AJNR. American journal of neuroradiology最新文献

{"title":"CT Perfusion Map Generation from Multi-phase CT Angiography Using Generative adversarial model for Acute Ischemic Stroke.","authors":"Yuxin Cai, Jianhai Zhang, Ganesh Arvind, Bo Hu, Menon Bijoy, Shengcai Chen, Wu Qiu","doi":"10.3174/ajnr.A8857","DOIUrl":"https://doi.org/10.3174/ajnr.A8857","url":null,"abstract":"<p><strong>Background and purpose: </strong>Multiphase CT Angiography (mCTA) has shown potential as a diagnostic tool for acute ischemic stroke (AIS), as it captures dynamic changes in cerebral vasculature. However, mCTA has limitations in assessing brain tissue perfusion, which reduces its clinical interpretability. To address this limitation, we aim to develop a generative adversarial network (GAN) that generates CT Perfusion (CTP)-like maps from mCTA. This approach aims to improve the interpretability of mCTA.</p><p><strong>Materials and methods: </strong>A total of 714 cases with NCCT, CTP, mCTA, and follow-up NCCT/MR were analyzed across internal and external datasets. A GAN was trained to generate multi-parametric CTP maps (Tmax, CBF, CBV). The model's performance was evaluated using SSIM, PSNR, and FID compared to actual CTP maps. Clinical utility was assessed by predicting infarct core and penumbra using threshold-based segmentation and evaluating metrics such as Dice coefficient, AUC of dichotomized infarct volume of < 70cc and mismatch ratio following DEFUSE 3 criteria, compared to the ground truth of actual CTP prediction.</p><p><strong>Results: </strong>The GAN achieved SSIM 0.647-0.662, PSNR 20.6-20.9, and FID 16.6-17.0 on internal data, surpassing both CycleGAN [11] (SSIM: 0.608-0.642, PSNR: 18.2-19.2, FID: 27.6-32.5) and Pix2Pix [10] (SSIM: 0.630-0.645, PSNR: 19.5-19.7, FID: 19.4-20.8) across all metrics. Predicted penumbra and infarct core showed Dice coefficients of 0.672 and 0.468, with strong correlations (penumbra: 0.921, core: 0.902) and AUCs of 0.854 (95% CI: 0.819-0.888)(mismatch ratio) and 0.850(95% CI: 0.817-0.884) (dichotomized infarct core). External data validation yielded Dice coefficients of 0.481 (penumbra) and 0.301 (core) with AUCs of 0.720(95% CI: 0.589- 0.808) (mismatch ratio) and 0.703(95% CI: 0.528-0.794)(dichotomized infarct core).</p><p><strong>Conclusions: </strong>The GAN effectively generated CTP-like maps from mCTA, improving interpretability and demonstrating promising diagnostic performance, particularly for resource-limited settings.</p><p><strong>Abbreviations: </strong>mCTA = Multiphase CT angiography, CTP = CT perfusion, CBF = Cerebral blood flow, CBV = Cerebral blood volume, GAN = Generative adversarial network, FID = Fréchet inception distance, AUC = Area under the receiver operating characteristic curve, AIS = acute ischemic stroke.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182567","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":"Decubitus Myelography for Spinal Extradural Arachnoid Cyst-Better Classified as a Lateral Dural CSF Leak?","authors":"Mark D Mamlouk, Anthony R Zamary, Niklas Lützen, Jürgen Beck, Adriana Gutierrez, Mark F Sedrak","doi":"10.3174/ajnr.A8856","DOIUrl":"https://doi.org/10.3174/ajnr.A8856","url":null,"abstract":"<p><p>Spinal extradural arachnoid cysts are rare lesions that may result in compressive myelopathy. Their etiology is unclear, but they are thought to represent extradural collections due to a one-way dural defect from the subarachnoid space to the cyst. To date, identifying this dural defect on MRI and myelography have had limited and variable success. Surgery is the standard treatment for these cysts; however, there is debate whether total cyst removal is necessary versus dural repair alone. In this technical report, we show how dynamic decubitus CT and digital subtraction myelography can identify the dural defect and precisely guide the surgical approach. We also discuss many similarities between spinal extradural arachnoid cysts and lateral dural tear CSF leaks observed in patients with spontaneous intracranial hypotension and suggest they may represent a spectrum of CSF leaks.ABBREVIATIONS: SIH ＝ spontaneous intracranial hypotension; CTM ＝ CT myelography; DSM = digital subtraction myelography.