AJNR. American journal of neuroradiology最新文献

{"title":"Clinical Implementation of Dynamic Parallel Transmission in 7T Brain MRI: Improved Homogeneity and Contrast Using SPACE Sequences.","authors":"Erik H Middlebrooks, Jürgen Herrler, Gian Franco Piredda, Shengzhen Tao, Jun Ma, Vishal Patel, Zeyu Liu, Erin M Westerhold, Xiangzhi Zhou","doi":"10.3174/ajnr.A8827","DOIUrl":"10.3174/ajnr.A8827","url":null,"abstract":"<p><strong>Background and purpose: </strong>The adoption of routine clinical 7T MRI has been constrained by several challenges, with heterogeneity of the transmit field (B1+) being among the most notable. Dynamic parallel transmission (pTx) presents a promising strategy to enhance B1+ transmit homogeneity; however, associated technical challenges have limited its routine use. We assess performance of a prototype dynamic pTx implementation for the 3D sampling perfection with application-optimized contrasts by using different flip angle evolution (SPACE) sequence and hypothesize that signal homogeneity and tissue contrast will improve versus single transmit mode (sTx).</p><p><strong>Materials and methods: </strong>Data from consecutive clinical patients undergoing 7T brain MRI for various indications were utilized. Signal homogeneity was assessed by using coefficient of variation (CoV). Tissue contrast was assessed by using an image intensity profile along an 8-mm line crossing the cortex into underlying white matter. Additionally, stability of signal homogeneity across a larger cohort of clinical patients was assessed with CoV. Predicted local specific absorption rate (SAR) for the head between pTx and sTx sequences was also compared.</p><p><strong>Results: </strong>For each sequence, 11 patients had both sTx and pTx scans. The comparison clinical cohort had 40 patients with pTx for each sequence. Image signal and contrast were significantly improved with pTx versus sTx for both T2-SPACE and FLAIR-SPACE (<i>P</i> = .001). Tissue contrast between white matter and cortex was also significantly improved in the temporal lobe with pTx (<i>P</i> = .001). CoV did not reveal any outlier cases across a large clinical cohort, demonstrating consistency in signal homogeneity. Despite increased SAR, T2-SPACE pTx consistently operated in first-level controlled mode, while FLAIR-SPACE pTx scans generally operated in normal mode.</p><p><strong>Conclusions: </strong>We demonstrate the feasibility of a time-efficient prototype dynamic pTx implementation in T2-SPACE and FLAIR-SPACE sequences, which significantly enhances signal and contrast across the brain compared with sTx, while exhibiting consistent and robust performance in a large cohort of clinical patients.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063499","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 Diagnostic Burden of Spontaneous Intracranial Hypotension: Imaging Volume and Specialists Involvement Prior to Diagnosis.","authors":"Parnian Habibi, Jared T Verdoorn, Ajay A Madhavan, John C Benson, Waleed Brinjikji, Ben A Johnson-Tesch, Chelsea J Dahl, Jeremy Cutsforth-Gregory, Ian T Mark","doi":"10.3174/ajnr.A9012","DOIUrl":"https://doi.org/10.3174/ajnr.A9012","url":null,"abstract":"<p><strong>Background and purpose: </strong>Spontaneous intracranial hypotension (SIH) is a disabling condition that is frequently underdiagnosed due to diagnostic challenges. Delays in diagnosis can be attributed to underrecognized MRI findings or lack of clinical suspicion, given the wide range of symptoms. This study aims to explore the diagnostic burden of SIH by examining the number of imaging exams and clinician visits prior to diagnosis.</p><p><strong>Materials and methods: </strong>This retrospective single-institution study included 71 patients with spinal CSF leaks who had a confirmed diagnosis of CSF-venous fistula (CVF) on digital subtraction myelography (DSM). We reviewed each patient's clinical history, including the number of providers in different specialties and institutions, as well as the number and type of imaging studies performed prior to the positive DSM at our center. Brain MR images were scored using the Bern criteria, and clinical history along with imaging data were compared across Bern groups (low, intermediate, high probability).</p><p><strong>Results: </strong>The mean patient age was 57.6 years with the majority being female (65%). The mean duration of symptoms was 3.8 years, and 14.1% of patients experienced symptoms for ≥10 years prior to the positive DSM. The mean number of specialists seen per patient was 2.6 (SD = 2.7; range, 0-13), and 28% of patients consulted 4 or more specialists prior to the positive DSM. On average, each patient underwent 6 imaging studies (SD: 3.8; range: 2-22) before the DSM, including 5.3 MRIs (SD: 3.7; range: 2-22), and 2.5 brain MRIs (SD: 2.1; range: 1-11). 