AJNR. American journal of neuroradiology最新文献

{"title":"Carotid Body Detection Rate and Size on Photon-Counting Versus Energy-Integrating Detector CT.","authors":"Robert H Unger, Elly Arizono, Karen Buch, Osamu Sakai","doi":"10.3174/ajnr.A9684","DOIUrl":"https://doi.org/10.3174/ajnr.A9684","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the carotid body (CB) detection rate and size measured on photon-counting CT (PCCT) versus energy-integrating detector CT (EIDCT), and to evaluate the effects of laterality and contrast phase.</p><p><strong>Methods: </strong>This retrospective study was conducted at a single institution on 48 adult patients who underwent head and neck CTA on both PCCT and EIDCT on arterial and venous phase imaging. CB detection was analyzed as a binary outcome using a mixed-effects logistic regression model with modality, phase, side, and modality-by-phase interaction as fixed effects, and patient as a random effect. CB size was analyzed using a linear mixed-effects model with the same fixed effects and patient as a random effect. Sensitivity analysis for CB size adjusted for age, sex, and hypertension.</p><p><strong>Results: </strong>CB detection rates were higher on PCCT than on EIDCT, particularly on the right side (arterial, 96% vs 77%; venous, 96% vs 82%), and slightly higher on the left side (arterial, 85% vs 81%; venous, 83% vs 82%). In mixed-effects logistic regression, PCCT was associated with higher odds of CB detection than EIDCT (OR, 3.97; P = .009). CB size was significantly smaller when measured on PCCT than on EIDCT (estimated difference, -2.7 mm³; P = .01). The right CB was larger than the left across modalities (estimated difference, +4.7 mm³; P < .001). There was no significant difference in CB measurements between arterial and venous phases (P = .53), and no significant modality-by-phase interaction (P = .98). In sensitivity analysis, the modality and side effects remained significant after adjustment for age, sex, and hypertension.</p><p><strong>Conclusion: </strong>PCCT improves CB detection compared with EIDCT but yields smaller CB measurements. CB size is greater on the right than on the left, with minimal effect of contrast phase. These findings remained robust after adjustment for age, sex, and hypertension.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225510","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":"Transcranial Focused Ultrasound: Established and Emerging Applications in Neurosciences.","authors":"Phuong Nguyen, Timothy J Kaufmann, Lubdha M Shah, Bhavya R Shah, Leo P Sugrue, Jody Tanabe","doi":"10.3174/ajnr.A9685","DOIUrl":"https://doi.org/10.3174/ajnr.A9685","url":null,"abstract":"<p><p>Transcranial MR-guided high-intensity focused ultrasound (HIFU) thermoablation is an established incisionless image-guided treatment for movement disorders; however, neuroradiologist involvement in clinical decision-making and procedural workflows is highly variable and site-specific. Transcranial low-intensity focused ultrasound (LIFU) is a rapidly evolving non-invasive, image-guided technology for neuromodulation and blood-brain barrier disruption. Compared with HIFU, the optimal protocol, therapeutic mechanism, and safety limits remain uncertain for LIFU. Despite these gaps, LIFU has significant potential for neuropsychiatric and neuro-oncologic diseases. Familiarity with transcranial ultrasound principles and the pivotal role of CT and MR imaging for targeting and evaluating outcomes is increasingly important for neuroradiologists. This review uses HIFU as a clinical model to illustrate the integration of imaging into focused ultrasound workflows. We then discuss LIFU with respect to technical factors, imaging considerations, safety, and limitations. We highlight its emerging applications, including neuromodulation, targeted drug delivery, and liquid biopsy. Finally, we conclude by summarizing key knowledge gaps, outlining future directions, and proposing strategies to more actively engage neuroradiologists in this emerging field.