AJNR. American journal of neuroradiology最新文献

{"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}

{"title":"Advanced Practice Providers in Spinal CSF Leak Programs: A Multi-Institutional Study of Current Roles and Perceived Impact on Patient Care.","authors":"Ajay A Madhavan, Michelle L Kodet, Peter G Kranz, Timothy J Amrhein, Mark D Mamlouk, Andrew Callen, Gayle Salama, J Levi Chazen, Vinil Shah, Wouter I Schievink, Rachelle Tache, Ian T Mark, Anousheh Sayah, Miriam E Peckam, Lubdha Shah, Amish H Doshi, Ian Carroll, E Hope Weant","doi":"10.3174/ajnr.A9679","DOIUrl":"https://doi.org/10.3174/ajnr.A9679","url":null,"abstract":"<p><strong>Background and purpose: </strong>Advanced practice providers (APPs), including nurse practitioners and physician assistants, are increasingly integrated into radiology practices. However, their utilization and clinical responsibilities in dedicated spinal CSF leak programs have not been characterized. Using a multicenter survey, we investigated APP training, clinical responsibilities, perceived impact, and challenges of APP integration at US spinal CSF leak programs.</p><p><strong>Materials and methods: </strong>A survey was distributed to physicians at US institutions with dedicated spinal CSF leak programs and APP involvement. Candidate institutions were identified through the International Society for Spinal CSF Leak and American Society of Spine Radiology. Survey questions addressed program characteristics, APP training and structure, clinical responsibilities, perceived impact, and challenges. Responses were summarized descriptively.</p><p><strong>Results: </strong>Twelve institutions completed the survey. Eight (67%) reported caring for more than 250 spinal CSF leak patients annually. APPs included nurse practitioners at 4 centers (33%), physician assistants at 3 (25%), and both at 5 (42%); 7 centers (58%) had APPs dedicated exclusively to spinal CSF leak care. APP training was primarily informal and on-the-job at all institutions. Common primary APP responsibilities included obtaining outside imaging, patient intake and symptom review, procedure and sedation orders, informed consent, post-procedural follow-up, pain management, and treatment of rebound intracranial hypertension. Shared APP and physician responsibilities commonly included outside record review, determining evaluation urgency, preliminary imaging review, sedation assessment, and multidisciplinary coordination. Procedural responsibilities such as lumbar puncture, intrathecal contrast administration, myelography planning, and CSF leak treatment were primarily performed by physicians in most programs. At least 75% of respondents strongly agreed that APP participation improved continuity of care, patient communication/accessibility, clinic efficiency, patient satisfaction, physician administrative burden, and multidisciplinary coordination. Common barriers included funding/support, billing/reimbursement, and limited procedural privileges.</p><p><strong>Conclusions: </strong>APPs are widely integrated into dedicated spinal CSF leak programs, with substantial involvement in pre-procedural evaluation, care coordination, and post-procedural management, while advanced myelography and CSF leak treatment remain predominantly physician-directed. APP participation was perceived to improve patient care and clinical workflow. These findings provide a framework for APP integration into specialized spinal CSF leak programs.</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":"149172087","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":"2024-2025 Academic Neuroradiology Workforce and Practice Survey: Faculty FTE and Effort, Recruitment and Retirement Benchmarks.","authors":"Max Wintermark, Rahul Bhala, Ari Blitz, Scott Faro, Ajay Malhotra, Julie Bykowski, Tabassum Kennedy","doi":"10.3174/ajnr.A9677","DOIUrl":"https://doi.org/10.3174/ajnr.A9677","url":null,"abstract":"<p><strong>Purpose: </strong>Rising RVU targets and clinical workloads in academic neuroradiology raise concerns about diagnostic accuracy, patient safety, faculty burnout, and erosion of education/research missions. This national survey of division chiefs characterized current practice patterns, effort models, moonlighting, operational factors, compensation, protected time, grant support, and perceptions of sustainable productivity.