AJNR. American journal of neuroradiology最新文献

{"title":"Large core trial: State of Practice.","authors":"Gianluca De Rubeis, Sebastiano Fabiano, Luca Bertaccini, Francesca Romana Pezzella, Valeria Caso, Luca Saba, Enrico Pampana","doi":"10.3174/ajnr.A8733","DOIUrl":"https://doi.org/10.3174/ajnr.A8733","url":null,"abstract":"<p><strong>Background: </strong>This review critically analyzed recent publications on large-core Randomized Controlled Trials (RCTs). Six RCTs demonstrated the superiority of mechanical thrombectomy over the best medical treatment in patients with low ASPECTs. However, the use of ASPECTs to define the ischemic core has limitations in detecting ischemic changes beyond the middle cerebral artery (MCA) territory. This review evaluates the implications of this choice on the external validity of the trials.</p><p><strong>Methods: </strong>The study evaluated ASPECTS reliability by examining the anatomical details of occlusion location, collateral blood flow, and perfusion imaging. An analysis comparing the HERMES collaboration with six RCTs on large-core infarcts was conducted to investigate how the occlusion site affects infarct size and salvageable brain tissue, as well as to support pathophysiological assessment.</p><p><strong>Key message: </strong>RCTs indicated a trend toward more proximal occlusions in large-core trials compared to HERMES collaboration, unpredictably increasing the mismatch between the ischemic core and salvageable tissue. ASPECTS inadequately depicted ischemic changes outside the proximal MCA occlusion, causing potential misinterpretations. Perfusion imaging identified core volume and salvageable areas better than ASPECTS alone by including all at-risk tissues, not just the MCA. This review advocates redefining infarct core assessment in large-core RCTs, prioritizing perfusion imaging over ASPECTS. It emphasizes the significance of the occlusion site in large-core stroke for clinical decisions and calls for research to refine the imaging criteria for thrombectomy eligibility.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627150","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":"Density and Time Characteristics of CSF-Venous Fistulas on CT Myelography in Patients with Spontaneous Intracranial Hypotension.","authors":"Diogo G L Edelmuth, Timothy J Amrhein, Peter G Kranz","doi":"10.3174/ajnr.A8516","DOIUrl":"10.3174/ajnr.A8516","url":null,"abstract":"<p><strong>Background and purpose: </strong>The conspicuity of CSF-venous fistulas (CVFs) on specialized myelographic imaging protocols varies, and the factors that determine their visibility have not yet been extensively studied. The purpose of this study was to determine the relative effect of 2 variables on CVF visibility: timing of imaging and intrathecal contrast attenuation.</p><p><strong>Materials and methods: </strong>A retrospective cohort of 24 patients with spontaneous intracranial hypotension due to a CVF who underwent a total of 34 CT myelographies was studied. All CTM acquisitions that included the level of the known definite CVF were evaluated for 1) time passed after injection of contrast, 2) attenuation of the adjacent subarachnoid space, 3) subjective visibility of the CVF on that series, 4) attenuation of the corresponding draining vein, and 5) contrast dose used.</p><p><strong>Results: </strong>A total of 131 acquisitions included the level of the known CVFs. Attenuation values of the thecal sac were significantly higher in acquisitions where the CVFs were definitely visible (average 2283 HU) than in acquisitions where the CVFs were equivocal or not visible (764 HU and 583 HU, respectively). No significant difference was shown in the timing of the acquisitions between the 3 groups (12.8 minutes, 20.4 minutes, and 17.5 minutes, respectively). Multivariate linear regression showed thecal sac attenuation to be the only independent predictor of the attenuation of the CVF draining vein. Time passed after contrast injection was not independently correlated.</p><p><strong>Conclusions: </strong>Intrathecal contrast attenuation has a strong positive relationship with the visibility of CVF. Timing of the acquisition was not an independent predictor of CVF visibility under our acquisition protocol.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334151","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":"Evidence of Small Vessel Disease in Patients with Transient Global Amnesia Based on the Peak Width of Skeletonized Mean Diffusivity.","authors":"Dong Ah Lee, Ho-Joon Lee, Kang Min Park","doi":"10.3174/ajnr.A8530","DOIUrl":"10.3174/ajnr.A8530","url":null,"abstract":"<p><strong>Background and purpose: </strong>The peak width of skeletonized mean diffusivity (PSMD) is a novel marker of small vessel disease. In this study, we aimed to investigate the presence of small vessel disease in patients with transient global amnesia (TGA) by using the PSMD.