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183661","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":"Time is Spine: A Novel Radiology Reporting System for Optimizing Spine Oncology Decision-Making and Reducing Time to Treatment.","authors":"Colbey W Freeman, Raghav Mattay, Charles E Kahn, Laurie Loevner, Anish A Butala, Neil R Malhotra, Alvand Hassankhani","doi":"10.3174/ajnr.A8845","DOIUrl":"https://doi.org/10.3174/ajnr.A8845","url":null,"abstract":"<p><strong>Background and purpose: </strong>Patients with spinal metastases are at risk of instability and cord compression, requiring prompt diagnosis and timely intervention. Effective communication between radiologists and treatment teams is critical to ensure timely treatment. To address this, we developed a novel dictation macro incorporating spine oncology imaging findings and a linked automated notification system to accelerate spine oncology referrals and enhance care delivery.</p><p><strong>Materials and methods: </strong>A spine MRI dictation macro was developed incorporating MRI-relevant elements of the Spine Imaging Neoplastic Score and an expanded Epidural Spinal Cord Compression scale into a Spine Oncology Imaging Score (SOIS). Finalized reports containing the macro triggered an automated email notification to a multidisciplinary spine oncology treatment team. Neuroradiologists were educated on the macro, but its use was optional. Time between MRIs to follow-up spine oncology clinic visits and subsequent treatment were compared for outpatients with and without the macro in a Cox proportional hazards model.</p><p><strong>Results: </strong>Between April 2021 and February 2023, 274 outpatients with spinal metastasis had MRI reports with the macro. Among these, 213 (77.7%) had follow-up visits related to the MRI findings and 154 (56.2%) received treatment. During this same period, 152 outpatients had MRI reports did not utilize this macro and 117 (77.0%) had follow-up visits and 58 (38.2%) received treatment. After controlling for SOIS, age, visit department, and treatment type, use of the macro was associated with earlier spine oncology visits (p=0.004) and treatment (p=0.03).</p><p><strong>Conclusions: </strong>The implementation of a structured spine oncology macro combined with an automated notification system to a specialized spine oncology team significantly reduced time to consultation and treatment in patients with spinal metastases. This suggests that incorporating structured reporting tools with critical elements like SOIS, coupled with an efficient notification system, can enhance clinical workflow and expedite decision making in oncology care.</p><p><strong>Abbreviations: </strong>SINS ＝ Spine Instability Neoplastic Score; ESCC ＝ Epidural Spinal Cord Compression; SOaR² = Spine Surgery, Medical Oncology, and Radiation Oncology/Radiology); SOIS = Spine Oncology Imaging Score; SQL = Structured Query Language; IQR = interquartile range; CMS = Centers for Medicare & Medicaid Services.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132040","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":"Adjunctive Flat-panel CT-based Reperfusion Grading after Endovascular Therapy: Enhanced Detection of Residual Distal Vessel Occlusion.","authors":"Sung Hyun Baik, Cheolkyu Jung, Jun Yup Kim, Do Yeon Kim, Nakhoon Kim, Beom Joon Kim, Jihoon Kang, Hee-Joon Bae","doi":"10.3174/ajnr.A8844","DOIUrl":"https://doi.org/10.3174/ajnr.A8844","url":null,"abstract":"<p><strong>Background and purpose: </strong>The detection of residual distal vessel occlusion is crucial for the evolution of endovascular therapy outcomes. This study evaluated whether distal occlusion tracker signs on immediate postprocedural flat-panel CT could assist in the detection of residual distal vessel occlusion in patients with acute ischemic stroke due to large vessel occlusion after thrombectomy.