</p><p><strong>Materials and methods: </strong>Web-based survey of academic neuroradiology division chiefs (American Society of Neuroradiology directory), with up to three reminders. 51 responses were collected anonymously and analyzed descriptively in Microsoft Excel. Questions covered workforce, clinical effort models, workload exceedance drivers, moonlighting, leadership protected time, and grant support.</p><p><strong>Results: </strong>Divisions had median 11 FTE (25th-75th: 7-17.25); faculty were mostly full-time (median 90% at 1.0 FTE). Retirement risk was low short-term (median 0% in 2 years, 10% in 5 years); median 2 hires/year. Median clinical effort was 74% cFTE. Effort models split between shift-based (47%) and RVU-target (45%; typically, 40th-70th percentile AAARAD); volume caps used in only 8%. Targets were frequently exceeded, mainly due to moonlighting/financial incentives (49%) and voluntary work (32%). Moonlighting was offered in 52% of divisions (median 50% participation), yielding typical additional income of $26K-$100K/year. Protected effort medians: 20% (division chiefs), 10% (fellowship directors). Grant support was commensurate with funding in most divisions; 62% received \"cap gap\" support for federal grants.</p><p><strong>Conclusion: </strong>Academic neuroradiology faces intense clinical demands, and relies heavily on voluntary and incentivized faculty moonlighting. These findings highlight the need for accurate productivity benchmarks, operational improvements, and stronger institutional protections to sustain quality, safety, faculty satisfaction, and the academic mission.</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":"149170421","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":"Microsurgical Resection versus Endovascular Embolization for Intramedullary Spinal Arteriovenous Malformations: A Systematic Review, Meta-Analysis, and Regression Modeling.","authors":"S Farzad Maroufi, Shahab Aldin Sattari, John N Theodore, Carlos A Bagley, Judy Huang, Luis Fernando Gonzalez, Nicholas Theodore","doi":"10.3174/ajnr.A9668","DOIUrl":"https://doi.org/10.3174/ajnr.A9668","url":null,"abstract":"<p><strong>Background: </strong>Intramedullary spinal arteriovenous malformations (sAVMs) are rare, high-risk lesions associated with progressive neurological decline, ischemia, and hemorrhage. Microsurgical resection (MR) and endovascular embolization (EE) are the primary treatment modalities, but their comparative efficacy and safety remain unclear.</p><p><strong>Purpose: </strong>To systematically compare angiographic and clinical outcomes of MR versus EE for intramedullary sAVMs.</p><p><strong>Data sources: </strong>A systematic literature search of PubMed and Embase was performed across major medical databases to identify relevant studies reporting outcomes of MR or EE in intramedullary sAVMs.</p><p><strong>Study selection: </strong>Studies including ≥5 patients with intramedullary sAVMs treated with MR or EE and reporting angiographic obliteration and clinical outcomes were included.</p><p><strong>Data analysis: </strong>Random-effects meta-analysis was used to estimate pooled outcome rates. Multivariable mixed-effects meta-regression identified predictors of angiographic and clinical outcomes.</p><p><strong>Data synthesis: </strong>Twenty-six studies were included (MR: 193 patients; EE: 303 patients). Baseline characteristics were generally comparable between groups, although MR patients had slightly higher pain presentation, glomus type lesions, and prior treatment. MR achieved significantly higher complete obliteration rates than EE (80.13% vs 27.44%, p<0.01). There were no significant differences in symptom improvement (42.70% vs 55.52%, p=0.35), complete recovery (36.37% vs 32.58%, p=0.92), worsening (13.81% vs 10.96%, p=0.45), post-treatment hemorrhage (1.83% vs 0.89%, p=0.30), or mortality (1.55% vs 0.99%, p=0.81). Higher obliteration independently predicted symptom improvement, though MR was associated with lower odds of improvement. EE, younger age, and non-hemorrhagic presentation predicted complete recovery.