AJNR. American journal of neuroradiology最新文献

{"title":"Endovascular Thrombectomy versus Medical Management for Acute Basilar Artery Occlusion Stroke in the Elderly.","authors":"Huanwen Chen, Marco Colasurdo, Mihir Khunte, Ajay Malhotra, Dheeraj Gandhi","doi":"10.3174/ajnr.A8473","DOIUrl":"10.3174/ajnr.A8473","url":null,"abstract":"<p><strong>Background and purpose: </strong>The efficacy and safety of endovascular thrombectomy (EVT) for elderly patients with basilar artery occlusion (BAO) stroke is unclear. The purpose of this study is to investigate the safety and efficacy of EVT for elderly BAO stroke patients.</p><p><strong>Materials and methods: </strong>This was an explorative retrospective analysis of the 2016-21 National Inpatient Sample in the United States. Elderly patients with BAO stroke (80 years of age or older) with an NIHSS score of at least 5 were included. Primary outcome was discharge home. Secondary outcomes included in-hospital mortality and intracranial hemorrhage (ICH). Outcomes were compared between patients treated with EVT and those treated with medical management (MM) alone. Propensity score matching (PSM) was performed to control confounders. Subgroup analyses were conducted for patients who did and did not receive IV thrombolysis (IVT).</p><p><strong>Results: </strong>We identified 2520 elderly patients with BAO stroke; 830 received EVT and 1690 received MM alone. After PSM, 1115 patients and 715 patients remained in the MM and EVT groups, respectively. Compared with PSM controls, EVT was not significantly associated with different rates of home discharge (17.5% versus 12.2%; OR, 1.36 [95% CI, 0.76-2.44], <i>P</i> = .30) or in-hospital mortality (31.5% versus 32.9%; OR, 1.00 [95% CI, 0.63-1.60], <i>P</i> = .99), but it was significantly associated with higher rates of ICH (18.2% versus 7.3%; OR, 2.69 [95% CI, 1.41-5.15], <i>P</i> = .003). Among patients who did not receive IVT, EVT was significantly associated with higher rates of home discharge (21.5% versus 11.5%; OR, 1.93 [95% CI, 1.02-3.66], <i>P</i> = .044), whereas EVT was not significantly associated with a different rate of home discharge among those treated with IVT (5.6% versus 15.0%; OR, 0.28 [95% CI, 0.05-1.46], <i>P</i> = .13). Interaction analysis revealed that IVT was a negative modulator of the positive association of EVTs with home discharge (interaction <i>P</i> = .031).</p><p><strong>Conclusions: </strong>EVT was not significantly associated with more favorable hospitalization outcomes for elderly patients with BAO stroke, and it was significantly associated with an increased risk of ICH. EVT may be an effective treatment for patients who did not receive IVT.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"278-284"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057553","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":"Comparison of Imaging Findings between Granulomatosis with Polyangiitis and Eosinophilic Granulomatosis with Polyangiitis on Sinus CT: Importance of High-Density Opacification of the Paranasal Sinuses.","authors":"Inseon Ryoo, Serena Poésy, Artem Kaliaev, Karen Buch, Osamu Sakai","doi":"10.3174/ajnr.A8485","DOIUrl":"10.3174/ajnr.A8485","url":null,"abstract":"<p><strong>Background and purpose: </strong>Granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA) are the most common causes of chronic sinusitis from systemic granulomatous diseases. While both are small- to medium-sized vasculitis with necrotizing granulomas, they have different clinical courses and prognoses. High-density sinus opacification has been reported in allergic fungal sinusitis with eosinophilic infiltrates. Given that EGPA also has eosinophilic tissue infiltrates, we evaluated the differences in sinus CT findings, focusing on the sinus secretion attenuation between patients with GPA and EGPA, along with other previously described findings.</p><p><strong>Materials and methods: </strong>This study included 31 patients with GPA and 22 patients with EGPA who underwent sinus CT. The attenuation of secretions within the paranasal sinuses was visually assessed, and the Hounsfield unit (HU) of the highest-density portions within each sinus was measured. Lund-Mackay scores (LMS), bony destruction, sclerotic wall changes, adjacent organ involvement, and nasal polyps were evaluated and compared between patients with GPA and EGPA. Multiple logistic regression analyses were conducted to determine which factors independently discriminated GPA from EGPA, and the diagnostic ability to differentiate between these 2 diseases was evaluated by using a receiver operating characteristic curve analysis.