanagihara score (r = -0.413, <i>P</i> = .02), which corresponds to a positive correlation with clinical severity. The Yanagihara score was the only independent predictor for TR_A/U in multiple regression analysis (β = -0.425, <i>P</i> = .04). ROC analysis showed high diagnostic performance: AUC = 0.908 for SR_A/U and 0.927 for TR_A/U.</p><p><strong>Conclusions: </strong>3D-DESS-WE may be a valuable tool for the routine clinical assessment of BP.</p><p><strong>Abbreviations: </strong>3D-DESS-WE＝3D Double-Echo Steady-State with Water Excitation; 3D-PSIF＝3D reversed fast imaging in steady-state free precession.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610543","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":"Uncommon Faces of Disc Herniation: Atypical Imaging Presentations and Mimics.","authors":"Maria-José Galante, Maria-Isabel Vargas, José Boto, Corrado Santarosa, Kevin Battistini, Daniele Botta, Karl-Olof Lövblad, Aikaterini Fitsiori","doi":"10.3174/ajnr.A8929","DOIUrl":"https://doi.org/10.3174/ajnr.A8929","url":null,"abstract":"<p><p>Disc herniation is a prevalent pathology encountered in routine clinical practice. Commonly observed pathological conditions such as disc protrusion, extrusion, migration, and sequestration are familiar to most radiologists and frequently documented in standard radiological reports. However, disc herniation can exhibit a broad spectrum of imaging features, which may pose diagnostic challenges for radiologists. This case-based review aims to present intriguing cases with atypical imaging presentations of disc herniation including extraforaminal herniation with a pseudotumoral appearance, massively calcified thoracic disc herniation, posttraumatic acute herniation, gas-containing disc herniation, cement leakage post vertebroplasty simulating disc herniation, and triple cervical disc treatment following sequential development of adjacent segment disease. By discussing their imaging features, we aim to facilitate the differential diagnosis of disc herniation from other entities and thus decrease the incidence of diagnostic errors. Additionally, we seek to provide a comprehensive visual resource that could be of significant educational value in daily clinical practice.ABBREVIATIONS: ACDF-Anterior Discectomy and Fusion, ASD-Adjacent Segment Disease, ASNR -American Society of Neuroradiology, ASSR-American Society of Spine Radiology, NASS-North American Spine Society, PET-CT -Positron Emission Tomography -Computed Tomography, HU -Hounsfield Units, PNST -Peripheral Nerve Sheath Tumors.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610542","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":"Photon-Counting Detector CT for Lenticulostriate Arteries: Comparison with Energy-Integrating Detector CT and Reconstruction Mode Optimization.","authors":"Wentian Tang, Wenjing Li, Yane Zhao, Jiliang Chen, Yingqian Ge, Dongsheng Jin, Song Luo, Guangming Lu","doi":"10.3174/ajnr.A8917","DOIUrl":"https://doi.org/10.3174/ajnr.A8917","url":null,"abstract":"<p><strong>Background and purpose: </strong>This study aimed to conduct a preliminary comparison of the visualization of lenticulostriate arteries (LSAs) in head and neck photon-counting detector computed tomography angiography (PCD-CTA) with four reconstruction modes.</p><p><strong>Materials and methods: </strong>This retrospective study included patients who underwent head and neck CTA with PCD-CT between January 2024 and May 2024 and those who underwent CTA with energy-integrating detector CT (EID-CT) between September 2023 and May 2024. The images were reconstructed in four modes for the PCD-CT group and one mode for the EID-CT group. The image quality was evaluated, and the LSAs were visualized using subjective evaluations and quantitative assessments. The Friedman test was used to compare the characteristics of the four reconstruction modes.</p><p><strong>Results: </strong>The PCD-CT group comprised 56 patients (average age 65 ± 14 years; 28 males), and the EID-CT group comprised 28 patients (average age, 64 ± 12 years; 14 males). In the PCD-CT group, the 0.2-mm-slice-thickness threshold 3 dimension (T3D) mode displayed the highest counts of LSAs (right side: 4.00 [range, 3.00-4.00]; left side: 4.00 [range, 3.00-4.00]) and the longest LSAs (right side: 23.33 ± 4.86 mm; left side: 24.18 ± 4.51 mm). The 0.4-mm-slice-thickness vascular spectral postprocessing (VSPP) mode obtained higher subjective evaluation scores. Furthermore, the PCD-CT group exhibited a higher count of LSAs, longer LSA lengths, and superior image quality than the EID-CT group.