</p><p><strong>Materials and methods: </strong>A single-center retrospective analysis was conducted on patients with anterior circulation large-vessel occlusion who achieved successful reperfusion, defined as a modified TICI score of ≥2b, following endovascular therapy and underwent immediate postprocedural flat-panel CT and perfusion MRI. Two reviewers, blinded to the clinical data and perfusion findings, independently assessed the presence, number, and location of distal occlusion tracker signs on flat-panel CT and the final reperfusion state on cerebral DSA. Distal occlusion tracker signs were defined as dot-like, round, or tubular hyperdensities along the course of the distal intracranial arteries on immediate postprocedural flat-panel CT. Two datasets were compared: (I) using DSA alone, and (II) using DSA combined with flat-panel CT. A core laboratory determined the TICI grading and residual distal occlusion using both DSA and postprocedural perfusion MRI as reference standards.</p><p><strong>Results: </strong>The distal occlusion tracker sign was present in 65/156 patients (41.7%), with excellent inter-rater agreement (weighted kappa = 0.91; 95%CI, 0.85-0.96). Distal occlusion tracker signs demonstrated a sensitivity and specificity of 81.5 and 96.2%, respectively. The diagnostic accuracy in detecting residual distal occlusion was greater with the addition of flat-panel CT findings to DSA than with DSA alone (the area under the curve increased from 0.884 to 0.955, P=0.009). Reperfusion grading overestimation decreased from 17.9% with DSA alone to 3.8% with the addition of flat-panel CT to DSA.</p><p><strong>Conclusions: </strong>Distal occlusion tracker signs are common findings on immediate postprocedural flat-panel CT, indicating residual distal vessel occlusion. The addition of flat-panel CT findings to DSA may enhance the detection of residual distal vessel occlusion after endovascular therapy.</p><p><strong>Abbreviations: </strong>EVT = endovascular therapy; DVO = distal vessel occlusion; FPCT = flat-panel computed tomography; DOT = distal occlusion tracker; FPCT+DSA__TICI = TICI grading performed using FPCT and DSA; DSA__TICI = TICI grading performed using DSA alone; Core__TICI = TICI grading performed by the Core laboratory.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133389","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":"Glymphatic Function as a Moderator in White Matter Injury and Cognitive Impairment: A Community-Dwelling Cohort Study.","authors":"Junjun Wang, Ying Zhou, Kemeng Zhang, Wang Ran, Wansi Zhong, Haidi Jin, Huan Zhou, Yifei Li, Jianzhong Sun, Min Lou","doi":"10.3174/ajnr.A8846","DOIUrl":"https://doi.org/10.3174/ajnr.A8846","url":null,"abstract":"<p><strong>Background and purpose: </strong>White matter injury (WMI) is associated with cognitive dysfunction in aging population; however, a clinicoradiological discrepancy often arises between WMI and cognition function in clinical practice. Emerging evidence suggests that the glymphatic system plays a crucial role in clearing metabolic waste and maintaining cognitive function. We hypothesize that glymphatic dysfunction may contribute to this discrepancy by moderating the impact of WMI on cognition.</p><p><strong>Materials and methods: </strong>We conducted a retrospective review of community-dwelling residents in our center who underwent multimodal MRI scan and neuropsychological testing from April 2017 to December 2021. WMI, as indicated by white matter hyperintensities (WMHs) and normal-appearing white matter (NAWM) microstructural injury, along with cerebral blood flow (CBF), were quantified by multimodal MRI. Cognition was assessed by mini-mental state examination (MMSE). Glymphatic function was evaluated using diffusion tensor imaging along the perivascular space (DTI-ALPS). Moderation analyses were performed to explore the potential role of glymphatic function.</p><p><strong>Results: </strong>A total of 947 participants were included in the final analysis. A higher WMHs burden was found to be associated with lower MMSE scores in the low DTI-ALPS group (r = -0.261, <i>p</i> <0.001), but the correlation was not significant in the high DTI-ALPS group (r = -0.082, <i>p</i> = 0.07). After adjusting for confounding factors, DTI-ALPS moderated the relationship between WMHs burden and MMSE score (β = 1.792, <i>p</i> = 0.02), and the moderating effect was significant in participants aged ≤60 years old (β = 2.573, <i>p</i> = 0.04), without lacunes (β = 2.576, <i>p</i> = 0.01) or without cerebral microbleeds (β = 3.008, <i>p</i> = 0.004). Longitudinal analysis demonstrated that DTIALPS also moderated the relationship between WMHs burden and cognitive decline (β = -3.771, <i>p</i> =0.001). Furthermore, DTI-ALPS moderated the relationship between NAWM microstructural injury and MMSE score (β = -20.201, <i>p</i> =0.01), but no moderating effect was detected between CBF and MMSE score (<i>p</i> > 0.05).