</p><p><strong>Results: </strong>More patients in the GPA group showed bony destructions, bone sclerosis, and involvement of organs adjacent to paranasal sinuses than in the EGPA group (<i>P</i> = .006, 0.048, and 0.035, respectively). The EGPA group had higher LMS and more nasal polyps than the GPA group (<i>P</i> = .078 and 0.333, respectively). More patients in the EGPA group showed internal high-density opacification than in the GPA group, and patients with EGPA had higher mean HUs (both <i>P</i> < .0001). The presence of high-density opacification or mean HUs independently distinguished GPA from EGPA (OR, 53.67 and 1.07; 95% CI, 4.07-708.03 and 1.02-1.13, respectively) and showed a greater ability to discriminate between these diseases compared with other findings.</p><p><strong>Conclusions: </strong>Patients with EGPA had more high-density sinus opacification and higher mean HU on sinus CT than the patients with GPA. In addition to the previously reported CT findings, such as bony destruction, bone sclerosis, and adjacent organ involvement, evaluating secretion attenuation can assist in distinguishing between GPA and EGPA.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"355-361"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018005","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":"Assessment of Attenuation in Pericarotid Fat among Patients with Carotid Plaque and Spontaneous Carotid Dissection.","authors":"Mohammed O Alalfi, Riccardo Cau, Giovanni Maria Argiolas, Roberta Scicolone, Cesare Mantini, Valentina Nardi, John C Benson, Jasjit S Suri, Zafer Keser, Amir Lerman, Giuseppe Lanzino, Paolo Siotto, Luca Saba","doi":"10.3174/ajnr.A8546","DOIUrl":"10.3174/ajnr.A8546","url":null,"abstract":"<p><strong>Background and purpose: </strong>Changes in perivascular fat density (PFD) and its association with inflammation have been topics of interest in both atherosclerotic and nonatherosclerotic vasculopathies. The objective of this study was to assess the PFD in patients with spontaneous internal carotid artery dissection (SICAD) or carotid atherosclerotic plaque, with and without intraplaque hemorrhage (IPH).</p><p><strong>Materials and methods: </strong>A cross-sectional retrospective bicentric analysis of 130 patients (30 with SICAD and 100 with carotid atherosclerotic plaque) who underwent CT angiography was performed. Among the subjects with atherosclerotic plaque, 36 showed the presence of IPH. PFD analysis was performed by 2 radiologists who placed 2 ROIs to identify the perivascular fat tissue attenuation. The Mann-Whitney <i>U</i> test was conducted to evaluate the difference between patient cohorts.</p><p><strong>Results: </strong>Carotid arteries with SICAD and IPH demonstrated an average PFD of -68.97 HU (95% CI, -72.11 to -65.82 HU) and -69.97 HU (95% CI, -73.00 to -66.95 HU), respectively, in comparison with patients without IPH, who showed an average PFD -77.11 HU (95% CI,-78.78 to -75.44 HU) (<i>P</i> < .001 for both). Conversely, no significant differences were found between patients with SICAD and those with carotid plaque with IPH (<i>P</i> = .324).</p><p><strong>Conclusions: </strong>The average PFDs in patients with SICAD and carotid atherosclerosis plaque with IPH were similar and higher than those in patients with carotid plaque without IPH. This finding suggests a shared pathologic inflammatory mechanism in these 2 conditions. Studies comparing pathologic specimens directly with radiologic images may be needed to confirm this indirect hypothesis.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"259-264"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030075","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":"Azygos Vein Stenosis in Frontotemporal Dementia Sagging Brain Syndrome.","authors":"Wouter I Schievink, Marcel M Maya, Rola Saouaf, H Gabriel Lipshutz, Rachelle B Taché, Daniel Scoffings, Jeremy D Schmahmann","doi":"10.3174/ajnr.A8532","DOIUrl":"10.3174/ajnr.A8532","url":null,"abstract":"<p><strong>Background and purpose: </strong>Symptoms indistinguishable from behavioral-variant frontotemporal dementia (bvFTD) can develop in patients with spontaneous intracranial hypotension associated with severe brain sagging. An underlying spinal CSF leak can be identified in only a minority of these patients and the success rate of nondirected treatments, such as epidural blood patching and dural reduction surgery, is low. The disability associated with bvFTD sagging brain syndrome is high and, because of the importance of the venous system in the pathophysiology of CSF leaks in general, we have investigated the systemic venous circulation in those patients with recalcitrant symptoms.