AJNR. American journal of neuroradiology最新文献

{"title":"State of Practice on Transcranial MR-Guided Focused Ultrasound: A Report from the ASNR Standards and Guidelines Committee and ACR Commission on Neuroradiology Workgroup.","authors":"Bhavya R Shah, Jody Tanabe, John E Jordan, Drew Kern, Stephen C Harward, Fabricio S Feltrin, Padraig O'Suilliebhain, Vibhash D Sharma, Joseph A Maldjian, Alexandre Boutet, Raghav Mattay, Leo P Sugrue, Kazim Narsinh, Steven Hetts, Lubdha M Shah, Jason Druzgal, Vance T Lehman, Kendall Lee, Shekhar Khanpara, Shivanand Lad, Timothy J Kaufmann","doi":"10.3174/ajnr.A8405","DOIUrl":"https://doi.org/10.3174/ajnr.A8405","url":null,"abstract":"<p><p>Transcranial focused ultrasound (FUS) is a versatile, MR-guided, incisionless intervention with diagnostic and therapeutic applications for neurologic and psychiatric diseases. It is currently FDA-approved as a thermoablative treatment of essential tremor and Parkinson disease. However, other applications of FUS including BBB opening for diagnostic and therapeutic applications, sonodynamic therapy, histotripsy, and low-intensity focused ultrasound neuromodulation are all in clinical trials. While FUS targeting for essential tremor and Parkinson disease has classically relied on an indirect, landmark-based approach, development of novel, advanced MR imaging techniques such as DTI tractography and fast gray matter acquisition T1 inversion recovery has the potential to improve individualized targeting and thus potentially enhance treatment response, decrease treatment times, and avoid adverse effects. As the technology advances and the number of clinical applications increases, the role of the neuroradiologist on a multidisciplinary team will be essential in pairing advanced structural and functional imaging to further this image-guided procedure via a precision medicine approach. This multi-institutional report, written by an experienced team of neuroradiologists, neurosurgeons, and neurologists, summarizes current practices, the use of advanced imaging techniques for transcranial MR-guided high-intensity FUS, recommendations for clinical implementation, and emerging clinical indications.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689930","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 medullary veins integrity and relationships with small vessel disease and interstitial diffusivity measures in patients with a recent small subcortical infarct.","authors":"Carla Brenlla, Caterina Sozzi, Andrés Girona, Emma Muñoz-Moreno, Carlos Laredo, Alejandro Rodríguez-Vázquez, Sergio Amaro, Arturo Renú, Antonio Doncel-Moriano, Laura Llull, Xabier Urra, Salvatore Rudilosso, Ángel Chamorro","doi":"10.3174/ajnr.A8591","DOIUrl":"https://doi.org/10.3174/ajnr.A8591","url":null,"abstract":"<p><strong>Background and purpose: </strong>The role of the venous compartment in cerebral small vessel disease has yet to be fully understood. As such, we evaluated how deep medullary veins integrity relates to MRI-based small vessel disease severity markers and glymphatic function assessed by DTI measures in patients with a recent small subcortical infarct.</p><p><strong>Materials and methods: </strong>We gathered demographic, clinical, and 3 Tesla-MRI imaging data from 50 patients with a recent small subcortical infarct. We evaluate the venular integrity using two visual scales based on their appearance on SWI. We assessed the number of lacunes and microbleeds, white matter hyperintensities volume, perivascular spaces volume in basal ganglia and white matter, summary-small vessel disease score, and brain volume. Diffusivity measures in normal-appearing white matter included free water fraction, mean diffusivity and fractional anisotropy with and without free water correction, and DTI along the perivascular spaces. After categorizing the cohort in quartiles according to both venular scores, we assessed their correlations with small vessel disease markers and diffusivity measures using multivariable ordinal regression analyses adjusting for age, sex, smoking, and summary small vessel disease score.</p><p><strong>Results: </strong>In univariate analysis most of the imaging variables, except for microbleeds, perivascular spaces in white matter and DTI-along the perivascular spaces, were associated with one or both venular scores. In multivariate analysis (OR, 95% CI), free water (1.33, 1.03-1.73), mean diffusivity (4.56, 1.32-15.81), fractional anisotropy (0.77, 0.63-0.93), free water-corrected mean diffusivity and fractional anisotropy (2.39, 1.06-5.39;0.78, 0.65-0.94, respectively), associated with vein appearance, while only brain volume (0.48, 0.25-0.94), fractional anisotropy with and without free water correction (0.82,0.86-0.99; 0.83, 0.7-0.99, respectively) remained significant for vein count.