</p><p><strong>Limitations: </strong>Findings are limited by the retrospective design of included studies, heterogeneity in patient selection and treatment strategies, and potential publication bias.</p><p><strong>Conclusions: </strong>MR provides higher angiographic obliteration but does not consistently translate to improved clinical recovery, likely due to procedure-related neural injury. EE remains an effective, less invasive option for complex or high-risk lesions, while MR may be best reserved for salvage therapy. Individualized treatment strategies based on lesion characteristics and patient factors are essential.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149191","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":"The Added Value of Vessel Wall MRI Over CTA for Differentiating Large-Artery Atherosclerotic and Cardioembolic Stroke in the Anterior and Posterior Circulations.","authors":"Cristina Sanchez-Vizcaino, Daniel S Hippe, Ahmed A Safwat, Mona Kharaji, Maoxue Wang, Dan Cheng, Gador Canton, Kristi D Pimentel, Lauren Klein-Murrey, Thomas S Hatsukami, Chun Yuan, Nazem W Akoum, Niranjan Balu, David L Tirschwell, Mahmud Mossa-Basha","doi":"10.3174/ajnr.A9664","DOIUrl":"https://doi.org/10.3174/ajnr.A9664","url":null,"abstract":"<p><strong>Background and purpose: </strong>Differentiation between stroke etiologies is essential for secondary prevention; however, etiologic classification remains challenging in many ischemic strokes. We evaluated whether magnetic resonance vessel wall imaging (VWI) plaque markers improve computed tomography angiography (CTA)-based differentiation between cardioembolic (CE) and large-artery atherosclerotic (LAA) stroke in the anterior and posterior circulations, as a step toward improving etiologic classification beyond current criteria.</p><p><strong>Methods: </strong>We retrospectively included patients with unilateral anterior or posterior circulation ischemic stroke between June 2022 and April 2024 across an academic health system, classified as LAA or CE according to modified TOAST criteria. Imaging markers included CTA-derived noncalcified plaque extent (>30% stenosis), VWI-derived intracranial plaque enhancement (IPE) extent, and intraplaque hemorrhage (IPH) presence, restricted to arterial segments upstream from the infarct. Given potential territory-specific plaque differences, analyses were stratified by circulation. Multivariable logistic regression models assessed associations of CTA and VWI markers with stroke etiology. Associations with LAA were summarized using adjusted odds ratios (aOR; plaque extent variables per 1-SD increase). Overall performance for discriminating between LAA and CE etiologies was assessed using the area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>Among 193 patients (median age, 70 years; 60% male), 137 had anterior circulation strokes (65 LAA, 72 CE) and 56 had posterior circulation strokes (38 LAA, 18 CE). In anterior circulation strokes, VWI markers improved discrimination over CTA alone (AUC, 0.57 for CTA alone vs 0.76 for CTA+VWI; p<0.001); CTA-derived noncalcified plaque extent (aOR, 1.7; p=0.02), IPH (aOR, 7.0; p<0.001), and IPE extent (aOR, 1.9; p=0.005) were independently associated with LAA. In posterior circulation strokes, IPE extent improved discrimination over CTA alone (AUC, 0.77 for CTA alone vs 0.84 for CTA+VWI; p=0.02); IPE extent (aOR, 2.2; p=0.02) and CTA-derived noncalcified plaque extent (aOR, 5.9; p=0.002) were independently associated with LAA. IPH was not significantly associated with posterior circulation stroke etiology (p=0.26).</p><p><strong>Conclusions: </strong>VWI adds complementary value for differentiating LAA and CE stroke etiologies in both vascular territories, supporting a pragmatic CTA-VWI approach for etiologic characterization beyond stenosis assessment alone.