AJNR. American journal of neuroradiology最新文献

{"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}

{"title":"Quantitative Susceptibility Mapping with Source Separation in Normal Brain Development of Newborns.","authors":"MinJung Jang, Alexey V Dimov, Kushal Kapse, Jonathan Murnick, Zachary Grinspan, Alan Wu, Arindam RoyChoudhury, Yi Wang, Pascal Spincemaille, Thanh D Nguyen, Catherine Limperopoulos, Zungho Zun","doi":"10.3174/ajnr.A8488","DOIUrl":"10.3174/ajnr.A8488","url":null,"abstract":"<p><strong>Background and purpose: </strong>Quantitative susceptibility mapping is an emerging method for characterizing tissue composition and studying myelination and iron deposition. However, accurate assessment of myelin and iron content in the neonate brain using this method is challenging because these 2 susceptibility sources of opposite signs (myelin, negative; iron, positive) occupy the same voxel, with minimal and comparable content in both sources. In this study, susceptibilities were measured in the healthy neonate brain using susceptibility source separation.</p><p><strong>Materials and methods: </strong>Sixty-nine healthy neonates without clinical indications were prospectively recruited for MRI. All neonates underwent gradient-echo imaging for quantitative susceptibility mapping. Positive (paramagnetic) and negative (diamagnetic) susceptibility sources were separated using additional information from R2* with linear modeling performed for the neonate brain. Average susceptibility maps were generated by normalizing all susceptibility maps to an atlas space. Mean regional susceptibility measurements were obtained in the cortical GM, WM, deep GM, caudate nucleus, putamen, globus pallidus, thalamus, and the 4 brain lobes.</p><p><strong>Results: </strong>A total of 65 healthy neonates (mean postmenstrual age, 42.8 [SD, 2.3] weeks; 34 females) were studied. The negative susceptibility maps visually demonstrated high signals in the thalamus, brainstem, and potentially myelinated WM regions, whereas the positive susceptibility maps depicted high signals in the GM compared with all WM regions, including both myelinated and unmyelinated WM. The WM exhibited significantly lower mean positive susceptibility and significantly higher mean negative susceptibility than cortical GM and deep GM. Within the deep GM, the thalamus showed a significantly lower mean negative susceptibility than the other nuclei, and the putamen and globus pallidus showed significant associations with neonate age in positive and/or negative susceptibility. Among the 4 brain lobes, the occipital lobe showed a significantly higher mean positive susceptibility and a significantly lower mean negative susceptibility than the frontal lobe.</p><p><strong>Conclusions: </strong>This study demonstrates regional variations and temporal changes in positive and negative susceptibilities of the neonate brain, potentially associated with myelination and iron deposition patterns in normal brain development. It suggests that quantitative susceptibility mapping with source separation may be used for early identification of delayed myelination or iron deficiency.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"380-389"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134714","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":"CSF-Venous Fistulas Arising Intraosseously within Bone Remodeled by Meningeal Diverticula.","authors":"Ajay A Madhavan, Vinil Shah, J Levi Chazen, Waleed Brinjikji, Jeremy K Cutsforth-Gregory, Thien Huynh, Ben A Johnson-Tesch, Ian T Mark, Darya P Shlapak, Mark D Mamlouk","doi":"10.3174/ajnr.A8507","DOIUrl":"10.3174/ajnr.A8507","url":null,"abstract":"<p><p>CSF-venous fistulas (CVFs) are a common and increasingly recognized type of spinal CSF leak. Most of these fistulas occur in the setting of spontaneous intracranial hypotension, though nonspontaneous cases have been described as well. In most instances, CVFs arise from the dome or neck of nerve root sleeve diverticula (also called meningeal diverticula). Venous drainage typically involves some combination of the internal epidural venous plexus and external vertebral venous plexus. Not uncommonly, venous drainage into the basivertebral venous plexus or other intraosseous veins can be seen. However, the drainage is usually a secondary finding related to normal communication between intraosseous and extraosseous veins. We have recently observed unique cases in which CVFs arise directly within the vertebral elements, resulting in primarily intraosseous drainage. It is possible that this phenomenon is secondary to prominent meningeal diverticula remodeling the adjacent vertebral elements. In this clinical report, we reviewed a multi-institutional series of CVFs exhibiting primary intraosseous drainage, with the goal of illustrating the imaging findings, treatment strategies, and outcomes of the patients. Nine cases were identified demonstrating this phenomenon. We show that intraosseous CVFs can arise in virtually any part of the vertebrae and describe how this feature affects treatment.