</p><p><strong>Conclusions: </strong>In patients with a recent small subcortical infarct, disruption of the deep medullary veins, increased extracellular water, and white matter injury appear to be associated.</p><p><strong>Abbreviations: </strong>SVD=small vessel disease; DMV=deep medullary veins; WMH=white matter hyperintensities; PVS=perivascular spaces; DTI-ALPS=diffusion tensor image analysis along the perivascular spaces; FW=free water; MD=mean diffusivity; FA= fractional anisotropy; BG=basal ganglia.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689926","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 algorithm for automatic quantification of nigrosome-1 and Parkinsonism classification using susceptibility map-weighted MRI.","authors":"Pae Sun Suh, Hwan Heo, Chong Hyun Suh, Myeong Oh Lee, Soohwa Song, Dong Hoon Shin, Sung Yang Jo, Sun Ju Chung, Hwon Heo, Woo Hyun Shim, Ho Sung Kim, Sang Joon Kim, Eung Yeop Kim","doi":"10.3174/ajnr.A8585","DOIUrl":"https://doi.org/10.3174/ajnr.A8585","url":null,"abstract":"<p><strong>Background and purpose: </strong>To develop and validate a deep learning-based automatic quantification for nigral hyperintensity and a classification algorithm for neurodegenerative parkinsonism using susceptibility map-weighted imaging (SMwI).</p><p><strong>Materials and methods: </strong>We retrospectively collected 450 participants (210 with idiopathic Parkinson's disease [IPD] and 240 individuals in the control group) for training data between November 2022 and May 2023, and 237 participants (168 with IPD, 58 with essential tremor, and 11 with drug-induced Parkinsonism) for validation data between July 2021 and January 2022. SMwI data were reconstructed from multi-echo GRE. Diagnostic performance for diagnosing IPD was assessed using deep learning-based automatic quantification (Heuron NI) and classification (Heuron IPD) model. Reference standard for IPD was based on ¹⁸F-FP-CIT PET finding. Additionally, the correlation between the H&Y stage and volume of nigral hyperintensity in patients with IPD was assessed.</p><p><strong>Results: </strong>Quantification of nigral hyperintensity using Heuron NI showed AUC of 0.915 (95% CI, 0.872-0.947) and 0.928 (95% CI, 0.887-0.957) on the left and right, respectively. Classification of nigral hyperintensity abnormality using Heuron IPD showed AUC of 0.967 (95% CI, 0.881-0.991) and 0.976 (95% CI, 0.948-0.992) on the left and right, respectively. H&Y score ≥ 3 showed significant smaller nigral hyperintensity volume (1.43 ± 1.19 mm³) compared to H&Y score 1-2.5 (1.98 ± 1.63 mm³; p = 0.008).</p><p><strong>Conclusions: </strong>Our deep learning-based model proves rapid, accurate automatic quantification of nigral hyperintensity, facilitating IPD diagnosis, symptom severity prediction, and patient stratification for personalized therapy. Further study is warranted to validate the findings across various clinical settings.</p><p><strong>Abbreviations: </strong>IPD = Idiopathic Parkinson's disease; SN = substantia nigra; SMwI = susceptibility map weighted imaging; QSM = quantitative susceptibility mapping; CNN = convolutional neural network; ICV = intracranial volume.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640405","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":"Association of Pretreatment Perfusion Imaging Parameters With 90-Day Excellent Functional Outcomes in Anterior Circulation Distal Medium Vessel Occlusion Stroke.","authors":"Hamza Adel Salim, Vaibhav Vagal, Dhairya A Lakhani, Janet Mei, Licia Luna, Yasmin Aziz, Aneri Balar, Adam A Dmytriw, Adrien Guenego, Basel Musmar, Nimer Adeeb, Victor C Urrutia, Elisabeth B Marsh, Raf Llinas, Argye E Hillis, Hanzhang Lu, Risheng Xu, Dylan Wolman, Benjamin Pulli, Kambiz Nael, Max Wintermark, Jeremy J Heit, Gregory W Albers, Tobias D Faizy, Vivek Yedavalli","doi":"10.3174/ajnr.A8584","DOIUrl":"https://doi.org/10.3174/ajnr.A8584","url":null,"abstract":"<p><strong>Background and purpose: </strong>Acute ischemic strokes caused by distal medium vessel occlusions (DMVO) represent a significant proportion of all stroke cases, yet the predictors of excellent functional outcomes in these patients remain poorly understood. This study aims to identify pretreatment computed tomography perfusion (CTP) parameters associated with excellent functional outcomes, defined as a modified Rankin Scale (mRS) score of 0-1 at 90 days, in patients with anterior circulation DMVO.