</p><p><strong>Materials and methods: </strong>We enrolled 75 patients newly diagnosed with TGA and included 65 age- and sex-matched healthy controls. DTI was performed by using a 3T MR imaging scanner. We measured the PSMD based on DTI by using the FSL program. This measure was compared between patients with TGA and healthy controls. Additionally, we conducted a correlation analysis to explore the relationship between PSMD and clinical factors.</p><p><strong>Results: </strong>A significant difference in the PSMD between patients with TGA and healthy controls was observed. Patients with TGA exhibited higher a PSMD compared with healthy controls (2.297 ± 0.232 versus 2.188 ± 0.216 × 10^-4 mm²/s, <i>P</i> = .005). Additionally, patients with TGA but without any vascular risk factors, such as diabetes, hypertension, or dyslipidemia, also exhibited higher a PSMD compared with healthy controls (2.278 ± 0.253 versus 2.188 ± 0.216 × 10^-4 mm²/s, <i>P</i> = .036). The PSMD positively correlated with age (<i>r</i> = 0.248, <i>P</i> = .032); however, it was not associated with duration of amnesia.</p><p><strong>Conclusions: </strong>This finding underscores the feasibility of using PSMD as a marker for detecting small vessel diseases in patients with neurologic disorders. Furthermore, our study also implies the presence of small vessel disease may be present in patients with TGA.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395918","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":"Primary Intraocular Lymphoma: Rad-Path and Ophthalmologic Correlation.","authors":"Denes Szekeres, Jonathan Parker, Evan Risch, Prasanna Vibhute, Girish Bathla, Shweta Agarwal, Amit Agarwal, Neetu Soni","doi":"10.3174/ajnr.A8517","DOIUrl":"10.3174/ajnr.A8517","url":null,"abstract":"<p><p>Primary intraocular lymphoma (PIOL) is a rare form of primary central nervous system lymphoma that poses diagnostic challenges because of its nonspecific clinical features and complex imaging characteristics. This paper presents a focus case and 2 companion cases, highlighting the complexities in identifying and treating PIOL. In the focus case, a 66-year-old man experienced gradual painless vision loss with choroidal thickening on funduscopic examination and subsequent follow-up MRI. Transvitreal biopsy confirmed PIOL, and the patient was treated with intravitreal steroids and systemic rituximab without recurrence. Companion case 1 involved a 66-year-old woman with vision changes and choroidal thickening with episcleral extension on MRI suggestive of intraocular lymphoma and ultimately treated with radiation with the presumed diagnosis of PIOL. In the companion case 2, a 63-year-old man with ocular symptoms was diagnosed with chronic lymphocytic leukemia along with vitreoretinal Richter transformation. Enucleation was performed because of a lack of visual potential and failure of chemotherapy, which confirmed PIOL. Distinguishing PIOL from other ocular conditions is crucial, given its potential for CNS involvement. Imaging plays a vital role in corroborating clinical findings. While cytology remains the standard for diagnosis, supplementary tests, including cytokine analysis, immunohistochemistry, and flow cytometry, provide additional insights. PIOL treatment strategies are tailored to disease extent, ranging from locoregional chemotherapy to invasive enucleation. CNS involvement carries a poor prognosis and must evaluated and surveilled with MRI. In conclusion, this case series reviews the clinical and radiologic features of PIOL, emphasizing the significance of diagnostic imaging in determining disease extent and guiding treatments.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334165","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":"Systematic Review and Meta-Analysis of Radiation Dose Reduction Studies in Pediatric Head CT.","authors":"Kevin He, Adam Boukind, Anusha S Sanka, Joseph G Ribaudo, Sophia Chryssofos, Gary B Skolnick, Lauren B Yaeger, Allan M Thomas, Ali Y Mian, Kamlesh B Patel","doi":"10.3174/ajnr.A8730","DOIUrl":"https://doi.org/10.3174/ajnr.A8730","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Conventional imaging protocols used in pediatric head CT scanning without specific adaptations to lower radiation dose or \"standard dose\" pediatric head CTs increase unnecessary radiation exposure. Modifying CT parameters, utilizing iterative reconstruction, and adopting specialized protocols are ongoing strategies to lower radiation dose in pediatric head