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":"421-425"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069502","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 MRI models for the differential diagnosis of tumefactive demyelination versus <i>IDH</i>-wildtype glioblastoma.","authors":"Gian Marco Conte, Mana Moassefi, Paul A Decker, Matthew L Kosel, Christina B McCarthy, Jessica A Sagen, Yalda Nikanpour, Mahboubeh Fereidan-Esfahani, Michael W Ruff, Fiorella S Guido, Heather K Pump, Terry C Burns, Robert B Jenkins, Bradley J Erickson, Daniel H Lachance, W Oliver Tobin, Jeanette E Eckel-Passow","doi":"10.3174/ajnr.A8645","DOIUrl":"10.3174/ajnr.A8645","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and purpose: &lt;/strong&gt;Diagnosis of tumefactive demyelination can be challenging. The diagnosis of indeterminate brain lesions on MRI often requires tissue confirmation via brain biopsy. Noninvasive methods for accurate diagnosis of tumor and non-tumor etiologies allows for tailored therapy, optimal tumor control, and a reduced risk of iatrogenic morbidity and mortality. Tumefactive demyelination has imaging features that mimic &lt;i&gt;isocitrate dehydrogenase&lt;/i&gt;-wildtype glioblastoma (&lt;i&gt;IDH&lt;/i&gt;wt GBM). We hypothesized that deep learning applied to postcontrast T1-weighted (T1C) and T2-weighted (T2) MRI images can discriminate tumefactive demyelination from &lt;i&gt;IDH&lt;/i&gt;wt GBM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Patients with tumefactive demyelination (n=144) and &lt;i&gt;IDH&lt;/i&gt;wt GBM (n=455) were identified by clinical registries. A 3D DenseNet121 architecture was used to develop models to differentiate tumefactive demyelination and &lt;i&gt;IDH&lt;/i&gt;wt GBM using both T1C and T2 MRI images, as well as only T1C and only T2 images. A three-stage design was used: (i) model development and internal validation via five-fold cross validation using a sex-, age-, and MRI technology-matched set of tumefactive demyelination and &lt;i&gt;IDH&lt;/i&gt;wt GBM, (ii) validation of model specificity on independent &lt;i&gt;IDH&lt;/i&gt;wt GBM, and (iii) prospective validation on tumefactive demyelination and &lt;i&gt;IDH&lt;/i&gt;wt GBM. Stratified AUCs were used to evaluate model performance stratified by sex, age at diagnosis, MRI scanner strength, and MRI acquisition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The deep learning model developed using both T1C and T2 images had a prospective validation area under the receiver operator characteristic curve (AUC) of 88% (95% CI: 0.82 - 0.95). In the prospective validation stage, a model score threshold of 0.28 resulted in 91% sensitivity of correctly classifying tumefactive demyelination and 80% specificity (correctly classifying &lt;i&gt;IDH&lt;/i&gt;wt GBM). Stratified AUCs demonstrated that model performance may be improved if thresholds were chosen stratified by age and MRI acquisition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;MRI images can provide the basis for applying deep learning models to aid in the differential diagnosis of brain lesions. Further validation is needed to evaluate how well the model generalizes across institutions, patient populations, and technology, and to evaluate optimal thresholds for classification. Next steps also should incorporate additional tumor etiologies such as CNS lymphoma and brain metastases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Abbreviations: &lt;/strong&gt;AUC = area under the receiver operator characteristic curve; CNS = central nervous system; CNSIDD = central nervous system inflammatory demyelinating disease; FeTS = federated tumor segmentation; GBM = glioblastoma; &lt;i&gt;IDH&lt;/i&gt;wt = &lt;i&gt;isocitrate dehydrogenase&lt;/i&gt; wildtype; IHC = immunohistochemistry; MOGAD = myelin oligodendrocyte glycoprotein antibody associated disorder; MS = multiple scleros","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960164","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":"Effects of psilocybin on mouse brain microstructure.","authors":"Paloma C Frautschi, Ajay P Singh, Nicholas A Stowe, Sean