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225476","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":"Black Belt Sign on Diluted Contrast 3D Rotational Angiography as a Potential Neointimal Marker Associated with Intracranial Aneurysm Occlusion after Flow Diversion.","authors":"Shuhei Egashira, Yusuke Hamada, Satoru Kawauchi, Shogo Yoda, Yuta Otomo, Satoshi Miyamoto, Jun Isozaki, Daiichiro Ishigami, Wataro Tsuruta","doi":"10.3174/ajnr.A9343","DOIUrl":"10.3174/ajnr.A9343","url":null,"abstract":"<p><strong>Background and purpose: </strong>Neointimal formation at the aneurysm neck is essential after flow diverter (FD) treatment; however, reliable imaging markers are lacking. The white collar sign (WCS), an established endothelialization marker after coil embolization, is paradoxically associated with incomplete occlusion after flow diversion. We aimed to propose the black belt sign (BBS), an endoluminal bandlike filling defect on 3D rotational angiography (3DRA), as a neointimal marker, determine the optimal imaging technique, and assess its association with aneurysm occlusion.</p><p><strong>Materials and methods: </strong>This single center, retrospective cohort study included consecutive patients who underwent FD placement from April 2015 to December 2024, completed 6- and 12-month followups, and underwent diluted 3DRA, pure 3DRA, and high-resolution conebeam CT at 6-months. Three blinded assessors graded the 6-month BBS (none, partial, full). The optimal technique was determined by interrater reliability. The BBS stage was compared across 6-month O'Kelly-Marotta (OKM) grades using the Cochran Armitage test. Among 6-month incompletely occluded aneurysms, 12-month complete occlusion rates were compared by BBS stage, and risk ratios were estimated using modified Poisson regression with cluster robust SEs at the patient level. The WCS on 6-month 2D DSA was recorded, and detection rates were examined across BBS stages and OKM grades.</p><p><strong>Results: </strong>We analyzed 142 aneurysms in 123 patients. Diluted 3DRA showed superior interrater reliability (mean of all pair-wise weighted Cohen κ values [Light's κ] = 0.82). The predominant BBS stage transitioned from none to partial to full as the 6-month OKM grades improved (none/partial/full: OKM A, 62/38/0%; B, 25/75/0%; C, 3/59/38%; D, 1/7/91%, respectively; <i>P</i> for trend < .01). Among the 61 incompletely occluded aneurysms at 6-months, the 12-month complete occlusion rates were 10% for none-BBS, 22% for partial BBS, and 71% for full BBS. Compared with none-BBS, the risk ratio for 12-month occlusion was 2.16 (95% CI, 0.30-15.5) for partial BBS and 7.14 (95% CI, 1.07-47.8) for full BBS. The WCS was most frequent in aneurysms with partial BBS and OKM grade B (75%).</p><p><strong>Conclusions: </strong>Diluted 3DRA was identified as the optimal technique. The BBS aligned with the concurrent aneurysm occlusion status and predicted subsequent complete occlusion, supporting its potential as a neointimal biomarker after FD treatment. The WCS may reflect immature neointimal formation after flow diversion.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679135","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":"Histologically Validated Ex Vivo Characterization of Intraplaque Hemorrhage and Lipid Components Using Quantitative Susceptibility Mapping.","authors":"Ayano Ishiyama, Hideki Ishimaru, Shinji Okano, Yohei Ikebe, Tsuyoshi Izumo, Yoichi Morofuji, Minoru Morikawa, Reiko Ideguchi, Ryo Toya","doi":"10.3174/ajnr.A9335","DOIUrl":"10.3174/ajnr.A9335","url":null,"abstract":"<p><strong>Background and purpose: </strong>Accurate characterization of carotid plaque components is essential for stroke risk assessment. Intraplaque hemorrhage (IPH) is a well-established marker of plaque vulnerability, whereas lipid-rich necrotic cores (LRNCs) often show overlapping signal characteristics with IPH on conventional MRI. The purpose of this study was to compare quantitative susceptibility mapping (QSM) with conventional MRI in differentiating IPH and lipid components in carotid plaques using ex vivo histologic validation.