CTs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This article will review studies reducing radiation exposure in pediatric patients undergoing head CT and provide metaanalysis of percent radiation dose reduction of the studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;Following PRISMA guidelines, we utilized Embase.com, Ovid Medline, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR), and Clinicaltrials.gov to identify all relevant articles pertaining to radiation dose reduction in pediatric head CT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study selection: &lt;/strong&gt;All human studies (excluding animal, phantom, and cadaveric) published after 2012, aiming to lower radiation dose of a \"Routine\" or \"Standard\" dose CT protocol in use, were selected for review and metanalyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data analysis: &lt;/strong&gt;We extracted study characteristics such as location, sample size, scanner, clinical indication, CT protocol parameter modifications, iterative reconstruction method if applicable, dose reduction, image quality metrics, and overall findings. CT protocol parameter modifications and dose reduction were summarized using descriptive statistics. Metanalyses on percent dose reduction were performed. Metanalyses were subgrouped by clinical indication, use of iterative reconstruction, and age group to isolate sources of heterogeneity between studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data synthesis: &lt;/strong&gt;This review identified 20 studies modifying their routine or standard dose pediatric head CT protocols on human patients. These studies modified CT parameters with or without the use of iterative reconstruction and/or used specialized protocols. Most common CT parameters modifications consisted of decreasing tube current time product (mAs) (N=13) and/or tube voltage (kV) (N=9). The most successful dose reduction studies had the clinical indication of craniosynostosis and utilized iterative reconstruction. Ernst et al. (2016) utilized Model Based Iterative Reconstruction (MBIR) for craniosynostosis and reduced effective dose by 97% and Lyoo et al. (2023) utilized Advanced Modeled Iterative Reconstruction (ADMIRE) with ClariCT for craniosynostosis and reduced CTDIvol by 95.9%. Metanalyses revealed significant differences in percent dose reduction based on clinical indication.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Heterogeneity of study protocols, incomplete protocol/outcome reporting, and variability of institution, scanner, patient demographics, and clinical indication limit the generalizability of our findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This system","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588713","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 Translation of Hyperpolarized ¹³C Metabolic Probes for Glioma Imaging.","authors":"Adam W Autry, Yaewon Kim, Duy Dang, Hsin-Yu Chen, James B Slater, Robert A Bok, Duan Xu, Janine M Lupo, Jeremy W Gordon, Peder E Z Larson, Daniel B Vigneron, Yan Li, Susan M Chang","doi":"10.3174/ajnr.A8726","DOIUrl":"https://doi.org/10.3174/ajnr.A8726","url":null,"abstract":"<p><p>Hyperpolarized carbon-13 (HP-¹³C) MRI enables the real-time measurement of dynamic metabolism by utilizing molecular probes whose magnetization has been transiently enhanced via dynamic nuclear polarization of ¹³C labels. Based on pre-clinical and clinical investigations demonstrating Warburg-related metabolic dysfunction and tricarboxylic acid (TCA)-cycle alterations in gliomas, HP¹³C techniques appear very promising for overcoming conventional challenges to evaluating tumor burden and extent, early therapeutic response and progression among patients non-invasively. This article surveys the multi-faceted translational development of HP-¹³C MRI in the context of glioma imaging, while emphasizing innovation concerning the pharmacy production of HP probes - [1-¹³C]/[2-¹³C]-pyruvate and [1-¹³C,5-¹²C]-alpha-ketoglutarate - that serve as non-radioactive metabolic contrast agents. Borrowing from practical experience, we present specific probe indications for isocitrate dehydrogenase (IDH)-wildtype glioblastomas and IDH-mutant gliomas together with example data to show the targeted, pathway-dependent function of these agents and their utility. Additional information pertaining to HP-¹³C hardware, acquisition and post-processing techniques provides an overview of the imaging methodology as it is currently performed at a leading institution. Considering the developing markers for progressive disease in glioblastomas and rapidly advancing capability, this unique imaging technology appears poised for translational impact following further evaluation.ABBREVIATIONS: 2-HG = D-2-hydroxyglutarate; α-KG = alpha-ketoglutarate; CSI = chemical shift imaging; d-DNP = dissolution-dynamic nuclear polarization; EPI = echo-planar imaging; EPSI = echo-planar spectroscopic imaging; IDHm = isocitrate dehydrogenasemutant; IR-SPGR = inversion recovery-prepared fast spoiled gradient-recalled (imaging); LrGGs = lower-grade gliomas; NMR = nuclear magnetic resonance; OGC = oxoglutarate carrier; PHIP = parahydrogen-induced polarization; SNR = signal-to-noise ratio; TCA cycle = tricarboxylic acid cycle; WHO = World Health Organization.