</p><p><strong>Materials and methods: </strong>We conducted a retrospective multicenter study involving patients with anterior DMVO, from three stroke centers within the Johns Hopkins Medical Enterprise. Baseline demographic, clinical, and imaging data were collected, with CTP parameters analyzed using RAPIDAI software. Univariable and multivariable logistic regression models were used to identify predictors of excellent outcomes. Receiver operating characteristic (ROC) curves were constructed to assess the predictive accuracy of CTP parameters.</p><p><strong>Results: </strong>Among the 82 patients (median age, 71 years; 57% female), occlusions were located in the M2 segment in 89%, M3 in 8.5%, and A2 in 2.4%. IVT was administered to 37% of patients, and EVT was attempted in 59%. Excellent outcomes at 90 days were achieved in 45% of patients. In univariate analysis, white race (OR, 4.14; 95% CI, 1.66-10.9; P=0.003), higher CBV index (OR per 0.1-unit change, 1.45; 95% CI, 1.08-2.05; P=0.022), and lower relative cerebral blood flow (rCBF < 20%) volumes (OR, 0.91; 95% CI, 0.81-0.98; P=0.038) were significantly associated with excellent outcomes. In multivariate analysis adjusting for age, sex, race, IVT administration, EVT attempted, dyslipidemia, and premorbid mRS, higher CBV index remained a significant independent predictor (OR per 0.1-unit change, 1.72; 95% CI, 1.14-2.81; P=0.017), and lower rCBF < 20% volume was associated with better outcomes (OR, 0.91; 95% CI, 0.80-0.98; P=0.05). The multivariate model demonstrated good predictive performance (area under the ROC curve, 80%; 95% CI, 70%-90%; P < 0.001).</p><p><strong>Conclusions: </strong>In patients with anterior circulation DMVO, a higher CBV index on pretreatment CTP is an independent predictor of excellent functional outcomes at 90 days. These findings suggest that CTP parameters, particularly the CBV index, may be useful in prognostic assessment for this stroke population. Further studies are needed to validate these results and optimize therapeutic approaches.</p><p><strong>Abbreviations: </strong>ABC＝ definition; XYZ＝ definition.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640303","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":"High wall shear stress is related to complicated AHA lesion type VI plaques in mild to moderate internal carotid artery stenosis - a 3D cardiovascular MRI study.","authors":"Christoph Strecker, Axel Joachim Krafft, Tobias Saam, Markus Huellebrand, Ute Ludwig, Anja Hennemuth, Jürgen Hennig, Andreas Harloff","doi":"10.3174/ajnr.A8583","DOIUrl":"https://doi.org/10.3174/ajnr.A8583","url":null,"abstract":"<p><strong>Background and purpose: </strong>Complicated American Heart Association (AHA) lesion type VI plaques (cCAPs), characterized by the presence of intraplaque hemorrhage, surface defect or thrombus, are strongly associated with ischemic stroke and stroke recurrence. Hemodynamics seem to play a relevant role for their development. Thus, we investigated the association of 4D flow-MRI derived local wall shear stress (WSS) and oscillatory shear stress (OSI) with the presence of cCAPs in patients with mild to moderate internal carotid artery (ICA) stenosis.</p><p><strong>Materials and methods: </strong>From a prospective and consecutive cross-sectional study with 121 patients with high cardiovascular risk, 39 patients (49 carotid arteries) demonstrated a 10-50% ICA-stenosis and were included in this analysis. Plaque composition was determined according to the modified AHA classification of lesions by high-resolution multi-contrast 3T-MRI. We determined WSS (minimum, mean and maximum) and OSI in vivo by 4D flow-MRI at different locations within the stenosis (upstream, stenosis center and downstream). We studied the association of each hemodynamic parameter with the presence cCAPs by logistic regression analysis adjusted for age, sex and plaque thickness.