</p><p><strong>Conclusions: </strong>PCD-CT achieves better visualization of LSAs and image quality than EID-CT and therefore constitutes an important method for observing LSAs in the future.</p><p><strong>Abbreviations: </strong>PCD-CTA＝ photon-counting detector computed tomography angiography; LSAs＝ lenticulostriate arteries; EID-CT＝ energy-integrating detector CT; T3D＝ threshold 3 dimension; VSPP＝ vascular spectral postprocessing; CSVD＝ progression of cerebral small vessel disease; ICAD＝ intracranial atherosclerotic disease; UHR＝ ultra-high-resolution; QIR＝ quantum iterative reconstruction; ROI＝ region of interest; HU＝ hounsfield units; SNR＝ signal-to-noise ratio; CNR＝ contrast-to-noise ratio; FWHM＝ full width of half maximum; MIP＝ maximum intensity projection; CPR＝ curved planar reformation; ICC＝ intraclass correlation coefficient.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610527","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":"Slice-to-Volume Reconstruction of Fetal Brain MR Imaging in Clinical Practice.","authors":"Usha D Nagaraj, Joshua S Greer, Pradipta Debnath, Jean A Tkach, Beth M Kline-Fath","doi":"10.3174/ajnr.A8728","DOIUrl":"https://doi.org/10.3174/ajnr.A8728","url":null,"abstract":"<p><p>Slice-to-volume reconstruction (SVR) is used to generate 3D isotropic high-resolution MR images from multiple 2D stacks to correct for fetal motion. The purpose of this study is to develop an automated SVR pipeline for integration into clinical workflow. This prospective, institutional review board-approved study included pregnant women undergoing fetal MRI. In addition to standard of care (SOC), which includes 2D T2-single-shot fast spin echo (SSFSE) contiguous images at 3-4 mm slice thickness, 2D T2-SSFSE images at 2.5 mm with 1.25 mm overlap in 5 imaging planes were obtained as inputs. Twenty-two patients (29.3 ± 5.7 weeks gestational age) were included. Though scan time alone was not significantly different between SOC (8.9 ± 2.9 minutes) versus SVR (9.3 ± 1.7 minutes, <i>P</i> = .5), the total examination time to include time between sequences was significantly longer for the SOC (17.2 ± 8.2 minutes) compared with SVR (10.9 ± 1.8 minutes, <i>P</i> = .001). Overall image quality, degree of noise/artifacts, and ability to obtain 2D measurements were all rated significantly higher for SVR compared with SOC (<i>P</i> < .05). SVR has the potential to improve image quality when compared with SOC in the fetal brain without increasing scan time.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610541","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 Role of Brain PET in Alzheimer Disease in the Era of Disease-Modifying Therapies.","authors":"Ana M Franceschi, Graham Keir, Tammie L S Benzinger, Petrice M Cogswell, Farzana Z Ali, Jeffrey R Petrella, Jeffrey W Prescott, Christopher T Whitlow, Greg Zaharchuk, Jason W Allen","doi":"10.3174/ajnr.A8738","DOIUrl":"https://doi.org/10.3174/ajnr.A8738","url":null,"abstract":"<p><p>Alzheimer disease (AD) is the leading cause of dementia, with an estimated 6.9 million Americans aged 65 and older living with Alzheimer dementia today, with this number projected to grow to 13.8 million by 2060. Amyloid and τ accumulation underpin our understanding of the pathophysiology of AD, with the abnormal accumulation of these proteins leading to neurodegeneration. With the recent approval of antiamyloid monoclonal antibody therapies for patients with early-stage Alzheimer disease by the Food and Drug Administration, there is renewed energy and focus on brain imaging for diagnosis, triage, and monitoring of patients with neurodegenerative disease. Furthermore, PET imaging of amyloid and τ has revolutionized our understanding of dementia progression and staging, and influences patient management in the clinical setting. We aim to update radiologists on the evolving role of amyloid and τ PET in clinical practice, emphasizing the need for standardized workflows and the integration of molecular imaging data with other disease biomarkers. We also discuss the clinical implications of amyloid and τ PET, including their impact on diagnosis and treatment decisions, as well as the challenges of reimbursement and workforce capacity. With recent shifts in the AD management landscape, it is crucial for radiologists to keep abreast of recent advances in clinical practice, thereby ensuring effective patient care.