</p><p><strong>Conclusions: </strong>Glymphatic system plays a moderate role in the association between WMI and cognitive impairment, highlighting its potential importance in WMI-related cognitive impairment. Further studies are needed to explore the relative mechanisms.</p><p><strong>Abbreviations: </strong>ASL = Arterial spin labeling; CMBs = Cerebral microbleeds; DTI-ALPS = Diffusion tensor imaging along the perivascular space; ESWAN = Enhanced T2 star weighted angiography; FA = Fractional anisotropy; ICV = Intracranial volume; MMSE = Mini-mental state examination; NAWM = Normal-appearing white matter; WMHs = White matter hyperintensities; WMI = White matter injury.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133391","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":"Digital Subtraction Myelography for the Detection of Type 1 Spinal CSF Leaks: Evaluation of Temporal Characteristics and Diagnostic Value.","authors":"Niklas Lützen, Florian Volz, Amir El Rahal, Katharina Wolf, Laura Krismer, Jürgen Beck, Horst Urbach, Charlotte Zander","doi":"10.3174/ajnr.A8847","DOIUrl":"https://doi.org/10.3174/ajnr.A8847","url":null,"abstract":"<p><strong>Background and purpose: </strong>Ventral dural tears (type 1 leaks) are reported to be the most common cause of spontaneous intracranial hypotension (SIH) and may require high dynamic myelography for detection. The aim of this cross-sectional study was to evaluate the temporal characteristics and diagnostic value of digital subtraction myelography (DSM) in type 1 leaks.</p><p><strong>Materials and methods: </strong>Between April 2022 and August 2024, 104 consecutive patients with type 1 leaks were retrospectively identified. Institutional diagnostic standard included DSM as first-line examination; where deviating, patients were excluded. A previously described positioning technique of patients was used, enabling examination even in the challenging cervicothoracic junction of the spine. We evaluated the time for the contrast agent to first appear in the epidural space after reaching the level of the leak intrathecally, and the overall diagnostic yield of DSM.</p><p><strong>Results: </strong>100/104 patients (49 women) were included. Mean age was 49 years (SD ± 11.9 years), mean BMI 24.8 (SD ± 4.29), and median Bern SIH score 4 (IQR 5). Type 1 leaks most commonly occurred at the T1/2 and T2/3 level (each 20/100), range C6/7-L1/2. The mean time for the contrast to be visible in the epidural space was on average 1.5 seconds (range 0-9 seconds) with 1 frame-persecond acquisition being sufficient for all but one patient. DSM as first-line investigation made the diagnosis in 76/100 patients, confirmed in all patients undergoing surgery (74/76). 24/100 patients required one or more subsequent dynamic CT-myelography (dCTM) for definite diagnosis another day, with 21/24 leaks confirmed at surgery. Bern SIH Score was significantly lower in dCTM compared to DSM group (3.25 vs 5; p=0.009), whereas age (p=0.548) and BMI (p=0.185) were not found to have an impact.</p><p><strong>Conclusions: </strong>DSM demonstrated a high diagnostic yield for type 1 leaks when used as a first-line investigation. We have confirmed the high-flow characteristics of these leaks, suggesting that DSM's high temporal resolution is ideally suited for their detection, with 1 frame-per-second being overall sufficient. A lower Bern SIH score could favor patients for primary use of dCTM, however, further research may clarify why DSM occasionally misses diagnoses.</p><p><strong>Abbreviations: </strong>SIH=spontaneous intracranial hypotension, DSM=digital subtraction myelography, dCTM=dynamic CT myelography.