</p><p><strong>Results: </strong>11 (22.4%) of the 49 ICA-stenosis in our cohort showed cCAP. WSS and OSI at the beginning of the stenosis did not differ between complicated and stable plaques. By contrast, WSS was significantly higher in the stenosis center and poststenotic region in cCAPs. OSI was significantly higher in the stenosis center of stable plaques. Logistic regression analysis revealed a significant association for WSS_mean (OR per SD increase 1.97, 95%-CI 1.14-3.39, p=0.015) and for WSS_max (OR per SD increase 1.84; 95%-CI 1.10-3.08; p=0.020), but not for WSS_min and OSI with the presence of cCAPs.</p><p><strong>Conclusions: </strong>Higher wall shear stress in ICA stenosis was significantly associated with the presence of cCAPs underlining the potential role of hemodynamics in their development.</p><p><strong>Abbreviations: </strong>cCAP, complicated carotid artery plaque; WSS, wall shear stress; OSI, oscillatory shear index.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640406","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":"Comprehensive Review of Inner Ear Anatomy on Photon-Counting CT.","authors":"Dinesh Rao, John V Murray, Amit K Agarwal, Sukhwinder Johnny Sandhu, Pat A Rhyner","doi":"10.3174/ajnr.A8410","DOIUrl":"10.3174/ajnr.A8410","url":null,"abstract":"<p><p>The inner ear contains many fissures and canals that can mimic pathology. Photon-counting CT allows greater spatial and contrast resolution of these structures over traditional energy-integrating CT detectors. Small channels containing nerves, arteries, and normal anatomy such as the cochlear cleft and cochlear and vestibular aqueducts are commonly encountered on temporal bone imaging. The improved visualization of these structures poses challenges for radiologists who are new to photon-counting CT. This article updates the existing temporal bone anatomy literature with a detailed anatomic review of the inner ear and major nerves frequently encountered when reviewing temporal bone imaging.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592389","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":"Enhancing Lesion Detection in Inflammatory Myelopathies: A Deep Learning-Reconstructed Double Inversion Recovery MRI Approach.","authors":"Qiang Fang, Qing Yang, Bao Wang, Bing Wen, Guangrun Xu, Jingzhen He","doi":"10.3174/ajnr.A8582","DOIUrl":"10.3174/ajnr.A8582","url":null,"abstract":"<p><strong>Background and purpose: </strong>The imaging of inflammatory myelopathies has advanced significantly over time, with MRI techniques playing a pivotal role in enhancing lesion detection. However, the impact of deep learning (DL)-based reconstruction on 3D double inversion recovery (DIR) imaging for inflammatory myelopathies remains unassessed. This study aims to compare acquisition time, image quality, diagnostic confidence, and lesion detection rates among sagittal T2WI, standard DIR, and DL -reconstructed DIR in patients with inflammatory myelopathies.</p><p><strong>Materials and methods: </strong>In this observational study, patients diagnosed with inflammatory myelopathies were recruited between June 2023 and March 2024. Each patient underwent sagittal conventional turbo spin-echo sequences and standard 3D DIR (T2WI and standard 3D DIR used as references for comparison), followed by an undersampled accelerated DIRDL examination. Three neuroradiologists evaluated the images using a four-point Likert scale (from 1 to 4) for overall image quality, perceived signal-tonoise ratio, sharpness, artifacts, and diagnostic confidence. The acquisition times, and lesion detection rates were also compared between the acquisition protocols.</p><p><strong>Results: </strong>A total of 149 participants were evaluated (mean age 40.6 ± 16.8 years; 71 females). The median acquisition time for DIRDL was significantly lower than for standard DIR (298 seconds [interquartile range (IQR), 288-301] vs 151 seconds [IQR, 148-155]; <i>P</i> < 0.001), showing a 49%time reduction. DIRDL images scored higher in overall quality, perceived signal-to-noise ratio, and artifact noise reduction (all <i>P</i> < 0.001). There were no significant differences in sharpness (<i>P</i> = 0.07), or diagnostic confidence (<i>P</i> = 0.06) between the standard DIR and DIRDL protocols. Additionally, DIRDL detected 37% more lesions compared to T2WI (300 vs. 219; <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>DIRDL significantly reduces acquisition time and improves image quality compared to standard DIR without compromising diagnostic confidence. Additionally, DIRDL enhances lesion detection in patients with inflammatory myelopathies, making it a valuable tool in clinical practice. These findings underscore the potential for incorporating DIRDL into future imaging guidelines.