M Grady, Zarmeen Zahid, Matthew I Banks, John-Paul J Yu","doi":"10.3174/ajnr.A8634","DOIUrl":"https://doi.org/10.3174/ajnr.A8634","url":null,"abstract":"<p><strong>Background and purpose: </strong>There is surging interest in the therapeutic potential of psychedelic compounds like psilocybin in the treatment of psychiatric illnesses like major depressive disorder (MDD). Recent studies point to the rapid antidepressant effect of psilocybin; however, the biological mechanisms underlying these differences remain unknown. This study determines the feasibility of using diffusion MRI to characterize and define the potential spatiotemporal microstructural differences in the brain following psilocybin treatment in C57BL/6J male mice.</p><p><strong>Materials and methods: </strong>11-15 week-old C57BL/6J male mice were randomized to receive psilocybin, 6F-DET (6-fluoro-N,Ndiethyltryptamine), or saline and <i>ex vivo</i> imaged 24h (n=18) and 72h (n=18) post treatment. A one-way ANOVA with multiple comparison testing (Bonferroni correction) assessed diffusion metric differences (tractography, DTI, NODDI) between the three groups and was performed in the following regions of interest: amygdala, striatum, hippocampus, thalamus, primary visual cortex area, frontal association cortex, and medial prefrontal cortex at 24h and 72h post drug administration.</p><p><strong>Results: </strong>Psilocybin treated mice demonstrated structural connectivity differences at 72h in the frontal association cortex (compared to saline, mean tract length increases, p=0.03). Psilocybin also induced microstructural differences at 24h post-injection in the primary visual cortex (compared to saline, MD increases, p=0.02) and 72h post-injection in the striatum (compared to saline; MD increases, p= 0.02, NDI decreases, p=0.02) and hippocampus (compared to saline; MD increases, p=0.04, NDI decreases, p=0.02).</p><p><strong>Conclusions: </strong>Diffusion microstructure imaging and white matter tractography are sensitive methods to detect and characterize the neural substrates and microstructural differences accompanying psilocybin treatment. These findings suggest the potential role for diffusion microstructure imaging to quantify the bioeffects of psychedelics like psilocybin on the brain, monitor treatment response, and identify salient clinical endpoints in an emerging therapeutic option for patients with MDD.</p><p><strong>Abbreviations: </strong>dMRI= diffusion-weighted MRI; 6F-DET= 6-fluoro-N,N-diethyltryptamine; NODDI= neurite orientation dispersion and density imaging; DTI= diffusion tensor imaging; NDI= neurite density index; ODI= orientation dispersion index; FA= fractional anisotropy; MD= mean diffusivity; MTL= mean tract length; mPFC= medial prefrontal cortex.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069676","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":"Posterior fossa ring-enhancing lesions in the adult immunocompetent host: illustrative cases, systematic review, and proposed diagnostic algorithm.","authors":"Elisabeth Van Boxstael, Alexia de Hennin, Eric Vigneul, Pasquale Scoppettuolo, Souraya El Sankari, Anna Paola Bocchio, Serena Borrelli, Valentina Lolli, Vincent van Pesch, Sofia Maldonado Slootjes, Patrice Finet, Àlex Rovira, Daniel S Reich, Pietro Maggi","doi":"10.3174/ajnr.A8677","DOIUrl":"https://doi.org/10.3174/ajnr.A8677","url":null,"abstract":"<p><strong>Purpose: </strong>Posterior fossa ring-enhancing lesions (PFREL) in the adult immunocompetent hosts pose a diagnostic challenge. We aimed to evaluate the spectrum of PFREL etiologies and propose a diagnostic algorithm.</p><p><strong>Methods: </strong>This study involved a retrospective analysis of PFREL cases from our institution (January 2023 to April 2024) and a systematic literature review conducted using Embase and PubMed databases following the PRISMA 2020 guidelines. Clinical and radiological features from these cases formed the basis of a diagnostic algorithm, which was further refined via an additional comprehensive literature review, and finally validated on an independent set of PFREL cases.</p><p><strong>Results: </strong>The systematic review (467 studies, 56 selected after inclusion/exclusion criteria) revealed that PFREL etiology was infectious in 52%, tumoral in 38% and inflammatory in 2% of cases. At initial presentation, mean age was 48 years and 36% of patients had multiple PFREL. Headache was the most common symptom (46%). Among those with reported outcomes, 36% showed complete resolution of symptoms, 29% showed improvement with residual symptoms, and 16% died. The diagnostic algorithm was created from a total of 116 PFREL cases (10 from our institutional series, 56 from the systematic literature review and 50 supplementary cases found in the literature) and included 29 possible PFREL etiologies. In the validation set (16 patients), the algorithm provided the correct diagnosis in each case.