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133390","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 Reconstruction for 7T MP2RAGE and SPACE MRI: Improving Image Quality at High Acceleration Factors.","authors":"Zeyu Liu, Vishal Patel, Xiangzhi Zhou, Shengzhen Tao, Thomas Yu, Jun Ma, Dominik Nickel, Patrick Liebig, Erin M Westerhold, Hamed Mojahed, Vivek Gupta, Erik H Middlebrooks","doi":"10.3174/ajnr.A8841","DOIUrl":"https://doi.org/10.3174/ajnr.A8841","url":null,"abstract":"<p><strong>Background and purpose: </strong>Deep learning (DL) reconstruction has been successful in realizing otherwise impracticable acceleration factors and improving image quality in conventional MRI field strengths; however, there has been limited application to ultra-high field MRI.The objective of this study was to evaluate the performance of a prototype DL-based image reconstruction technique in 7T MRI of the brain utilizing MP2RAGE and SPACE acquisitions, in comparison to reconstructions in conventional compressed sensing (CS) and controlled aliasing in parallel imaging (CAIPIRINHA) techniques.</p><p><strong>Materials and methods: </strong>This retrospective study involved 60 patients who underwent 7T brain MRI between June 2024 and October 2024, comprised of 30 patients with MP2RAGE data and 30 patients with SPACE FLAIR data. Each set of raw data was reconstructed with DL-based reconstruction and conventional reconstruction. Image quality was independently assessed by two neuroradiologists using a 5-point Likert scale, which included overall image quality, artifacts, sharpness, structural conspicuity, and noise level. Inter-observer agreement was determined using top-box analysis. Contrast-to-noise ratio (CNR) and noise levels were quantitatively evaluated and compared using the Wilcoxon signed-rank test.</p><p><strong>Results: </strong>DL-based reconstruction resulted in a significant increase in overall image quality and a reduction in subjective noise level for both MP2RAGE and SPACE FLAIR data (all P<0.001), with no significant differences in image artifacts (all P>0.05). When compared to standard reconstruction, the implementation of DL-based reconstruction yielded an increase in CNR of 49.5% [95% CI 33.0-59.0%] for MP2RAGE data and 90.6% [95% CI 73.2-117.7%] for SPACE FLAIR data, along with a decrease in noise of 33.5% [95% CI 23.0-38.0%] for MP2RAGE data and 47.5% [95% CI 41.9-52.6%] for SPACE FLAIR data.</p><p><strong>Conclusions: </strong>DL-based reconstruction of 7T MRI significantly enhanced image quality compared to conventional reconstruction without introducing image artifacts. The achievable high acceleration factors have the potential to substantially improve image quality and resolution in 7T MRI.</p><p><strong>Abbreviations: </strong>CAIPIRINHA = Controlled Aliasing In Parallel Imaging Results IN Higher Acceleration; CNR = contrast-to-noise ratio; CS = compressed sensing; DL = deep learning; MNI = Montreal Neurological Institute; MP2RAGE = Magnetization-Prepared 2 Rapid Acquisition Gradient Echoes; SPACE = Sampling Perfection with Application-Optimized Contrasts using Different Flip Angle Evolutions.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112958","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 Cortical Vein Opacification Score (COVES) is independently associated with good and excellent functional outcomes at 90-days in minor stroke patients with anterior circulation large vessel occlusion: A Multicenter Study.","authors":"Dhairya A Lakhani, Hamza Salim, Aneri B Balar, Subtain Ali, Sijin Wen, Janet Mei, Argye E Hillis, Victor C Urrutia, Risheng Xu, Gabriel Broocks, Jens Fiehler, Helge C Kniep, Paul Stracke, Hermann Krähling, Gregory W Albers, Maarten Lansberg, Max Wintermark, Jeremy J Heit, Tobias D Faizy, Vivek S Yedavalli","doi":"10.3174/ajnr.A8739","DOIUrl":"https://doi.org/10.3174/ajnr.A8739","url":null,"abstract":"<p><strong>Background: </strong>There is currently no consensus on the most appropriate emergent treatment for patients with acute ischemic stroke secondary to large vessel occlusion (AIS-LVO) and minor stroke. These patients were excluded from prior randomized controlled trials assessing the efficacy of mechanical thrombectomy (MT) in LVO, making it challenging to determine the best treatment approach. Therefore, identifying markers that can predict functional outcomes would be invaluable for triaging these patients for MT. This study aimed to investigate pretreatment clinical and imaging markers and their association with functional outcomes at 90 days in minor AIS- LVO patients.