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149223","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":"Intratumoral susceptibility signals on susceptibility-weighted imaging for glioma grading and molecular profiling: a systematic review and meta-analysis.","authors":"Arian Allaei, Humberto Abraham Cortés Magdaleno, Elisabeth Amadeo, Karabo Kago Marole, Guilherme Alexandre Quint, Samir Shinnawi","doi":"10.3174/ajnr.A9672","DOIUrl":"https://doi.org/10.3174/ajnr.A9672","url":null,"abstract":"<p><strong>Background: </strong>Intratumoral susceptibility signals on susceptibility-weighted imaging have emerged as a potential biomarker for glioma grading and molecular characterization.</p><p><strong>Purpose: </strong>To evaluate the diagnostic performance of intratumoral susceptibility signals for glioma grading using harmonized World Health Organization grade contrasts.</p><p><strong>Data sources: </strong>PubMed, Embase, and Cochrane were searched from inception through December 18, 2025.</p><p><strong>Study selection: </strong>Studies reporting preoperative semiquantitative assessment of intratumoral susceptibility signals in histologically confirmed gliomas were included; grading reference standards ranged from histology-based to integrated 2021 World Health Organization histomolecular diagnosis.</p><p><strong>Data analysis: </strong>The primary analysis compared World Health Organization grades III-IV with grade II. Alternative contrasts were analyzed separately. Threshold-specific sensitivity and specificity were pooled when at least 3 comparable studies were available. Observed-only and leave-one-out analyses assessed robustness.</p><p><strong>Data synthesis: </strong>Nineteen studies including 1383 patients were included; 10 contributed to quantitative grading analyses. For World Health Organization grade III-IV versus II, pooled sensitivity and specificity were 0.96 (95% CI, 0.86-0.99) and 0.48 (0.22-0.75) at an intratumoral susceptibility signal threshold ≥1, 0.85 (0.74-0.91) and 0.93 (0.84-0.97) at threshold ≥2, and 0.72 (0.59-0.82) and 0.97 (0.93-0.99) at threshold ≥3. Molecular findings were heterogeneous and summarized descriptively, with higher intratumoral susceptibility signal burden most consistently associated with isocitrate dehydrogenase wild-type status.</p><p><strong>Limitations: </strong>Studies were predominantly retrospective and single-center, with heterogeneous intratumoral susceptibility signal scoring, imaging protocols, and World Health Organization reference standards. Some contingency tables required reconstruction.</p><p><strong>Conclusions: </strong>Intratumoral susceptibility signals showed threshold-dependent performance for distinguishing World Health Organization grade III-IV from grade II gliomas. Among the prespecified ordinal thresholds, a threshold ≥2 provided the most balanced sensitivity-specificity profile. Molecular evidence remains exploratory.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149301","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 and Efficacy of Combined Middle Meningeal Artery and CSF Venous Fistula Embolization in Treatment of Spontaneous Intracranial Hypotension with Concurrent Subdural Fluid Collection.","authors":"Roy Zhou, Seth C Ransom, Nicholas J Kendall, Carlotta Ranali, Waleed Brinjikji","doi":"10.3174/ajnr.A9671","DOIUrl":"https://doi.org/10.3174/ajnr.A9671","url":null,"abstract":"<p><strong>Introduction: </strong>Fistulas forming between cerebrospinal fluid (CSF) and spinal veins is a common cause of spontaneous intracranial hypotension (SIH) with subdural fluid collections(SDFC). CSF-venous fistulas embolization (CVFE) can be performed with a combined middle meningeal artery embolization (MMAE) to close the fistula and treat the SDFC.</p><p><strong>Objective: </strong>Assess the safety and efficacy of combined MMAE and CVFE treatment.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of 40 patients who underwent combined MMAE and CVFE or CVFE alone with SIH and SDFC at a single institution. Patients deemed nonsurgical candidates were excluded. Their demographics, clinical outcomes, and complications were reviewed.</p><p><strong>Results: </strong>18 patients who underwent combined embolization were compared to 22 patients who underwent CVFE alone. The median age at embolization was 69 years for the CVFE only group and 66 years for the combined group. 