</p><p><strong>Materials and methods: </strong>Twenty-four carotid plaque specimens obtained by en bloc excision during carotid endarterectomy between October 2017 and August 2021 were examined. All specimens underwent ex vivo MRI at 3T, including T1WI, T2WI, and TOF-equivalent FLASH, as well as QSM reconstructed from multiecho FLASH phase data. After MRI, specimens were serially sectioned and stained using H&E and immunohistochemical techniques. ROIs corresponding to histologically confirmed IPH and lipid components were delineated on MRI by consensus of 2 radiologists. On conventional MRI, signal intensities were measured in corresponding histologic regions, and contrast-to-noise ratios (CNRs) were calculated relative to surrounding agarose gel. On QSM, absolute magnetic susceptibility values were measured in the same regions. The difference between plaque tissue and the surrounding agarose gel was defined as the relative susceptibility value (rSV), which was used for statistical analysis. CNRs and rSVs among plaque components were compared using the Kruskal-Wallis test, followed by the Steel-Dwass test for pair-wise comparisons.</p><p><strong>Results: </strong>Seventy-nine matched cross-sectional slices were analyzed, yielding 24 IPH, 61 LRNCs, and 13 foam-cell aggregates (FAs). No significant difference in CNR was observed between IPH and LRNC on T1WI or FLASH. Histopathologic analysis demonstrated that many LRNCs exhibited erythrocyte-derived remnants consistent with prior hemorrhagic events. FAs showed lower CNRs than IPH on T1WI and FLASH (<i>P</i> < .05). On T2WI, IPH showed lower CNRs than LRNCs or FAs (<i>P</i> < .05). On QSM, IPH demonstrated higher rSVs than LRNCs or FAs (<i>P</i> < .01).</p><p><strong>Conclusions: </strong>Histologic validation demonstrates that many LRNCs contain erythrocyte remnants, which may contribute to their overlapping signal characteristics with IPH on conventional MRI. QSM captures erythrocyte-derived susceptibility effects within plaques and provides complementary susceptibility-based information not available from conventional MRI.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639807","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":"Novel Neuroimaging Biomarker of Cortical Gray/White Border Integrity in Blast-Related Mild Traumatic Brain Injury.","authors":"V Carlota Andreu Arasa, Francesca C Fortenbaugh, Aubrey A Knoff, Catherine B Fortier, William P Milberg, David H Salat","doi":"10.3174/ajnr.A9347","DOIUrl":"10.3174/ajnr.A9347","url":null,"abstract":"<p><strong>Background and purpose: </strong>Recent studies suggest that blast or mid-impact neurotrauma are characterized by scar-border forming astrogliosis at the gray-white matter junction. Individuals with mild traumatic brain injury (mTBI) and blast trauma have increased neuroinflammation and impairment of axonal remyelination on postmortem histopathology. However, there are currently only limited methodologies to use in the assessment of the cortical gray/white interface using in vivo neuroimaging. The purpose was to investigate the gray-white matter contrast (GWC) at the gray-white matter junction that may be linked to neuroinflammation/astrogliosis in the setting of blast exposure and/or mTBI, through 3D T1-weighted MPRAGE images.</p><p><strong>Materials and methods: </strong>Post-9/11 veterans (<i>n</i>=723) from the Translational Research Center for TBI and Stress Disorders completed MRI. Participants were grouped into 4 categories: participants with a history of blast-related mTBI (blast-mTBI), participants with a history of mTBI due to other mechanical forces (blunt-mTBI), participants with a history of close blast exposure but no mTBI, and those without a history of lifetime mTBI or close blast exposure. MRI data processing for morphometry and cortical surface mapping was done using FreeSurfer image analysis. Signal intensities in gray and white matter along the cortical and white matter interface were used to calculate mean GWC value.</p><p><strong>Results: </strong>Veterans in the blast-mTBI group showed diffuse patterns of increased GWC relative to the other groups, particularly in the frontotemporal lobes. This effect was driven primarily by a greater number of high GWC regions in the blast-mTBI group compared with the no-neurotrauma and blunt-mTBI groups.