40.8% of patients underwent ≥ 7 total imaging studies, and 53.5% had ≥ 3 Brain MRIs prior to diagnosis. Although no significant differences were found in the mean number of specialists or imaging exams between Bern score groups, a trend of increasing diagnostic burden was observed from the high to low Bern score groups.</p><p><strong>Conclusions: </strong>Patients with spinal CSF leaks often undergo an extensive number of imaging and specialty consultations, contributing to delays in diagnosis and appropriate treatment. This study highlights the need to increase awareness among healthcare providers regarding the typical symptoms and imaging features of spinal CSF leaks.</p><p><strong>Abbreviations: </strong><b>CVF</b>= CSF-venous fistulas; <b>CTM</b> = CT myelography; <b>DSM</b> = digital subtraction myelography; <b>OH</b> = orthostatic headache; <b>SIH</b> = spontaneous intracranial hypotension.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088187","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 and VASARI Features to Predict <i>CDKN2A/B</i> Homozygous Deletion in <i>IDH</i>-Mutant Astrocytomas: A Multicenter Study.","authors":"Huiquan Yang, Zhengyang Zhu, Lu Zhou, Jianan Zhou, Zhennan Tao, Xi Wu, Chuanshuai Tian, Dongming Liu, Liangpeng Wei, Haoyao Wang, Zihe Zhao, Yan Zhu, Xun Wang, Tiexiang Li, Wenwei Lin, Yuxiang Dai, Xin Zhang, Bing Zhang","doi":"10.3174/ajnr.A8861","DOIUrl":"https://doi.org/10.3174/ajnr.A8861","url":null,"abstract":"<p><strong>Background and purpose: </strong>Cyclin-dependent kinase inhibitor (<i>CDKN</i>)<i>2A/B</i> homozygous deletion holds an important value in the prognostic analysis of isocitrate dehydrogenase (<i>IDH</i>)-mutant astrocytomas. This study aimed to develop and validate a prediction model based on clinical and Visually AcceSAble Rembrandt Images (VASARI) MRI features for identifying <i>CDKN2A/B</i> homozygous deletion status in <i>IDH</i>-mutant astrocytomas.</p><p><strong>Materials and methods: </strong>Preoperative MR images of 122 patients with astrocytoma (101 without <i>CDKN2A/B</i> homozygous deletion, and 21 with <i>CDKN2A/B</i> homozygous deletion) were retrospectively collected as a training set. Eighteen patients with astrocytomas from another center (14 without <i>CDKN2A/B</i> homozygous deletion, and 4 with <i>CDKN2A/B</i> homozygous deletion) were enrolled as an external test set. VASARI features in MR images of patients with astrocytoma were evaluated by radiologists. Prediction models for identifying <i>CDKN2A/B</i> homozygous deletion status based on clinical and VASARI features were constructed by using logistic regression.</p><p><strong>Results: </strong>Multivariate regression analysis showed that definition of enhancing margin (OR: 13.19, <i>P</i> = .003) was an independent predictor of <i>CDKN2A/B</i> homozygous deletion in <i>IDH</i>-mutant astrocytomas. The area under the curve of prediction model in the training set and external test set was 0.84 (95% CI, 0.73-0.96) and 0.96 (95% CI, 0.86-1.00), respectively. The optimal cutoff value of the nomogram calculated by using the Youden index was 124.20 points. Under the cutoff value, the prediction model exhibited 85% accuracy, 67% sensitivity, and 88% specificity in the training set, and 83% accuracy, 75% sensitivity, and 86% specificity in external test set.</p><p><strong>Conclusions: </strong>The nomogram model based on clinical and VASARI MRI features was useful for prediction of <i>CDKN2A/B</i> homozygous deletion status in <i>IDH</i>-mutant astrocytomas.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088223","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":"Remote Robotic Neurointervention: Overcoming Procedural and Connectivity Challenges.","authors":"Gary R Duckwiler, Charles B Beaman, Michael Kilpatrick, Daniel L Cooke, Kazim H Narsinh, Geoffrey P Colby, David J Bell, Ben Waldau","doi":"10.3174/ajnr.A8807","DOIUrl":"10.3174/ajnr.A8807","url":null,"abstract":"<p><strong>Background and purpose: </strong>Access to endovascular interventions for neurointerventional procedures remains concentrated in metropolitan centers, limiting availability in smaller cities, rural regions, and developing nations. The feasibility of remote robotic intervention faces several challenges, including enabling full robotic navigation, managing contrast injection, and maintaining stable network connectivity. This study addresses these key obstacles.