</p><p><strong>Abbreviations: </strong>DL = deep learning; DIR = double inversion recovery; IQR = interquartile range; MS = multiple sclerosis; AQP4+NMOSD = AQP4-IgG positive neuromyelitis optica spectrum disorders; MOG = myelin oligodendrocyte glycoprotein; MOGAD = MOG antibody-associated diseases.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634323","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":"Prevalence of Spinal Meningeal Diverticula in Autosomal Dominant Polycystic Kidney Disease.","authors":"Usama Sattar, Xiaorui Yin, Xianfu Luo, Chenglin Zhu, Zhongxiu Hu, Jon D Blumenfeld, Hanna Rennert, Alan Wu, Arindam RoyChoudhury, Gayle Salama, Martin R Prince","doi":"10.3174/ajnr.A8407","DOIUrl":"10.3174/ajnr.A8407","url":null,"abstract":"<p><strong>Background and purpose: </strong>Patients with autosomal dominant polycystic kidney disease (ADPKD) develop cysts in the kidneys, liver, spleen, pancreas, prostate, and arachnoid spaces. In addition, spinal meningeal diverticula have been reported. To determine whether spinal meningeal diverticula are associated with ADPKD, we compared their prevalence in subjects with ADPKD with a control cohort without ADPKD.</p><p><strong>Materials and methods: </strong>Subjects with ADPKD and age- and sex-matched controls without ADPKD undergoing abdominal MRI from the midthorax to the pelvis from 2003 to 2023 were retrospectively evaluated for spinal meningeal diverticula by 4 blinded observers. The prevalence of spinal meningeal diverticula in ADPKD was compared with that in control subjects, using <i>t</i> tests and correlated with clinical and laboratory data and MR imaging features, including cyst volumes and cyst counts.</p><p><strong>Results: </strong>Identification of spinal meningeal diverticula in ADPKD (<i>n</i> = 285, median age, 47; interquartile range [IQR], 37-56 years; 54% female) and control (<i>n</i> = 285, median age, 47; IQR, 37-57 years; 54% female) subjects had high interobserver agreement (pairwise Cohen κ = 0.74). Spinal meningeal diverticula were observed in 145 of 285 (51%) subjects with ADPKD compared with 66 of 285 (23%) control subjects without ADPKD (<i>P</i> < .001). Spinal meningeal diverticula in ADPKD were more prevalent in women (98 of 153 [64%]) than men (47 of 132 [36%], <i>P</i> < .001). The mean number of spinal meningeal diverticula per affected subject with ADPKD was 3.6 ± 2.9 compared with 2.4 ± 1.9 in controls with cysts (<i>P</i> < .001). The median volume (IQR, 25%-75%) of spinal meningeal diverticula was 400 (IQR, 210-740) mm³ in those with ADPKD compared with 250 (IQR, 180-440) mm³ in controls (<i>P</i> < .001). The mean spinal meningeal diverticulum diameter was greater in the sacrum (7.3 [SD, 4.1] mm) compared with thoracic (5.4 [SD, 1.8] mm) and lumbar spine (5.8 [SD, 2.0] mm), (<i>P</i> < .001), suggesting that hydrostatic pressure contributed to enlargement.</p><p><strong>Conclusions: </strong>ADPKD has a high prevalence of spinal meningeal diverticula, particularly in women.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592348","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":"Development and Evaluation of Automated Artificial Intelligence-Based Brain Tumor Response Assessment in Patients with Glioblastoma.","authors":"Jikai Zhang, Dominic LaBella, Dylan Zhang, Jessica L Houk, Jeffrey D Rudie, Haotian Zou, Pranav Warman, Maciej A Mazurowski, Evan Calabrese","doi":"10.3174/ajnr.A8580","DOIUrl":"https://doi.org/10.3174/ajnr.A8580","url":null,"abstract":"<p><strong>Background and purpose: </strong>To develop and evaluate an automated, AI-based, volumetric brain tumor MRI response assessment algorithm on a large cohort of patients treated at a high-volume brain tumor center.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed data from 634 patients treated for glioblastoma at a single brain tumor center over a 5-year period (2017-2021). The mean age was 56 +/-13 years. 372/634 (59%) patients were male, and 262/634 (41%) patients were female. Study data consisted of 3,403 brain MRI exams and corresponding standardized, radiologist-based brain tumor response assessments (BT-RADS). An artificial intelligence (AI)-based brain tumor response assessment algorithm was developed using automated, volumetric tumor segmentation. AI-based response assessments were evaluated for agreement with radiologist-based response assessments and ability to stratify patients by overall survival. Metrics were computed to assess the agreement using BTRADS as the ground-truth, fixed-time point survival analysis was conducted to evaluate the survival stratification, and associated P-values were calculated.