</p><p><strong>Conclusions: </strong>There was diffuse increased GWC on MR in the blast-mTBI group compared with the no-neurotrauma, close blast exposure, and blunt-mTBI groups. These findings may be linked to astrogliosis and neuroinflammation in patients with blast-mTBI. Histopathologic correlation with imaging findings will be necessary to better understand these effects.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679307","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":"Quantitative Perihematomal Imaging Analysis for the Prediction of Intracerebral Hematoma Expansion.","authors":"Yuval Wiesel, Michael Findler, Jonathan Naftali, Asaf Honig, Rani Barnea, Eitan Auriel","doi":"10.3174/ajnr.A9334","DOIUrl":"10.3174/ajnr.A9334","url":null,"abstract":"<p><strong>Background and purpose: </strong>Hematoma expansion (HE) is a major cause of early neurologic deterioration and poor outcome in spontaneous intracerebral hemorrhage. The perihematomal region (PHR), a potential site of secondary vascular injury, remains poorly characterized. We evaluated whether quantitative PHR features provide predictive information for HE beyond hematoma features and insight into HE dynamics.</p><p><strong>Materials and methods: </strong>In this retrospective 2-center study, 149 patients with acute intracerebral hemorrhage underwent baseline CT within 24 hours of symptom onset and follow-up CT within 72 hours. HE was defined as >6 mL or >33% hematoma growth on follow-up CT. Hematoma regions and PHRs were segmented using relative (half and full radius) and absolute (2, 5, and 10 mm) definitions. Radiomic features were extracted and modeled using multivariable logistic regression. Clinical predictors were added to create combined clinical radiomic models, and performance was evaluated on an independent test set.</p><p><strong>Results: </strong>HE occurred in 29% (44/149) of patients. The hematoma only radiomic model showed modest discrimination (area under the receiver operating characteristic curve [AUROC] = 0.71; 95% CI, 0.62-0.80). Incorporating PHR features improved performance, with the absolute 5-mm PHR model achieving the highest discrimination (AUROC = 0.91; 95% CI, 0.86-0.95). Adding clinical predictors further enhanced performance (AUROC = 0.94; 95% CI, 0.90-0.97). Key PHR features associated with HE included reduced sphericity, increased texture coarseness, and clustered heterogeneity.</p><p><strong>Conclusions: </strong>Quantitative PHR characterization was strongly associated with HE and provided incremental value beyond hematoma derived radiomics, with further improvement when combined with clinical predictors. This contrast-free approach may support objective risk stratification, guide targeted interventions, and reduce expansion related morbidity.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640124","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 Presentation, Misdiagnosis, and Imaging Findings of Anterior Disc Herniations.","authors":"Ola A E Mohamed, Sevda Alipour Khabir, Parnian Habibi, Carrie M Carr, Ethan A Thonn, Ben Johnson-Tesch, Steven A Messina, Ian T Mark","doi":"10.3174/ajnr.A9379","DOIUrl":"10.3174/ajnr.A9379","url":null,"abstract":"<p><p>Anterior and anterolateral lumbar disc herniations are uncommon and usually do not present with classic radicular symptoms. This contributes to a broader and sometimes misleading differential diagnosis based on the initial presentation. When identified on cross-sectional imaging performed for nonspinal indications, displaced disc material can be mistaken for a retroperitoneal mass, potentially prompting additional imaging or invasive evaluation. We report 6 cases of anterior and anterolateral disc herniations identified on CT and MRI, including some patients presenting with abdominal or flank pain. Imaging demonstrated anterior disc extrusion, some with marked inflammatory changes. In some cases, the initial diagnosis included retroperitoneal neoplasm or an inflammatory process. Recognizing this imaging pattern and its clinical context may help accurate diagnosis, avoid unnecessary procedures, and guide appropriate management.