</p><p><strong>Materials and methods: </strong>A robotic system was deployed at the Translational Research Imaging Center Lab at University of California, Los Angeles. Connectivity was assessed both before and during the procedures. Five remote neurointerventionalists operated 4 devices: 2 novel steerable catheters, 1 off-the-shelf microcatheter, and 1 guidewire from femoral access to the MCA in a silicone vascular model. Radiopaque contrast injections were performed, and audiovisual communication was maintained throughout. Connectivity metrics, including round-trip time (RTT) and bandwidth, were monitored. Primary end points included successful navigation to the MCA within 15 minutes, first-attempt vessel entry rate, and episodes of tooltip contact with the vessel wall.</p><p><strong>Results: </strong>Following catheter placement in the femoral sheath, all procedures were fully robotically controlled without bedside intervention. Procedural times ranged from 11 minutes 1 second to 14 minutes, with a mean RTT of <150 ms; 2 brief episodes of unsafe latency (RTT of >150 ms) were recorded. First-attempt vessel entry was successful in 84.2% of cases, and minimal vessel wall contact occurred (1-2 episodes per procedure).</p><p><strong>Conclusions: </strong>This study demonstrates the feasibility of remote robotic neurointervention, effectively addressing key challenges in robot-assisted endovascular procedures and network connectivity management.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054458","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":"MRI on a Budget: Leveraging Low and Ultra-Low Intensity Technology in Africa.","authors":"Khadija Khamis Ussi, Rovaldo Barbadis Mtenga","doi":"10.3174/ajnr.A9014","DOIUrl":"https://doi.org/10.3174/ajnr.A9014","url":null,"abstract":"<p><p>Magnetic resonance imaging (MRI) is a cornerstone of brain and spine diagnostics. Yet, access across Africa is limited by high installation costs, power requirements, and the need for specialized shielding and facilities. Low-and ultra low-field (ULF) MRI systems operating below 0.3 T are emerging as a practical alternative to expand neuroimaging capacity in resource-constrained settings. However, its faced with challenges that hinder its use in clinical setting. Technological advances that seek to tackle these challenges such as permanent Halbach array magnets, portable scanner designs such as those successfully deployed in Uganda and Malawi, and deep learning methods including convolutional neural network electromagnetic interference cancellation and residual U-Net image reconstruction have improved image quality and reduced noise, making ULF MRI increasingly viable. We review the state of low-field MRI technology, its application in point-of-care and rural contexts, and the specific limitations that remain, including reduced signal-to-noise ratio, larger voxel size requirements, and susceptibility to motion artifacts. Although not a replacement for high-field scanners in detecting subtle or small lesions, low-field MRI offers a promising pathway to broaden diagnostic imaging availability, support clinical decision-making, and advance equitable neuroimaging research in under-resourced regions.ABBREVIATIONS: CNN＝Convolutional neural network; EMI＝Electromagnetic interference; FID＝Free induction wave; LMIC＝Low and middle income countries; MRI＝Magnetic Resonance Imaging; NCDs＝Non communicable diseases; RF＝Radiofrequency Pulse; SNR＝ Signal to noise ratio; TBI＝Traumatic brain Injury.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088269","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":"Added Value of Amyloid PET Quantification with the Centiloid Scale in Clinical Practice.","authors":"Akarsh Vijayashankar, Graham Keir, Matthew Sagnelli, David Petrover, Mehdi Djekidel, Joseph Glaser, Chris Caravella, Sean A P Clouston, Josephine Rini, Ana M Franceschi","doi":"10.3174/ajnr.A8850","DOIUrl":"https://doi.org/10.3174/ajnr.A8850","url":null,"abstract":"<p><strong>Background and purpose: </strong>The objectives for amyloid brain PET/CT and PET/MRI fusion images are to determine the agreement between visual interpretations of amyloid PET and to compare the results of visual interpretation with quantitative analysis as measured by the Centiloid (CL) scale.