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569266","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 Hole Sign under Anticoagulant Therapy: A Retrospective Comparison of Warfarin and Direct Oral Anticoagulants.","authors":"Hirotaka Sato, Manabu Kinoshita, Takuma Takano, Takahiro Sanada, Seiya Fujikawa, Masahiro Toda, Kiyoshi Choji, Teruo Kimura","doi":"10.3174/ajnr.A8528","DOIUrl":"10.3174/ajnr.A8528","url":null,"abstract":"<p><strong>Background and purpose: </strong>Direct oral anticoagulants (DOAC) have rapidly replaced warfarin. Intracerebral hemorrhage (ICH) is known to be one of the most severe side effects of anticoagulant drugs. The black hole (BH) sign is reportedly a valid radiologic sign for predicting hematoma expansion in acute ICH. Here, we hypothesized that the frequency of BH signs might differ between warfarin and DOAC treatment. We critically evaluated the clinical value of the BH sign in acute ICH under warfarin versus DOAC therapy.</p><p><strong>Materials and methods: </strong>Patients with acute ICH under anticoagulant therapy were enrolled. Hematoma volumes were measured by ABC/2. Radiologists blinded to the clinical information determined the presence or absence of the BH sign on CT images. This study defined a more than 12.5 mL increase in hematoma volume as cases with \"expanded hematoma.\"</p><p><strong>Results: </strong>We analyzed 111 patients with acute ICH under anticoagulant therapy. Among them, 21 patients were treated with antagonists in this cohort. Multivariate logistic regression analysis revealed that the presence of ventricular perforation (<i>P</i> = .02; adjusted OR: 3.51; 95% CI: 1.32-10.2) and the BH sign (<i>P</i> < .01; adjusted OR: 4.86; 95% CI: 1.73-14.3) were significantly different between expanded and nonexpanded hematoma cases. Comparison of hematoma volume and the presence of the BH sign between warfarin and DOAC cases indicated significant differences in maximum hematoma volume (<i>P</i> = .03) and presence of the BH sign (<i>P</i> < .01). The increase in hematoma volume was significantly greater when the BH sign was present under warfarin therapy (<i>P</i> = .05). In contrast, the increase in hematoma volume did not differ between cases with and without the BH sign in patients under DOAC therapy (<i>P</i> = .14).</p><p><strong>Conclusions: </strong>The BH sign is a useful radiologic signature to predict the expansion of acute ICH under anticoagulant therapy. ICH under warfarin tended to present the BH sign more frequently than that under DOAC. The results also showed that the BH sign is more reliable under warfarin than under DOAC therapy in patients with ICH.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"489-494"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395916","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":"Lee F. Rogers.","authors":"Eric J Russell","doi":"10.3174/ajnr.A8669","DOIUrl":"10.3174/ajnr.A8669","url":null,"abstract":"","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"643"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525466","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 Results of the ANAIS Study: Mechanical Thrombectomy Using the ANA Device in Combination with a Stent Retriever in Subjects with Acute Ischemic Stroke.","authors":"Alejandro Tomasello, Joaquín Zamarro, Mikel Terceño, Jose Diaz-Perez, Saima Bashir, Laura Ludovica Gramegna, Manuel Requena, Francesco Diana, Eila Rivera, Marta De Dios, David Hernández, Sonia Sánchez, Inyaki Galve, Marc Ribo","doi":"10.3174/ajnr.A8556","DOIUrl":"https://doi.org/10.3174/ajnr.A8556","url":null,"abstract":"<p><strong>Background and purpose: </strong>The ANA thrombectomy system is a funnel catheter comprising a self-expanding coated funnel that works in conjunction with a standard stent retriever and is designed to locally restrict flow and reduce clot fragmentation. The ANAIS Study to Confirm the Safety and Performance of the ANA 5F Advanced Neurovascular Access investigated the performance of the ANA funnel catheter in patients with stroke.