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610526","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":"Cavernous Sinus Dural Arteriovenous Fistula: Treatment via the Transfemoral Transfacial Route.","authors":"Alexandru Dimancea, Anca Hasiu, Raoul Pop","doi":"10.3174/ajnr.A8878","DOIUrl":"https://doi.org/10.3174/ajnr.A8878","url":null,"abstract":"<p><p>Cavernous sinus dural arteriovenous fistulas (dAVFs) are most frequently treated by a transvenous approach via the inferior petrosal sinus (IPS). However, in certain patients, the IPS is not amenable to navigation. In this technical video, we present the case of a patient with a cavernous sinus dAVF embolized by the transfemoral transfacial venous route on a failed attempt to catheterize the IPS. Preprocedural head and neck imaging was performed, documenting the facial vein draining to the internal jugular vein via the common facial vein on the side of the fistula. Embolization was accomplished without complications, with complete exclusion of the fistula. We suggest that treatment via the transfemoral transfacial venous pathway should be attempted and followed through whenever the IPS is not amenable to catheterization, on the basis of favorable preprocedural anatomy and the safety and efficacy demonstrated in several published case series.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610525","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":"Safety of emergent intracranial stenting after thrombolysis: a multicenter matched analysis.","authors":"Andrea M Alexandre, Luca Scarcia, Arturo Consoli, Wen Sun, Yingjie Xu, Xianjun Huang, Charlotte Chung, Alessandro Sgreccia, Mohamad Abdalkader, Nicola Limbucci, Alessandro Pedicelli, Davide De Leoni, Maria P Ganimede, Chiara Gaudino, Riccardo Russo, Chrysanthi Papagiannaki, Roberta Partesano, Nicolò Mandruzzato, Joseph D Gabrieli, Pietro Panni, Andrea Zini, Frédéric Clarençon, Eytan Raz, Thanh N Nguyen, Aldobrando Broccolini","doi":"10.3174/ajnr.A8918","DOIUrl":"https://doi.org/10.3174/ajnr.A8918","url":null,"abstract":"<p><strong>Background and purpose: </strong>In patients with acute large vessel occlusion (LVO) of the MCA and underlying intracranial artery stenosis (ICAS), rescue stenting (RS) has been associated with better angiographic outcomes and higher rates of functional independence compared to mechanical thrombectomy (MT) alone. However, uncertainty exists regarding safety of RS in patients at higher risk for intracranial bleeding.The primary aim of this retrospective multicenter study was to compare safety outcomes between patients with acute ICAS-LVO of the MCA who underwent MT and RS with or without prior intravenous thrombolysis (IVT). Efficacy outcomes were assessed as a secondary aim.</p><p><strong>Methods: </strong>We screened the prospective databases of 26 stroke centers across Europe, the United States, and China for consecutive patients with acute MCA ICAS-LVO who received RS. Patients were divided into two groups based on prior administration of IVT: IVT/RS and no-IVT/RS. Propensity score matching (PSM), based on a set of covariates that also included peri-procedural antiplatelet therapies, was used to estimate the effect of IVT treatment. Primary safety outcomes were the occurrence of symptomatic intracranial hemorrhage (sICH) and 90-day mortality.</p><p><strong>Results: </strong>After PSM, 52 pairs of patients were available for analysis. No significant differences were observed between the two groups regarding rates of sICH (11.5% in IVT/RS group vs. 9.6% in no-IVT/RS group, OR 1.2, 95% CI 0.4-4.3, p = 0.75) and 90-day mortality (14.3% in the IVT/RS group vs. 11.7% in the no-IVT/RS group, OR 1.3, 95% CI 0.4-4.2, p = 0.71). There were also no significant differences in the occurrence of parenchymal hemorrhage types 1 and 2, successful recanalization rates and 90-day functional outcome.</p><p><strong>Conclusions: </strong>The safety of RS in ICAS-LVO is not significantly affected by prior IVT administration. Furthermore, IVT does not result in improved recanalization and clinical outcome. These findings should be interpreted with caution and require validation through future randomized controlled studies.