</p><p><strong>Materials and methods: </strong>One hundred sixty-seven clinical amyloid brain PET/CT scans were reviewed by 3 readers blinded to the original reports. Readers interpreted the amyloid PET scans as negative (0), positive (1), or indeterminate (2) for amyloid deposition. For quantitative analysis, 2 additional readers analyzed amyloid PET images using MIMNeuro to generate CL scores and regional standardized uptake ratios. Reader agreement was determined for visual and quantitative assessment. Using positive scan cutoffs of CL ≥ 40, we determined visual assessment-versus-quantitative assessment for scans consistently interpreted as positive by all 3 readers and for each reader.</p><p><strong>Results: </strong>Fifty-three scans (31.74%) were rated amyloid-positive by all readers, while 62 scans (37.13%) were rated as amyloid-negative by all readers. The remaining 52 scans had inconsistent ratings with an agreement rate of 69.46%. Most (99/167; 59.28%) scans had CL scores above the CL-positive cutoff (CL ≥ 40), and 47/167 (28.14%) were CL-negative scans (CL <10). The lowest CL score to achieve visual positivity among all 3 readers was 57, while the lowest CL score to receive at least 1 indeterminate score was 11. The readers had a high degree of interreader reliability when rating scans as either positive (κ = 0.62) or negative (κ = 0.66) but were inconsistent when rating scans as indeterminate (κ = 0.17). Optimal cut-points were CL <3.6 for consistent negative and CL ≥28.8 for consistent visual positivity.</p><p><strong>Conclusions: </strong>Given the emergence of antiamyloid monoclonal therapies for early-stage Alzheimer disease, reliable detection of amyloidosis is critical for patient care. This study suggests that visual reads of amyloid PET may be insensitive when amyloidosis is milder but are spread across multiple regions (CL ranging from 40 to 59). Quantification of amyloid PET using the CL scale may help guide treatment of patients with mild amyloidosis who are under consideration for antiamyloid disease-modifying therapeutics.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088227","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":"Differentiation between Nonenhancing Tumor in Glioblastoma and Vasogenic Edema using Diffusion-Weighted and Dynamic Susceptibility Contrast MR Imaging.","authors":"Sahar Alizada, Yasmin Aly, Hongbo Bao, Dhairya Lakhani, Vivek Yedavalli, Haris Sair, Janet Mei","doi":"10.3174/ajnr.A8788","DOIUrl":"https://doi.org/10.3174/ajnr.A8788","url":null,"abstract":"<p><strong>Background and purpose: </strong>Differentiating nonenhancing glioblastoma from vasogenic edema remains a challenge in neuroimaging. This study evaluates the utility of diffusion-weighted and dynamic susceptibility contrast MR imaging, particularly ADC and relative CBV (rCBV), in distinguishing these entities.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 111 patients diagnosed with glioblastoma with available pretreatment MRIs from January 1, 2022, to December 31, 2023, including 13 patients with 15 solid, nonenhancing glioblastoma lesions and 98 patients with perilesional nonenhancing T2-FLAIR hyperintensity surrounding enhancing glioblastomas. Their ADC and rCBV values were compared with those of 30 brain metastatic lesions age- and sex-matched to solid, nonenhancing glioblastoma lesions. Receiver operating characteristic analysis was performed to determine optimal ADC and rCBV thresholds for classification.</p><p><strong>Results: </strong>Solid, nonenhancing glioblastomas had significantly lower mean ADC values and higher mean rCBV values compared with vasogenic edema (1.08 [SD, 0.22] × 10^-3 versus 1.74 [SD, 0.17] × 10^-3 mm²/s and 2.4 [SD, 0.86] versus 0.30 [SD, 0.13], respectively; <i>P</i> < .001). The optimal ADC and rCBV cutoffs for differentiating solid, nonenhancing glioblastoma from vasogenic edema were 1.36 × 10^-3 mm²/s and 1.04, achieving excellent sensitivity (0.93-1) and specificity (1). Perilesional nonenhancing T2-FLAIR hyperintensity around enhancing glioblastomas had ADC values similar to those of vasogenic edema (1.67 [SD, 0.33] × 10^-3 versus 1.74 [SD, 0.17] × 10^-3 mm²/s; <i>P</i> = .32) but significantly higher rCBV (0.60 [SD, 0.61] versus 0.30 [SD, 0.13]; <i>P</i> = .03). An rCBV cutoff value of 0.42 distinguished perilesional tumor infiltration from pure vasogenic edema with 86% specificity.</p><p><strong>Conclusions: </strong>Diffusion- and perfusion-weighted MR imaging, particularly ADC and rCBV measurements, provide valuable biomarkers for differentiating nonenhancing glioblastoma from vasogenic edema. The identified threshold values may enhance glioblastoma characterization, improve preoperative differentiation from metastases, and support more precise, image-guided clinical management.