</p><p><strong>Conclusion: </strong>PFREL in immunocompetent adults encompass a broad differential diagnosis. Our algorithm integrates clinical and radiologic data to assist in identifying the underlying cause of PFREL, potentially reducing the need for neurosurgical biopsy. This approach aims to enhance diagnostic accuracy, leading to better treatment decisions and improved patient outcomes.</p><p><strong>Abbreviations: </strong>ADEM = acute disseminated encephalomyelitis; CLL = chronic lymphocytic leukemia; CSF = cerebrospinal fluid; DLBCL: diffuse large B cell lymphoma; FLAIR = fluid attenuated inversion recovery; MeSH = medical subject headings; MRI = magnetic resonance imaging; NIHSS = National Institutes of Health Stroke Scale; NMOSD = neuromyelitis optic spectrum disorder; PFREL = posterior fossa ring enhancing lesion; PRISMA = Preferred Reporting Items for Systematic reviews and Meta-Analyses; SUV max = maximum standardized uptake value.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069970","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 Imaging of Type 2 Spinal CSF Leaks with Ultrahigh-Resolution Cone-Beam CT Myelography.","authors":"Niklas Lützen, Charlotte Zander, Jürgen Beck, Florian Volz, Katharina Wolf, Amir El Rahal, Horst Urbach","doi":"10.3174/ajnr.A8675","DOIUrl":"https://doi.org/10.3174/ajnr.A8675","url":null,"abstract":"<p><p>Type 2 CSF leaks are spinal lateral dural tears, causing spontaneous intracranial hypotension (SIH). They may be visualized with digital subtraction myelography (DSM), cone-beam CT (CBCT) myelography, energy-integrating detector or photon-counting CT myelography. A recently introduced ultrahigh-resolution cone-beam CT (UHR-CBCT) myelography has shown beneficial visualization of CSF-venous fistula, another cause of SIH. However, the use of this technique has not yet been reported in imaging of type 2 leaks. In this technical report, we describe first experiences and highlight the advantages of UHR-CBCT for visualizing type 2 leaks in SIH.ABBREVIATIONS: SIH=Spontaneous intracranial hypotension, DSM=Digital subtraction myelography, CBCT=Cone-beam CT, UHRCBCT=Ultrahigh-resolution cone-beam CT.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069501","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":"Endovascular Treatment for Tentorial Dural Arteriovenous Fistulas: A Retrospective Single-Center Study.","authors":"Guanghao Zhang, Miao Pang, Zhe Li, Chenghao Shang, Yuhang Zhang, Qi Zhang, Qinghai Huang, Yi Xu, Guoli Duan, Qiang Li, Jianmin Liu","doi":"10.3174/ajnr.A8676","DOIUrl":"https://doi.org/10.3174/ajnr.A8676","url":null,"abstract":"<p><strong>Background and purpose: </strong>Current evidence suggests that tentorial dural arteriovenous fistulas with endovascular treatment offer a high rate of occlusion and reduced procedural risks. Here we report the clinical and angiographic outcomes in patients with tentorial dural arteriovenous fistulas who underwent endovascular treatment as first-line treatment.</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted on 83 patients with tentorial dural arteriovenous fistulas treated at our center from April 2009 to November 2023 using endovascular treatment. Patient demographics, clinical presentation, angiographic, treatment results, and follow-up outcomes were registered. Univariable and multivariable logistic regression were performed to identify onset of intracranial hemorrhage predictors, procedure-related complications predictors and predictors of poor functional outcome.</p><p><strong>Results: </strong>Eighty-three patients underwent endovascular treatment as first-line treatment. Most patients (80.7%) were symptomatic and a total of 25 patients (30.1%) presented with intracranial hemorrhage. Presence of deep venous drainage and midline location was associated with a lower incidence of intracranial hemorrhage. Middle meningeal artery (57.8%, 48/83) and pial artery (15.7%, 13/83) were the most frequently used access routes for embolization. A total of 74 (89.1%) TDAVFs were completely occluded after the last EVT session immediately. Complications occurred in 11 patients (13.3%). Six-month angiographic follow-up was performed in 68 patients (81.8%), and 91.2% (62/68) tentorial dural arteriovenous fistulas were occluded. At clinical follow-up (100%, 83/83), good functional outcome (mRS 0-2) was documented in 74 (89.1%) patients. Logistic regression analysis identified baseline mRS 3-5 as the most significant independent predictor of poor functional outcome. Subgroup analysis showed no statistically significant differences in baseline characteristics, angiographic and clinical results between patients treated with targeted pial artery embolization and non-targeted pial artery embolization.