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791672","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":"Concordance and Association of Kidokoro MRI Scores at 32 and 40 Weeks Postmenstrual Age with Neurodevelopmental Outcomes in Very Preterm Infants.","authors":"Linda Bonezzi, Tommaso Biagioni, Simona Fiori, Carly Luke, Joanne M George, Paul B Colditz, Jurgen Fripp, Robert S Ware, Kerstin Pannek, Roslyn N Boyd","doi":"10.3174/ajnr.A9350","DOIUrl":"10.3174/ajnr.A9350","url":null,"abstract":"<p><strong>Background and purpose: </strong>Early identification of neurodevelopmental risk in very preterm infants is critical for timely intervention. The Kidokoro MRI scoring system offers a semiquantitative approach to evaluating brain abnormalities. This study aimed to assess the agreement of Kidokoro scores obtained in the same infants at 32 and 40 weeks postmenstrual age, and their association to cognitive, language, and motor outcomes at 24 months corrected age.</p><p><strong>Materials and methods: </strong>A cohort of 187 very preterm infants (median 28⁺⁵ weeks gestational age; 55% boys) underwent structural MRI at 2 time points: early (median 32⁺² weeks) and term-equivalent age (TEA; median 40⁺⁵ weeks), using 3T scanners. Scans were scored independently using a modified version of the Kidokoro system. Bland-Altman analysis assessed agreement between early and TEA scores. Neurodevelopmental outcomes were assessed at 24 months using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Multivariable linear regression models evaluated the predictive value of MRI scores, adjusting for sex, gestational age, birth weight centile, and socioeconomic status.</p><p><strong>Results: </strong>Early MRI scores were consistently higher than TEA scores (mean difference: 1.9; 95% CI, 1.6-2.2), with WM scores showing the largest discrepancy (mean difference: 1.68; 95% CI, 1.46-1.90), primarily due to the myelination delay item. Excluding this item reduced the difference to 0.32 (95% CI, -0.01 to 0.64). Early and TEA Kidokoro Global Brain Abnormality Score (GBAS) were negatively associated with Bayley-III cognitive and motor, but not language scores. Higher GBAS were associated with lower cognitive (early: β = -0.67 [95% CI, -1.23 to -0.11], partial <i>R</i> ² = 0.03; TEA: β = -0.60 [95% CI, -1.15 to -0.06], partial <i>R</i> ² = 0.03) and motor scores (early: β = -1.04 [95% CI, -1.67 to -0.41], partial <i>R</i> ² = 0.06; TEA: β = -1.18 [95% CI, -1.78 to -0.58], partial <i>R</i> ² = 0.08). Reduction in GBAS from early to TEA correlated with higher motor scores (β = 1.02 [95% CI, 0.03-2.02], partial <i>R</i> ² = 0.02). WM abnormalities were linked to poorer motor outcomes at both time points.</p><p><strong>Conclusions: </strong>Kidokoro scores at early and term-equivalent time points are associated with neurodevelopmental outcomes at 24 months. Global abnormalities and WM scored at either time points, or their longitudinal changes are significantly linked to motor outcomes. Refinement of the scoring system for the early assessment may enhance clinical utility.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694170","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":"Dual-Lumen Balloon Assisted Onyx Embolization of Middle Meningeal Artery for Chronic Subdural Hematoma.","authors":"Abraham Madjidov, Varun Naragum, Dennis Oh, Kamal Kalia, Huanwen Chen, Jay Gutta, Dheeraj Gandhi","doi":"10.3174/ajnr.A9678","DOIUrl":"https://doi.org/10.3174/ajnr.A9678","url":null,"abstract":"<p><strong>Background and purpose: </strong>Middle meningeal artery embolization (MMAE) with liquid embolic agents (LEAs) is increasingly used to manage chronic subdural hematoma (CSDH). Conventional microcatheters require distal wedge positioning of the microcatheter tip or proximal plug formation to prevent reflux and achieve effective distal penetration. Dual-lumen balloon microcatheters limit reflux and enable controlled LEA injection, which may improve procedural efficiency. The evidence base for dual-lumen balloons in CSDH is limited.