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088212","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":"Timing of adjunctive middle meningeal artery embolization relative to surgical evacuation for chronic and subacute subdural hematomas.","authors":"Huanwen Chen, Matthew K McIntyre, Dhairya A Lakhani, Hamza A Salim, Ajay Malhotra, Marco Colasurdo, Dheeraj Gandhi","doi":"10.3174/ajnr.A9003","DOIUrl":"https://doi.org/10.3174/ajnr.A9003","url":null,"abstract":"<p><strong>Background and purpose: </strong>Recent randomized trials have suggested that middle meningeal artery embolization (MMAE) is an effective treatment for preventing the recurrence of subacute and chronic subdural hematoma (SDH). As such, MMAE is increasingly being adopted as the standard of care worldwide, and it is projected to become the most common neuro-interventional procedure by 2029. While MMAE is an effective surgical adjunct, the optimal timing of MMAE relative to surgical evacuation remains unclear. This study evaluated whether the timing of MMAE influences clinical and healthcare utilization outcomes.</p><p><strong>Materials and methods: </strong>We conducted a retrospective cohort study using the 2019-2022 Nationwide Readmissions Database. Non-electively hospitalized SDH patients who received both surgical evacuation and MMAE were included. Patients were stratified into three groups based on MMAE timing: before, same-day (concurrent), or after surgery. Outcomes included discharge disposition, in-hospital complications and mortality, 180-day treatment failure and surgical rescue, hospitalization cost, and length of stay (LOS). Multivariable adjustments were made for baseline characteristics that were different between study groups (p<0.10).</p><p><strong>Results: </strong>Of 1,518 patients, 325 (21.4%) received concurrent MMAE+surgery, 149 (9.8%) MMAE first, and 1,043 (68.7%) surgery first. There were no significant differences in discharge disposition, in-hospital complications, mortality, or 180-day outcomes across timing groups (all p>0.05). However, concurrent MMAE+surgery was associated with shorter LOS (median 5 days) compared to MMAE first (8 days, adjusted p<0.001) and surgery first (8 days, adjusted p<0.001). Moreover, concurrent MMAE+surgey was associated with significantly lower hospitalization costs (median 42,147 USD) compared to MMAE-first (53,536 USD, adjusted p=0.014) and surgery-first (median 53,941 USD, adjusted p<0.001).</p><p><strong>Conclusions: </strong>Clinical outcomes were comparable across timing strategies for MMAE as an adjunct to surgery. However, concurrent MMAE+surgery was associated with significantly reduced LOS and hospitalization costs, suggesting logistical and economic advantages for same-day treatment.</p><p><strong>Abbreviations: </strong>MMAE＝ middle meningeal artery embolization; SDH＝ subdural hematoma; LOS＝ length of stay.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088211","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":"Expected Trainee Interpretive Volumes and Potential Threats to Neuroradiology Program Viability: A Survey of Neuroradiology Fellowship Program Directors.","authors":"Karen Buch, Srinivasan Vedantham, Mari Hagiwara, James Y Chen","doi":"10.3174/ajnr.A8821","DOIUrl":"https://doi.org/10.3174/ajnr.A8821","url":null,"abstract":"<p><strong>Background and purpose: </strong>Nationally clinical volumes are rising, putting greater pressure on radiologists to read more and in turn jeopardizing the academic missions of many training programs. The purpose of this study was to survey neuroradiology fellowship program directors (PDs) to identify reasonable expected trainee and faculty interpretive volumes, common barriers to study interpretation, and threats to fellowship program viability.</p><p><strong>Materials and methods: </strong>This was an institutional review board-approved survey study disseminated to neuroradiology fellowship PDs through the American Society of Neuroradiology. This Web-based survey included basic program information regarding practice setting, faculty size, fellowship size, and multiple questions related to interpretative volumes, barriers to study interpretation, threats to program viability, etc. Summary statistics were computed for count and rank variables. For survey questions by using ranking, cumulative ranks across all institutions were computed with a statistical ranking procedure based on Savage scores.