</p><p><strong>Materials and methods: </strong>Mechanical thrombectomy using the ANA device in combination with a stent retriever in subjects with acute ischemic stroke. This is a prospective, single-arm, multicenter study with blinded outcome assessment by an independent imaging Core Lab. Patients with anterior circulation stroke undergoing mechanical thrombectomy were eligible. The primary end point was successful reperfusion (expanded TICI 2b50-3) within 3 passes without rescue therapy. The safety end point combined symptomatic intracranial hemorrhage and severe adverse device effect.</p><p><strong>Results: </strong>Forty-three subjects were treated in 3 centers: mean age, 70.5 (SD, 13.1) years, 44.2% (19/43) women; median admission NIHSS score, 16.0 (range, 12.5-19.5). The primary end point was achieved in 70% (30/43) and 81% (26/32) in the intention-to-treat (ITT) and per-protocol (PP) populations, respectively. The rates of first pass expanded TICI 2c-3 were 44% (19/43) and 56% (18/32) in the ITT and PP populations, respectively. There were no severe adverse device effects/symptomatic ICH at 24 hours (0/43). When the funnel was deployed in the C1 segment of the internal carotid artery (Bouthillier Classification), the primary end point (ITT, 36%; PP, 57%) was lower than when deployed in the C2/C3 segments (ITT, 89%; PP, 100%; <i>P</i> < .01), or in the C4 or above segments (ITT, 71%; PP, 77%; <i>P</i> < .05). The primary end point was higher when continuous aspiration was applied from initiation of the retrieval maneuver (ITT, 81%; PP, 92%) compared with end-aspiration only (ITT, 36%; PP, 50%, <i>P</i> < .01).</p><p><strong>Conclusions: </strong>The ANA funnel catheter achieved high rates of reperfusion and first pass success, with a good safety profile. Successful reperfusion was superior when the funnel was deployed above the C1 segment of the ICA and clot retrieval was performed under continuous aspiration.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":"46 3","pages":"502-509"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558790","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":"Prediction of Difficult Round Window Visibility during Cochlear Implantation via a Reformatted CT Facial Recess View: A Retrospective Study with Surgical Correlation.","authors":"Si Wei Kheok, Jia Hui Ng, Lishya Liauw, Vanessa Yee Jueen Tan, Jiun Fong Thong","doi":"10.3174/ajnr.A8503","DOIUrl":"10.3174/ajnr.A8503","url":null,"abstract":"<p><strong>Background and purpose: </strong>Cochlear implant surgery is performed commonly through the facial recess via the round window (RW) approach. This study aims to evaluate the utility of reformatting the preoperative CT temporal bone scan into a CT facial recess view in alerting surgeons to a potentially difficult surgery with poorly visualized RW.</p><p><strong>Materials and methods: </strong>This is a retrospective study of 41 patients (43 ears), who had undergone cochlear implant surgery. Intraoperative findings of RW position relative to second genu-mastoid portion of facial nerve, and RW membrane orientation were recorded by the surgeons. Preoperative CTs were analysed by 2 radiologists in both axial and reformatted planes, with the later simulating the surgeon's view via the facial recess. Radiologic assessment markers include the facial nerve-chorda tympani nerve width measured 1.2 mm inferior to the exit point of the chorda tympani nerve into the tympanic cavity, RW position relative to second genu-mastoid segment of the facial nerve, and RW membrane's angle from the vertical axis.</p><p><strong>Results: </strong>The best predictor for difficult RW intraoperative visibility is the RW position relative to the second genu-mastoid segment of the facial nerve lying lateral to it on CT facial recess reformatted images. A RW that lies partially to completely posterior to the posterior border of the second genu-mastoid segment of the facial nerve had up to 55.6% risk of encountering difficult access, while those positioned anterior to or partially anterior to the anterior edge of the second genu-mastoid segment of the facial nerve had 0% risk of difficult access (<i>P</i> < .05). There are substantial agreements in the intrarater (κ = 0.751, <i>P</i> < .001) and interrater reliability (κ = 0.698, <i>P</i> < .001). There is no significant association between surgical difficulty and facial nerve to chorda tympani distance or RW angle (<i>P</i> > .05).</p><p><strong>Conclusions: </strong>Identification of RW positions in the reformatted CT facial recess view is a useful tool in predicting potentially difficult RW access in cochlear implant surgery.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"572-579"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303162","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}