</p><p><strong>Materials and methods: </strong>This single-center retrospective study included consecutive adults with CSDH treated from December 2021 to September 2025. The Scepter XC dual-lumen balloon microcatheter was used to arrest antegrade flow and control Onyx-18 delivery, first distal to the anterior branch origin and then from the MMA trunk into the posterior branch. Outcomes included >50% hematoma thickness reduction and complete resolution on computed tomography (CT), recurrence, retreatment, complications, hospital stay, and procedure time.</p><p><strong>Results: </strong>152 patients were identified; 33 (21.7%) underwent concomitant surgery and 108 (71.1%) standalone MMAE. Median follow-up was 3 months. This technique achieved >50% hematoma thickness reduction in 90.4% and complete resolution in 70.6% at 3 months or last follow-up. There were no serious adverse events definitely associated with the dual-lumen balloon technique. Overall postprocedural complications occurred in 4 patients (2.6%): transient facial palsy in 2 (1.3%), transient diplopia in 1 (0.7%), and bilateral watershed territory cerebral infarctions without long-term neurological deficits in 1 (0.7%). Median hospital stay was 2 days (IQR 1-4), and median procedure duration was 31.5 minutes (IQR 24.3-48.8). None of the patients who completed follow-up experienced CSDH recurrence or required retreatment.</p><p><strong>Conclusions: </strong>Scepter XC-assisted Onyx-18 MMAE was technically feasible and associated with high rates of CSDH resorption and resolution, with a safety profile similar to other MMAE techniques and no serious adverse events directly attributable to dual-lumen balloon microcatheter use.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186789","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":"Moyamoya-Type Collaterals in ACTA2 p. Arg179 Related Arteriopathy: Challenging the Paradigm of Absent Neovascularization-A Longitudinal DSA Study.","authors":"Jawid Madjidyar, Anna Kyselyova, Zsolt Kulcsar, Tilman Schubert, Patrick Thurner, Nadia Khan","doi":"10.3174/ajnr.A9674","DOIUrl":"https://doi.org/10.3174/ajnr.A9674","url":null,"abstract":"<p><strong>Background and purpose: </strong>ACTA2 p. Arg179 variants can cause a distinctive cerebrovascular arteriopathy historically described lacking classic moyamoya basal collaterals. Limited data on collateral architecture and surgical outcomes have led to uncertainty regarding revascularization strategies. The purpose of this study is to provide a systematic longitudinal DSA assessment of collateral patterns and postoperative findings in pediatric ACTA2-associated cerebrovascular disease.</p><p><strong>Material and methods: </strong>Ten pediatric patients with genetically confirmed ACTA2 mutations underwent DSA imaging. Eight consecutive patients with neurological instability and confirmed hemodynamic compromise underwent surgical revascularization (indirect or combined direct-indirect). Two patients with stable neurological status were managed conservatively. Paired DSA (7 patients) and magnetic resonance angiography (5 patients) were performed at baseline and follow-up of the operated cohort. Collaterals were classified as classic moyamoya-type, distal moyamoya-type, leptomeningeal, or duropial. Postoperative revascularization was graded using Matsushima classification.</p><p><strong>Results: </strong>Mean baseline vessel calibers demonstrated marked proximal ectasia (petrous ICA 8.4 ± 2.8 mm vs. normative 3.8 ± 0.4) transitioning to distal stenosis (supraclinoid ICA 2.6 ± 0.7 mm vs. normative 3.3 ± 0.3). Classic moyamoya-type collaterals were present in 2 patients at baseline and in 5 patients at follow-up. Postoperative Matsushima grading demonstrated Grade A/B in 6 patients, with surgical collateralization remaining patent and sufficient up to 14 years.</p><p><strong>Conclusions: </strong>ACTA2 p. Arg179 related cerebral arteriopathy demonstrates moyamoya-type collaterals challenging the historical paradigm of absent collateralization. Robust surgical neovascularization comparable to idiopathic moyamoya may support revascularization in symptomatic pediatric patients with confirmed hemodynamic compromise.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167690","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}