19/22 (86%) patients experienced complete or significant improvement in symptoms in the CVFE only group versus 15/18 (83%) in the combined group. One patient in the dual embolization group had repeat SDFC while three patients in the CVFE only group had repeat SDFC. One patient in both groups experienced no improvement or worse clinical outcomes after the procedure. No patients in either group experienced any procedural complications.</p><p><strong>Conclusion: </strong>Combined MMAE and CVFE was not found to have worse clinical outcomes or higher complication rates when compared to CVFE alone. In patients presenting with SDFC with CSF-venous fistula, combined embolization may be a potential therapy that can address all symptoms.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148966","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 MRI Assessment of Olfactory System in Septo-Optic Dysplasia Spectrum and Related Midline Brain Malformations.","authors":"Elly Arizono, Joel Kevin Raj Samuel, Edward P Lin, Karen Buch, Kazuhiro Saito, Osamu Sakai","doi":"10.3174/ajnr.A9667","DOIUrl":"https://doi.org/10.3174/ajnr.A9667","url":null,"abstract":"<p><strong>Background and purpose: </strong>Although olfactory system abnormalities have been described in septo-optic dysplasia (SOD), prior studies have relied on qualitative or semiquantitative assessment, and the reproducibility of continuous MRI measurements remains unknown.We assessed the reproducibility of quantitative MRI measurements of the olfactory sulcus (OS) and olfactory bulb (OB) in patients with the SOD spectrum and related midline brain malformations, and examined their associations with consensus olfactory system abnormality scores.</p><p><strong>Materials and methods: </strong>In this IRB-approved, single-center, retrospective study, pediatric and adult patients were identified by searching radiology reports for \"septo-optic dysplasia.\" The full cohort included patients with classic SOD, SOD-plus, partial/possible SOD-spectrum phenotypes, and related septal/callosal abnormalities. Those without adequate postnatal MRI for olfactory assessment or with septal abnormalities considered secondary to longstanding severe hydrocephalus were excluded. Three readers measured OS depth and OB width on coronal images or reformats and OS length on axial images or reformats. These measurements were normalized to biparietal diameter (BPD) to derive BPD-normalized olfactory metrics. Readers also assigned ordinal olfactory system abnormality scores (0-3) for the ipsilateral olfactory bulb and tract, with the median across readers serving as the consensus score. Measurement reproducibility was assessed by calculating intraclass correlation coefficients (ICCs). Associations with consensus scores were evaluated using rank-transformed linear mixed-effects models. Reproducibility and score associations were reassessed in a subgroup restricted to patients with classic SOD or SOD-plus phenotypes.</p><p><strong>Results: </strong>The study included 37 patients (mean age, 22.6 ± 20.5 years; range, 0-65 years; 19 women; 74 sides). BPD-normalized olfactory metrics showed moderate reproducibility, with ICCs of 0.58 for OS depth/BPD, 0.69 for OS length/BPD, and 0.69 for OB width/BPD, whereas the olfactory system abnormality score showed low inter-reader agreement. OS depth/BPD, OS length/BPD, and OB width/BPD were significantly associated with consensus score categories (all P range, < .001-.01). Findings were preserved in the 25-patient classic SOD/SOD-plus subgroup.</p><p><strong>Conclusions: </strong>BPD-normalized olfactory metrics were reproducible and associated with consensus scores, suggesting that they may facilitate more consistent recognition and characterization of olfactory system involvement in the SOD spectrum and complement categorical visual assessment.