</p><p><strong>Methods: </strong>We included patients with AIS-LVO and minor strokes from four sites across North America and Europe. Minor stroke was defined as a baseline National Institutes of Health Stroke Scale (NIHSS) score of ≤5. The primary outcome measure, good functional outcome, was defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days. The secondary outcome, excellent functional outcome, was defined as an mRS score of 0-1 at 90 days. Univariable and multivariable logistic regression analyses, along with receiver operating characteristic (ROC) curve analysis, were performed.</p><p><strong>Results: </strong>Among 168 consecutive patients with minor strokes, 123 achieved a good functional outcome, and 103 patients had an excellent functional outcome at 90 days. The cortical vein opacification score (COVES) was independently associated with both excellent and good functional outcomes, whereas no other CT, CTA, or CTP markers showed a significant association with these outcomes. ROC analysis of COVES showed an area under the curve (AUC) of 0.638 (95% CI: 0.517-0.759, p = 0.026) for predicting a good functional outcome and 0.689 (95% CI: 0.537-0.741, p = 0.008) for predicting an excellent functional outcome. Similar results were observed in the subgroup of patients who underwent mechanical thrombectomy (MT). Interestingly, neither intravenous thrombolysis (IVT) nor mechanical thrombectomy (MT) was associated with functional outcomes.</p><p><strong>Conclusions: </strong>Our analysis demonstrates that COVES is independently associated with good and excellent functional outcomes at 90 days in minor AIS-LVO cases. Further prospective studies are needed to better understand the role of COVES in determining optimal management strategies for these patients.</p><p><strong>Abbreviations: </strong>CS: Collateral status; COVES: Cortical vein opacification score; MT: mechanical thrombectomy; IVT: intravenous thrombolysis; NIHSS: National Institutes of Health Stroke Scale.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103116","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":"Thirteen-Year Trends and Advancements of Endovascular Therapy for Dural Arteriovenous Fistulas in Japan: Insights from a Nationwide Study of 6470 Procedures.","authors":"Satoshi Murai, Tomohito Hishikawa, Masafumi Hiramatsu, Jun Haruma, Kenji Sugiu, Koji Iihara, Hirotoshi Imamura, Akira Ishii, Yuji Matsumaru, Chiaki Sakai, Tetsu Satow, Shinichi Yoshimura, Nobuyuki Sakai","doi":"10.3174/ajnr.A8840","DOIUrl":"https://doi.org/10.3174/ajnr.A8840","url":null,"abstract":"<p><strong>Background and purpose: </strong>Endovascular therapy (EVT) for dural arteriovenous fistulas (dAVFs) has evolved with advancements in imaging technology and devices. However, few large-scale, nationwide studies have been reported. This study aimed to investigate the trends and advancements in EVT for dAVFs over the past 13 years.</p><p><strong>Materials and methods: </strong>We identified patients from the Japanese Registry of Neuroendovascular Therapy (JR-NET) database treated for dAVFs between 2007 and 2019. We compared patient demographics, disease characteristics, treatment methods, and outcomes between JR-NET2 (2007-2009), JR-NET3 (2010-2014) and JR-NET4 (2015-2019). Predictive factors of complications were evaluated using multivariate logistic regression analysis.</p><p><strong>Results: </strong>In total, we analyzed 6,470 procedures. Comparing JR-NET2, 3, and 4, the treatment for tentorial and anterior cranial fossa dAVFs has increased, and the use of precipitating liquid materials in transarterial embolization (TAE) increased to 31.7%. Complete obliteration in TAE alone increased to 38.0%, with no significant changes in complication rates, morbidity, or mortality at 30 days. In JR-NET2&3, complications were significantly associated with the cavernous sinus, tentorium, anterior cranial fossa, and emergency treatment. In JR-NET4, aggressive symptoms and precipitating liquid embolic materials were significantly correlated with complications. Supervision by senior trainers significantly reduced complications.