</p><p><strong>Materials and methods: </strong>We reviewed the medical records and imaging studies of 21 consecutive patients with bvFTD sagging brain syndrome in whom no spinal CSF leak could be found and who underwent imaging of the systemic venous circulation (MR- or CT-venography). An SIH Disability Assessment Score (SIHDAS) questionnaire was completed to assess the severity of the symptoms.</p><p><strong>Results: </strong>The mean age of the 3 women and 18 men was 50 years (range, 26-68 years). Seven patients were found to have venous stenosis. Endovascular stent placement of moderate to high-grade azygos vein stenosis in 3 patients resulted in prompt and remarkable improvement of symptoms in 2 patients (SIHDAS: very severe disability to no or mild disability) and mild improvement in 1 patient (SIHDAS: very severe disability to severe disability). Treatment of internal jugular vein and inferior vena cava stenosis in 2 patients each did not result in any improvement of symptoms. Endovascular (5 patients) or surgical (2 patients) interruption of multiple epidural spinal venous pathways did not result in any clinical improvement.</p><p><strong>Conclusions: </strong>The azygos vein is the main conduit between the spinal CSF space and the systemic venous circulation and this study demonstrates that isolated azygos vein stenosis may be a cause of spinal CSF loss and sagging brain syndrome. In this study, the yield of finding a clinically important treatable venous lesion among patients with recalcitrant bvFTD sagging brain syndrome was relatively low (15%). However, high quality and safe noninvasive imaging of the systemic venous system is available, eg, MR-venography, and should be considered for those patients who have exhausted treatments for this devastating condition, focusing on the azygos system.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"408-415"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030108","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":"Reply.","authors":"","doi":"10.3174/ajnr.A8649","DOIUrl":"10.3174/ajnr.A8649","url":null,"abstract":"","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"456"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070108","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":"Quantification of Collateral Supply with Local-AIF Dynamic Susceptibility Contrast MRI Predicts Infarct Growth.","authors":"Mira M Liu, Niloufar Saadat, Steven P Roth, Marek A Niekrasz, Mihai Giurcanu, Timothy J Carroll, Gregory A Christoforidis","doi":"10.3174/ajnr.A8441","DOIUrl":"10.3174/ajnr.A8441","url":null,"abstract":"<p><strong>Background and purpose: </strong>In ischemic stroke, leptomeningeal collaterals can provide delayed and dispersed compensatory blood flow to tissue-at-risk despite an occlusion and can impact treatment response and infarct growth. The purpose of this work is to test the hypothesis that the inclusion of this delayed and dispersed flow with an appropriately calculated local arterial input function (local-AIF) is needed to quantify the degree of collateral blood supply in tissue distal to an occlusion.</p><p><strong>Materials and methods: </strong>Seven experiments were conducted in a preclinical middle cerebral artery occlusion model. Dynamic susceptibility contrast MRI was imaged and postprocessed to yield quantitative cerebral blood flow (qCBF) maps with both a traditionally chosen single arterial input function applied globally to the whole brain (ie, \"global-AIF\") and a delay and dispersion corrected AIF (ie, \"local-AIF\") that is sensitive to retrograde flow. Leptomeningeal collateral arterial recruitment was quantified with a pial collateral score from x-ray angiograms, and infarct growth was calculated from serially acquired diffusion-weighted MRI scans.</p><p><strong>Results: </strong>The degree of collateralization at x-ray correlated more strongly with local-AIF qCBF in the ischemic penumbra (R² = 0.81) than with traditional global-AIF qCBF (R² = 0.05). Local-AIF qCBF was negatively correlated with infarct growth (slower infarct progression with higher perfusion, R² = 0.79) more strongly than global-AIF qCBF (R² = 0.02).</p><p><strong>Conclusions: </strong>In acute stroke, qCBF calculated with a local-AIF is more accurate for assessing tissue status and collateral supply than traditionally chosen global-AIFs. These findings support the use of a local-AIF that corrects for delayed and dispersed retrograde flow in determining quantitative tissue perfusion with collateral supply in occlusive disease.