</p><p><strong>Conclusions: </strong>Endovascular treatment is a safe and effective primary modality for managing tentorial dural arteriovenous fistulas, achieving high rates of complete angiographic occlusion and favorable functional outcomes. Transarterial embolization, predominantly via middle meningeal artery, was the mainstay of treatment. In patients with pial arterial feeders, omitting aggressive embolization did not compromise efficacy or increase complications.</p><p><strong>Abbreviations: </strong>DAVF = dural arteriovenous fistula; TDAVF = tentorial dural arteriovenous fistula; EVT = endovascular treatment; TAE = transarterial embolization; TVE = transvenous embolization; MMA = middle meningeal artery.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069613","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":"Effect of SARS-CoV2 Infection on Endovascular Thrombectomy Outcomes - Data from the Florida Stroke Registry.","authors":"Hayes B Fountain, Ian Ramsay, Ruijie Yin, Ahmed Abdelsalam, Michael Silva, David Z Rose, Angus Jameson, Ying Hao, Ayham Alkhachroum, Carolina M Gutierrez, Victor J Del Brutto, Robert M Starke, Tanja Rundek, Hannah Gardener, Jose G Romano, Negar Asdaghi","doi":"10.3174/ajnr.A8673","DOIUrl":"https://doi.org/10.3174/ajnr.A8673","url":null,"abstract":"<p><strong>Background and purpose: </strong>Endovascular thrombectomy outcomes are impacted by changes in stroke systems of care. During the pandemic, SARS-CoV2 positive status had major implications on hospital arrival and treatment models of non-COVID related hospital admissions. Using the Florida Stroke Registry, we compared the rates of in-hospital death and discharge outcomes of patients treated with endovascular thrombectomy who tested positive for SARS-CoV2 infection during their hospitalization.</p><p><strong>Materials and methods: </strong>Data from Get with the Guidelines-Stroke hospitals participating in the Florida Stroke Registry during the COVID pandemic from March 2020 to December 2022 were reviewed to identify endovascular thrombectomy patients with coding for SARS-CoV2 testing during their hospital stay. Associations between SARS-CoV2 status and favorable endovascular thrombectomy outcomes of mRS (0-2) at discharge, discharge to home or rehabilitation centre, symptomatic intracerebral hemorrhage, in-hospital mortality, and independent ambulation at discharge were examined using multivariate logistic regression modeling adjusting for demographics, vascular risk factors, and clinical characteristics. Temporal analyses were used to compare outcomes across the study period.</p><p><strong>Results: </strong>A total of 8,184 patients underwent endovascular thrombectomy (median age 71.1 years, female 50%, mean NIHSS 14), of these, 180 (2.2%) were SARS-CoV2 positive. Compared to SARS-CoV2 negative endovascular thrombectomy patients, those who tested positive were younger, more frequently male, but with comparable stroke severity at presentation. In multivariable analysis, adjusting for baseline differences and confounding variables, there was a 33% lower likelihood of being discharged to home/inpatient rehab (OR=0.67, 95% CI=(0.49-0.93)), 65% higher odds of in-hospital death (OR=1.65, 95% CI=(1.06-2.58)), as well as a 85% less chance of having a high mRS (>2) at discharge (OR=0.15, 95% CI=(0.04-0.60)) for patients with positive SARS-CoV2 infection. However, a similar risk of symptomatic intracerebral hemorrhage was present compared to SARS-CoV2 negative patients (OR=0.97, 95% CI=(0.501.88)). Temporal analysis of SARS-CoV2 positive patients showed no significant differences.</p><p><strong>Conclusions: </strong>In this large multicenter stroke registry, despite comparable clinical presentation and in-hospital treatment timelines, SARS-CoV2 positive status negatively impacted thrombectomy outcomes.</p><p><strong>Abbreviations: </strong>AIS = acute ischemic stroke; LVO = large vessel occlusion; EVT = endovascular thrombectomy; FSR = Florida Stroke Registry; sICH = symptomatic intracerebral hemorrhage.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054205","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}