</p><p><strong>Results: </strong>Forty-three of 85 PDs responded to the survey. Median daily interpretive expectations for fellows were 20 daily cases during the first 6 months of the year and 30 during the second 6 months. Median daily interpretive expectations for faculty working with fellows was 32 daily cases during the first 6 months of the year and 38.5 during the second 6 months. Telephone calls from technologists and referring clinicians and protocoling were identified as major barriers to interpreting studies. Perceived major threats to program viability included increasing case volumes, understaffing, and burnout.</p><p><strong>Conclusions: </strong>Reasonable interpretive volumes determined by fellowship directors ranged between 20-30 daily cases for fellows and 32-38.5 daily cases for faculty working with fellows. Common barriers to interpretation were related to phone call interruptions and protocoling. Perceived major program viability threats remain centered on increasing clinical volumes and burnout.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088266","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":"Simultaneous Multiparametric Estimation of AVM Hemodynamics Using MR Fingerprinting Arterial Spin-Labeling.","authors":"Zhiyi Hu, Dengrong Jiang, Wen Shi, Hamza A Salim, Dhairya A Lakhani, Risheng Xu, Judy Huang, Kambiz Nael, Hanzhang Lu, Vivek S Yedavalli","doi":"10.3174/ajnr.A8806","DOIUrl":"10.3174/ajnr.A8806","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and purpose: &lt;/strong&gt;Accurate hemodynamic characterization of cerebral AVMs is critical for treatment-planning, risk-stratification, and posttreatment monitoring but remains challenging due to their abnormal angioarchitecture. MR-fingerprinting (MRF) arterial spin-labeling (ASL) is a novel, noninvasive technique that enables simultaneous quantification of CBF, arterial CBV (aCBV), and bolus-arrival time (BAT) within a single 5-minute scan. This study evaluates the feasibility of MRF-ASL in assessing AVM hemodynamics and compares its sensitivity for AVM detection with CBF measurements obtained using single-delay pseudocontinuous ASL (pCASL).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Patients with DSA-confirmed AVMs were scanned on a 3T MRI system. Imaging protocols included MRF-ASL, standard single-delay pCASL, and T2-weighted MRI. MRF-ASL simultaneously-derived CBF, aCBV, and BAT, with CBF estimated using 2 kinetic models: a 1-compartment model, which reflects combined tissue and arterial contributions, and a 2-compartment model, which separates arterial signal from tissue perfusion. Regions of interest were manually drawn over the AVM nidus and contralateral nonaffected tissue. MRF-ASL parameters and pCASL-derived CBF were compared between the AVM nidus and nonaffected tissue. Additionally, linear regression analyses were conducted to examine the relationships among MRF-ASL parameters, single-delay pCASL CBF, and the Spetzler-Martin (SM) grade.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Six patients with AVMs with SM grades ranging from 1 to 5 were included in this study. MRF-ASL parameters revealed significantly elevated CBF&lt;sub&gt;1-compartment&lt;/sub&gt; (AVM, 129.3 [SD, 21.5 mL/100 g/minute] versus nonaffected, 51.6 [SD, 23.9 mL/100 g/minute], &lt;i&gt;P&lt;/i&gt; = .03), CBF&lt;sub&gt;2-compartment&lt;/sub&gt; (AVM, 109.8 [SD, 24.4 mL/100 g/minute] versus nonaffected, 36.6 [SD, 18.6 mL/100 g/minute], &lt;i&gt;P&lt;/i&gt; = .03), aCBV (AVM, 7.0 [SD, 4.5%] versus nonaffected, 0.6 [SD, 0.4%], &lt;i&gt;P&lt;/i&gt; = .03), and shortened BAT (AVM, 784 [SD, 337 ms] versus nonaffected, 1099 [SD, 500 ms], &lt;i&gt;P&lt;/i&gt; = .03) in the AVM nidus compared with contralateral nonaffected tissue in the same patient. In contrast, no significant difference was observed for pCASL CBF (AVM, 47.5 [SD, 49.2 mL/100 g/minute] versus nonaffected, 39.4 [SD, 14.0 mL/100 g/minute], &lt;i&gt;P&lt;/i&gt; = .44). A significant positive correlation was identified between the SM grade and both CBF&lt;sub&gt;2-compartment&lt;/sub&gt; (&lt;i&gt;P&lt;/i&gt; = .006) and aCBV (&lt;i&gt;P&lt;/i&gt; = .005). No association was found for CBF&lt;sub&gt;1-compartment&lt;/sub&gt; (&lt;i&gt;P&lt;/i&gt; = .12), BAT (&lt;i&gt;P&lt;/i&gt; = .15), or pCASL CBF (&lt;i&gt;P&lt;/i&gt; = .13).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In our preliminary study, MRF-ASL has the potential to provide comprehensive and multiparametric evaluation of AVM hemodynamics, demonstrating superior sensitivity for detecting AVM abnormalities compared with single-delay pCASL. These findings show the feasibility of MRF-ASL as a potentially useful tool f","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060348","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}