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"251-258"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972428","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":"\"Synthetic\" DSC Perfusion MRI with Adjustable Acquisition Parameters in Brain Tumors Using Dynamic Spin-and-Gradient-Echo Echoplanar Imaging.","authors":"Francesco Sanvito, Jingwen Yao, Nicholas S Cho, Catalina Raymond, Donatello Telesca, Whitney B Pope, Richard G Everson, Noriko Salamon, Jerrold L Boxerman, Timothy F Cloughesy, Benjamin M Ellingson","doi":"10.3174/ajnr.A8475","DOIUrl":"10.3174/ajnr.A8475","url":null,"abstract":"<p><strong>Background and purpose: </strong>Normalized relative cerebral blood volume (nrCBV) and percentage of signal recovery (PSR) computed from dynamic susceptibility contrast (DSC) perfusion imaging are useful biomarkers for differential diagnosis and treatment response assessment in brain tumors. However, their measurements are dependent on DSC acquisition factors, and CBV-optimized protocols technically differ from PSR-optimized protocols. This study aimed to generate \"synthetic\" DSC data with adjustable synthetic acquisition parameters using dual-echo gradient-echo (GE) DSC datasets extracted from dynamic spin-and-gradient-echo echoplanar imaging (dynamic SAGE-EPI). Synthetic DSC was aimed at: 1) simultaneously create nrCBV and PSR maps using optimal sequence parameters, 2) compare DSC datasets with heterogeneous external cohorts, and 3) assess the impact of acquisition factors on DSC metrics.</p><p><strong>Materials and methods: </strong>Thirty-eight patients with contrast-enhancing brain tumors were prospectively imaged with dynamic SAGE-EPI during a non-preloaded single-dose contrast injection and included in this cross-sectional study. Multiple synthetic DSC curves with desired pulse sequence parameters were generated using the Bloch equations applied to the dual-echo GE data extracted from dynamic SAGE-EPI datasets, with or without optional preload simulation.</p><p><strong>Results: </strong>Dynamic SAGE-EPI allowed for simultaneous generation of CBV-optimized and PSR-optimized DSC datasets with a single contrast injection, while PSR computation from guideline-compliant CBV-optimized protocols resulted in rank variations within the cohort (Spearman's ρ = 0.83-0.89, i.e. 31%-21% rank variation). Treatment-naïve glioblastoma exhibited lower parameter-matched PSR compared to the external cohorts of treatment-naïve primary CNS lymphomas (PCNSL) (<i>p</i><0.0001), supporting a role of synthetic DSC for multicenter comparisons. Acquisition factors highly impacted PSR, and nrCBV without leakage correction also showed parameter-dependence, although less pronounced. However, this dependence was remarkably mitigated by post-hoc leakage correction.</p><p><strong>Conclusions: </strong>Dynamic SAGE-EPI allows for simultaneous generation of CBV-optimized and PSR-optimized DSC data with one acquisition and a single contrast injection, facilitating the use of a single perfusion protocol for all DSC applications. This approach may also be useful for comparisons of perfusion metrics across heterogeneous multicenter datasets, as it facilitates post-hoc harmonization.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"311-320"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147042","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":"Performance of the CT-Guided C1-C2 Facet (Lateral Atlantoaxial Joint) Injection.","authors":"Ryan D Stockard, Drew Artrip, Troy A Hutchins, Lubdha M Shah, Miriam E Peckham","doi":"10.3174/ajnr.A8652","DOIUrl":"10.3174/ajnr.A8652","url":null,"abstract":"<p><p>CT-guided C1-C2 facet joint injections are a valuable tool for managing cervicogenic headaches caused by degenerative and inflammatory conditions of the atlantoaxial joint. This video article presents the procedural technique for a CT-guided C1-C2 facet joint injection in a patient with left-sided cervicogenic headache. Despite concerns regarding potential complications such as vascular injury to the vertebral artery and nerve injury to the C2 dorsal root ganglion, careful anatomic planning and imaging guidance allows safe and effective treatment. The injection involves precise needle placement between the vertebral artery and the C2 dorsal root ganglion, followed by contrast injection to confirm positioning and administration of a steroid-anesthetic mixture. Preprocedural imaging and safety precautions such as reviewing the international normalized ratio and platelet levels are essential. While rare adverse events have been reported, this technique remains a valuable option for pain relief in patients unresponsive to conservative therapies.