</p><p><strong>Results: </strong>For all BT-RADS categories, AI-based response assessments showed moderate agreement with radiologists' response assessments (F1 = 0.587-0.755). Kaplan-Meier survival analysis revealed statistically worse overall fixed time point survival for patients assessed as image worsening equivalent to RANO progression by human alone compared to by AI alone (log-rank P=0.007). Cox proportional hazard model analysis showed a disadvantage to AI-based assessments for overall survival prediction (P=0.012).</p><p><strong>Conclusions: </strong>AI-based volumetric glioblastoma MRI response assessment following BT-RADS criteria yielded moderate agreement for replicating human response assessments and slightly worse stratification by overall survival.</p><p><strong>Abbreviations: </strong>GBM＝ Glioblastoma; RANO＝ Response Assessment in Neuro-Oncology; BTRADS＝ Brain Tumor Reporting and Data System; NLP = Natural Language Processing.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634272","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":"DANTE-CAIPI Accelerated Contrast-Enhanced 3D T1: Deep Learning-Based Image Quality Improvement for Vessel Wall MRI.","authors":"Mona Kharaji, Gador Canton, Yin Guo, Mohamad Hosaam Mosi, Zechen Zhou, Niranjan Balu, Mahmud Mossa-Basha","doi":"10.3174/ajnr.A8424","DOIUrl":"10.3174/ajnr.A8424","url":null,"abstract":"<p><strong>Background and purpose: </strong>Accelerated and blood-suppressed postcontrast 3D intracranial vessel wall MRI (IVW) enables high-resolution rapid scanning but is associated with low SNR. We hypothesized that a deep-learning (DL) denoising algorithm applied to accelerated, blood-suppressed postcontrast IVW can yield high-quality images with reduced artifacts and higher SNR in shorter scan times.</p><p><strong>Materials and methods: </strong>Sixty-four consecutive patients underwent IVW, including conventional postcontrast 3D T1-sampling perfection with application-optimized contrasts by using different flip angle evolution (SPACE) and delay alternating with nutation for tailored excitation (DANTE) blood-suppressed and CAIPIRINHIA-accelerated (CAIPI) 3D T1-weighted TSE postcontrast sequences (DANTE-CAIPI-SPACE). DANTE-CAIPI-SPACE acquisitions were then denoised by using an unrolled deep convolutional network (DANTE-CAIPI-SPACE+DL). SPACE, DANTE-CAIPI-SPACE, and DANTE-CAIPI-SPACE+DL images were compared for overall image quality, SNR, severity of artifacts, arterial and venous suppression, and lesion assessment by using 4-point or 5-point Likert scales. Quantitative evaluation of SNR and contrast-to-noise ratio (CNR) was performed.</p><p><strong>Results: </strong>DANTE-CAIPI-SPACE+DL showed significantly reduced arterial (1 [1-1.75] versus 3 [3-4], <i>P</i> < .001) and venous flow artifacts (1 [1-2] versus 3 [3-4], <i>P</i> < .001) compared with SPACE. There was no significant difference between DANTE-CAIPI-SPACE+DL and SPACE in terms of image quality, SNR, artifact ratings, and lesion assessment. For SNR ratings, DANTE-CAIPI-SPACE+DL was significantly better compared with DANTE-CAIPI-SPACE (2 [1-2], versus 3 [2-3], <i>P</i> < .001). No statistically significant differences were found between DANTE-CAIPI-SPACE and DANTE-CAIPI-SPACE+DL for image quality, artifact, arterial blood and venous blood flow artifacts, and lesion assessment. Quantitative vessel wall SNR and CNR median values were significantly higher for DANTE-CAIPI-SPACE+DL (SNR: 9.71, CNR: 4.24) compared with DANTE-CAIPI-SPACE (SNR: 5.50, CNR: 2.64) (<i>P</i> < .001 for each), but there was no significant difference between SPACE (SNR: 10.82, CNR: 5.21) and DANTE-CAIPI-SPACE+DL.</p><p><strong>Conclusions: </strong>DL denoised postcontrast T1-weighted DANTE-CAIPI-SPACE accelerated and blood-suppressed IVW showed improved flow suppression with a shorter scan time and equivalent qualitative and quantitative SNR measures relative to conventional postcontrast IVW. It also improved SNR metrics relative to postcontrast DANTE-CAIPI-SPACE IVW. Implementing DL denoised DANTE-CAIPI-SPACE IVW has the potential to shorten protocol time while maintaining or improving the image quality of IVW.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749957","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}