</p><p><strong>Abbreviations: </strong>MT＝ mechanical thrombectomy; LVO＝ large vessel occlusion; ICAS = intracranial artery stenosis; RS = rescue stenting; IVT = intravenous thrombolysis; sICH = symptomatic intracranial Hemorrhage; PH = parenchymal hematoma; SD = standard deviation; IQR = interquartile range; PSM = propensity score matching; SMD = standardized mean difference; OTG = onset-to-groin; GPI = glycoprotein IIb/IIIa inhibitors.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610528","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":"Irregular Cervicothoracic Nerve Sheaths on Digital Subtraction Myelography: A CSF-Venous Fistula Mimic.","authors":"Asmita S Patel, Jared T Verdoorn, Ajay A Madhavan, John C Benson, Waleed Brinjikji, Ben A Johnson-Tesch, Parnian Habibi, Ian T Mark","doi":"10.3174/ajnr.A8892","DOIUrl":"10.3174/ajnr.A8892","url":null,"abstract":"<p><strong>Background and purpose: </strong>Spontaneous intracranial hypotension (SIH) can be caused by cerebrospinal fluid-venous fistulas (CVFs), which often require a specialized lateral decubitus exam such as digital subtraction myelography (DSM) for diagnosis. DSM interpretations can be confounded by irregular nerve sheath diverticula at the cervicothoracic junction, potentially mimicking a true CVF. This study aimed to characterize anatomic variations of nerve sheaths at the cervicothoracic junction, in effort to reduce the risk of misdiagnosis.</p><p><strong>Materials and methods: </strong>We retrospectively identified 35 patients with low-risk Bern scores who were negative for CVF on DSM. Nerve sheaths at C6-C7, C7-T1, and T1-T2 were classified as normal (<5 mm), elongated linear (≥5 mm), linear-bulbous, linear-branching, or diverticular. Results were obtained on both the left and right side for each patient.</p><p><strong>Results: </strong>Data was obtained for 34 patients. Among these, 74% (25/34) demonstrated at least one variant nerve sheath configuration. The most common site of variation was C7-T1 on the right (seen in 55%, 18/33), and the most frequent morphologic variant overall was an elongated linear sheath (28/198 levels; 40% of all variants).</p><p><strong>Conclusions: </strong>Nerve sheath morphology at the cervicothoracic junction is frequently irregular, and these variants can resemble a CVF on DSM. Recognizing such normal anatomic variations is essential to avoid unwarranted interventions for suspected CVF in patients evaluated for SIH.</p><p><strong>Abbreviations: </strong>CV<b>F</b> = CSF-venous fistula, <b>DSM</b> = Digital subtraction myelography, <b>SIH</b>＝ Spontaneous intracranial hypotension.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478208","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":"Deep Learning based Collateral Scoring on Multi-Phase CTA in patients with acute ischemic stroke in MCA region.","authors":"Hao Liu, Jianhai Zhang, Shengcai Chen, Aravind Ganesh, Yang Xu, Bo Hu, Bijoy K Menon, Wu Qiu","doi":"10.3174/ajnr.A8911","DOIUrl":"https://doi.org/10.3174/ajnr.A8911","url":null,"abstract":"<p><strong>Background and purpose: </strong>Collateral circulation is a critical determinant of clinical outcomes in acute ischemic stroke (AIS) patients and plays a key role in patient selection for endovascular therapy. This study aimed to develop an automated method for assessing and quantifying collateral circulation on multi-phase CT angiography, aiming to reduce observer variability and improve diagnostic efficiency.</p><p><strong>Materials and methods: </strong>This retrospective study included mCTA images from 420 AIS patients within 14 hours of stroke symptom onset. A deep learning-based classification method with a tailored preprocessing module was developed to assess collateral circulation status. Manual evaluations using the simplified Menon method served as the ground truth. Model performance was assessed through five-fold cross-validation using metrics including accuracy, F1 score, precision, sensitivity, specificity, and the area under the receiver operating characteristic curve.