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"433"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069805","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":"Dextromethorphan-Associated Neurotoxicity with Cerebellar Edema Syndrome in Young Children: Neuroimaging Features.","authors":"Smily Sharma, Sarbesh Tiwari, Lokesh Saini, Taruna Yadav, Sujatha Manjunathan, Ananya Panda, Bharat Choudhary, Daisy Khera","doi":"10.3174/ajnr.A8455","DOIUrl":"10.3174/ajnr.A8455","url":null,"abstract":"<p><p>Dextromethorphan toxicity in young children (especially those 4 years of age or younger) can have an extremely poor prognosis if untreated. However, if timely recognized and optimally managed, it can have a good clinical outcome despite a profound initial insult. We present 3 pediatric cases (younger than 5 years of age) with sudden unresponsiveness following ingestion of cough medications containing dextromethorphan. All these children showed cytotoxic edema in the cerebellar hemispheres on MR of the brain, with diffusion-restricting foci in the supratentorial white matter in 2 patients. These features resemble the recently described acute opioid toxidrome in children, pediatric opioid use-associated neurotoxicity with cerebellar edema (POUNCE). Hence, we named this entity dextromethorphan-associated neurotoxicity with cerebellar edema (DANCE) to increase the awareness of dextromethorphan toxicity in young children and the need to promptly recognize it to initiate optimal management.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"390-394"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141997060","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 Etiology of Intracranial Artery Stenosis in Autoimmune Rheumatic Diseases: An Observational High-Resolution MR Imaging Study.","authors":"Shun Li, Qiuyu Yu, Yangzhong Zhou, Manqiu Ding, Huanyu Zhou, Yiyang Liu, Yinxi Zou, Haoyao Guo, Yuelun Zhang, Mengtao Li, Mingli Li, Yan Xu, Weihai Xu","doi":"10.3174/ajnr.A8474","DOIUrl":"10.3174/ajnr.A8474","url":null,"abstract":"<p><strong>Background and purpose: </strong>Autoimmune rheumatic diseases (AIRD) can cause intracranial artery stenosis (ICAS) and lead to stroke. This study aimed to characterize patients with ICAS associated with AIRD.</p><p><strong>Materials and methods: </strong>Using data from a high-resolution MR imaging database, we retrospectively reviewed patients with AIRD with ICAS. Stratification into vasculitis, atherosclerosis, and mixed atherovasculitis subtypes was based on imaging findings, followed by a comparative analysis of clinical characteristics and outcomes across these subgroups.</p><p><strong>Results: </strong>Among 139 patients (mean, 45.1 [SD, 17.3] years; 64.7% women), 56 (40.3%) were identified with vasculitis; 57 (41.0%), with atherosclerosis; and 26 (18.7%), with mixed atherovasculitis. The average interval from AIRD onset to high-resolution MRI was 5 years. Patients with vasculitis presented at a younger age of AIRD onset (mean, 34.5 [SD, 19.4] years), nearly 10 years earlier than other groups (<i>P</i> = .010), with a higher artery occlusion incidence (44.6% versus 21.1% and 26.9%, <i>P</i> = .021). Patients with atherosclerosis showed the highest cardiovascular risk factor prevalence (73.7% versus 48.2% and 61.5%, <i>P</i> = .021) but fewer intracranial artery wall enhancement instances (63.2% versus 100% in others, <i>P</i> < .001). The mixed atherovasculitis group, predominantly men (69.2% versus 30.4% and 24.6%, <i>P</i> < .001), exhibited the most arterial involvement (5 arteries per person versus 3 and 2, <i>P</i> = .001). Over an average 21-month follow-up, 23 (17.0%) patients experienced stroke events and 8 (5.9%) died, with the mixed atherovasculitis group facing the highest risk of stroke events (32.0%) and the highest mortality (12.0%).</p><p><strong>Conclusions: </strong>Intracranial arteries are injured and lead to heterogeneous disease courses when exposed to AIRD and cardiovascular risk factors. While atherosclerosis acceleration is common, vasculitis may further contribute to the early development of occlusion and multiple artery involvement. Varied intracranial arteriopathies may result in different outcomes.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"265-271"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057554","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}