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149696","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":"Management Strategies for Intracranial Dural Arteriovenous Fistulas with an Isolated Sinus: A 20-Year Single-Center Experience.","authors":"James Lord, Joao A Sousa, Uri Singfer, Ronette Goodluck Tyndall, Patrick Nicholson, Robert Willinsky, Vitor M Pereira, Hugo Andrade, Pascal J Mosimann, Ivan Radovanovic, Karel Ter Brugge, David Volders, Timo Krings, Eef J Hendriks","doi":"10.3174/ajnr.A9673","DOIUrl":"https://doi.org/10.3174/ajnr.A9673","url":null,"abstract":"<p><strong>Background: </strong>Isolated sinus dural arteriovenous fistulas (DAVFs) are rare, aggressive subtypes of arteriovenous shunt. Optimal treatment strategies remain poorly defined.</p><p><strong>Objective: </strong>To present a 20-year single-center experience evaluating treatment strategies and outcomes for isolated sinus DAVFs.</p><p><strong>Methods: </strong>We retrospectively analyzed all adult patients treated for isolated sinus DAVFs at our institution from January 2004 to March 2025. Isolated sinus DAVFs were defined as fistulas draining into venous sinus segments that are functionally isolated, i.e. have no antegrade or retrograde venous sinus outflow. Data included clinical presentation, angiographic features, treatment approach, outcomes, and complications.</p><p><strong>Results: </strong>Of 425 patients treated for intracranial DAVFs, 35/425 (8%) had an isolated sinus DAVF and underwent 43 treatment sessions. Transarterial embolization (TAE) was the initial treatment in 23/35 (66%) patients, achieving immediate single-session angiographic occlusion in 17/23 (74%) and final single-session occlusion in 18/23 (78%) after spontaneous thrombosis of a residual fistula in one case. Transvenous embolization (TVE) was the initial treatment in 10/35 (29%) patients, achieving immediate single-session angiographic occlusion in 8/10 (80%) and final single-session occlusion in 9/10 (90%) after spontaneous thrombosis in one case. Three open burr-hole-assisted TVE procedures - one primary and two salvage - achieved complete occlusion. Two open surgical disconnections, one primary and one salvage, also achieved complete occlusion. Five patients (5/35; 14%) required more than one treatment session. Three major complications occurred across 43 treatment sessions (3/43; 7%). No residual fistula was identified in any patient at last available imaging follow-up.</p><p><strong>Conclusion: </strong>Isolated sinus DAVFs are challenging to manage and may require multimodal treatment. Our findings support individualized, angioarchitecture-based treatment selection for this complex DAVF subtype.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149436","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":"Bevacizumab Infusion into Middle Meningeal Arteries for Chronic Subdural Hematoma: Insights from 35 Hemispheres in 25 Patients.","authors":"Ajith J Thomas, Jane Khalife, Hamza A Shaikh, Daniel A Tonetti, Corey M Mossop, Ahmad A Ballout, Pratit D Patel, Tudor G Jovin, Manisha Koneru","doi":"10.3174/ajnr.A9655","DOIUrl":"https://doi.org/10.3174/ajnr.A9655","url":null,"abstract":"<p><p>Bevacizumab is an anti-vascular endothelial growth factor antibody that may disrupt the pro-inflammatory cascade driving chronic subdural hematoma (CSDH) development, expansion, and recurrence. This expanded case series describes clinical and radiographic outcomes of intra-arterial infusion of bevacizumab into the middle meningeal artery for treatment of chronic subdural hematoma in 35 hemispheres of 25 patients. Adult patients with asymptomatic or mild symptoms and either unilateral or bilateral CSDH with mixed-density appearance or presence of membranes infused with intra-arterial bevacizumab in one or both middle meningeal arteries under fluoroscopic guidance were included. The primary outcome was the percent reduction in CSDH size from baseline to 90-day follow-up. Of 25 included patients, median age was 77 years (IQR 68-86). Of 35 treated hemispheres, 80% (28/35) hemispheres demonstrated greater than 50% CSDH resolution, and 25.7% (9/35) hemispheres had 100% resolution by 90 days. There were no rescue interventions for symptomatic recurrence, new stroke or neurological deterioration, or mortality by 90 days. In conclusion, intra-arterial bevacizumab infusion demonstrates potential as a novel endovascular approach to CSDH in select patients.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149634","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}