</p><p><strong>Conclusions: </strong>The use of precipitating liquid embolic materials has improved TAE outcomes. While their use has also emerged as a new risk factor for complications, supervision by senior trainers has been shown to mitigate these risks.</p><p><strong>Abbreviations: </strong>CVR = cortical venous reflux; dAVFs = dural arteriovenous fistulas; EVT = endovascular therapy; JR-NET = Japanese Registry of Neuroendovascular Therapy = JSNET, Japanese Society for Neuroendovascular Therapy; TAE = transarterial embolization; TVE = transvenous embolization.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210461","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":"FDG-PET intensity normalization improves radiomics- based survival prediction in oropharyngeal cancer patients: a comparison of the SUV with alternative normalization techniques.","authors":"Seyedmehdi Payabvash, Kariem Sharaf, Tal Zeevi, Moritz Gross, Amit Mahajan, Benjamin H Kann, Benjamin L Judson, Andrea Schreier, Jasmin Krenn, Manju L Prasad, Barbara Burtness, Mariam Aboian, Martin Canis, Philipp Baumeister, Christoph A Reichel, Stefan P Haider","doi":"10.3174/ajnr.A8836","DOIUrl":"https://doi.org/10.3174/ajnr.A8836","url":null,"abstract":"<p><strong>Background and purpose: </strong>Despite the widespread research application of radiomics, there is a knowledge gap regarding the optimal voxel intensity normalization strategy for FDG-PET radiomics. We investigated the impact of three normalization strategies on the prognostic utility of individual radiomic features and machine learning models in oropharyngeal squamous cell carcinoma (OPSCC) patients.</p><p><strong>Materials and methods: </strong>We included n=330 (overall survival, OS, study group), n=335 (progression-free survival, PFS, study group) and n=309 (locoregional progression, LRP, study group) OPSCC patients. Three FDG-PET intensity normalization strategies were applied: the conventional body weight-corrected Standardized Uptake Value (SUV), and standardized uptake ratios to the lentiform nucleus and to the cerebellum. The raw PET voxel intensities were also analyzed. To quantify and compare features' association with oncologic outcome, we fitted univariate Cox regression models, calculated Harrell's C-index, and fitted random survival forest (RSF) machine learning algorithms.</p><p><strong>Results: </strong>All normalization strategies tended to improve the prognostic value of radiomic features. Features from lentiform nucleus- normalized PET demonstrated the highest prognostic improvement, with n=750/1037, n=809/1037 and n=652/1037 primary tumor features attaining a significant association with OS, PFS, and LRP, respectively, compared to n=0, n=211, and n=1 SUV-based PET features, respectively. The median C-index of lentiform nucleus-normalized PET features was 0.64, 0.61 and 0.62 for OS, PFS, and LRP, respectively, while SUV-based PET features reached 0.59, 0.58 and 0.60, respectively. The best performing lentiform nucleus- normalization RSF model significantly outperformed the raw PET RSF model in predicting OS (C-index=0.66 vs. C-index=0.57; p=0.019), with model comparisons for PFS and LRP approaching statistical significance (p=0.053 and p=0.084, respectively). In contrast, the best performing SUV-based RSF models were not significantly different from raw PET models.</p><p><strong>Conclusions: </strong>Normalizing PET intensities, especially to the lentiform nucleus, improves the prognostic performance of individual radiomic features and machine learning models in predicting oncologic outcome.</p><p><strong>Abbreviations: </strong>FDG-PET = [18F]fluorodeoxyglucose positron emission tomography; SUV = standardized uptake value; OPSCC = oropharyngeal squamous cell carcinoma; HPV = human papillomavirus; VOI = volume of interest; OS = overall survival; PFS = progression-free survival; LRP = locoregional progression; C-index = Harrell's concordance index; RSF = random survival forest; CV = cross-validation; AUC = area under the curve; SD = standard deviation.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. American journal of neuroradiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086621","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}