</p><p><strong>Results: </strong>The median age of the 420 patients was 73 years (IQR: 64-80 years; 222 men), and the median time from symptom onset to mCTA acquisition was 123 minutes (IQR: 79-245.5 minutes). The proposed framework achieved an accuracy of 87.6% for three-class collateral scores (good, intermediate, poor), with F1 score (85.7%), precision (83.8%), sensitivity (89.3%), specificity (92.9%), AUC (93.7%), ICC (0.832), and Kappa (0.781). For two-class collateral scores, we obtained 94.0% accuracy for good vs. non-good scores (F1 score(94.4%), precision (95.9%), sensitivity (93.0%), specificity (94.1%), AUC (97.1%),ICC(0.882),kappa(0.881)) and 97.1% for poor vs. non-poor scores (F1 score (98.5%), precision (98.0%), sensitivity (99.0%), specificity (84.8%), AUC (95.6%), ICC(0.740), kappa(0.738)). Additional analyses demonstrated that multi-phase CTA showed improved performance over single or two-phase CTA in collateral assessment.</p><p><strong>Conclusions: </strong>The proposed deep learning framework demonstrated high accuracy and consistency with radiologist-assigned scores for evaluating collateral circulation on multi-phase CTA in AIS patients. This method may offer a useful tool to aid clinical decision-making, reducing variability and improving diagnostic workflow.</p><p><strong>Abbreviations: </strong>AIS = Acute Ischemic Stroke; mCTA = multi-phase Computed Tomography Angiography; DL = deep learning; AUC = area under the receiver operating characteristic curve; IQR = interquartile range; ROC = receiver operating characteristic.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585848","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 clinical and radiological factors on CT-Perfusion timing in acute ischemic stroke.","authors":"B Proner, V Vingiani, R Valletta, T Gorgatti, A Posteraro, E Dall'Ora, E Franchini, G Zamboni, M Bonatti","doi":"10.3174/ajnr.A8904","DOIUrl":"https://doi.org/10.3174/ajnr.A8904","url":null,"abstract":"<p><strong>Background and purpose: </strong>To assess the impact of radiological and clinical variables on brain CT-perfusion (CTP) curves in patients with acute ischemic stroke.</p><p><strong>Materials and methods: </strong>IRB-approved retrospective observational cohort study, need for informed consent was waived. We included 295 patients who underwent CTP for acute ischemic stroke in our Institution (Jan2020-Mar2024). Two radiologist evaluated arterial input function (AIF) and reference vessel (RefV) curves to assess bolus arrival delay and time to equilibrium; discrepancies were resolved by consensus. Additionally, they evaluated the unenhanced brain CTs acquired before CTP for the presence of microangiopathy (van Swieten scale) and intracranial arterial wall calcifications (yes/no). CT-Angiography was evaluated for the site of occlusion. Age, sex, arterial blood pressure, heart rate, presence of arrhythmias, and NIHSS were retrieved from an institutional database. A univariate analysis was performed to establish significant variables; variables with a P value <0.1 in the univariate analysis were subsequently included in a multivariate logistic regression model to adjust for potential confounding factors.</p><p><strong>Results: </strong>Logistic regression identified cardiac arrhythmias and increasing age as independent predictors of non-diagnostic perfusion CT exams (p < 0.001). Other factors, including arterial calcifications, white-matter lesions, NIHSS score, and large vessel occlusion, were not significantly associated with non-diagnostic outcomes. Logistic regression analysis revealed that the arterial time-to-peak value was significantly associated with the presence of cardiac arrhythmias (p<0.0001), with higher time-to-peak values observed among patients with arrhythmias (24.0s; IQR 20.2 -27.1s) compared to those without (18.6s; IQR 15.5 -21.7s). Similarly, the venous time-to-peak was found to be longer in patients with cardiac arrhythmias (median 30.2s; IQR 26.4 -32.0s) compared to those without (25.6s; IQR 22.5 -28.7s), p<0.0001.</p><p><strong>Conclusions: </strong>Our study showed that patients with cardiac arrhythmias need longer CTP acquisition times to avoid perfusion curve truncation and potentially non-diagnostic results. The knowledge of the impact of clinical variables on CTP may help better tailor the acquisition delays to improve diagnostic quality and avoid unnecessary radiation doses.</p><p><strong>Abbreviations: </strong>AIS = acute ischemic stroke; AIF = arterial input function; RefV = reference vessel curve; LVO = Large Vessel Occlusion; IQR = interquartile range.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585850","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}